Association between Sensitization to Common Fungi and Severe Asthma

Ziqiu ChenYu HeHuaien Bu^*

• Tianjin University of Traditional Chinese Medicine, Tianjin, China

The term severe asthma with fungal sensitization (SAFS) has been coined due to the non-negligible role of fungal sensitization in the development of asthma. These patients typically exhibit poorer lung function, worse clinical prognosis, and a significantly elevated risk of life-threatening asthma exacerbations. Methods: We conducted electronic searches in three databases as of October 31, 2024. Two evaluators independently screened titles and abstracts to identify studies for fulltext review. For studies meeting inclusion and exclusion criteria, the investigators used the JBI Critical Appraisal Checklist and the Newcastle-Ottawa Scale (NOS) to evaluate the quality of cross-sectional studies and a case-control study, respectively, followed by data extraction from included studies.Results: Among the 10 fungal genera examined, sensitization to Aspergillus, Penicillium, and Cladosporium spp. was significantly associated with an increased risk of severe asthma, with pooled odds ratios (ORs) and 95% confidence intervals (CIs) of 2.36 (1.29 -4.31), 1.75 (1.02-3.03), and 2.68 (1.80-4.02), respectively. Within the Aspergillus spp., Aspergillus fumigatus-specific sensitization demonstrated a stronger association with severe asthma (OR = 2.98, 95% CI: 1.32-6.75). Subgroup analyses further revealed that Aspergillus (A. fumigatus) sensitization was more strongly linked to severe asthma risk in younger and male populations: ORs with 95% CIs were 2.55 (1.35-4.83) in the ≥40 years subgroup, 3.04 (1.01-9.12) in the <40 years subgroup, and 2.77 (1.16-6.62) in the femalemajority subgroup.In this study, we quantified the risk of sensitization to distinct fungal genera/species, aiming to provide a scientific rationale for screening high-risk fungal 2 sensitization, early detection of severe asthma risk, and personalized health management for patients.