PURPOSE OF THE STUDY.
To estimate the prevalence of fungal sensitization in moderate to severe persistent asthma and compare clinical characteristics between fungal-sensitized and non-fungal-sensitized patients.
Sixty-four children with moderate to severe persistent asthma were recruited from 2 academic pediatric pulmonary practices in the greater New York area between November 2010 and June 2012.
Serum was analyzed for total and specific immunoglobulin E (IgE) for Aspergillus spp, Alternaria spp, Candida spp, Cladosporium spp, Setomelanomma spp, Mucor spp, and Penicilliam spp. For purposes of the study, all IgE responses ≥0.35 kUA/L (ie, class ≥1) were considered to be indicative of sensitization. Additional screening for allergic bronchopulmonary aspergillosis (ABPA) was performed for those sensitized to Aspergillus. Pulmonary function testing had been performed as part of routine care.
Twenty-five of the 64 children (39%) had evidence of fungal sensitization, most class ≥2. Twenty-five were sensitized to nonfungal allergens; 14 had no sensitization. Twelve sensitized to Aspergillus had IgE levels >1000 IU, but none met diagnostic criteria for ABPA. There was no gender differences between those fungal sensitized and the others. Fungal-sensitized children had a median age of 11 compared with 9 years for the others (P = .02). Their total IgE levels were higher (1049 IU/mL vs 78 IU/mL, P < .0001). Fungal-sensitized patients had worse pulmonary function testing than nonfungal sensitized, forced expiratory volume in 1 second 81.5% versus 95.5% predicted, respectively (P = .016) with similar differences when the fungal sensitized were compared with only those sensitized to nonfungal allergens. Similar magnitudes of differences were also present for forced expiratory volume in 1 second/forced vital capacity, and forced expiratory flow 25% to 75%. Aspergillus and Alternaria were the most common fungal allergens identified (84% and 72%, respectively). Severe persistence characterized 19 of the 25 (76%) fungal-sensitized patients, whereas only 13 of 39 (33%) had been so characterized among those without fungal sensitization for an odds ratio 6.33 (95% confidence interval 2.05–19.68, P = .0014).
Fungal sensitization in childhood asthma is associated with disease severity.
This study is consistent with the observed association of Alternaria mold as a major cause of often severe seasonal allergic asthma in the Midwest, where it has even been associated with near-fatal episodes in a report from the Mayo Clinic (O’Hollaren MT, Yunginger JW, Offord KP, et al. Exposure to an aeroallergen as a possible precipitating factor in respiratory arrest in young patients with asthma. N Engl J Med 1991;324:359–363). Although controlled clinical trials of immunotherapy for pollens provide strong support for the effective decrease in clinical sensitivity to those allergens, data for molds is much more limited despite their apparent greater importance for severe asthma.
- Copyright © 2013 by the American Academy of Pediatrics