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Fungal allergy in asthma-state of the art and research needs.
[allergic bronchopulmonary aspergillosis]
Sensitization
to
fungi
and
long
term
or
uncontrolled
fungal
infection
are
associated
with
poor
control
of
asthma
,
the
likelihood
of
more
severe
disease
and
complications
such
as
bronchiectasis
and
chronic
pulmonary
aspergillosis
.
Modelling
suggests
that
>
6
.
5
million
people
have
severe
asthma
with
fungal
sensitizations
(
SAFS
)
,
up
to
50
%
of
adult
asthmatics
attending
secondary
care
have
fungal
sensitization
,
and
an
estimated
4
.
8
million
adults
have
allergic
bronchopulmonary
aspergillosis
(
ABPA
)
.
There
is
much
uncertainty
about
which
fungi
and
fungal
allergens
are
relevant
to
asthma
,
the
natural
history
of
sensitisation
to
fungi
,
if
there
is
an
exposure
response
relationship
for
fungal
allergy
,
and
the
pathogenesis
and
frequency
of
exacerbations
and
complications
.
Genetic
associations
have
been
described
but
only
weakly
linked
to
phenotypes
.
The
evidence
base
for
most
management
strategies
in
ABPA
,
SAFS
and
related
conditions
is
weak
.
Yet
straightforward
clinical
practice
guidelines
for
management
are
required
.
The
role
of
environmental
monitoring
and
optimal
means
of
controlling
disease
to
prevent
disability
and
complications
are
not
yet
clear
.
In
this
paper
we
set
out
the
key
evidence
supporting
the
role
of
fungal
exposure
,
sensitisation
and
infection
in
asthmatics
,
what
is
understood
about
pathogenesis
and
natural
history
and
identify
the
numerous
areas
for
research
studies
.
Diseases
Validation
Diseases presenting
"and the pathogenesis and frequency of exacerbations and complications"
symptom
allergic bronchopulmonary aspergillosis
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