Evaluation of the association between sensitization to common inhalant fungi and poor asthma control

Background Fungi are well-known airborne allergens that are predisposing environmental factors to asthma. Few comparative studies have evaluated sensitization to common inhalant fungi in relation to poor asthma control in patients with asthma. Objective To evaluate the association between sensitization to individual fungi and asthma control and elucidate the characteristics of patients with poorly controlled asthma sensitized to fungi. Methods This cross-sectional study was performed at Showa University Hospital between September 2014 and December 2014. The specific IgE levels for several major aeroallergens, including house dust mites, Japanese cedar, various types of pollen, furry animals, or insects, were measured with a fluorescent enzyme immunoassay in 160 patients with adult asthma. Results Fungal sensitization was predominant in men with asthma, and it was associated with poor asthma control. Sensitization to house dust mites, Japanese cedar, pollen, furry animals, or insects was not associated with poor asthma control. Logistic regression analyses revealed that patients sensitized to Aspergillus and Penicillium had a significantly increased risk of poor asthma control. More Penicillium IgE–positive patients were men and pet owners compared with Penicillium IgE–negative patients; in addition, Penicillium IgE–positive patients had higher total IgE levels. The Asthma Control Test level was significantly higher in Penicillium IgE–positive patients than in Penicillium IgE–negative patients. However, there were no differences in fractional exhaled nitric oxide, forced vital capacity, and forced expiratory volume in 1 second. Finally, sensitization to Aspergillus , Cladosporium , and Trichophyton were positively correlated with sensitization to Penicillium . Conclusion Sensitization to fungi is predominant in men, and it is associated with poor asthma control. In particular, sensitization to Penicillium and Aspergillus is a risk factor for asthma severity. These results have potential relevance in asthma management.