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Asthma and Fungus: Role in Allergic Bronchopulmonary Aspergillosis (ABPA) and Other Conditions

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Abstract

Asthma is an allergic, respiratory disorder characterized by hyper responsiveness of the airway to external stimuli. Considerable research is currently being directed towards understanding the role of environmental and genetic factors contributing to the development of asthma and its severity. Recent years have seen a substantial rise in evidence linking fungi to asthma. Few major clinical conditions associated with fungal sensitization and hypersensitive immune response are Allergic bronchopulmonary aspergillosis (ABPA), Allergic fungal rhinosinusitis (AFRS) and Severe asthma with fungal sensitization (SAFS). The most common fungi implicated in these conditions belong to genus Aspergillus, although an association with several other fungi has been described. In this review authors discuss the varying clinical characteristics of fungus induced respiratory complications in individuals with asthma. They also highlight the epidemiology of these conditions including their prevalence in children and their fungal etiological profile. Laboratory diagnostic methods and clinical case definitions have also been discussed. Future studies evaluating the role of fungal exposure and susceptibility to asthma are required. Till date there are no guidelines for the diagnosis and treatment of ABPA in pediatric population, thus it is also imperative to establish validated clinical definitions of fungal allergic manifestations in pediatric patients with asthma to fully understand this complex interaction.

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References

  1. Lambrecht BN, Hammad H. The immunology of asthma. Nat Immunol. 2015;16:45–56.

    Article  CAS  Google Scholar 

  2. Denning DW, O’Driscoll BR, Hogaboam CM, Bowyer P, Niven RM. The link between fungi and severe asthma: a summary of the evidence. Eur Respir J. 2006;27:615–26.

    Article  CAS  Google Scholar 

  3. Agarwal R. Severe asthma with fungal sensitization. Curr Allergy Asthma Rep. 2011;11:403–13.

    Article  CAS  Google Scholar 

  4. Hedayati MT, Pasqualotto AC, Warn PA, Bowyer P, Denning DW. Aspergillus flavus: human pathogen, allergen and mycotoxin producer. Microbiology. 2007;153:1677–92.

    Article  CAS  Google Scholar 

  5. Kradin RL, Mark EJ. The pathology of pulmonary disorders due to aspergillus spp. Arch Pathol Lab Med. 2008;132:606–14.

    PubMed  Google Scholar 

  6. Rick EM, Woolnough K, Pashley CH, Wardlaw AJ. Allergic fungal airway disease. J Investig Allergol Clin Immunol. 2016;26:344–54.

    Article  CAS  PubMed  Google Scholar 

  7. Schwartz HJ, Citron KM, Chester EH, et al. A comparison of the prevalence of sensitization to aspergillus antigens among asthmatics in Cleveland and London. J Allergy Clin Immunol. 1978;62:9–14.

    Article  CAS  Google Scholar 

  8. Maurya V, Gugnani HC, Sarma PU, Madan T, Shah A. Sensitization to aspergillus antigens and occurrence of allergic bronchopulmonary aspergillosis in patients with asthma. Chest. 2005;127:1252–9.

    PubMed  Google Scholar 

  9. Longbottom JL, Pepys J. Pulmonary aspergillosis: diagnostic and immunological significance of antigens and c-substance in aspergillus fumigatus XXXVIII in the serum of patients suffering from pulmonary aspergillosis. J Pathol Bacteriol. 1964;88:141–51.

    Article  CAS  Google Scholar 

  10. Hendrick DJ, Davies RJ, D’Souza MF, Pepys J. An analysis of skin prick test reactions in 656 asthmatic patients. Thorax. 1975;30:2–8.

    Article  CAS  PubMed  Google Scholar 

  11. Goh KJ, Chau A, Yii A, Lapperre TS, Chan AKW, Chew FT. Sensitization to aspergillus species is associated with frequent exacerbations in severe asthma. J Asthma Allergy. 2017;10:131–40.

    Article  CAS  PubMed  Google Scholar 

  12. Agarwal R, Gupta D, Aggarwal AN, et al. Clinical significance of decline in serum IgE levels in allergic bronchopulmonary aspergillosis. Respir Med. 2010;104:204–10.

    Article  Google Scholar 

  13. Chetty A, Bhargava S, Jain RK. Allergic bronchopulmonary aspergillosis in Indian children with bronchial asthma. Ann Allergy. 1985;54:46–9.

  14. Singh M, Das S, Chauhan A, et al. The diagnostic criteria for allergic bronchopulmonary aspergillosis in children with poorly controlled asthma need to be re-evaluated. Acta Pediatr. 2015;105:e206–9.

    Article  Google Scholar 

  15. Rosenberg M, Patterson R, Mintzer R, Cooper BJ, Roberts M, Harris KE. Clinical and immunologic criteria for the diagnosis of allergic bronchopulmonary aspergillosis. Ann Intern Med. 1977;86:405–14.

    Article  CAS  Google Scholar 

  16. Agarwal R, Chakrabarti A, Shah A, et al. Allergic bronchopulmonary aspergillosis: review of literature and proposal of new diagnostic and classification criteria. Clin Exp Allergy. 2013;43:850–73.

    Article  CAS  Google Scholar 

  17. Patterson R, Greenberger PA, Radin RC, Roberts M. Allergic bronchopulmonary aspergillosis: staging as an aid to management. Ann Intern Med. 1982;96:286–91.

    Article  CAS  Google Scholar 

  18. Kauffman HF. Immunopathogenesis of allergic bronchopulmonary aspergillosis and airway remodeling. Front Biosci. 2003;8:e190–6.

    Article  CAS  Google Scholar 

  19. Radin RC, Greenberger PA, Patterson R, Ghory A. Mould counts and exacerbations of allergic bronchopulmonary aspergillosis. Clin Allergy. 1983;13:271–5.

    Article  CAS  Google Scholar 

  20. Agarwal R, Maskey D, Aggarwal AN, et al. Diagnostic performance of various tests and criteria employed in allergic bronchopulmonary aspergillosis: a latent class analysis. PLoS One. 2013;8:1–7.

    Article  Google Scholar 

  21. Thia LP, Balfour Lynn IM. Diagnosing allergic bronchopulmonary aspergillosis in children with cystic fibrosis. Paediatr Respir Rev. 2009;10:37–42.

    Article  Google Scholar 

  22. Patterson R, Greenberger PA, Halwig JM, Liotta JL, Roberts M. Allergic bronchopulmonary aspergillosis. Natural history and classification of early disease by serologic and roentgenographic studies. Arch Intern Med. 1986;146:916–8.

    Article  CAS  Google Scholar 

  23. Kumar R. Mild, moderate and severe forms of allergic bronchopulmonary aspergillosis. A clinical and serologic evaluation. Chest. 2003;124:890–2.

    Article  Google Scholar 

  24. Agarwal R, Khan A, Gupta D, Aggarwal AN, Saxena AK, Chakrabarti A. An alternate method of classifying allergic bronchopulmonary aspergillosis based on high-attenuation mucus. PLoS One. 2010;5:1–9.

    Article  CAS  PubMed  Google Scholar 

  25. Agarwal R. Pictorial essay: allergic bronchopulmonary aspergillosis. World J Radiol. 2011;3:178–81.

  26. Kumar R. Mild, moderate, and severe forms of allergic bronchopulmonary aspergillosis: a clinical and serologic evaluation. Chest. 2003;124:890–2.

    Article  Google Scholar 

  27. Katzenstein ALA, Sale SR, Greenberger PA. Allergic aspergillus sinusitis: a newly recognized form of sinusitis. J Allergy Clin Immunol. 1983;72:89–93.

    Article  CAS  Google Scholar 

  28. Safirstein BH. Allergic bronchopulmonary aspergillosis with obstruction of the upper respiratory tract. Chest. 1976;70:788–90.

    Article  CAS  Google Scholar 

  29. Bent JP, Kuhn FA. Diagnosis of allergic fungal sinusitis. Otolaryngol Head Neck Surg. 1994;111:580–8.

    Article  Google Scholar 

  30. Tracy MC, Okorie CUA, Foley EA, Moss RB. Allergic bronchopulmonary aspergillosis. J Fungi. 2016;2:17.

    Article  Google Scholar 

  31. Gresnigt MS, Netea MG, Van de Veerdonk FL. Pattern recognition receptors and their role in invasive aspergillosis. Ann N Y Acad Sci. 2012;1273:60–7.

    Article  CAS  Google Scholar 

  32. Blanco JL, Garcia ME. Immune response to fungal infections. Vet Immunol Immunopathol. 2008;125:47–70.

    Article  CAS  Google Scholar 

  33. Rapaka RR, Kolls JK. Pathogenesis of allergic bronchopulmonary aspergillosis in cystic fibrosis: current understanding and future directions. Med Mycol. 2009;47:S331–7.

    Article  CAS  Google Scholar 

  34. Kurup VP, Raju R, Manickam P. Profile of gene expression in a murine model of allergic bronchopulmonary aspergillosis. Society. 2005;73:4381–4.

    CAS  Google Scholar 

  35. Fricker-Hidalgo H, Coltey B, Llerena C, et al. Recombinant allergens combined with biological markers in the diagnosis of allergic bronchopulmonary aspergillosis in cystic fibrosis patients. Clin Vaccine Immunol. 2010;17:1330–6.

    Article  CAS  PubMed  Google Scholar 

  36. Nouri-Aria KT, Durham SR. Regulatory T cells and allergic disease. Inflamm Allergy Drug Targets. 2008;7:237–52.

    Article  CAS  Google Scholar 

  37. Kraemer R, Deloséa N, Ballinari P, Gallati S, Crameri R. Effect of allergic bronchopulmonary aspergillosis on lung function in children with cystic fibrosis. Am J Respir Crit Care Med. 2006;174:1211–20.

    Article  Google Scholar 

  38. Nandakumar S, Miller CW, Kumaraguru U. T regulatory cells: an overview and intervention techniques to modulate allergy outcome. Clin Mol Allergy. 2009;7:5.

    Article  PubMed  Google Scholar 

  39. Skowronski E, Fitzgerald DA. Life-threatening allergic bronchopulmonary aspergillosis in a well child with cystic fibrosis. Med J Aust. 2005;182:482–3.

    Google Scholar 

  40. Wark P. Pathogenesis of allergic bronchopulmonary aspergillosis and an evidence-based review of azoles in treatment. Respir Med. 2004;98:915–23.

    Article  Google Scholar 

  41. Patterson K, Strek ME. Allergic bronchopulmonary aspergillosis. Proc Am Thorac Soc. 2010;7:237–44.

    Article  Google Scholar 

  42. FDA Safety Notice. FDA issues early communication concerning safety of asthma drug Xolair. MD Consult July 17, 2009.

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Authors and Affiliations

  1. Advanced Pediatrics Centre, PGIMER, Chandigarh, 160012, India

    Meenu Singh & Nandini Paul

  2. Department of Microbiology, PGIMER, Chandigarh, India

    Shreya Singh

  3. Department of Otolaryngology, PGIMER, Chandigarh, India

    Gyan Ranjan Nayak

Authors
  1. Meenu Singh
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  2. Nandini Paul
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  3. Shreya Singh
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  4. Gyan Ranjan Nayak
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Contributions

MS: Article conceived and drafted. NP: Literature search and writing; SS and GN: Literature search and review. MS will act as guarantor for this paper.

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Correspondence to Meenu Singh.

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None.

Source of Funding

ICMR, New Delhi has supported the fellowship of Ms. Nandini Paul.

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Meenu Singh and Nadini Paul will act as first authors for this manuscript

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Singh, M., Paul, N., Singh, S. et al. Asthma and Fungus: Role in Allergic Bronchopulmonary Aspergillosis (ABPA) and Other Conditions. Indian J Pediatr 85, 899–904 (2018). https://doi.org/10.1007/s12098-018-2646-8

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  • DOI: https://doi.org/10.1007/s12098-018-2646-8

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