Severe asthma and fungi: current evidence

Area of Science:

• Pulmonology
• Allergology
• Mycology

Background:

• Bronchial asthma is an inflammatory airway disease exacerbated by extrinsic factors, notably allergens.
• Fungal allergens are significant contributors to asthma exacerbations, with strong evidence of fungal sensitization in asthmatic patients.
• Fungal sensitization is associated with asthma severity, though the causal relationship requires further investigation.

Purpose of the Study:

• To review the current evidence linking fungal exposure to severe asthma.
• To identify key fungal agents implicated in severe asthma with fungal sensitization (SAFS).
• To discuss diagnostic methods and current management strategies for SAFS.

Main Methods:

• Literature review of studies on fungi, asthma, and fungal sensitization.
• Analysis of diagnostic approaches including skin testing and specific IgE measurement.
• Evaluation of the association between fungal sensitization and asthma severity.

Main Results:

• Fungal sensitization is prevalent in asthma and correlates with increased disease severity.
• Aspergillus species are highlighted as potential key agents in SAFS due to diverse immunologic responses.
• Current management of SAFS mirrors that of non-fungal sensitized asthma, with limited evidence for antifungal agents like itraconazole.

Conclusions:

• Fungi are important triggers and potential drivers of severe asthma.
• Aspergillus species warrant further investigation as primary culprits in SAFS.
• Refined diagnostic and therapeutic strategies are needed for effective SAFS management.