Fungi and allergic lower respiratory tract diseases

Alan P. Knutsen, Robert K. Bush, Jeffrey G. Demain, David W. Denning, Anupma Dixit, Abbie Fairs, Paul A. Greenberger, Barbara Kariuki, Hirohito Kita, Viswanath P. Kurup, Richard B. Moss, Robert M. Niven, Catherine H. Pashley, Raymond G. Slavin, Hari M. Vijay, Andrew J. Wardlaw

Research output: Contribution to journalArticle

266 Citations (Scopus)

Abstract

Asthma is a common disorder that in 2009 afflicted 8.2% of adults and children, 24.6 million persons, in the United States. In patients with moderate and severe persistent asthma, there is significantly increased morbidity, use of health care support, and health care costs. Epidemiologic studies in the United States and Europe have associated mold sensitivity, particularly to Alternaria alternata and Cladosporium herbarum, with the development, persistence, and severity of asthma. In addition, sensitivity to Aspergillus fumigatus has been associated with severe persistent asthma in adults. Allergic bronchopulmonary aspergillosis (ABPA) is caused by A fumigatus and is characterized by exacerbations of asthma, recurrent transient chest radiographic infiltrates, coughing up thick mucus plugs, peripheral and pulmonary eosinophilia, and increased total serum IgE and fungus-specific IgE levels, especially during exacerbation. The airways appear to be chronically or intermittently colonized by A fumigatus in patients with ABPA. ABPA is the most common form of allergic bronchopulmonary mycosis (ABPM); other fungi, including Candida, Penicillium, and Curvularia species, are implicated. The characteristics of ABPM include severe asthma, eosinophilia, markedly increased total IgE and specific IgE levels, bronchiectasis, and mold colonization of the airways. The term severe asthma associated with fungal sensitization (SAFS) has been coined to illustrate the high rate of fungal sensitivity in patients with persistent severe asthma and improvement with antifungal treatment. The immunopathology of ABPA, ABPM, and SAFS is incompletely understood. Genetic risks identified in patients with ABPA include HLA association and certain T H2-prominent and cystic fibrosis variants, but these have not been studied in patients with ABPM and SAFS. Oral corticosteroid and antifungal therapies appear to be partially successful in patients with ABPA. However, the role of antifungal and immunomodulating therapies in patients with ABPA, ABPM, and SAFS requires additional larger studies.

Original languageEnglish (US)
Pages (from-to)280-291
Number of pages12
JournalJournal of Allergy and Clinical Immunology
Volume129
Issue number2
DOIs
StatePublished - Feb 2012

Fingerprint

Respiratory Tract Diseases
Allergic Bronchopulmonary Aspergillosis
Fungi
Asthma
Invasive Pulmonary Aspergillosis
Immunoglobulin E
Pulmonary Eosinophilia
Cladosporium
Alternaria
Aspergillus fumigatus
Bronchiectasis
Penicillium
Eosinophilia
Mucus
Candida
Cystic Fibrosis
Health Care Costs
Epidemiologic Studies
Adrenal Cortex Hormones
Thorax

Keywords

  • Allergic bronchopulmonary aspergillosis
  • allergic bronchopulmonary mycosis
  • Alternaria alternata
  • Aspergillus fumigatus
  • Cladosporium herbarum
  • severe asthma with fungal sensitivity

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

Cite this

Knutsen, A. P., Bush, R. K., Demain, J. G., Denning, D. W., Dixit, A., Fairs, A., ... Wardlaw, A. J. (2012). Fungi and allergic lower respiratory tract diseases. Journal of Allergy and Clinical Immunology, 129(2), 280-291. https://doi.org/10.1016/j.jaci.2011.12.970

Fungi and allergic lower respiratory tract diseases. / Knutsen, Alan P.; Bush, Robert K.; Demain, Jeffrey G.; Denning, David W.; Dixit, Anupma; Fairs, Abbie; Greenberger, Paul A.; Kariuki, Barbara; Kita, Hirohito; Kurup, Viswanath P.; Moss, Richard B.; Niven, Robert M.; Pashley, Catherine H.; Slavin, Raymond G.; Vijay, Hari M.; Wardlaw, Andrew J.

In: Journal of Allergy and Clinical Immunology, Vol. 129, No. 2, 02.2012, p. 280-291.

Research output: Contribution to journalArticle

Knutsen, AP, Bush, RK, Demain, JG, Denning, DW, Dixit, A, Fairs, A, Greenberger, PA, Kariuki, B, Kita, H, Kurup, VP, Moss, RB, Niven, RM, Pashley, CH, Slavin, RG, Vijay, HM & Wardlaw, AJ 2012, 'Fungi and allergic lower respiratory tract diseases', Journal of Allergy and Clinical Immunology, vol. 129, no. 2, pp. 280-291. https://doi.org/10.1016/j.jaci.2011.12.970
Knutsen AP, Bush RK, Demain JG, Denning DW, Dixit A, Fairs A et al. Fungi and allergic lower respiratory tract diseases. Journal of Allergy and Clinical Immunology. 2012 Feb;129(2):280-291. https://doi.org/10.1016/j.jaci.2011.12.970
Knutsen, Alan P. ; Bush, Robert K. ; Demain, Jeffrey G. ; Denning, David W. ; Dixit, Anupma ; Fairs, Abbie ; Greenberger, Paul A. ; Kariuki, Barbara ; Kita, Hirohito ; Kurup, Viswanath P. ; Moss, Richard B. ; Niven, Robert M. ; Pashley, Catherine H. ; Slavin, Raymond G. ; Vijay, Hari M. ; Wardlaw, Andrew J. / Fungi and allergic lower respiratory tract diseases. In: Journal of Allergy and Clinical Immunology. 2012 ; Vol. 129, No. 2. pp. 280-291.
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