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Fungal allergy in asthma-state of the art and research needs

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 fu... Full description

Journal Title: Clinical and Translational Allergy April 15, 2014, Vol.4(1)
Main Author: Denning, David W
Other Authors: Pashley, Catherine , Hartl, Domink , Wardlaw, Andrew , Godet, Cendrine , Del Giacco, Stefano , Delhaes, Laurence , Sergejeva, Svetlana
Format: Electronic Article Electronic Article
Language: English
Subjects:
ID: ISSN: 2045-7022 ; DOI: 10.1186/2045-7022-4-14
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recordid: gale_hrca541252820
title: Fungal allergy in asthma-state of the art and research needs
format: Article
creator:
  • Denning, David W
  • Pashley, Catherine
  • Hartl, Domink
  • Wardlaw, Andrew
  • Godet, Cendrine
  • Del Giacco, Stefano
  • Delhaes, Laurence
  • Sergejeva, Svetlana
subjects:
  • Infection -- Health Aspects
  • Immunoglobulin E -- Health Aspects
  • Mycoses -- Health Aspects
  • Allergens -- Health Aspects
  • Antifungal Agents -- Health Aspects
  • Asthma -- Health Aspects
ispartof: Clinical and Translational Allergy, April 15, 2014, Vol.4(1)
description: 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. Keywords: Aspergillus, Severe asthma, SAFS, ABPA, ABPM, Corticosteroid, Eosinophil, IgE, Itraconazole, Hypertonic saline
language: English
source:
identifier: ISSN: 2045-7022 ; DOI: 10.1186/2045-7022-4-14
fulltext: fulltext
issn:
  • 2045-7022
  • 20457022
url: Link


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titleFungal allergy in asthma-state of the art and research needs
creatorDenning, David W ; Pashley, Catherine ; Hartl, Domink ; Wardlaw, Andrew ; Godet, Cendrine ; Del Giacco, Stefano ; Delhaes, Laurence ; Sergejeva, Svetlana
ispartofClinical and Translational Allergy, April 15, 2014, Vol.4(1)
identifierISSN: 2045-7022 ; DOI: 10.1186/2045-7022-4-14
subjectInfection -- Health Aspects ; Immunoglobulin E -- Health Aspects ; Mycoses -- Health Aspects ; Allergens -- Health Aspects ; Antifungal Agents -- Health Aspects ; Asthma -- Health Aspects
descriptionSensitization 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. Keywords: Aspergillus, Severe asthma, SAFS, ABPA, ABPM, Corticosteroid, Eosinophil, IgE, Itraconazole, Hypertonic saline
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abstractSensitization 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. Keywords: Aspergillus, Severe asthma, SAFS, ABPA, ABPM, Corticosteroid, Eosinophil, IgE, Itraconazole, Hypertonic saline
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date2014-04-15