Imperial College London
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ProfessorAndrewBush

Faculty of Medicine, National Heart & Lung Institute

Professor of Paediatric Respirology
 
 
 
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Contact

 

+44 (0)20 7352 8121 ext 2255a.bush

 
 
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Location

 

Chelsea WingRoyal Brompton Campus

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Summary

 

Publications

Citation

BibTex format

@article{Bush:2020:10.3390/jof6020055,
author = {Bush, A},
doi = {10.3390/jof6020055},
journal = {Journal of Fungi},
title = {Kids, Difficult Asthma and Fungus},
url = {http://dx.doi.org/10.3390/jof6020055},
volume = {6},
year = {2020}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Fungi have many potential roles in paediatric asthma, predominantly by being a source of allergens (severe asthma with fungal sensitization, SAFS), and also directly damaging the epithelial barrier and underlying tissue by releasing proteolytic enzymes (fungal bronchitis). The umbrella term 'fungal asthma' is proposed for these manifestations. Allergic bronchopulmonary aspergillosis (ABPA) is not a feature of childhood asthma, for unclear reasons. Diagnostic criteria for SAFS are based on sensitivity to fungal allergen(s) demonstrated either by skin prick test or specific IgE. In children, there are no exclusion criteria on total IgE levels or IgG precipitins because of the rarity of ABPA. Diagnostic criteria for fungal bronchitis are much less well established. Data in adults and children suggest SAFS is associated with worse asthma control and greater susceptibility to asthma attacks than non-sensitized patients. The data on whether anti-fungal therapy is beneficial are conflicting. The pathophysiology of SAFS is unclear, but the epithelial alarmin interleukin-33 is implicated. However, whether individual fungi have different pathobiologies is unclear. There are many unanswered questions needing further research, including how fungi interact with other allergens, bacteria, and viruses, and what optimal therapy should be, including whether anti-neutrophilic strategies, such as macrolides, should be used. Considerable further research is needed to unravel the complex roles of different fungi in severe asthma.
AU  - Bush,A
DO  - 10.3390/jof6020055
PY  - 2020///
SN  - 2309-608X
TI  - Kids, Difficult Asthma and Fungus
T2  - Journal of Fungi
UR  - http://dx.doi.org/10.3390/jof6020055
UR  - https://www.ncbi.nlm.nih.gov/pubmed/32349347
UR  - http://hdl.handle.net/10044/1/79845
VL  - 6
ER  -
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