Katsunori Masaki1, Koichi Fukunaga2, Masako Matsusaka1, Hiroki Kabata1, Takae Tanosaki1, Takao Mochimaru1, Takashi Kamatani1, Kengo Ohtsuka1, Rie Baba1, Soichiro Ueda1, Yusuke Suzuki3, Fumio Sakamaki4, Yoshitaka Oyamada5, Takashi Inoue6, Tsuyoshi Oguma7, Koichi Sayama8, Hidefumi Koh9, Morio Nakamura10, Akira Umeda11, Katsuhiko Kamei12, Kenji Izuhara13, Koichiro Asano7, Tomoko Betsuyaku1. 1. Division of Pulmonary Medicine, Department of Medicine, Keio University, School of Medicine, Tokyo, Japan. 2. Division of Pulmonary Medicine, Department of Medicine, Keio University, School of Medicine, Tokyo, Japan. Electronic address: km-fuku@cpnet.med.keio.ac.jp. 3. Department of Respiratory Medicine, Kitasato Institute Hospital, Tokyo, Japan. 4. Division of Pulmonary Medicine, Department of Medicine, Tokai University Hachioji Hospital, Tokyo, Japan. 5. Department of Respiratory Medicine, Tokyo Medical Center, Tokyo, Japan. 6. Department of Medicine, Sano Kosei General Hospital, Tochigi, Japan. 7. Division of Pulmonary Medicine, Department of Medicine, Tokai University, School of Medicine, Kanagawa, Japan. 8. Department of Medicine, Kawasaki Municipal Hospital, Kanagawa, Japan. 9. Department of Medicine, KKR-Tachikawa Hospital, Tokyo, Japan. 10. Department of Medicine, Tokyo Saiseikai Central Hospital, Tokyo, Japan. 11. Department of Medicine, Shioya Hospital, International University of Health and Welfare, Tochigi, Japan. 12. Medical Mycology Research Center, Chiba University, Chiba, Japan. 13. Division of Medical Biochemistry, Department of Biomolecular Sciences, Saga Medical School, Saga, Japan.
Abstract
BACKGROUND: 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. OBJECTIVE: To investigate the clinical characteristics of severe asthma with fungal sensitization. METHODS: 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). RESULTS: 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. CONCLUSION: 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. TRIAL REGISTRATION: UMIN Clinical Trials Registry (UMIN-CTR; www.umin.ac.jp/ctr/index-j.htm): UMIN 000002980.
BACKGROUND: 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. OBJECTIVE: To investigate the clinical characteristics of severe asthma with fungal sensitization. METHODS: 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). RESULTS: 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. CONCLUSION: 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. TRIAL REGISTRATION: UMIN Clinical Trials Registry (UMIN-CTR; www.umin.ac.jp/ctr/index-j.htm): UMIN 000002980.
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