Institute for Lung Health, Department of Infection, Immunity & Inflammation, University of Leicester and Department of Respiratory Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK.
J Investig Allergol Clin Immunol. 2016;26(6):344-354. doi: 10.18176/jiaci.0122.
Fungi are ubiquitous and form their own kingdom. Up to 80 genera of fungi have been linked to type I allergic disease, and yet, commercial reagents to test for sensitization are available for relatively few species. In terms of asthma, it is important to distinguish between species unable to grow at body temperature and those that can (thermotolerant) and thereby have the potential to colonize the respiratory tract. The former, which include the commonly studied Alternaria and Cladosporium genera, can act as aeroallergens whose clinical effects are predictably related to exposure levels. In contrast, thermotolerant species, which include fungi from the Candida, Aspergillus, and Penicillium genera, can cause a persistent allergenic stimulus independent of their airborne concentrations. Moreover, their ability to germinate in the airways provides a more diverse allergenic stimulus, and may result in noninvasive infection, which enhances inflammation. The close association between IgE sensitization to thermotolerant filamentous fungi and fixed airflow obstruction, bronchiectasis, and lung fibrosis suggests a much more tissue-damaging process than that seen with aeroallergens. This review provides an overview of fungal allergens and the patterns of clinical disease associated with exposure. It clarifies the various terminologies associated with fungal allergy in asthma and makes the case for a new term (allergic fungal airway disease) to include all people with asthma at risk of developing lung damage as a result of their fungal allergy. Lastly, it discusses the management of fungirelated asthma.
真菌无处不在，自成一界。多达 80 属的真菌与 I 型过敏疾病有关，但可用于检测致敏的商业试剂相对较少。就哮喘而言，区分无法在体温下生长的物种和能够（耐热）并因此有可能定植呼吸道的物种很重要。前者包括常见的研究过的链格孢属和枝孢属，可作为气传过敏原，其临床效果可预测与其暴露水平有关。相比之下，耐热物种包括来自念珠菌属、曲霉属和青霉属的真菌，可在不依赖于其空气浓度的情况下引起持续的过敏刺激。此外，它们在气道中发芽的能力提供了更多样化的过敏原刺激，并且可能导致非侵入性感染，从而增强炎症。对耐热丝状真菌的 IgE 致敏与固定气流阻塞、支气管扩张和肺纤维化之间的密切关联表明，与气传过敏原相比，这是一个更具组织破坏性的过程。本文综述了真菌过敏原以及与暴露相关的临床疾病模式。它澄清了与哮喘中的真菌过敏相关的各种术语，并提出了一个新术语（过敏性真菌性气道疾病），以包括所有因真菌过敏而有发展为肺部损伤风险的哮喘患者。最后，它讨论了与真菌相关的哮喘的管理。
