Challenging cases in fungal asthma.

Fungal asthma broadly encompasses the presence of fungal sensitization or fungal allergy in patients with asthma. The clinical presentation of fungal asthma can vary from fungal-sensitized asthma at one end to allergic bronchopulmonary mycosis at the other end of the spectrum. Here we present five cases that illustrate some of the most challenging aspects of the diagnosis and management of fungal asthma. The cases are aimed at elucidating complex clinical presentations in fungal asthma such as allergic bronchopulmonary mycosis presenting with normal immunoglobulin E (IgE) values, the role of several different fungi in causing allergic mycosis, newer treatments like omalizumab (and mepolizumab), and a complication of long-standing allergic bronchopulmonary aspergillosis, namely, chronic pulmonary aspergillosis.