Masaki Katsunori, Fukunaga Koichi, Matsusaka Masako, Kabata Hiroki, Tanosaki Takae, Mochimaru Takao, Kamatani Takashi, Ohtsuka Kengo, Baba Rie, Ueda Soichiro, Suzuki Yusuke, Sakamaki Fumio, Oyamada Yoshitaka, Inoue Takashi, Oguma Tsuyoshi, Sayama Koichi, Koh Hidefumi, Nakamura Morio, Umeda Akira, Kamei Katsuhiko, Izuhara Kenji, Asano Koichiro, Betsuyaku Tomoko
Division of Pulmonary Medicine, Department of Medicine, Keio University, School of Medicine, Tokyo, Japan.
Division of Pulmonary Medicine, Department of Medicine, Keio University, School of Medicine, Tokyo, Japan.
Ann Allergy Asthma Immunol. 2017 Sep;119(3):253-257. doi: 10.1016/j.anai.2017.07.008. Epub 2017 Aug 8.
Some patients with severe asthma also have fungal sensitization and are considered to have severe asthma with fungal sensitization. However, there is limited information on the clinical features of SAFS.
To investigate the clinical characteristics of severe asthma with fungal sensitization.
The present study enrolled 124 patients with severe asthma. We evaluated clinical aspects, such as various serum cytokines, fractional exhaled nitric oxide, pulmonary function, and serum immunoglobulin E (IgE). Fungal sensitization was assessed by determining serum levels of IgE specific to fungal allergens (Aspergillus, Alternaria, Candida, Cladosporium, Penicillium, and Trichophyton species and Schizophyllum commune). The protocol was registered at a clinical trial registry (www.umin.ac.jp/ctr/index-j.htm; UMIN 000002980).
Thirty-six patients (29%) showed sensitization to at least 1 fungal allergen. The most common species were Candida (16%), Aspergillus (11%), and Trichophyton (11%). The rate of early-onset asthma (<16 years of age) was higher in patients with fungal sensitization than in those without fungal sensitization (45% vs 25%; P = .02). Interleukin-33 levels were higher in patients with fungal sensitization than in those without fungal sensitization. Of patients with atopic asthma, Asthma Control Test scores were worse in patients with multiple fungal sensitizations than in patients with a single fungal sensitization or those without fungal sensitization.
Severe asthma with fungal sensitization is characterized by early onset of disease and high serum levels of interleukin-33. Multiple fungal sensitizations are associated with poor asthma control.
UMIN Clinical Trials Registry (UMIN-CTR; www.umin.ac.jp/ctr/index-j.htm): UMIN 000002980.
一些重度哮喘患者也存在真菌致敏情况，被认为患有真菌致敏性重度哮喘。然而，关于真菌致敏性重度哮喘（SAFS）临床特征的信息有限。
研究真菌致敏性重度哮喘的临床特征。
本研究纳入了124例重度哮喘患者。我们评估了临床指标，如各种血清细胞因子、呼出一氧化氮分数、肺功能和血清免疫球蛋白E（IgE）。通过测定针对真菌过敏原（曲霉属、链格孢属、念珠菌属、枝孢属、青霉属、毛癣菌属物种以及裂褶菌）的特异性IgE血清水平来评估真菌致敏情况。该方案已在临床试验注册中心（www.umin.ac.jp/ctr/index-j.htm；UMIN 000002980）注册。
36例患者（29%）显示对至少1种真菌过敏原致敏。最常见的物种是念珠菌（16%）、曲霉（11%）和毛癣菌（11%）。真菌致敏患者的早发性哮喘（<16岁）发生率高于无真菌致敏患者（45%对25%；P = 0.02）。真菌致敏患者的白细胞介素-33水平高于无真菌致敏患者。在特应性哮喘患者中，多重真菌致敏患者的哮喘控制测试得分比单一真菌致敏患者或无真菌致敏患者更差。
真菌致敏性重度哮喘的特征是疾病早发和血清白细胞介素-33水平高。多重真菌致敏与哮喘控制不佳有关。
UMIN临床试验注册中心（UMIN-CTR；www.umin.ac.jp/ctr/index-j.htm）：UMIN 000002980
