The Indian Journal of Pediatrics

, Volume 85, Issue 10, pp 899–904 | Cite as

Asthma and Fungus: Role in Allergic Bronchopulmonary Aspergillosis (ABPA) and Other Conditions

  • Meenu Singh
  • Nandini Paul
  • Shreya Singh
  • Gyan Ranjan Nayak
Review Article


Asthma is an allergic, respiratory disorder characterized by hyper responsiveness of the airway to external stimuli. Considerable research is currently being directed towards understanding the role of environmental and genetic factors contributing to the development of asthma and its severity. Recent years have seen a substantial rise in evidence linking fungi to asthma. Few major clinical conditions associated with fungal sensitization and hypersensitive immune response are Allergic bronchopulmonary aspergillosis (ABPA), Allergic fungal rhinosinusitis (AFRS) and Severe asthma with fungal sensitization (SAFS). The most common fungi implicated in these conditions belong to genus Aspergillus, although an association with several other fungi has been described. In this review authors discuss the varying clinical characteristics of fungus induced respiratory complications in individuals with asthma. They also highlight the epidemiology of these conditions including their prevalence in children and their fungal etiological profile. Laboratory diagnostic methods and clinical case definitions have also been discussed. Future studies evaluating the role of fungal exposure and susceptibility to asthma are required. Till date there are no guidelines for the diagnosis and treatment of ABPA in pediatric population, thus it is also imperative to establish validated clinical definitions of fungal allergic manifestations in pediatric patients with asthma to fully understand this complex interaction.


Asthma Fungus Allergic bronchopulmonary aspergillosis (ABPA) 



MS: Article conceived and drafted. NP: Literature search and writing; SS and GN: Literature search and review. MS will act as guarantor for this paper.

Compliance with Ethical Standards

Conflict of Interest


Source of Funding

ICMR, New Delhi has supported the fellowship of Ms. Nandini Paul.


  1. 1.
    Lambrecht BN, Hammad H. The immunology of asthma. Nat Immunol. 2015;16:45–56.CrossRefGoogle Scholar
  2. 2.
    Denning DW, O’Driscoll BR, Hogaboam CM, Bowyer P, Niven RM. The link between fungi and severe asthma: a summary of the evidence. Eur Respir J. 2006;27:615–26.CrossRefGoogle Scholar
  3. 3.
    Agarwal R. Severe asthma with fungal sensitization. Curr Allergy Asthma Rep. 2011;11:403–13.CrossRefGoogle Scholar
  4. 4.
    Hedayati MT, Pasqualotto AC, Warn PA, Bowyer P, Denning DW. Aspergillus flavus: human pathogen, allergen and mycotoxin producer. Microbiology. 2007;153:1677–92.CrossRefGoogle Scholar
  5. 5.
    Kradin RL, Mark EJ. The pathology of pulmonary disorders due to aspergillus spp. Arch Pathol Lab Med. 2008;132:606–14.PubMedGoogle Scholar
  6. 6.
    Rick EM, Woolnough K, Pashley CH, Wardlaw AJ. Allergic fungal airway disease. J Investig Allergol Clin Immunol. 2016;26:344–54.CrossRefPubMedGoogle Scholar
  7. 7.
    Schwartz HJ, Citron KM, Chester EH, et al. A comparison of the prevalence of sensitization to aspergillus antigens among asthmatics in Cleveland and London. J Allergy Clin Immunol. 1978;62:9–14.CrossRefGoogle Scholar
  8. 8.
    Maurya V, Gugnani HC, Sarma PU, Madan T, Shah A. Sensitization to aspergillus antigens and occurrence of allergic bronchopulmonary aspergillosis in patients with asthma. Chest. 2005;127:1252–9.PubMedGoogle Scholar
  9. 9.
    Longbottom JL, Pepys J. Pulmonary aspergillosis: diagnostic and immunological significance of antigens and c-substance in aspergillus fumigatus XXXVIII in the serum of patients suffering from pulmonary aspergillosis. J Pathol Bacteriol. 1964;88:141–51.CrossRefGoogle Scholar
  10. 10.
    Hendrick DJ, Davies RJ, D’Souza MF, Pepys J. An analysis of skin prick test reactions in 656 asthmatic patients. Thorax. 1975;30:2–8.CrossRefPubMedGoogle Scholar
  11. 11.
    Goh KJ, Chau A, Yii A, Lapperre TS, Chan AKW, Chew FT. Sensitization to aspergillus species is associated with frequent exacerbations in severe asthma. J Asthma Allergy. 2017;10:131–40.CrossRefPubMedGoogle Scholar
  12. 12.
    Agarwal R, Gupta D, Aggarwal AN, et al. Clinical significance of decline in serum IgE levels in allergic bronchopulmonary aspergillosis. Respir Med. 2010;104:204–10.CrossRefGoogle Scholar
  13. 13.
    Chetty A, Bhargava S, Jain RK. Allergic bronchopulmonary aspergillosis in Indian children with bronchial asthma. Ann Allergy. 1985;54:46–9.Google Scholar
  14. 14.
    Singh M, Das S, Chauhan A, et al. The diagnostic criteria for allergic bronchopulmonary aspergillosis in children with poorly controlled asthma need to be re-evaluated. Acta Pediatr. 2015;105:e206–9.CrossRefGoogle Scholar
  15. 15.
    Rosenberg M, Patterson R, Mintzer R, Cooper BJ, Roberts M, Harris KE. Clinical and immunologic criteria for the diagnosis of allergic bronchopulmonary aspergillosis. Ann Intern Med. 1977;86:405–14.CrossRefGoogle Scholar
  16. 16.
    Agarwal R, Chakrabarti A, Shah A, et al. Allergic bronchopulmonary aspergillosis: review of literature and proposal of new diagnostic and classification criteria. Clin Exp Allergy. 2013;43:850–73.CrossRefGoogle Scholar
  17. 17.
    Patterson R, Greenberger PA, Radin RC, Roberts M. Allergic bronchopulmonary aspergillosis: staging as an aid to management. Ann Intern Med. 1982;96:286–91.CrossRefGoogle Scholar
  18. 18.
    Kauffman HF. Immunopathogenesis of allergic bronchopulmonary aspergillosis and airway remodeling. Front Biosci. 2003;8:e190–6.CrossRefGoogle Scholar
  19. 19.
    Radin RC, Greenberger PA, Patterson R, Ghory A. Mould counts and exacerbations of allergic bronchopulmonary aspergillosis. Clin Allergy. 1983;13:271–5.CrossRefGoogle Scholar
  20. 20.
    Agarwal R, Maskey D, Aggarwal AN, et al. Diagnostic performance of various tests and criteria employed in allergic bronchopulmonary aspergillosis: a latent class analysis. PLoS One. 2013;8:1–7.CrossRefGoogle Scholar
  21. 21.
    Thia LP, Balfour Lynn IM. Diagnosing allergic bronchopulmonary aspergillosis in children with cystic fibrosis. Paediatr Respir Rev. 2009;10:37–42.CrossRefGoogle Scholar
  22. 22.
    Patterson R, Greenberger PA, Halwig JM, Liotta JL, Roberts M. Allergic bronchopulmonary aspergillosis. Natural history and classification of early disease by serologic and roentgenographic studies. Arch Intern Med. 1986;146:916–8.CrossRefGoogle Scholar
  23. 23.
    Kumar R. Mild, moderate and severe forms of allergic bronchopulmonary aspergillosis. A clinical and serologic evaluation. Chest. 2003;124:890–2.CrossRefGoogle Scholar
  24. 24.
    Agarwal R, Khan A, Gupta D, Aggarwal AN, Saxena AK, Chakrabarti A. An alternate method of classifying allergic bronchopulmonary aspergillosis based on high-attenuation mucus. PLoS One. 2010;5:1–9.CrossRefPubMedGoogle Scholar
  25. 25.
    Agarwal R. Pictorial essay: allergic bronchopulmonary aspergillosis. World J Radiol. 2011;3:178–81.Google Scholar
  26. 26.
    Kumar R. Mild, moderate, and severe forms of allergic bronchopulmonary aspergillosis: a clinical and serologic evaluation. Chest. 2003;124:890–2.CrossRefGoogle Scholar
  27. 27.
    Katzenstein ALA, Sale SR, Greenberger PA. Allergic aspergillus sinusitis: a newly recognized form of sinusitis. J Allergy Clin Immunol. 1983;72:89–93.CrossRefGoogle Scholar
  28. 28.
    Safirstein BH. Allergic bronchopulmonary aspergillosis with obstruction of the upper respiratory tract. Chest. 1976;70:788–90.CrossRefGoogle Scholar
  29. 29.
    Bent JP, Kuhn FA. Diagnosis of allergic fungal sinusitis. Otolaryngol Head Neck Surg. 1994;111:580–8.CrossRefGoogle Scholar
  30. 30.
    Tracy MC, Okorie CUA, Foley EA, Moss RB. Allergic bronchopulmonary aspergillosis. J Fungi. 2016;2:17.CrossRefGoogle Scholar
  31. 31.
    Gresnigt MS, Netea MG, Van de Veerdonk FL. Pattern recognition receptors and their role in invasive aspergillosis. Ann N Y Acad Sci. 2012;1273:60–7.CrossRefGoogle Scholar
  32. 32.
    Blanco JL, Garcia ME. Immune response to fungal infections. Vet Immunol Immunopathol. 2008;125:47–70.CrossRefGoogle Scholar
  33. 33.
    Rapaka RR, Kolls JK. Pathogenesis of allergic bronchopulmonary aspergillosis in cystic fibrosis: current understanding and future directions. Med Mycol. 2009;47:S331–7.CrossRefGoogle Scholar
  34. 34.
    Kurup VP, Raju R, Manickam P. Profile of gene expression in a murine model of allergic bronchopulmonary aspergillosis. Society. 2005;73:4381–4.Google Scholar
  35. 35.
    Fricker-Hidalgo H, Coltey B, Llerena C, et al. Recombinant allergens combined with biological markers in the diagnosis of allergic bronchopulmonary aspergillosis in cystic fibrosis patients. Clin Vaccine Immunol. 2010;17:1330–6.CrossRefPubMedGoogle Scholar
  36. 36.
    Nouri-Aria KT, Durham SR. Regulatory T cells and allergic disease. Inflamm Allergy Drug Targets. 2008;7:237–52.CrossRefGoogle Scholar
  37. 37.
    Kraemer R, Deloséa N, Ballinari P, Gallati S, Crameri R. Effect of allergic bronchopulmonary aspergillosis on lung function in children with cystic fibrosis. Am J Respir Crit Care Med. 2006;174:1211–20.CrossRefGoogle Scholar
  38. 38.
    Nandakumar S, Miller CW, Kumaraguru U. T regulatory cells: an overview and intervention techniques to modulate allergy outcome. Clin Mol Allergy. 2009;7:5.CrossRefPubMedGoogle Scholar
  39. 39.
    Skowronski E, Fitzgerald DA. Life-threatening allergic bronchopulmonary aspergillosis in a well child with cystic fibrosis. Med J Aust. 2005;182:482–3.Google Scholar
  40. 40.
    Wark P. Pathogenesis of allergic bronchopulmonary aspergillosis and an evidence-based review of azoles in treatment. Respir Med. 2004;98:915–23.CrossRefGoogle Scholar
  41. 41.
    Patterson K, Strek ME. Allergic bronchopulmonary aspergillosis. Proc Am Thorac Soc. 2010;7:237–44.CrossRefGoogle Scholar
  42. 42.
    FDA Safety Notice. FDA issues early communication concerning safety of asthma drug Xolair. MD Consult July 17, 2009.Google Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 2018

Authors and Affiliations

  • Meenu Singh
    • 1
  • Nandini Paul
    • 1
  • Shreya Singh
    • 2
  • Gyan Ranjan Nayak
    • 3
  1. 1.Advanced Pediatrics CentrePGIMERChandigarhIndia
  2. 2.Department of MicrobiologyPGIMERChandigarhIndia
  3. 3.Department of OtolaryngologyPGIMERChandigarhIndia

Personalised recommendations