Aspergillus Hypersensitivity in Childhood Bronchial Asthma

Abstract

Asthma is a common and potentially serious disease that imposes a substantial burden on patients, their families and the community. It causes respiratory symptoms, limitation of activity and flare-ups. Allergic bronchopulmonary aspergillosis is a complex pulmonary disorder caused by immunologic reactions to antigens released by Aspergillus fumigates. The clinical presentation is usually poorly controlled asthma. Recent epidemiological studies clearly outline the link between fungal sensitization and exacerbations of allergic asthma, leading to increased morbidity and mortality. So, this cross-sectional study aimed to demonstrate the association between Aspergillus sensitization by skin prick test- and asthma severity in Egyptian children. The study was conducted on 60 asthmatic children recruited from Pediatric Chest Clinic Children hospital, Ain Shams University during the period from September 2013 to October 2014. The study group consisted of 42 males (70%) and 18 females (30%), their ages ranged between four to seventeen years. The duration of asthma among the study group ranged from one year to fifteen years with a mean of five years. All studied patients were subjected to the following: Full medical history, thorough clinical examination, complete blood count, measurement of serum IgE, chest X-ray, pulmonary function tests and skin prick test to Aspergillus fumigates. Collected data were reviewed and statistical analysis was done using SPSS (statistical package for social science) version 18. The sample included 25 patients with mild persistant asthma (41%), 25 patients with moderate persistant asthma (41%) and 10 patients with severe persistant asthma (16%). Thirty-four patients (56%) had their asthma controlled on medications, while twenty-six (43%) manifested uncontrolled asthma, classified based on GINA guidelines (2012). The study revealed that: Hypersensitivity to Aspergillus was detected in eight patients (13.3%) of the studied group. The results showed that there was a statistically significant difference between positive and negative Aspergillus SPT as regard environmental tobacco smoke exposure and residence, while other demographic data as age, sex, duration of asthma, history of atopy and socioeconomic status were insignificant. Also, current study showed a statistically significant difference between positive and negative Aspergillus SPT as regard severity and control of asthma. All Aspergillus positive patients had moderate to severe persistant asthma and all had their asthma uncontrolled on therapy and had significantly higher eosinophilic count and lower values of pulmonary function tests (FEV1, FVC, MMEF %) of expected for age and sex. No statistically significant difference was found between positive and negative Aspergillus SPT patients as regard other CBC parameters, serum IgE levels and radiologic findings. In conclusion, Aspergillus skin prick test predicted to be positive among asthmatic patients with higher severity exposed to environmental tobacco smoke and in patients having lower FEV1 values, making it crucial for asthmatic patients to be routinely screened for Aspergillus hypersensitivity for early diagnosis and management.