Severe asthma and fungi: current evidence
Severe asthma and fungi: current evidence
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DOI：
10.3109/13693786.2010.504752
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发表时间：
2011-04-01
期刊：
影响因子：
2.9
通讯作者：
Gupta, Dheeraj
中科院分区：
文献类型：
--
作者：
Agarwal, Ritesh;Gupta, Dheeraj
支气管哮喘是一种气道炎症性疾病，可由于许多外在因素而恶化。最常见的触发因素是持续暴露于过敏原，其中真菌因子是重要因素。有压倒性的证据表明哮喘患者存在真菌致敏。真菌致敏的诊断可以通过使用来自真菌的抗原进行皮肤试验或测量特异性IgE水平来进行。真菌致敏性与哮喘严重程度之间也有很强的相关性。这种关系是因果关系还是偶然关系还有待研究。已知多种真菌可引起哮喘患者的致敏作用，但目前尚不清楚导致严重哮喘伴真菌致敏（SAFS）的最重要的真菌制剂。曲霉属似乎是最强的候选者，因为只有曲霉属。是否会遇到两种极端的免疫学现象，即，过敏性支气管肺曲霉病。SAFS的初始临床处理应与无真菌致敏的哮喘患者相同。有一些证据表明伊曲康唑在SAFS治疗中的作用，但其在SAFS中的常规使用需要进一步评估。本文综述了真菌与严重哮喘之间联系的现有证据。
Bronchial asthma is an inflammatory disease of the airways which may be worsened due to numerous extrinsic factors. The most common trigger is continuous exposure to allergens of which fungal agents are important factors. There is overwhelming evidence for the presence of fungal sensitization in patients with asthma. The diagnosis of fungal sensitization can be made either with skin testing with antigens derived from fungi or measuring specific IgE levels. There is also a strong association between fungal sensitization and severity of asthma. Whether this relationship is causal or just casual remains to be investigated. A variety of fungi are known to cause sensitization in asthmatics, but the most important fungal agent(s) causing severe asthma with fungal sensitization (SAFS) are currently unknown. Aspergillus species seem to be the strongest candidates as only with Aspergillus spp. does one encounter two extreme immunologic phenomena, i.e., the Aspergillus-sensitive asthma and allergic bronchopulmonary aspergillosis. The initial clinical management of SAFS should be the same as asthmatics without fungal sensitization. There is some evidence of the role of itraconazole in the management of SAFS but its routine use in SAFS requires further evaluation. This review summarizes the current evidence on the link between fungi and severe asthma.