Kids, Difficult Asthma and Fungus

Area of Science:

• Pediatric Pulmonology
• Clinical Immunology
• Mycology

Background:

• Fungi are implicated in pediatric asthma, primarily via allergens causing severe asthma with fungal sensitization (SAFS) or direct epithelial damage (fungal bronchitis).
• Allergic bronchopulmonary aspergillosis (ABPA) is not observed in childhood asthma, for unknown reasons.
• The term 'fungal asthma' encompasses these pediatric manifestations.

Purpose of the Study:

• To review the current understanding of fungal involvement in pediatric asthma.
• To highlight diagnostic criteria and challenges for fungal sensitization and bronchitis in children.
• To identify knowledge gaps and future research directions in fungal asthma.

Main Methods:

• Review of existing literature on fungi and pediatric asthma.
• Analysis of diagnostic criteria for SAFS and fungal bronchitis.
• Discussion of clinical associations and therapeutic considerations.

Main Results:

• SAFS diagnosis relies on skin prick tests or specific IgE; criteria for fungal bronchitis are less defined.
• SAFS is linked to poorer asthma control and increased exacerbations in children and adults.
• Evidence for anti-fungal therapy efficacy in fungal asthma remains conflicting.

Conclusions:

• Fungal sensitization and bronchitis represent significant, though not fully understood, contributors to pediatric asthma.
• Further research is crucial to elucidate fungal pathobiology, interactions with other triggers, and optimal therapeutic strategies, including anti-neutrophilic agents.