Studying The State of Respiratory Fungal Colonization Concomitant with IgA Assay and Their Relation to Bronchial Asthma Course Among Egyptian Asthmatics

Background: Fungal-associated asthma, also known as allergic fungal airway disease, is a growing area of research, with studies exploring the role of fungi in asthma development and exacerbation. Fungal asthma can manifest itself as fungal sensitization or fungal colonization. Aim: To study the state of fungal colonization and sensitization concomitant with IgA assay and its impact on the course of the disease among Egyptian asthmatics. Subjects and methods: This prospective observational study held at Al-Azhar Allergy Immunology Center involved 45 asthma patients and 20 controls. Sputum samples were collected for examination & culture. Atopic status was determined by skin prick test (SPT), IgE total & IgE specific. All patients had been assessed by the asthma control test (ACT), Spirometry, serum IgA, CBC, and chest imaging. Results: Out of 45 patients, no fungal growth was detected after 21 days of incubation. However, the present investigation has arrived at conclusions regarding the level of fungal sensitivity; 16 patients had fungal sensitization, compared to 29 patients who had non-fungal sensitization. The fungal sensitized group showed high levels of IgE (p<0.001) and eosinophil counts (p<0.001) compared with the non-fungal sensitized group. Additionally, compared to the control group, asthma patients had a statistically significantly lower IgA level (p<0.001), while the fungal sensitized group had a significantly higher frequency of acute exacerbations (AE) (p<0.011), ED visits (p<0.002), and hospitalizations (p<0.003). Conclusion: Fungal-associated asthma has a poor outcome, and non-fungal colonized asthma patients still have fungal sensitization, which was associated with a more severe asthma. Asthma is associated with serum IgA deficiency. Patients may have a better quality of life, fewer exacerbations, and better control of the primary disease if they are diagnosed early and treated with antifungals and specific immunotherapy (SIT).