Allergic fungal airways diseases: analysis of data in the register of patients with asthma

Introduction. Allergy to microscopic fungi (micromycetes), which can colonize the respiratory tract, is associated with an eosinophilic endotype of inflammation and a severe course of the disease. Among the hallmarks of fungal allergy, experts identify fixed airways obstruction, bronchiectasis, and fibrosis. Currently, the term "allergic fungal airways disease" (AFAD) has been proposed, which combines various clinical phenotypes, the pathogenesis of which is based on an IgE-mediated allergic reaction to fungal spores colonizing the respiratory tract. According to this approach, the AFAD group includes severe asthma with fungal sensitization and allergic bronchopulmonary aspergillosis. A promising direction in the treatment of AFAD is the use of genetically engineered biological drugs against T-2 inflammation. Aim: to evaluate the prevalence of sensitization to Aspergillus spp. and allergic bronchopulmonary aspergillosis in patients with asthma. Materials and methods. A retrospective single-center registry study based in the North-Western State Medical University. I.I. Mechnikov of the Ministry of Health of Russia. The study included 523 patients with asthma of varying severity. The level of total and specific IgE to aeroallergens, including Aspergillus spp., was determined by enzyme immunoassay in blood serum. 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. registered in 16.6% 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, women (64%) aged 40 years and older predominated. The main clinical manifestations of ABPA were cough (96%) and shortness of breath (76%), radiological changes on CT scan were bronchiectasis (72%). Conclusion. A high prevalence of sensitization to Aspergillus spp. in patients with asthma. It is necessary to include Aspergillus spp. in the list of tested allergens when examining patients with chronic lung diseases for the timely detection of AFAD and the prescription of adequate anti-inflammatory or antimycotic therapy.