scholarly journals Allergic bronchopulmonary aspergillosis in patients with asthma: Results of a prospective study

2017 ◽  
Vol 89 (8) ◽  
pp. 13-16 ◽  
Author(s):  
Ya I Kozlova ◽  
E V Frolova ◽  
L V Filippova ◽  
A E Uchevatkina ◽  
O V Aak ◽  
...  
Keyword(s):  
Severe Asthma ◽  
Allergic Bronchopulmonary Aspergillosis ◽  
Specific Ige ◽  
Skin Tests ◽  
Asthmatic Patients ◽  
Fungal Allergens ◽  
Allergenic Fungi ◽  
Fungal Allergen ◽  
A Prospective Study ◽  
Fungal Sensitization

Aim. To estimate the frequency of fungal sensitization and the incidence of allergic bronchopulmonary aspergillosis (ABPA) in asthmatic patients. Subjects and methods. A total of 140 asthmatic patients were examined. They underwent allergologic (skin tests for fungal allergens, estimation of total and fungal allergen-specific IgE levels) and mycological (microscopy and inoculation of respiratory biosubstrates) examinations. Chest computed tomography, when indicated, was done. A group of patients with ABPA and that of patients with severe asthma and fungal sensitization were identified. Results. The frequency of fungal sensitization in asthmatic patients was 36%; the main allergenic fungi were Aspergillus and Alternaria. The incidence of ABPA was as high as 4% in the patients with asthma and 11% in those with severe asthma and fungal sensitization. Conclusion. The given current diagnostic criteria will assist practitioners to identify ABPA, to prevent its progression, and to initiate specific anti-inflammatory and antifungal therapy in due time.

scholarly journals BASOPHILE ACTIVATION TEST FOR THE DIAGNOSTICS OF FUNGAL SENSITIZATION IN THE PATIENTS WITH CYSTIC FIBROSIS

2019 ◽  
Vol 21 (5) ◽  
pp. 919-928
Author(s):  
Ya. I. Kozlova ◽  
E. V. Frolova ◽  
A. E. Uchevatkina ◽  
L. V. Filippova ◽  
O. V. Aak ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Stimulation Index ◽  
Allergic Bronchopulmonary Aspergillosis ◽  
Basophil Activation Test ◽  
Specific Ige ◽  
Basophil Activation ◽  
Total Ige ◽  
Activation Test ◽  
Fungal Allergens ◽  
Fungal Sensitization

Aspergillus fumigatus colonization in the patients with cystic fibrosis (CF) may cause sensitization against A. fumigatus and/or allergic bronchopulmonary aspergillosis (ABPA), which significantly worsens the course of underlying disease. At the present time, new diagnostic tests are searched for detection of fungal sensitization in these patients. The aim of this work was to evaluate an opportunity of application of basophile activation test with A. fumigatus allergen in vitro using flow cytometry, aiming for identification of fungal sensitization in the CF patients. The study included 190 patients with CF aged 1 to 37 years. All the patients underwent common allergy screening (skin tests with fungal allergens, determination of serum levels of total IgE and specific IgE for the fungal allergens), and mycological examination (microscopy and culture of respiratory substrates). Computed tomography of the chest was performed upon clinical indications. The basophil activation test with the A. fumigatus allergen was performed in 10 CF patients with ABPA, and 10 CF patients without ABPA, in addition to the standard allergological examination. Frequency of sensitization to A. fumigatus in the patients with cystic fibrosis was 27%, the incidence of allergic bronchopulmonary aspergillosis was 5.7%. The number of eosinophils, total IgE and specific IgE levels in CF patients with ABPA were significantly higher than in CF patients without ABPA. In blood of the ABPA patients we have identified 68.5 (52.5-81.5%) of basophilic leukocytes activated by A. fumigatus allergen, with a stimulation index of 17.07 (10.30-27.70). In appropriate comparison group, the stimulation index did not exceed 1.5 (p = 0.000). Direct positive correlation between the levels of specific IgE to A. fumigatus and the number of basophils activated by A. fumigatus allergens was revealed (r = 0.77; р < 0.05). FVC values and the body mass index in CF patients with ABPA were significantly lower when compared with the patients without fungal sensitization. Introduction of the basophil activation test, along with standard techniques, may enable a more differentiated assessment of ABPA development in CF patients. Timely detection of associations between A. fumigatus sensitization and clinical status of CF patients will facilitate early and effective administration of specific therapy.

scholarly journals Kids, Difficult Asthma and Fungus

2020 ◽  
Vol 6 (2) ◽  
pp. 55 ◽  
Author(s):  
Andrew Bush
Keyword(s):  
Diagnostic Criteria ◽  
Severe Asthma ◽  
Proteolytic Enzymes ◽  
Allergic Bronchopulmonary Aspergillosis ◽  
Specific Ige ◽  
Prick Test ◽  
Interleukin 33 ◽  
Adults And Children ◽  
Fungal Allergen ◽  
Difficult Asthma

Fungi have many potential roles in paediatric asthma, predominantly by being a source of allergens (severe asthma with fungal sensitization, SAFS), and also directly damaging the epithelial barrier and underlying tissue by releasing proteolytic enzymes (fungal bronchitis). The umbrella term ‘fungal asthma’ is proposed for these manifestations. Allergic bronchopulmonary aspergillosis (ABPA) is not a feature of childhood asthma, for unclear reasons. Diagnostic criteria for SAFS are based on sensitivity to fungal allergen(s) demonstrated either by skin prick test or specific IgE. In children, there are no exclusion criteria on total IgE levels or IgG precipitins because of the rarity of ABPA. Diagnostic criteria for fungal bronchitis are much less well established. Data in adults and children suggest SAFS is associated with worse asthma control and greater susceptibility to asthma attacks than non-sensitized patients. The data on whether anti-fungal therapy is beneficial are conflicting. The pathophysiology of SAFS is unclear, but the epithelial alarmin interleukin-33 is implicated. However, whether individual fungi have different pathobiologies is unclear. There are many unanswered questions needing further research, including how fungi interact with other allergens, bacteria, and viruses, and what optimal therapy should be, including whether anti-neutrophilic strategies, such as macrolides, should be used. Considerable further research is needed to unravel the complex roles of different fungi in severe asthma.

scholarly journals Allergic bronchopulmonary aspergillosis in patients with asthma: dynamics of immunological parameters during antimycotic therapy

2016 ◽  
Vol 13 (6) ◽  
pp. 37-42
Author(s):  
Y I Kozlova ◽  
A V Sobolev ◽  
E V Frolova ◽  
A E Uchevatkina ◽  
L V Filippova ◽  
...  
Keyword(s):  
Allergic Bronchopulmonary Aspergillosis ◽  
Specific Ige ◽  
Absolute Number ◽  
Skin Tests ◽  
Immunological Parameters ◽  
Total Ige ◽  
Antimycotic Therapy ◽  
Fungal Allergens ◽  
Ifn Γ ◽  
Serum Total Ige

Background. To determine the frequency of allergic bronchopulmonary aspergillosis in patients with asthma and to study the dynamics of immunological parameters in patients with allergic bronchopulmonary aspergillosis during antimycotic therapy. Methods. During investigation of 176 patients with asthma the group of patients with allergic bronchopulmonary aspergillosis was isolated. Allergological (skin tests with fungal allergens, serum total IgE, specific IgE to fungal allergens), immunological (IFN-γ, IL-10) and mycological (microscopy and culture of respiratory samples) examination was performed. Computer tomography of the chest was done when indicated. Results. In patients with asthma frequency of sensitization to Aspergillus spp. was 27%, with allergic bronchopulmonary aspergillosis - 4%. The increased activity of T-helper type 2 in patients with allergic bronchopulmonary aspergillosis (n=7) was revealed. After itraconazole treatment during 24 weeks serum total IgE reduced (p=0,04), spontaneous and induced production of IFN-γ ratio was normalized. The reduction of the absolute number of eosinophils in 4 (80%) patients, decreased production of sIgE to Aspergillus spp. in 3 (60%) patients were noted. Conclusion. All patients with severe asthma needed additional allergological and mycological examination for the detection of allergic bronchopulmonary aspergillosis. Itraconazole therapy was effective, reduced fungal burden, and resulted to restoring of Th2/Th1 imbalance in patients with allergic bronchopulmonary aspergillosis.

scholarly journals Features of fungal sensitization in patients with asthma and cystic fibrosis: the results of a prospective study

2018 ◽  
Vol 15 (2) ◽  
pp. 11-16
Author(s):  
Y I Kozlova ◽  
E V Frolova ◽  
Y V Borzova ◽  
A V Sobolev ◽  
E V Burygina ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Allergic Bronchopulmonary Aspergillosis ◽  
Specific Ige ◽  
Test System ◽  
Candida Spp ◽  
Ige Antibodies ◽  
Fungal Allergens ◽  
Patients At Risk ◽  
Fungal Sensitization

Background. To estimate the frequency of fungal sensitization and allergic bronchopulmonary aspergillosis in patients with asthma or cystic fibrosis. Methods. The study included 205 patients with asthma and 190 patients with cystic fibrosis. For detection of fungal sensitization specific IgE antibodies in the blood serum with «AllergoELISA-specific IgE» test system and biotinylated fungal allergens were determined. Mycological examination included microscopy and cultural study of respiratory biomaterials. According to the indications, a CAT scan of the chest was performed. Results. The incidence of fungal sensitization in patients with asthma was 35,6%, CI [29,1%; 42,6%], in patients with cystic fibrosis - 56,8% [49,5%; 64%]. In patients with severe asthma the main fungal allergens were Alternaria spp. (70%) and Aspergillus spp. (60%); in patients with cystic fibrosis: Candida spp. - 73%, Alternaria spp. - 34%, Aspergillus spp. - 27%. The incidence of allergic bronchopulmonary aspergillosis (ABPA) in patients with asthma was 5,3%, in patients with cystic fibrosis - 5,7%. Conclusion Early detection of ABPA in patients with asthma and cystic fibrosis is very important as it changes the therapeutic measures of patients’ management and prevents progression of bronchiectasis and respiratory failure. Determination of specific Aspergillus spp. IgE antibodies in vitro is a necessary stage of diagnosis of ABPA in patients at risk.

scholarly journals Prevalence of specific immunoglobulin E and G against Aspergillus fumigatus in patients with asthma

2019 ◽  
Author(s):  
Newsha Hedayati ◽  
Vida Mortezaee ◽  
Seyed Alireza Mahdaviani ◽  
Maryam Sadat Mirenayat ◽  
Maryam Hassanzad ◽  
...  
Keyword(s):  
Aspergillus Fumigatus ◽  
Severe Asthma ◽  
Immunoglobulin E ◽  
Clinical Symptoms ◽  
Specific Ige ◽  
Total Ige ◽  
Asthmatic Patients ◽  
Specific Immunoglobulin E ◽  
Specific Immunoglobulin ◽  
The Mean

Background and Purpose: Aspergillus fumigatus as a ubiquitous fungus can be found in the respiratory tract of the asthmatic and healthy people. The inhalation of Aspergillus spores leads to an immune response in individuals with asthma and results in the aggravation of the clinical symptoms. The present study aimed to investigate the prevalence of specific immunoglobulin E and G (IgE and IgG) against A.fumigatus in asthmatic patients.Materials and Methods: This study was conducted on 200 consecutive patients with moderate to severe asthma referring to Masih Daneshvari hospital Tehran, Iran, from January 2016 to February 2018. Skin prick test (SPT) was performed in all subjects with Aspergillus allergens. Moreover, all patients underwent specific IgE testing for Aspergillus using Hycor method. Enzyme immune assay was applied to measure total IgE and Aspergillus-specific IgG.Results: According to the results, the mean age of the patients was 45.8 years (age range: 18-78 years). The mean levels of total IgE and Aspergillus specific IgE in asthmatic patients were obtained as 316.3 (range: 6-1300 IU/ml) and 1.5 (range: 0.1-61.3 IU/ml), respectively. Out of 200 patients, 27 (13.5%), 65 (32.5%), 22 (11.0%), and 86 (43.0%) cases had positive Aspergillus SPT, total IgE of > 417 IU/ml, Aspergillus-specific IgE, and IgG, respectively. The level of these variables in patients with severe asthma were 16 (16.5%), 36 (37.1%), 15 (15.5%), and 46 (47.4%), respectively.Conclusion: As the findings indicated, reactivity to Aspergillus is a remarkable phenomenon in asthmatic patients. It is also emphasised that the climatic condition may affect the positive rate of hypersensitivity to Aspergillus.

Unusual Clustering of Allergic Bronchopulmonary Aspergillosis in Children With Cystic Fibrosis

PEDIATRICS ◽  
1988 ◽  
Vol 82 (6) ◽  
pp. 835-839
Author(s):  
Sabine Maguire ◽  
Patricia Moriarty ◽  
Edward Tempany ◽  
Muiris FitzGerald
Keyword(s):  
Cystic Fibrosis ◽  
Allergic Bronchopulmonary Aspergillosis ◽  
Specific Ige ◽  
Skin Tests ◽  
Immediate Hypersensitivity ◽  
Positive Type ◽  
X Ray ◽  
Suppurative Lung Disease ◽  
Peripheral Blood Eosinophilia

Allergic bronchopulmonary aspergillosis has been recognized in association with cystic fibrosis in children since 1965. Since then, however, there have been a paucity of reports of pediatric cystic fibrosis complicated by allergic bronchopulmonary aspergillosis, and, in most cases, these have been diagnosed retrospectively. A cluster of five acute cases seen during a 4-month period in a single cystic fibrosis center with a systemic illness and deterioration in respiratory status are described. In all five patients, reversible bronchoconstriction and infiltrative changes on x-ray films suggested the diagnosis. This was confirmed by the presence of (1) peripheral blood eosinophilia, (2) elevated total IgE and Aspergillus fumigatus-specific IgE, and (3) circulating serum precipitins against A fumigatus in all cases. All children tested had positive type 1 immediate hypersensitivity to skin tests for A fumigatus, in sputum eosinophilia, and Aspergillus cultured from sputum. Only three of five children were previously noted to be atopic and none had severe advanced suppurative lung disease. All children had previously received bronchodilator therapy and appropriate antibiotics. Following treatment with corticosteroids, acute symptoms and radiologic changes resolved for 1 to 5 months. To date, no children have had recurrence of their allergic bronchopulmonary aspergillosis while receiving alternate-day steroid treatment for 6 months.

Allergic Fungal Sinusitis Associated with Allergic Bronchopulmonary Aspergillosis: An Uncommon Sinobronchial Allergic Mycosis

2007 ◽  
Vol 21 (4) ◽  
pp. 412-416 ◽  
Author(s):  
Jean Jacques Braun ◽  
Gabrielle Pauli ◽  
Philippe Schultz ◽  
André Gentine ◽  
David Ebbo ◽  
...  
Keyword(s):  
Allergic Bronchopulmonary Aspergillosis ◽  
Specific Ige ◽  
Antifungal Drugs ◽  
Sinus Surgery ◽  
Skin Tests ◽  
Fungal Sinusitis ◽  
Allergic Fungal Sinusitis ◽  
Positive Skin ◽  
Oral Corticosteroids ◽  
Blood Eosinophils

Background The identification of allergic fungal sinusitis (AFS) is still controversial and much more recent than that of allergic bronchopulmonary aspergillosis (ABPA). Their association has been reported very rarely in the literature. Methods The aim of this study was to present a review of 6 cases of AFS associated with ABPA from a series of 12 cases of AFS and to compare AFS associated with ABPA and isolated AFS. Results All cases of AFS presented with chronic rhinosinusitis. The six cases with AFS and ABPA were atopic, asthmatic, with pulmonary infiltrates (five cases), central bronchiectasis (four cases), and both (three cases). The mycological and immunoallergological features of isolated AFS and AFS associated with ABPA were similar: eosinophilic allergic mucin with noninvasive fungi hyphae, high levels of blood eosinophils, total IgE, specific IgE, IgG, and positive skin tests to Aspergillus. The association of AFS and ABPA was concomitant (two cases) or remote in time (four cases). The treatment with oral corticosteroids and sinus surgery (six cases) associated with antifungal drugs (four cases) led to resolution in three cases, considerable improvement in one case, and therapeutic failure in two cases (follow-up longer than 5 years in all cases). Conclusion Independently of the signs linked to the organs involved (sinuses and bronchi) the mycological and immunoallergological features were similar for AFS and AFS associated with ABPA. AFS and ABPA can be isolated or associated in a sinobronchial allergic mycosis.

scholarly journals Initiation and Pathogenesis of Severe Asthma with Fungal Sensitization

Cells ◽  
2021 ◽  
Vol 10 (4) ◽  
pp. 913
Author(s):  
Meenakshi Tiwary ◽  
Amali E. Samarasinghe
Keyword(s):  
Allergic Asthma ◽  
Mouse Models ◽  
Severe Asthma ◽  
Human Disease ◽  
Fungal Allergens ◽  
Immunologic Parameters ◽  
Fungal Sensitization

Fungi represent one of the most diverse and abundant eukaryotes on earth, and their ubiquity and small proteolytically active products make them pervasive allergens that affect humans and other mammals. The immunologic parameters surrounding fungal allergies are still not fully elucidated despite their importance given that a large proportion of severe asthmatics are sensitized to fungal allergens. Herein, we explore fungal allergic asthma with emphasis on mouse models that recapitulate the characteristics of human disease, and the main leukocyte players in the pathogenesis of fungal allergies. The endogenous mycobiome may also contribute to fungal asthma, a phenomenon that we discuss only superficially, as much remains to be discovered.

scholarly journals Fungal sensitization of patients with asthma in St. Petersburg

2015 ◽  
Vol 12 (5) ◽  
pp. 3-8
Author(s):  
Y I Kozlova ◽  
E V Frolova ◽  
A V Sobolev ◽  
O V Aak ◽  
A E Uchevatkina ◽  
...  
Keyword(s):  
Severe Asthma ◽  
Asthma Severity ◽  
Th2 Cells ◽  
Course Of Disease ◽  
Fungal Allergens ◽  
Asthma Patients ◽  
Serum Total Ige ◽  
Fungal Sensitization

Background. Fungal sensitization is associated with severe uncontrolled asthma. Connections of specific, micromycetes and fungal allergens with disease development and immunopathogenesis of asthma with fungal sensitization are not well understood. Methods. The study included 120 patients with different grades of asthma severity. Results. Fungal sensitization was detected in 48 patients with asthma (40%). Severe course of asthma with fungal sensitization was identified in 7 patients (14,6%). The main fungal allergens in patients with severe asthma were Alternaria spp. and Aspergillus spp., in patients with mild and moderate course of disease - Aspergillus spp. and Penicillium spp. Increasing of serum total IgE and enhancing the ability of blood cells to produce IL2 and IFN-y in patients with bronchial asthma with fungal sensitization were revealed. The obtained results indicated the important role of Th1 along with Th2 cells in the development of immunopathological process in asthma patients withfungal sensitization. Conclusion. Further research is necessary for determination of clinical and immunological criteria of severe asthma with fungal sensitization and study of the effectiveness of antimycotic therapy.

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