Page 41 - Škrgat, Sabina, ed. 2023. Severe Asthma Forum - Monitoring and Treatable Traits in Severe Asthma. Koper: University of Primorska Press. Severe Asthma Forum, 2
P. 41
ergillus Sensitisation and Severe Asthma 2.1
Clinical Outcomes
Sabina Škrgat,1,2 Katarina Pelicon Slabanja3
Abstract 1 Department for pulmonary
Fungal lung diseases represent a heterogenous group of conditions and the differing definitions and allergic diseases, University
are used to describe these relationships. Historically there has been the nomenclature evolution Medical Centre Ljubljana,
on the spectrum of lung diseases linked to sensitisation to A. Fumigatus including SAFS (se- Slovenija
vere asthma with fungal sensitisation) and ABPA/M (allergic bronchopulmonary aspergillo-
sis/mycosis). It seems that AFAD (airway fungal airway disease) therefore represents an open 2 Medical Faculty, University
definition of IgE sensitisation to thermotolerant fungi. It covers not only the most severe forms of Ljubljana
of the disease as SAFS and ABPA, but also milder forms of airway disease. It might represent
a treatable trait which has to be seen, longitudinally observed, and treated and consequently 3 Pulmonary Department,
preventing lung damage. General Hospital dr. Franc
Derganc, Šempeter, Slovenija
Keywords: allergic fungal airway disease, severe asthma, I gE sensibilisation
Introduction tal fungi such as non-thermotolerant Alter-
naria and Cladosporium which act as season-
Fungal lung disease represents a heterogene- al aeroallergens, the symptoms of which are
ous group of conditions1. They can be divid- directly related to airborne concentrations
ed into infective, toxic, or allergic in nature, of fungal material, and which can include
although there is a degree of overlap. Some of acute severe exacerbations. The second type
them are connected and interact in patients involves an allergic response to thermotoler-
with asthma and particularly in severe asth- ant filamentous fungi such as species from the
ma. Its behaviour in interaction with fungi re- Aspergillus and Penicillium which can act as
sults in different clinical asthma outcomes, aeroallergens, and they have the additional
which are under recognised and represents a property of being able to germinate in the air-
clinical and diagnostical challenge. ways. Consequently, they are colonising the
lungs and causing a persistent allergenic stim-
The differing nomenclatures are used ulus that can lead to lung damage2–4.
to describe these relationships. A recent pro-
posal of various clinical outcomes of airway Historically the clinical and immunolog-
colonisation with thermotolerant filamentous ical variability in presentation of fungal aller-
fungi e.g. A. Fumigatus (table 1) includes al- gy to thermotolerant fungi has developed into
lergic group. This allergic group can again be a separate differentiation/definition of two
broadly divided into two, both of which can conditions: allergic bronchopulmonary a sper-
be associated with severe asthma. The first gillosis/mycosis (ABPA/M) and severe asth-
type is an allergenic response to environmen-
https://doi.org/10.26 493/978 -961-293 -297-8.41- 46
Clinical Outcomes
Sabina Škrgat,1,2 Katarina Pelicon Slabanja3
Abstract 1 Department for pulmonary
Fungal lung diseases represent a heterogenous group of conditions and the differing definitions and allergic diseases, University
are used to describe these relationships. Historically there has been the nomenclature evolution Medical Centre Ljubljana,
on the spectrum of lung diseases linked to sensitisation to A. Fumigatus including SAFS (se- Slovenija
vere asthma with fungal sensitisation) and ABPA/M (allergic bronchopulmonary aspergillo-
sis/mycosis). It seems that AFAD (airway fungal airway disease) therefore represents an open 2 Medical Faculty, University
definition of IgE sensitisation to thermotolerant fungi. It covers not only the most severe forms of Ljubljana
of the disease as SAFS and ABPA, but also milder forms of airway disease. It might represent
a treatable trait which has to be seen, longitudinally observed, and treated and consequently 3 Pulmonary Department,
preventing lung damage. General Hospital dr. Franc
Derganc, Šempeter, Slovenija
Keywords: allergic fungal airway disease, severe asthma, I gE sensibilisation
Introduction tal fungi such as non-thermotolerant Alter-
naria and Cladosporium which act as season-
Fungal lung disease represents a heterogene- al aeroallergens, the symptoms of which are
ous group of conditions1. They can be divid- directly related to airborne concentrations
ed into infective, toxic, or allergic in nature, of fungal material, and which can include
although there is a degree of overlap. Some of acute severe exacerbations. The second type
them are connected and interact in patients involves an allergic response to thermotoler-
with asthma and particularly in severe asth- ant filamentous fungi such as species from the
ma. Its behaviour in interaction with fungi re- Aspergillus and Penicillium which can act as
sults in different clinical asthma outcomes, aeroallergens, and they have the additional
which are under recognised and represents a property of being able to germinate in the air-
clinical and diagnostical challenge. ways. Consequently, they are colonising the
lungs and causing a persistent allergenic stim-
The differing nomenclatures are used ulus that can lead to lung damage2–4.
to describe these relationships. A recent pro-
posal of various clinical outcomes of airway Historically the clinical and immunolog-
colonisation with thermotolerant filamentous ical variability in presentation of fungal aller-
fungi e.g. A. Fumigatus (table 1) includes al- gy to thermotolerant fungi has developed into
lergic group. This allergic group can again be a separate differentiation/definition of two
broadly divided into two, both of which can conditions: allergic bronchopulmonary a sper-
be associated with severe asthma. The first gillosis/mycosis (ABPA/M) and severe asth-
type is an allergenic response to environmen-
https://doi.org/10.26 493/978 -961-293 -297-8.41- 46
