Table 1.
Criteria for diagnosis of fungal allergic airways diseases associated with severe asthma and their complications
| Disease entity | Clinical criteria | Immunologic | Mycologic | Complications |
|---|---|---|---|---|
| Allergic bronchopulmonary aspergillosis (ABPA) |
1. Asthma or cystic fibrosisa 2. Fleeting or fixed pulmonary opacities on chest radiograph 3. Peripheral eosinophil count > 500 cells/µL |
1. Type I Aspergillus skin test positive (immediate cutaneous hypersensitivity reaction to Af) or elevated IgE levels against A. fumigatus, 2. Elevated total IgE levels more than 1000 IU/mL (unless all other criteria is met, then total IgE levels can be less than 1000 IU/mL) 3. Elevated Aspergillus IgG or precipitating antibodies |
None |
Bronchiectasis Hyper-attenuated mucous Asthma exacerbations ABPA exacerbations Bronchiectasis exacerbations Fixed airways obstruction Chronic pulmonary aspergillosis Focal pleural based fibrosis areas |
| Allergic fungal airways disease (AFAD) or Airways Mycosis | Asthma with sensitization and/or inflammation and tissue damage including radiological abnormalities and fixed airways obstruction | Positive immediate skin test (SPT) and fungal specific IgE | Documented (PCR or culture) or presumed |
Bronchial wall thickening Bronchiectasis Fixed airways obstruction |
| Severe asthma with fungal sensitisation (SAFS) | Severe asthma | Positive immediate skin test (SPT) and specific IgE to Aspergillus fumigatus, Alternaria alternata, Cladosporium herbarum, Penicillium chrysogenum, Candida albicans, Trichophyton mentagrophytes, or Botrytis cinereal | None |
Asthma exacerbations Bronchial wall thickening Fixed airways obstruction Chronic pulmonary aspergillosis |
| Aspergillus bronchitis# |
Non-immunocompromised Major symptoms of cough, breathlessness and sputum production Bronchiectasis common |
May have a raised Aspergillus fumigatus IgG | Culture or PCR positive for Aspergillus on at least 2 occasions separated in time (to exclude colonisation) |