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The association between fungi exposure and hypersensitivity pneumonitis: a systematic review

Marta Lopes Gomes1, António Morais2, João Cavaleiro Rufo3

  • 1Escola Superior de Saúde do Politécnico do Porto.

Porto Biomedical Journal
|February 3, 2021
PubMed

Insights

Fungi exposure, particularly Penicillium and Aspergillus species, is linked to hypersensitivity pneumonitis (HP), an interstitial lung disease. Avoiding fungal triggers may improve HP symptoms, but more research is needed on indoor microbial risks.

Area of Science:

  • Environmental Health
  • Pulmonology
  • Mycology

Background:

  • Hypersensitivity pneumonitis (HP) is an interstitial lung disease (ILD) caused by immune responses to inhaled antigens.
  • HP accounts for 1.5% to 12% of ILD cases in Europe.
  • Indoor fungi are implicated as a significant source of exposure leading to HP.

Purpose of the Study:

  • To systematically review studies on the association between fungi exposure and hypersensitivity pneumonitis.
  • To identify specific fungi species commonly linked to HP.
  • To evaluate the impact of fungi avoidance on HP patient outcomes.

Main Methods:

  • Systematic review of PubMed-indexed studies adhering to PRISMA guidelines.
  • Inclusion of 14 studies, with 6 primary eligible studies and 8 case reports for discussion.
  • Focus on fungi as etiological agents in hypersensitivity pneumonitis.

Main Results:

  • Penicillium spp. and Aspergillus spp. were the most frequently identified fungi associated with HP onset.
  • Some studies indicated symptom improvement upon avoidance of causative fungi.
  • Other studies faced challenges in pinpointing the exact source of sensitization.

Conclusions:

  • Fungi, especially Penicillium and Aspergillus, are key contributors to hypersensitivity pneumonitis.
  • While antigen avoidance shows promise, identifying sensitization sources remains difficult.
  • Further research on microbial exposure in the built environment is crucial for risk assessment.
Keywords:
fungihypersensitivity pneumonitisinterstitial lung diseaseoccupational environmentresidential environment

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