Allergic Pulmonary Mycosis and Associated Conditions

Allergic pulmonary mycosis encompasses a spectrum of hypersensitivity lung disorders arising from immune responses to filamentous fungi, most commonly Aspergillus species. Conditions such as allergic bronchopulmonary aspergillosis (ABPA), severe asthma with fungal sensitisation (SAFS) and allergic bronchopulmonary mycosis (ABPM) share features of airway inflammation, bronchiectasis, mucoid impaction and progressive decline in lung function. At its core, the pathogenesis involves a Th2-biased immune response, leading to elevated IgE, eosinophilia and recurrent pulmonary infiltrates. Both genetic predisposition and environmental exposure shape disease risk, while persistent fungal colonisation and cellular events such as eosinophil extracellular trap formation contribute to mucus plugging and airway remodelling. Globally, under-recognition of these disorders delays diagnosis and management, yet targeted therapies including azole antifungals, monoclonal antibodies against IgE and interleukin-5 blockade show promise. The integration of improved diagnostic criteria, airway microbiome analysis and immune profiling is driving advances in personalised care and reducing long-term complications.

Research from Nature Portfolio

Single-cell transcriptomic mapping of airway samples from patients with ABPA and SAFS has delineated distinct immune cell subsets characterised by overexpression of interleukin-5 and eotaxin, uncovering interactions between dendritic cells and Th2-polarised lymphocytes that underlie persistent inflammation. This work highlights potential cellular targets for biologic therapies and refines our understanding of disease heterogeneity. In parallel, proteomic analyses of serum and sputum have identified novel biomarkers reflective of early fungal sensitisation and airway mycosis. A panel of complement-derived peptides and chitinase-3-like protein emerged as predictors of disease progression, enabling stratification of high-risk individuals before radiological changes appear. These findings illustrate the power of multi-omics in unveiling mechanistic pathways and guiding precision interventions.

Allergic Pulmonary Mycosis and Associated Conditions publication trend

The graph below shows the total number of articles in allergic pulmonary mycosis and associated conditions across all publications each year (not limited to Nature Index journals).

Technical terms

Allergic bronchopulmonary aspergillosis (ABPA): A Th2 hypersensitivity reaction to Aspergillus antigens causing bronchiectasis, mucoid impaction and recurrent pulmonary infiltrates.

Severe asthma with fungal sensitisation (SAFS): A phenotype of asthma marked by IgE-mediated sensitisation to one or more fungal allergens, associated with poor control and exacerbations.

Allergic bronchopulmonary mycosis (ABPM): A broadened term for hypersensitivity lung disease triggered by non-Aspergillus fungi, presenting with features similar to ABPA.

Eosinophil extracellular trap cell death (ETosis): A process in which eosinophils release web-like chromatin structures into airways, contributing to mucus viscosity and tissue injury.

Thermotolerant fungi: Fungal species capable of growth at body temperature, able to colonise the respiratory tract and sustain antigenic stimulation.

High-attenuation mucus (HAM): Radiologically dense mucus plugs on computed tomography, serving as a marker of active inflammation and severity in ABPA/ABPM.

References

1. Fungal allergy in asthma–state of the art and research needs. Clinical and Translational Allergy (2014).
2. New clinical diagnostic criteria for allergic bronchopulmonary aspergillosis/mycosis and its validation. Journal of Allergy and Clinical Immunology (2020).
3. The airway fungal microbiome in asthma. Clinical & Experimental Allergy (2020).
4. Allergic Bronchopulmonary Aspergillosis–A Luminal Hypereosinophilic Disease With Extracellular Trap Cell Death. Frontiers in Immunology (2018).