ATS 2012, SAN FRANCISCO –New research presented at the ATS 2012 International Conference in San Francisco suggests that a significant proportion of children with asthma failing Step 4 or greater therapy may have severe asthma with fungal sensitization (SAFS).
"SAFS is a newly described sub-phenotype of asthma, and its prevalence and clinical characteristics in children are unknown," said Alfin Vicencio, MD, chief of pediatric pulmonology and cystic fibrosis at the Cohen Children's Medical Center in Great Neck, NY, and David Goldman, associate professor of pediatric infectious diseases at the Children's Hospital at Montefiore, Bronx, NY.
"Accordingly, we prospectively analyzed serum immunoglobulin E (IgE) levels and fungal sensitization patterns in 41 children failing combination asthma therapy. Of these 41 patients, 17 (41.5%) were diagnosed with SAFS."
Compared with those without SAFS, children with SAFS were older, had higher serum IgE levels, and performed worse on pulmonary function tests. These differences remained significant when children with SAFS were compared to a subset of children without SAFS who were sensitized to non-fungal environmental allergens.
The most commonly implicated organisms were Aspergillus spp (81.2%) and Alternaria spp (68.8%), but numerous other species were represented. More than 65% of children with SAFS exhibited sensitization to more than one fungal species. Airway remodeling and persistent eosinophilia may also be associated with SAFS, although the researchers note that additional studies are required to more clearly characterize these features of the disease.
"Our results suggest that SAFS may account for a significant proportion of severe asthma in our pediatric population," said Dr. Vicencio. "At this point, however, there are still many unanswered questions, including the role of anti-fungal therapy."
"We are actively pursuing new methods to identify fungal organisms in the lower airway, which would enable us to better define treatment protocols," Dr. Vicencio concluded. "In addition, we are hoping to identify genetic risk factors for disease, which could potentially lead to targeted preventive strategies early in life."
"Severe Asthma With Fungal Sensitization In Children: Characterization Of A New Pediatric Asthma Sub-Phenotype" (Session C27, Tuesday, May 22, 2012: 8:15-10:45 a.m., Room 2010-2012, Moscone Center; Abstract 28785)
* Please note that numbers in this release may differ slightly from those in the abstract. Many of these investigations are ongoing; the release represents the most up-to-date data available at press time.
Abstract 28785
Severe Asthma With Fungal Sensitization In Children: Characterization Of A New Pediatric Asthma Sub-Phenotype
Type: Scientific Abstract
Category: 14.02 - Pediatric Asthma (PEDS)
Authors: A.G. Vicencio1, E.A. Foley1, D. Bush1, K. Tsirilakis1, M.T. Santiago1, A. Stone2, D.L. Goldman3; 1Cohen Children's Medical Center - Great Neck, NY/US, 2Weill Cornell Medical College - New York, NY/US, 3Children's Hospital at Montefiore - Bronx, NY/US
Abstract Body
Rational: Severe asthma with fungal sensitization (SAFS) is a newly described sub-phenotype of asthma which has been shown to respond to itraconazole therapy. Currently, the prevalence and clinical characteristics for SAFS in children are unknown.
Methods: We prospectively analyzed serum IgE levels and fungal sensitization patterns of children failing combination asthma therapy in order to estimate the prevalence of SAFS in our population. We also compared clinical characteristics of SAFS and non-SAFS patients.
Results: Forty-one patients with asthma who were failing Step 4 or greater therapy were recruited into the study. Of these patients, 17 (41.5 %) were diagnosed with SAFS based on serum IgE and fungal sensitization testing. There was a male predominance in SAFS compared to non-SAFS patients, but this difference was not statistically significant. Children with SAFS were older than non-SAFS children (median ages 11 and 8.5 years, respectively, p=0.0325), and demonstrated higher serum IgE levels (more than 1 log10 fold, Table 1). Children with SAFS also exhibited worse pulmonary function tests (PFTs), including FEV1, FEV1/FEV and FEF25-75 (Table 1). Differences in IgE and PFTs remained significant when comparing SAFS children to a subset of the non-SAFS children who were sensitized to non-fungal environmental allergens. The most commonly implicated fungi (in decreasing order) included: Aspergillus spp (81.2%), Alternariaspp (68.8%), Candida spp (31.2%), Cladosporiumspp (31.2%), Setomelanommaspp (31.2%), Mucorspp (25%) and Penicilliumspp (18.8%). More than 65% of children with SAFS demonstrated sensitization to more than one organism.
Conclusions: SAFS is a newly described sub-phenotype of asthma that may be under-diagnosed in children. Our results suggest that a significant proportion of children failing Step 4 or greater asthma therapy may have SAFS. Further characterization of SAFS in children is required to determine regional sensitization patterns, genetic and environmental risk factors, optimal treatment protocols and preventive strategies.
Funded by: None reported