New Perspectives in the Diagnosis and Management of Allergic Fungal Airway Disease.

摘要: Allergy to airway-colonising, thermotolerant, filamentous fungi represents a distinct eosinophilic endotype of often severe lung disease. This endotype, which particularly affects adult asthma, but also complicates other airway diseases and sometimes occurs de novo, has heterogeneous presentation ranging from asthma lobar collapse. Its hallmark is damage, characterised by fixed airflow obstruction (FAO), bronchiectasis fibrosis. It number monikers including with fungal sensitisation (SAFS) allergic bronchopulmonary aspergillosis/mycosis (ABPA/M), these exclusive terms constitute only sub-sets the condition. In order capture full extent syndrome we prefer inclusive term disease (AFAD), criteria for are IgE relevant in association The primary fungus involved Aspergillus fumigatus, thermotolerant species several genera have been implicated. unifying mechanism involves germination inhaled spores context sensitisation, leading persistent vigorous inflammatory response release proteases. Most allergenic fungi, Alternaria Cladosporium species, not cannot germinate airways so act as aeroallergens do cause AFAD. Studies mycobiome shown that A. fumigatus colonises normal much asthmatic airway, suggesting it tendency become IgE-sensitised critical triggering factor AFAD rather than colonisation per se. Treatment aimed at preventing exacerbations glucocorticoids increasingly use anti-T2 biological therapies. Anti-fungal therapy limited place management, an effective treatment bronchitis about 10% cases.