New Perspectives in the Diagnosis and Management of Allergic Fungal Airway Disease
Andrew J Wardlaw,1 Eva-Maria Rick,1 Leyla Pur Ozyigit,2 Alys Scadding,2 Erol A Gaillard,3 Catherine H Pashley1 1Institute for Lung Health, Department of Respiratory Sciences, College of Life Sciences, University of Leicester, and Allergy and Respiratory Medicine Service, NIHR Biomedical Research Cen...
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2021-05-01
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| Series: | Journal of Asthma and Allergy |
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| Online Access: | https://www.dovepress.com/new-perspectives-in-the-diagnosis-and-management-of-allergic-fungal-ai-peer-reviewed-fulltext-article-JAA |
| _version_ | 1818601969941479424 |
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| author | Wardlaw AJ Rick EM Pur Ozyigit L Scadding A Gaillard EA Pashley CH |
| author_facet | Wardlaw AJ Rick EM Pur Ozyigit L Scadding A Gaillard EA Pashley CH |
| author_sort | Wardlaw AJ |
| collection | DOAJ |
| description | Andrew J Wardlaw,1 Eva-Maria Rick,1 Leyla Pur Ozyigit,2 Alys Scadding,2 Erol A Gaillard,3 Catherine H Pashley1 1Institute for Lung Health, Department of Respiratory Sciences, College of Life Sciences, University of Leicester, and Allergy and Respiratory Medicine Service, NIHR Biomedical Research Centre: Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK; 2Allergy and Respiratory Services University Hospitals of Leicester NHS Trust, Leicester, UK; 3Institute for Lung Health, Department of Respiratory Sciences, College of Life Sciences, Department of Paediatrics, NIHR Biomedical Research Centre: Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UKCorrespondence: Andrew J WardlawGlenfield Hospital, Groby Road, Leicester, LE3 9QP, UKTel +44 116 2583841Email aw24@le.ac.ukAbstract: Allergy to airway-colonising, thermotolerant, filamentous fungi represents a distinct eosinophilic endotype of often severe lung disease. This endotype, which particularly affects adult asthma, but also complicates other airway diseases and sometimes occurs de novo, has a heterogeneous presentation ranging from severe eosinophilic asthma to lobar collapse. Its hallmark is lung damage, characterised by fixed airflow obstruction (FAO), bronchiectasis and lung fibrosis. It has a number of monikers including severe asthma with fungal sensitisation (SAFS) and allergic bronchopulmonary aspergillosis/mycosis (ABPA/M), but these exclusive terms constitute only sub-sets of the condition. In order to capture the full extent of the syndrome we prefer the inclusive term allergic fungal airway disease (AFAD), the criteria for which are IgE sensitisation to relevant fungi in association with airway disease. The primary fungus involved is Aspergillus fumigatus, but a number of other thermotolerant species from several genera have been implicated. The unifying mechanism involves germination of inhaled fungal spores in the lung in the context of IgE sensitisation, leading to a persistent and vigorous eosinophilic inflammatory response in association with release of fungal proteases. Most allergenic fungi, including Alternaria and Cladosporium species, are not thermotolerant and cannot germinate in the airways so only act as aeroallergens and do not cause AFAD. Studies of the airway mycobiome have shown that A. fumigatus colonises the normal as much as the asthmatic airway, suggesting it is the tendency to become IgE-sensitised that is the critical triggering factor for AFAD rather than colonisation per se. Treatment is aimed at preventing exacerbations with glucocorticoids and increasingly by the use of anti-T2 biological therapies. Anti-fungal therapy has a limited place in management, but is an effective treatment for fungal bronchitis which complicates AFAD in about 10% of cases.Keywords: fungi, Aspergillus, ABPA, SAFS, asthma, eosinophils |
| first_indexed | 2024-12-16T12:59:50Z |
| format | Article |
| id | doaj.art-ca7882ae4d8245b2a6194d0ed92806f7 |
| institution | Directory Open Access Journal |
| issn | 1178-6965 |
| language | English |
| last_indexed | 2024-12-16T12:59:50Z |
| publishDate | 2021-05-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Journal of Asthma and Allergy |
| spelling | doaj.art-ca7882ae4d8245b2a6194d0ed92806f72022-12-21T22:30:53ZengDove Medical PressJournal of Asthma and Allergy1178-69652021-05-01Volume 1455757365151New Perspectives in the Diagnosis and Management of Allergic Fungal Airway DiseaseWardlaw AJRick EMPur Ozyigit LScadding AGaillard EAPashley CHAndrew J Wardlaw,1 Eva-Maria Rick,1 Leyla Pur Ozyigit,2 Alys Scadding,2 Erol A Gaillard,3 Catherine H Pashley1 1Institute for Lung Health, Department of Respiratory Sciences, College of Life Sciences, University of Leicester, and Allergy and Respiratory Medicine Service, NIHR Biomedical Research Centre: Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK; 2Allergy and Respiratory Services University Hospitals of Leicester NHS Trust, Leicester, UK; 3Institute for Lung Health, Department of Respiratory Sciences, College of Life Sciences, Department of Paediatrics, NIHR Biomedical Research Centre: Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UKCorrespondence: Andrew J WardlawGlenfield Hospital, Groby Road, Leicester, LE3 9QP, UKTel +44 116 2583841Email aw24@le.ac.ukAbstract: Allergy to airway-colonising, thermotolerant, filamentous fungi represents a distinct eosinophilic endotype of often severe lung disease. This endotype, which particularly affects adult asthma, but also complicates other airway diseases and sometimes occurs de novo, has a heterogeneous presentation ranging from severe eosinophilic asthma to lobar collapse. Its hallmark is lung damage, characterised by fixed airflow obstruction (FAO), bronchiectasis and lung fibrosis. It has a number of monikers including severe asthma with fungal sensitisation (SAFS) and allergic bronchopulmonary aspergillosis/mycosis (ABPA/M), but these exclusive terms constitute only sub-sets of the condition. In order to capture the full extent of the syndrome we prefer the inclusive term allergic fungal airway disease (AFAD), the criteria for which are IgE sensitisation to relevant fungi in association with airway disease. The primary fungus involved is Aspergillus fumigatus, but a number of other thermotolerant species from several genera have been implicated. The unifying mechanism involves germination of inhaled fungal spores in the lung in the context of IgE sensitisation, leading to a persistent and vigorous eosinophilic inflammatory response in association with release of fungal proteases. Most allergenic fungi, including Alternaria and Cladosporium species, are not thermotolerant and cannot germinate in the airways so only act as aeroallergens and do not cause AFAD. Studies of the airway mycobiome have shown that A. fumigatus colonises the normal as much as the asthmatic airway, suggesting it is the tendency to become IgE-sensitised that is the critical triggering factor for AFAD rather than colonisation per se. Treatment is aimed at preventing exacerbations with glucocorticoids and increasingly by the use of anti-T2 biological therapies. Anti-fungal therapy has a limited place in management, but is an effective treatment for fungal bronchitis which complicates AFAD in about 10% of cases.Keywords: fungi, Aspergillus, ABPA, SAFS, asthma, eosinophilshttps://www.dovepress.com/new-perspectives-in-the-diagnosis-and-management-of-allergic-fungal-ai-peer-reviewed-fulltext-article-JAAfungiaspergillusabpasafsasthmaeosinophils |
| spellingShingle | Wardlaw AJ Rick EM Pur Ozyigit L Scadding A Gaillard EA Pashley CH New Perspectives in the Diagnosis and Management of Allergic Fungal Airway Disease Journal of Asthma and Allergy fungi aspergillus abpa safs asthma eosinophils |
| title | New Perspectives in the Diagnosis and Management of Allergic Fungal Airway Disease |
| title_full | New Perspectives in the Diagnosis and Management of Allergic Fungal Airway Disease |
| title_fullStr | New Perspectives in the Diagnosis and Management of Allergic Fungal Airway Disease |
| title_full_unstemmed | New Perspectives in the Diagnosis and Management of Allergic Fungal Airway Disease |
| title_short | New Perspectives in the Diagnosis and Management of Allergic Fungal Airway Disease |
| title_sort | new perspectives in the diagnosis and management of allergic fungal airway disease |
| topic | fungi aspergillus abpa safs asthma eosinophils |
| url | https://www.dovepress.com/new-perspectives-in-the-diagnosis-and-management-of-allergic-fungal-ai-peer-reviewed-fulltext-article-JAA |
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