Fungi-Induced Upper and Lower Respiratory Tract Allergic Diseases: One Entity

Area of Science:

• Allergy and Immunology
• Pulmonology
• Otolaryngology

Background:

• Allergic bronchopulmonary aspergillosis (ABPA) is a pulmonary allergic disease caused by Aspergillus antigens.
• Allergic fungal rhinosinusitis (AFRS) involves hypersensitivity reactions to fungi in the sinuses, often presenting as chronic rhinosinusitis (CRS).

Purpose of the Study:

• To investigate whether ABPA and AFRS represent a common disease entity.
• To compare clinical and mycological findings between ABPA patients with and without co-existing AFRS.

Main Methods:

• A prospective cohort study of 75 ABPA patients.
• Patients were categorized into two groups: ABPA with confirmed AFRS (CT and fungal evidence) and ABPA without AFRS.
• Comparison of sinonasal findings, allergy testing, and home air sampling between groups.

Main Results:

• AFRS was confirmed in 80% of ABPA patients, with allergic mucin present in all.
• Fungal hyphae were found in 60% of sinonasal aspirates, and cultures revealed fungal presence in 97% of the ABPA+AFRS group.
• ABPA+AFRS patients exhibited higher rates of complicated CRS, nasal polyps, positive skin prick tests for Aspergillus fumigatus, and higher fungal loads in home air samples.

Conclusions:

• AFRS is the upper airway manifestation of ABPA, indicating a shared pathogenesis in fungi-induced allergic upper and lower respiratory diseases.
• The findings support considering ABPA and AFRS as a common disease entity.
• Further research is required to elucidate the mechanisms of fungal immune triggers and develop novel diagnostic and therapeutic strategies.