title: Allergic fungal airway disease: pathophysiologic and diagnostic considerations.
abstract: OBJECTIVE
  Fungal spores are ubiquitously present in indoor and outdoor air. A number can act as aeroallergens in Immunoglobulin E (IgE)-sensitized individuals and some thermotolerant fungi germinate in the lung where they can cause a combined allergic and infective stimulus leading to a number of clinical presentations characterized by evidence of lung damage. We discuss which biomarkers are useful in helping to guide diagnosis, prognosis and treatment of allergic fungal airway disease (AFAD).
  
  
  RESULTS
  Diagnostic biomarkers, such as specific IgEs and fungal culture, for AFAD are limited by sensitivity, although this may be improved with novel agents such as specific IgEs to fungal components and quantitative PCR. Total IgE and hypereosinophilia are nonspecific and do not clearly relate to disease activity. High attenuation mucus and proximal bronchiectasis are specific, albeit insensitive markers of AFAD. Biomarkers that predict prognosis and treatment response are yet to be defined.
  
  
  CONCLUSIONS
  This review summarizes the fungi involved and the current debate regarding the diagnostic criteria to define fungal-associated lung disease. We advocate the phasing out of the term allergic bronchopulmonary aspergillosis and the use of a more inclusive term such as AFAD, together with a more liberal set of criteria based largely on IgE sensitization to thermotolerant fungi, which identifies those patients at risk of developing lung damage.
authors.affiliation: aInstitute for Lung Health, Department of Infection Immunity and Inflammation, University of Leicester bDepartment of Allergy and Respiratory Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK.
authors.forename: Kerry
authors.initials: K
authors.lastname: Woolnough
authors.forename: Abbie
authors.initials: A
authors.lastname: Fairs
authors.forename: Catherine H
authors.initials: CH
authors.lastname: Pashley
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Wardlaw
mesh_terms: D000391:Air Microbiology; D000485:Allergens / Q000276:immunology*; D000946:Antigens, Fungal / Q000276:immunology*; D001229:Aspergillosis, Allergic Bronchopulmonary / Q000175:diagnosis* / Q000276:immunology / Q000503:physiopathology*; D006801:Humans; D007073:Immunoglobulin E / Q000276:immunology*; D009093:Mucus / Q000382:microbiology*; D011379:Prognosis; D012720:Severity of Illness Index; D013172:Spores, Fungal / Q000276:immunology*
chemical_list: D000485:Allergens; D000946:Antigens, Fungal; D007073:Immunoglobulin E