Int J Clin Exp Med 2017;10(12):16540-16547 www.ijcem.com /ISSN:1940-5901/IJCEM0056562 Original Article Clinical and immunological characteristics of severe asthma with fungal sensitization and allergic bronchopulmonary aspergillosis: potential utility for differential diagnosis Peiyan Zheng 1,2* , Shiquan Wu 3* , Jiaxing Xie 1 , Wenting Luo 1 , Huimin Huang 1,2 , Nili Wei 1,2 , Lu Li 1,2 , Xi Chen 1 , Qingling Zhang 1,2 , Baoqing Sun 1,2 1 Guangzhou Institute of Respiratory Diseases, State Key Laboratory of Respiratory Disease, National Clinical Re- search Center for Respiratory Disease, Department of Allergy and Clinical Immunology, First Affliated Hospital of Guangzhou Medical University, Guangzhou 510120, Guangdong, China; 2 Sino-French Hoffmann Institute, Guang- zhou Medical University, Guangzhou 511436, Guangdong, China; 3 Department of Respiration, Hexian Memorial Affliated Hospital, Southern Medical University, Guangzhou 511400, Guangdong, China. * Equal contributors. Received February 7, 2017; Accepted September 23, 2017; Epub December 15, 2017; Published December 30, 2017 Abstract: Fungal-sensitized asthmatic condition SAFS and the Aspergillus-related asthmatic condition ABPA are the focus of intense research. To investigate the clinical and immunological characteristics of severe asthma with fungal sensitization (SAFS) and allergic bronchopulmonary aspergillosis (ABPA) and provide for the early differential diagnosis and treatment of ABPA. The following parameters were measured in the serum of all recruited patients: total IgE (tIgE) levels, specifc IgE (sIgE) and IgG (sIgG) antibodies against Aspergillus fumigatus, and sIgE antibod- ies against mixed fungal cultures (sIgE-M.x). Pulmonary function, fractional exhaled nitric oxide, and induced spu- ta were examined; routine blood tests and computerized tomography of the lungs were performed. For SAFS pati- ents, IgE antibody levels against eight types of fungi were measured. The percentage level of bronchiectasis, ratio of eosinophils in the induced sputa, and total number of blood eosinophils were signifcantly higher in ABPA than in SAFS. There were no signifcant differences in lung indicators, (percentage of predicted forced vital capacity [FVC% pred], percentage of predicted forced expiratory volume in 1 s [FEV 1 % pred], FEV1%, and FVC). SIgE-M.x, sIgE, and sIgG antibodies against A. fumigatus, and tIgE antibodies were signifcantly higher in ABPA than in SAFS. The clini- cal reference values for total blood eosinophils, sIgE-M.x antibodies, and sIgE as well as sIgG antibodies against A. fumigatus for differential diagnosis of SAFS and ABPA were 0.41 × 10 9 /L, 3.22 kU/L, 3.86 kU/L, and 28.75 mgA/L, respectively. This panel should be considered for the differential diagnosis of ABPA and SAFS. Keywords: Bronchial asthma, allergic bronchopulmonary aspergillosis, fungal allergen, specifc IgE Introduction Fungi are common allergens, known to exacer- bate the severity of asthma in asthmatic pa- tients. Moreover, Aspergillus fumigatus, Peni- cillium chrysogenum, Candida albicans, Alter- naria alternata, and Cladosporium herbarum are commonly implicated in exacerbating as- thma [1-3], while Setomelanomma rostrata, Mucor racemosus, and Botrytis cinerea are less commonly reported. Fungal allergens are widely found both indoors and outdoors [4]. Long-term exposure to an environment contain- ing fungi is correlated with poor management of asthma, an increased incidence of acute asthmatic attacks, higher hospitalization rates, and increased mortality [3, 5-8]. Simon-Nobbe et al. [9] additionally reported that over half the patients with asthma were sensitized by fungi. Denning [10] showed that fungal sensitization was prevalent in asthmatic patients who re- quired hospitalization and that the severity of asthma was correlated with the degree of fun- gal sensitization [11]. However, studies of pa- tients with severe asthma with fungal sensitiza- tion (SAFS) suggest that prolonged antifungal therapy has benefcial effects in the context of severe persistent asthma. Furthermore, anti-