Page 42 - Škrgat, Sabina, ed. 2023. Severe Asthma Forum - Monitoring and Treatable Traits in Severe Asthma. Koper: University of Primorska Press. Severe Asthma Forum, 2
P. 42
Table 1. Clinical outcomes of airway colonisation graded with the criteria proposed by the In-
with thermotolerant filamentous fungi e.g., A. ternational
Fumigatus (adapted from 1)
Society for Human & Animal Mycolo-
Basic Clinical Further subclasification gy (ISHAM)7 which are more relaxed mak-
manifestaton ing them more relevant to clinical practice5.
Aspergilloma
Upper Allergic fungal sinusitis Fungal allergy Proposed ABPA criteria includes:
airway Chronic pulmonary
aspergillosis 1. the presence of asthma or cystic fibrosis,
Lower Cavitating lung disease Ekstrinsic allergy 2. evidence of specific IgE to A. fumigatus
airway alveolitis
F ungal bronchitis and total IgE above 1000 IU/ml
42 Chronic Lung disease Invasive a spergillosis 3. at least two of raised IgG antibodies to
Immunocompromised A. fumigatus, abnormal radiology con-
host sistent with ABPA and an eosinophil
count (steroid-naive patients of greater
severe asthma forum 2: severe asthma - monitoring and treatable traits in severe asthma ma with fungal sensitisation (SAFS). Recent than 0.5X109/l)
publications1 support the idea that these pre-
sentations should not be strictly seen as a com- In an accompanying diagnostic algo-
pletely different entities since there is limited rithm, total IgE was central in distinguishing
evidence that there are distinct mechanisms between ABPA and IgE sensitization without
involved in the spectrum of thermotolerant ABPA
fungal lung allergy. Consequently, recently
an inclusive set of criteria which includes all This structure has been very recently
presentations of the disease under the umbrel- further upgraded8 with the work of the Japan
la term a llergic fungal airway disease (AFAD) ABPM research program, supported by the
is preferred1,5. Japan Medical Research and Development
Organization. They developed new ten-com-
Evolution of terminology toward AFAD ponent diagnostic criteria for ABPA/ABPM
in non-cystic fibrosis patients (table 2 ) where
The fungi that play a role in asthma can be they compared the sensitivity and specificity
divided into two groups: those that can grow of the new and conventional criteria to dis-
at body temperature, referred to as thermo- criminate pathological and physician-diag-
tolerant, which are capable of both infection nosed ABPA/ABPM from related diseases,
and allergy, and those that cannot but can still including fungus-negative mucoid impaction
act as allergens in IgE sensitised individuals. in bronchi, chronic eosinophilic pneumonia,
It is the thermotolerant group of filamentous fungus-sensitized severe asthma, and chron-
fungi that cause AFAD1,5. The pathophysiol- ic pulmonary aspergillosis. The new diagnos-
ogy behind different clinical outcomes is the tic criteria, compared with existing criteria,
host response to airway colonising, allergenic, showed better sensitivity and specificity for
thermotolerant, filamentous fungi, with A. fu- diagnosing ABPA/ABPM; The sensitivity for
migatus as the major culprit5. pathological ABPM with Rosenberg-Patter-
son criteria, ISHAM criteria, and these new
Sensitisation ot A. Fumigatus has been criteria were 25.3%, 77.2%, and 96.2%, re-
associated with a spectrum of states includ- spectively. The sensitivity for physician di-
ing SAFS and ABPA/M. The descriptions of agnosed ABPA/ABPM were 49.2%, 82.7%,
ABPA criteria have developed over time and and 94.4%, respectively. The areas under the
the Petterson s criteria6 were later further up- curve for the receiver operating characteris-
tic curves were 0.85, 0.90, and 0.98, respec-
tively7.
with thermotolerant filamentous fungi e.g., A. ternational
Fumigatus (adapted from 1)
Society for Human & Animal Mycolo-
Basic Clinical Further subclasification gy (ISHAM)7 which are more relaxed mak-
manifestaton ing them more relevant to clinical practice5.
Aspergilloma
Upper Allergic fungal sinusitis Fungal allergy Proposed ABPA criteria includes:
airway Chronic pulmonary
aspergillosis 1. the presence of asthma or cystic fibrosis,
Lower Cavitating lung disease Ekstrinsic allergy 2. evidence of specific IgE to A. fumigatus
airway alveolitis
F ungal bronchitis and total IgE above 1000 IU/ml
42 Chronic Lung disease Invasive a spergillosis 3. at least two of raised IgG antibodies to
Immunocompromised A. fumigatus, abnormal radiology con-
host sistent with ABPA and an eosinophil
count (steroid-naive patients of greater
severe asthma forum 2: severe asthma - monitoring and treatable traits in severe asthma ma with fungal sensitisation (SAFS). Recent than 0.5X109/l)
publications1 support the idea that these pre-
sentations should not be strictly seen as a com- In an accompanying diagnostic algo-
pletely different entities since there is limited rithm, total IgE was central in distinguishing
evidence that there are distinct mechanisms between ABPA and IgE sensitization without
involved in the spectrum of thermotolerant ABPA
fungal lung allergy. Consequently, recently
an inclusive set of criteria which includes all This structure has been very recently
presentations of the disease under the umbrel- further upgraded8 with the work of the Japan
la term a llergic fungal airway disease (AFAD) ABPM research program, supported by the
is preferred1,5. Japan Medical Research and Development
Organization. They developed new ten-com-
Evolution of terminology toward AFAD ponent diagnostic criteria for ABPA/ABPM
in non-cystic fibrosis patients (table 2 ) where
The fungi that play a role in asthma can be they compared the sensitivity and specificity
divided into two groups: those that can grow of the new and conventional criteria to dis-
at body temperature, referred to as thermo- criminate pathological and physician-diag-
tolerant, which are capable of both infection nosed ABPA/ABPM from related diseases,
and allergy, and those that cannot but can still including fungus-negative mucoid impaction
act as allergens in IgE sensitised individuals. in bronchi, chronic eosinophilic pneumonia,
It is the thermotolerant group of filamentous fungus-sensitized severe asthma, and chron-
fungi that cause AFAD1,5. The pathophysiol- ic pulmonary aspergillosis. The new diagnos-
ogy behind different clinical outcomes is the tic criteria, compared with existing criteria,
host response to airway colonising, allergenic, showed better sensitivity and specificity for
thermotolerant, filamentous fungi, with A. fu- diagnosing ABPA/ABPM; The sensitivity for
migatus as the major culprit5. pathological ABPM with Rosenberg-Patter-
son criteria, ISHAM criteria, and these new
Sensitisation ot A. Fumigatus has been criteria were 25.3%, 77.2%, and 96.2%, re-
associated with a spectrum of states includ- spectively. The sensitivity for physician di-
ing SAFS and ABPA/M. The descriptions of agnosed ABPA/ABPM were 49.2%, 82.7%,
ABPA criteria have developed over time and and 94.4%, respectively. The areas under the
the Petterson s criteria6 were later further up- curve for the receiver operating characteris-
tic curves were 0.85, 0.90, and 0.98, respec-
tively7.
