IV.2.1. Asthma
Thermotolerant mold-sensitized individuals are at high risk for
developing chronic severe lung disease, including life-threatening
asthma, bronchiectasis, and lung fibrosis (6). Conversely, the severity
of mesophilic-mold related lung diseases resides mostly in acute
allergenic stimulation (81). Examples are Aspergillus
fumigatus -related fungal asthma, as opposed to A.
alternata -related asthma attacks in the aftermath of summer storms.
With respect to A. fumigatus , it has been demonstrated that both
specific IgE production (sensitization) and airway colonization
(culturable mold present in bronchial samples) are associated with lung
function deterioration (6). In adults from the European Community
Respiratory Health Survey (ECRHS), sensitization to Alternariawas associated with severe asthma (82) and a decrease in lung function,
especially in women (83); also, sensitization to molds
(Cladosporium and Alternaria ) was more prevalent in
individuals living in damp dwellings and related to current asthma (84).
In pediatric asthma, mold sensitization related to impaired pulmonary
function and increased airway hyperresponsiveness (85). In adults with
severe asthma, multiple fungal sensitizations are related to poorer
asthma control (86). Conversely, A. fumigatus specific IgG has
not been associated with modified clinical outcomes in asthma, in the
absence of allergic broncho-pulmonary aspergillosis (ABPA) or
hypersensitivity pneumonitis (HSP).