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- Title
Prevalance of severe asthma with fungal sensitization (SAFS) and asthma associated with fungal sensitization (AAFS) by focusing on the Aspergillus sensitization in Iran.
- Authors
Mortezae, Vida; Mahdaviani, Seyed Alireza; Mirenayat, Maryam sadat; Poorabdollah, Mihan; Hassanzad, Maryam; Sharifynia, Somayeh; Bongomin, Felix; Maleki, Maedeh; Heshmatnia, Jalal; Fakharian, Atefeh; Vakili, Mahshid; Gheisari, Maryam; Hedayati, Mohammad T.
- Abstract
Introduction: A new and particular phenotype of severe asthma, has been described recently, is a severe asthma with fungal sensitization (SAFS) and another form of asthma is, asthma associated with fungal sensitization (AAFS); which may be seen in patients with mild to moderate asthma. These conditions may be progress to allergic bronchopulmonary aspergillosis (ABPA). The major complications of ABPA include bronchiectasis, chronic pulmonary aspergillosis, chronic cavitary pulmonary aspergillosis (CCPA) and fibrosis of lung. The exact diagnosis of fungal sensitization is increasingly important in patients with severe asthma due to therapeutic criteria for patients with ABPA or SAFS. This is the first comprehensive report of the prevalence of SAFS and AAFS in patients with allergic asthma from Iran. Materials and Methods: Two hundred consecutive outpatients aged = 18 years with diagnosis of moderate to severe allergic asthma, referred to Pediatric Respiratory Diseases Research Center of Doctor Masih Daneshvari hospital (Tehran, Iran) over a period of 25 months were screened for SAFS and AAFS by following criteria: 1.Bronchial asthma, 2.Positive type I skin prick test to Aspergillus allergens and/or rised Aspergillus specific IgE > 0.35 kUA/L, 3.Negative (usually) Aspergillus specific IgG (< 26.9 kUA/L), 4.Total IgE < 1000 kIU/mL (usually less than 500 IU/mL), 5.Normal or central bronchiectasis less than 3 lobes, no centrilobulars nodules/mucoid impaction/hyperdense mucus, 6.Eosinophil count generally < 500 cells/µl. Result: During this cross sectional study period, 200 outpatients, male 89 (44.5%) and female 111 (55.5%), with moderate (51.5%) to severe (48.5%) allergic broncial asthma and no smoking were evaluated for SAFS and AAFS by focusing on the Aspergillus sensitization. The mean (range) of age was 45.8 (18-78) years and All patients underwent the Aspergillus skin prick test that 27 (13.5%) out of 200 patients were sensitive to Aspergillus antigens. Of these, 10 (37.0%) patients with overall prevalence 5.0% fulfilled all the diagnostic criteria for SAFS and AAFS. In the next step Aspergillus specific IgE values were measured by using immuno CAP assay for all subjects and 22 (11%) of asthmatic patients showed sensitivity to Aspergillus antigen and 10 (45.5%) of these, with overall prevalence 5.0% met all the diagnostic criteria for SAFS and AAFS. After all criteria were screened, the findings our study revealed a 7 (7.2%) prevalance of SAFS and 6 (5.8%) prevalance of AASF in outpatients with severe and moderate allergic asthma in Iran. Conclusion: The detection of SAFS or AAFS should be done carefully, because there is probably a significant overlap with ABPA, especially with ABPA-S. Therefore, in severe asthma or moderate asthma patients, who show signs of fungal sensitization, should consider the risk of SAFS and AAFS. Given the fact that, the therapeutic criteria for ABPA and SAFS is different, thus, we need more data to determine the exact state and prevalence of SAFS as a specific phenotype of severe asthma to managing it timely and accurately.
- Subjects
IRAN; ASTHMA treatment; ANTIFUNGAL agents; ASPERGILLUS; ASTHMA; CONFERENCES &; conventions; SEVERITY of illness index
- Publication
Current Medical Mycology, 2018, Vol 4, p32
- ISSN
2423-3439
- Publication type
Article
- DOI
10.18502/cmm.4.S1.2018.179