S82 Fungal sensitisation in children with severe therapy resistant asthma. (2nd December 2011)

• Record Type: Journal Article
• Authors: Castanhinha, S; Gupta, A; Maglione, M; Koo, S; Bossley, C; Fleming, L; Bush, A; Saglani, S
• Is Part Of: Thorax. Volume 66(2011)Supplement 4
• Page Start: A39
• Page End: A40
• Publication Date: 2011-12-02
• Subjects: Chest -- Diseases -- Periodicals; Thorax; Chest -- Diseases; Periodicals; Periodicals; 617.54
• DOI: 10.1136/thoraxjnl-2011-201054b.82
• Languages: English
• ISSNs: 0040-6376

Abstract

Abstract : Introduction: Severe asthma with fungal sensitisation (SAFS) in adults is associated with reduced lung function and increased morbidity [ EurRespir J 2006;27 :615–26, Am J RespirCare Med 2009; 179 :11–18]. We hypothesised that fungal sensitisation in children with severe, therapy-resistant asthma (STRA) is associated with increased symptoms, medication use and airway inflammation, and reduced lung function. Methods: STRA was defined as before [ Lancet 2010;376 :814–25]. All children had been through a detailed assessment to optimise adherence and other aspects of basic management, as far as possible. We retrospectively evaluated 166 patients (median age at referral 11.7 years [4;17]; 61% males). SAFS (n=76) was defined as specific IgE (spIgE) or skin prick test (SPT) positivity to any of Aspergillus fumigatus, Alternaria alternata or Cladosporium herbarum . Non-sensitised patients (n=90) had negative spIgE and SPT to all fungal allergens tested. Age of onset, atopy, symptoms (asthma control test), medication usage, lung function and airway inflammation were assessed. Results: More boys had SAFS (57/76 (75%) vs 43/90 (48%), p<0.001). Children with SAFS had earlier onset of asthma (median 0.5 years [0;12.5] vs 1.5 [0;12.5], p=0.006), higher total serum IgE (637 IU/ml [12;6737] vs 177 [1;10 881], p=0.002) and higher sum of inhalant allergen SPT and spIgE [ Allergy 2007;62 :1379;86] (16 mm [0;38] vs 9 mm [0;36], p<0.001, and 78 IU/ml [0;400] vs 19 IU/ml [0;243], p=0.02, respectively). Children with SAFS had a lower FEV1 (1.4 L [0.5;3.8], vs 1.9 [0.7;4.3], p=0.008) and lower FVC (2.3 L [0.6;4] vs 2.6 [0.8;5.5], p=0.045). Bronchodilator reversibility was more frequent in SAFS (n=59/73 (81%) vs 42/81 (52%), p<0.001). Maintenance oral steroids were more frequently prescribed in SAFS (n=18/76(24%) vs 8/88 (9%), p=0.02). Symptoms and airway inflammation (assessed in sputum, bronchoalveolar lavage and endobronchial biopsy) were similar in children with and without fungal sensitisation. Conclusions: Children with STRA and fungal sensitisation had lower lung function, earlier asthma onset, more atopy and more bronchodilator responsiveness. There is a need for a randomised controlled trial of antifungal therapy in paediatric SAFS.