title: Fungal allergy in asthma-state of the art and research needs.
abstract: Sensitization to fungi and long term or uncontrolled fungal infection are associated with poor control of asthma, the likelihood of more severe disease and complications such as bronchiectasis and chronic pulmonary aspergillosis. Modelling suggests that >6.5 million people have severe asthma with fungal sensitizations (SAFS), up to 50% of adult asthmatics attending secondary care have fungal sensitization, and an estimated 4.8 million adults have allergic bronchopulmonary aspergillosis (ABPA). There is much uncertainty about which fungi and fungal allergens are relevant to asthma, the natural history of sensitisation to fungi, if there is an exposure response relationship for fungal allergy, and the pathogenesis and frequency of exacerbations and complications. Genetic associations have been described but only weakly linked to phenotypes. The evidence base for most management strategies in ABPA, SAFS and related conditions is weak. Yet straightforward clinical practice guidelines for management are required. The role of environmental monitoring and optimal means of controlling disease to prevent disability and complications are not yet clear. In this paper we set out the key evidence supporting the role of fungal exposure, sensitisation and infection in asthmatics, what is understood about pathogenesis and natural history and identify the numerous areas for research studies.
authors.affiliation: The National Aspergillosis Centre, University Hospital of South Manchester, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK ; Education and Research Centre, UHSM, Southmoor Road, Manchester M23 9LT, UK.
authors.forename: David W
authors.initials: DW
authors.lastname: Denning
authors.affiliation: Leicester Institute for Lung Health and Respiratory Biomedical Research Unit, Department of Infection Immunity and Inflammation, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK.
authors.forename: Catherine
authors.initials: C
authors.lastname: Pashley
authors.affiliation: Department of Pediatrics, Infectious Diseases & Immunology, University of Tübingen, Tübingen, Germany.
authors.forename: Domink
authors.initials: D
authors.lastname: Hartl
authors.affiliation: Leicester Institute for Lung Health and Respiratory Biomedical Research Unit, Department of Infection Immunity and Inflammation, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Wardlaw
authors.affiliation: Department of Infectious Diseases, CHU la Milétrie, Poitiers, France.
authors.forename: Cendrine
authors.initials: C
authors.lastname: Godet
authors.affiliation: Department of Medical Sciences "M. Aresu", University of Cagliari, Cagliari, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Del Giacco
authors.affiliation: Biology & Diversity of Emerging Eukaryotic Pathogens (BDEEP), Center for Infection and Immunity of Lille (CIIL), INSERM U1019, CNRS UMR8204, IFR142, Lille Pasteur Institute, Lille Nord de France University (EA4547), Lille, France ; Department of Parasitology-Mycology, Regional Hospital Center, Faculty of Medicine, Lille, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Delhaes
authors.affiliation: Translational Immunology Group, Institute of Technology, Tartu University, Tartu, Estonia ; North Estonia Medical Centre, Tallinn, Estonia.
authors.forename: Svetlana
authors.initials: S
authors.lastname: Sergejeva
keywords: ABPA; ABPM; Aspergillus; Corticosteroid; Eosinophil; Hypertonic saline; IgE; Itraconazole; SAFS; Severe asthma
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