Allergic fungal airway diseases: analysis of data in asthma patient register

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Introduction. Allergy to microscopic fungi (micromycetes), which can colonize the respiratory tract, is associated with an eosinophilic endotype of inflammation and severe disease course. Among the hallmarks of fungal allergy, experts identify fixed airways obstruction, bronchiectasis, and fibrosis. Currently, there has been proposed the term “allergic fungal airways disease” (AFAD), which combines various clinical phenotypes, which pathogenesis is based on IgE-mediated allergic reaction against fungal spores colonizing the respiratory tract. According to this approach, the AFAD group includes severe asthma with fungal sensitization and allergic bronchopulmonary aspergillosis (ABPA). A promising direction in AFAD treatment implies the use of genetically engineered biological drugs against T-2 inflammation. The aim of the study was to evaluate the prevalence of Aspergillus spp. sensitization and allergic bronchopulmonary Aspergillosis in patients with asthma. 

Materials and methods. A retrospective single-center registry study was conducted in the I.I. Mechnikov North-Western State Medical University, Ministry of Health of Russian Federation. The study included 523 patients with asthma of varying severity. The level of total and specific blood serum IgE against aeroallergens, including Aspergillus spp., was analyzed by enzyme immunoassay. The diagnosis of asthma was established in accordance with the recommendations of the GINA working group and the Clinical recommendations of the Ministry of Health of the Russian Federation, fungal sensitization and ABPA — in accordance with the recommendations of the ISHAM working group. Results. During the examination of patients with asthma, sensitization to Aspergillus spp. recorded in 16.6% cases, severe asthma with sensitization to Aspergillus spp. — in 7.4%, ABPA — in 6.1%. In patients with allergic asthma, the prevalence of sensitization to Aspergillus spp. was 22%, severe asthma with sensitization to Aspergillus spp. — 10.1%, ABLA — 8.1%. Among patients with ABPA, females (64%) aged 40 years and older prevailed. The major clinical manifestations of ABPA were presented as cough (96%) and shortness of breath (76%), CT scan radiological changes were in a form of bronchiectasis (72%). 

Conclusion. A high prevalence of sensitization to Aspergillus spp. in patients with asthma was found. It is necessary to include Aspergillus spp. into the list of tested allergens while examining patients with chronic lung diseases for timely detection of AFAD and prescription of proper anti-inflammatory or antimycotic therapy.

作者简介

Yana Kozlova

I.I. Mechnikov North-Western State Medical University

编辑信件的主要联系方式.
Email: kozlova510@mail.ru
ORCID iD: 0000-0002-4602-2438
SPIN 代码: 5842-6039

DSc (Medicine), Associate Professor, Department of Clinical Mycology, Allergology and Immunology, P.N. Kashkin Research Institute of Medical Mycology

俄罗斯联邦, Saint-Petersburg

Nikolay Vasiliev

I.I. Mechnikov North-Western State Medical University

Email: wwjd2000@mail.ru
ORCID iD: 0000-0003-0793-2831
SPIN 代码: 2150-3380

PhD Student, Department of Clinical Mycology, Allergology and Immunology, P.N. Kashkin Research Institute of Medical Mycology

俄罗斯联邦, Saint-Petersburg

Ekaterina Frolova

I.I. Mechnikov North-Western State Medical University

Email: ekaterina.frolova@szgmu.ru
ORCID iD: 0000-0002-7696-2236
SPIN 代码: 9904-8776

PhD (Medicine), Head of the Research Laboratory of Allergology and Immunology, P.N. Kashkin Research Institute of Medical Mycology

俄罗斯联邦, \Saint-Petersburg

Alexandra Uchevatkina

I.I. Mechnikov North-Western State Medical University

Email: a.uchevatkina@szgmu.ru
ORCID iD: 0000-0001-6688-7781
SPIN 代码: 3001-4022

PhD (Medicine), Senior Researcher, Research Laboratory of Allergology and Immunology, P.N. Kashkin Research Institute of Medical Mycology

俄罗斯联邦, Saint-Petersburg

Larisa Filippova

I.I. Mechnikov North-Western State Medical University

Email: larisa.filippova@szgmu.ru
ORCID iD: 0000-0003-4167-7440
SPIN 代码: 6810-0871

PhD (Medicine), Senior Researcher, Research Laboratory of Allergology and Immunology, P.N. Kashkin Research Institute of Medical Mycology

俄罗斯联邦, Saint-Petersburg

Oleg Aak

I.I. Mechnikov North-Western State Medical University

Email: kozlova510@mail.ru

PhD (Chemistry), Leading Researcher, Research Laboratory of Allergology and Immunology, P.N. Kashkin Research Institute of Medical Mycology

俄罗斯联邦, St. Petersburg

Alexei Sobolev

I.I. Mechnikov North-Western State Medical University

Email: sobolev757@rambler.ru
SPIN 代码: 5448-4106

DSc (Medicine), Professor of the Department of Clinical Mycology, Allergology and Immunology, P.N. Kashkin Research Institute of Medical Mycology

俄罗斯联邦, Saint-Petersburg

Natalia Vasilyeva

I.I. Mechnikov North-Western State Medical University

Email: mycobiota@szgmu.ru
ORCID iD: 0000-0003-3693-5468
SPIN 代码: 3829-4370

DSc (Biology), Professor, Honored Scientist of the Russian Federation, Director, P.N. Kashkin Research Institute of Medical Mycology

俄罗斯联邦, Saint-Petersburg

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2. Figure 1. Relationship between phenotypes of allergic fungal airway diseases (adapted from Wardlaw A.J. et al., 2021)

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3. Figure 2. Clinical symptoms of patients with ABPA

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4. Figure 3. Chest CT scan changes in patients with ABPA

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5. Figure 4. Infiltrates and bronchiectasis in patients with allergic bronchopulmonary aspergillosis Note. A — bilateral bronchiectasis, B — infiltrate of the middle and lower lobe of the right lung with radiant contours and bronchiectasis, the bronchus walls are thickened — a symptom of “tram rails”.

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6. Figure 4.1 Infiltrates and bronchiectasis in patients with allergic bronchopulmonary aspergillosis Note. A — bilateral bronchiectasis, B — infiltrate of the middle and lower lobe of the right lung with radiant contours and bronchiectasis, the bronchus walls are thickened — a symptom of “tram rails”.

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版权所有 © Kozlova Y., Vasiliev N., Uchevatkina A., Filippova L.V., Aak O.V., Sobolev A.V., Vasilyeva N.V., Frolova E.V., 2023

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