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Allergic fungal airway disease: Pathophysiologic and diagnostic considerations

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posted on 2018-06-11, 09:00 authored by Kerry Woolnough, Abbie Fairs, Catherine H. Pashley, Andrew J. Wardlaw
Purpose of review Fungal spores are ubiquitously present in indoor and outdoor air. A number can act as aeroallergens in Immunoglobulin E (IgE)-sensitized individuals and some thermotolerant fungi germinate in the lung where they can cause a combined allergic and infective stimulus leading to a number of clinical presentations characterized by evidence of lung damage. We discuss which biomarkers are useful in helping to guide diagnosis, prognosis and treatment of allergic fungal airway disease (AFAD). Recent findings Diagnostic biomarkers, such as specific IgEs and fungal culture, for AFAD are limited by sensitivity, although this may be improved with novel agents such as specific IgEs to fungal components and quantitative PCR. Total IgE and hypereosinophilia are nonspecific and do not clearly relate to disease activity. High attenuation mucus and proximal bronchiectasis are specific, albeit insensitive markers of AFAD. Biomarkers that predict prognosis and treatment response are yet to be defined. Summary This review summarizes the fungi involved and the current debate regarding the diagnostic criteria to define fungal-associated lung disease. We advocate the phasing out of the term allergic bronchopulmonary aspergillosis and the use of a more inclusive term such as AFAD, together with a more liberal set of criteria based largely on IgE sensitization to thermotolerant fungi, which identifies those patients at risk of developing lung damage.


Research from our group quoted in this paper was supported by Asthma UK, Pfizer, the Midlands Asthma and Allergy Research Association and the National Institute for Health Research Leicester Respiratory Biomedical Research Unit.



Current Opinion in Pulmonary Medicine, 2015, 21 (1), pp. 39-47

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/Organisation/COLLEGE OF LIFE SCIENCES/School of Medicine/Department of Infection, Immunity and Inflammation


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Current Opinion in Pulmonary Medicine


Lippincott, Williams & Wilkins





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