Association between sensitization to common fungi and severe asthma

Background 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 full-text 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 2.63 (1.76–3.92), 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 female-majority subgroup. Conclusion 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 sensitization, early detection of severe asthma risk, and personalized health management for patients. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/ , identifier [CRD42024620737]

Asthma · Sensitization · Skin sensitization · Antifungal resistance and susceptibility · Asthma and respiratory diseases · Medicine · Psychology · Respiratory and Cough-Related Research · Immunology