Allergic Bronchopulmonary Aspergillosis and Fungal Allergy in Severe Asthma
Allergic hypersensitivity to fungi, especially to Aspergillus fumigatus, in asthmatic and cystic fibrosis patients may be complicated by the development of allergic bronchopulmonary aspergillosis (ABPA) or allergic fungal bronchopulmonary mycosis (ABPM). Recently, two fungal allergic disorders causing severe asthma have been described, allergic fungal asthma disease (AFAD) and severe asthma associated with fungal sensitivity (SAFS). In AFAD and SAFS, the principal fungal sensitivity is to A. fumigatus, and it has been proposed that AFAD and perhaps SAFS may be milder forms of ABPA. In this review, the clinical features, immunopathology, genetic risks, and treatment of ABPA, ABPM, AFAD and SAFS are discussed.