Fungi-Induced Upper and Lower Respiratory Tract Allergic Diseases: One Entity
Aleksandra Barac1,2, David S Y Ong3,4, Ljiljana Jovancevic5,6
1Clinic for Infectious and Tropical Diseases, Clinical Centre of Serbia, Belgrade, Serbia.
Abstract:
Introduction:Aspergillus can cause different allergic diseases including allergic bronchopulmonary aspergillosis (ABPA) and allergic fungal rhinosinusitis (AFRS). ABPA is allergic pulmonary disease against Aspergillus antigens. AFRS is a type of chronic rhinosinusitis (CRS) presented as hypersensitivity reactions to the fungal presence in sinuses. The aim of the present study was to clarify if ABPA and AFRS could be considered as a common disease entity. Methodology: The prospective cohort study included 75 patients with ABPA. Patients were divided into two groups and compared with each other: (i) patients with CT confirmation of rhinosinusitis and presence of fungi in sinuses (ABPA+AFRS group) and (ii) patients without CT or without mycological evidence of AFRS (ABPA group). Results: Findings of this study were: (i) AFRS was confirmed in 80% of patients with ABPA; (ii) all ABPA+AFRS patients had allergic mucin while fungal hyphae were present in 60% sinonasal aspirate; (iii) ABPA+AFRS patients had more often complicated CRS with (nasal polyps) NP (p < 0.001) and more severe forms of CRS; (iv) culture of sinonasal aspirate revealed fungal presence in 97% patients with ABPA+AFRS; (v) patients with ABPA+AFRS had more common positive skin prick test (SPT) for A. fumigatus (p = 0.037), while patients without AFRS had more common positive SPT for Alternaria alternata and Penicillium notatum (p = 0.04 and p = 0.03, respectively); (vi) 67% of ABPA patients had Aspergillus induced AFRS; (vii) larger number of fungi was isolated from the air-samples obtained from homes of patients with ABPA+AFRS than from the homes of patients without AFRS, while the most predominant species were A. fumigatus and A. niger isolated from almost 50% of the air-samples. Conclusion: The pathogenesis of ABPA and AFRS is similar, and AFRS can be considered as the upper airway counterpart of ABPA. Fungi-induced upper and lower respiratory tract allergic diseases present common entity. Next studies should clarify the mechanism by which fungi turn from "normal flora" into trigger of immunological reactions, resulting in ABPA or AFRS as well as to find new approaches for its' diagnosis and treatment.
Insights
Allergic fungal rhinosinusitis (AFRS) is present in 80% of patients with allergic bronchopulmonary aspergillosis (ABPA), suggesting a common fungal-induced allergic airway disease entity. Further research is needed to understand fungal triggers and improve diagnosis and treatment.
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.
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