الفهرس 
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Abstract
Asthma is defined as a heterogeneous disease, usually characterized by chronic airway inflammation. It is defined by the history of respiratory symptoms such as wheeze, shortness of breath, chest tightness and cough that vary over time and in intensity, together with variable expiratory airflow limitation (GINA, 2014).
Fungi can be linked to severe asthma in a multitude of ways, including 1) inhalation of fungal spores; 2) fungal sensitization; and 3) allergic bronchopulmonary aspergillosis (ABPA), a severe degree of fungal sensitization culminating in irreversible bronchopulmonary damage. Many fungi have been associated with SAFS or allergic bronchopulmonary mycosis. Exposure to outdoor fungal spores has been associated with worsening asthma symptoms, poor lung function, hospital admissions, and asthma-related deaths in children as well as adults (Newson et al., 2000).
Severe asthma with fungal sensitization (SAFS) is a recently described phenotype characterized by the presence of:
Severe asthma
Fungal sensitization
But without bronchiectasis and mucus plugging
And total IgE values <1000 IU/mL (Denning et al. 2009).
Our aim was to identify frequency of SAFS in atopic severe patients attending our tertiary care clinic.
Our study was a cohort study conducted on 50 patients with severe bronchial asthma recruited from the Allergy and Immunology clinic at Ain Shams University hospitals. Our objective is to determine the prevalence of SAFS in these patients
Results showed that SAFS is very common, we report a prevalence of 76% of SAFS patients among all asthma patients included in the study.
The most common fungal allergens elicited in SAFS patients that exhibited statistical significance were Alternaria alternata (65.8%), Aspergillus fumigatus (55.3%) and Cladosporium (52.6%). Sensitisation to Penicillium was found in 8 patients (21.1%); however it did not exhibit statistical significance.
In a recent study, exposure to Cladosporium, Alternaria, Aspergillus, and Penicillium species increased the exacerbation of current asthma symptoms by 36% to 48% compared with those exposed to lower concentrations of these fungi, as shown by using random-effect estimates (Sharpe et al., 2015).
In our study we found no statistically significant difference between SAFS and non- SAFS patients regarding age, sex and positive family history of asthma.
Our patients with SAFS did not have higher incidence of associated allergic conditions (urticarial and/or allergic rhinitis) than non- SAFS patients. However, a study that investigated whether natural exposure to Alternaria induces rhinoconjuctivitis symptoms in Alternaria-sensitized children concluded that exposure to Alternaria spores may be an important cause of allergic rhinoconjunctivitis (Andersson et al., 2003).
In terms of treatment, important aspects in the clinical management of fungal allergy in asthma include avoidance of fungi, proper control of the inflammatory process, improvement of airway air flow through reduction of mucus and obstruction and reduction of fungal burden (Denning et al., 2014). Environmental management established from the viewpoint of both the ecology and life cycle of the responsible fungi can enable proper control of fungus-associated asthma (Ogawa et al., 2014).
Moreover, clinical efficacy of specific immunotherapy with fungal extracts has been previously shown in 79 actively treated patients in four controlled trials, with only two fungal species, namely Alternaria alternata and Cladosporium. The use of recombinant fungal allergens might create new prospects in diagnosis and specific immunotherapy for fungal allergy (Helbling et al., 2003).
In conclusion, we found high frequency of fungal sensitisation (76%), patients were sensitized to an average of 1-3 fungi, with the most statistically significant fungi being Aspergillus Fumigatus, Alternaria alternata and Cladosporium.