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).