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Table 1 Definitions

From: Fungal allergy in asthma–state of the art and research needs

Entity Current definition Proposed definition Comments
Fungal allergy Immune-mediated inflammatory response to a fungus sometimes leading to tissue damage Same, being inclusive of all allergic immunopathologies Demonstrating and documenting ‘Tissue damage’ can sometimes be difficult.
Fungal sensitisation Immune-mediated response to a fungus, without evidence of inflammation or tissue damage, usually documented by an elevated fungal-specific IgE. Same Tends to reflect specific-IgE response (or skin prick test result) only.
Fungal colonisation None 1. One (or preferably two or more) respiratory sample (s) positive for a fungus by culture or PCR Such criteria may apply to other filamentous fungi, but not Candida. They need to be tested in prospective studies.
2. No new major respiratory symptoms
3. No evidence of ABPA or other forms of aspergillosis
4. No overt immunocompromise
5. Negative fungal specific IgG in serum.
ABPA 1. Asthma (or CF) with deterioration of lung function 1. Asthma (or CF) No definition addressed robustly with prospective study and combinations of diagnostic criteria.
2. Elevated total serum IgE of >1000 ng/ml (>417 IU/ml) 2. A. fumigatus skin test positive or elevated A. fumigatus IgE levels
3. Elevated A. fumigatus specific IgE and/or IgG antibodies 3. Elevated total serum IgE of >1000 IU/ml
+ 2 of the following:
a. Positive A. fumigatus IgG or precipitating antibodies
b. Radiographic opacities consistent with ABPA
c. Eosinophil count >500 cells/uL
4. Immediate Aspergillus species skin test reactivity  
5. Eosinophilia (>1,000/uL)
6. Presence of central (or proximal) bronchiectasis
7. Chest radiographic infiltrates
8. High attenuation mucus present.
Allergic bronchopulmonary mycosis (ABPM) 1. Asthma (or CF) with deterioration of lung function No new proposal, but similar to ABPA, with substitution of a different fungal specific tests. Too rare to develop patient cohorts to formally validate a definition.
2. Elevated total serum IgE of >1000 ng/ml (>417 IU/ml)
3. Elevated fungal specific IgE and/or IgG antibodies
4. Immediate fungal species skin test reactivity
5. Eosinophilia (>1,000/uL)
6. Presence of central (or proximal) bronchiectasis
7. Chest radiographic infiltrates
Severe asthma with fungal sensitisation (SAFS) 1. Severe asthma   Severe asthma is a variable, usually treatment-based entity.
2. Total IgE <1,000 IU/mL Variable performance of different skin and sIgE test reagents, makes SAFS an imprecise entity until diagnostics improve.
3. Sensitisation to any fungus by skin prick test or sIgE  
Aspergillus bronchitis None 1. Multiple respiratory sample positive for Aspergillus spp by culture or PCR Few patients reported. Some cases are caused by non-fumigatus species, and so serology criterion may be falsely negative.
2. Major respiratory symptoms for >4 weeks
3. No evidence of ABPA or other forms of aspergillosis
4. No overt immunocompromise
   5. Positive Aspergillus IgG or precipitins in serum.  
  1. Fungal allergy, fungal sensitisation and fungal colonisation may be clinically silent.