Section of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston, Tex.
Section of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston, Tex.
J Allergy Clin Immunol Pract. 2017 Jul-Aug;5(4):1025-1031.e2. doi: 10.1016/j.jaip.2016.11.015. Epub 2016 Dec 22.
Fungal sensitization in patients with asthma has been associated with severe asthma and worse asthma outcomes.
The purpose of this study was to determine the relationship between fungal and nonfungal sensitization, asthma severity, and clinical outcomes.
A retrospective review of patients with asthma evaluated in an urban pulmonary subspecialty clinic in the United States was performed. Patients with fungal and nonfungal allergen sensitization were identified based on serum-specific immunoglobulin E (sIgE) testing. Demographic, clinical, laboratory, and spirometric data were obtained. The relationship between fungal sensitization and asthma outcomes was examined.
Of 390 patients with asthma identified, 307 had sIgE testing, of whom 53 (17.3%) had fungal sensitization, 117 (38.1%) had nonfungal sensitization, and 137 (44.6%) had no sensitization. Patients with fungal sensitization were more likely to be sensitized to ≥5 allergens than patients with nonfungal sensitization (66% for fungal vs 29% for nonfungal, P < .001). Serum IgE concentrations were highest in patients with fungal sensitization compared with patients with no sensitization or nonfungal sensitization (median, 825, 42, and 203 IU/mL, respectively, P < .001). Fungal sensitized patients were more likely to require intensive care unit (ICU) admission and mechanical ventilation than those with no sensitization or nonfungal sensitization (13.2%, 3.7%, and 3.4%, respectively, for ICU admission, P = .02; 11.3%, 1.5%, and 0.9%, respectively, for ventilation, P < .001).
Fungal sensitization is common in patients with asthma in an urban setting and is associated with greater sensitization to nonfungal allergens and increased risk of life-threatening asthma.
哮喘患者的真菌感染与严重哮喘和更差的哮喘结局有关。
本研究旨在确定真菌感染和非真菌感染致敏、哮喘严重程度和临床结局之间的关系。
对美国一家城市肺病专科诊所评估的哮喘患者进行回顾性研究。根据血清特异性免疫球蛋白 E（sIgE）检测确定真菌和非真菌过敏原致敏的患者。获取人口统计学、临床、实验室和肺功能数据。检查真菌感染致敏与哮喘结局之间的关系。
在确定的 390 例哮喘患者中，有 307 例进行了 sIgE 检测，其中 53 例（17.3%）有真菌感染致敏，117 例（38.1%）有非真菌感染致敏，137 例（44.6%）无致敏。真菌感染致敏患者比非真菌感染致敏患者更有可能对≥5 种过敏原致敏（真菌感染致敏患者占 66%，而非真菌感染致敏患者占 29%，P<.001）。与无致敏或非真菌感染致敏患者相比，真菌感染致敏患者的血清 IgE 浓度最高（中位数分别为 825、42 和 203 IU/mL，P<.001）。与无致敏或非真菌感染致敏患者相比，真菌感染致敏患者更有可能需要入住重症监护病房（ICU）和接受机械通气（入住 ICU 的分别为 13.2%、3.7%和 3.4%，P=.02；接受通气的分别为 11.3%、1.5%和 0.9%，P<.001）。
在城市环境中，哮喘患者真菌感染很常见，与对非真菌过敏原的更高致敏性和危及生命的哮喘风险增加相关。
