ASTHMA: Edited by Zuzana Diamant and Nicola A. HananiaThe impact of fungal allergic sensitization on asthmaKao, Christina C.a; Hanania, Nicola A.a; Parulekar, Amit D.bAuthor Information aSection of Pulmonary, Critical Care, and Sleep, Department of Medicine, Baylor College of Medicine, Houston, Texas bDivision of Allergy, Pulmonary, and Critical Care, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA Correspondence to Amit D. Parulekar, Division of Allergy, Pulmonary, and Critical Care, Department of Medicine, Vanderbilt University Medical Center, 1161 21st Avenue South, T1218 MCN, Nashville, TN 37232, USA. Tel: +1 615 322 0813; e-mail: [email protected] Current Opinion in Pulmonary Medicine: January 2021 - Volume 27 - Issue 1 - p 3-8 doi: 10.1097/MCP.0000000000000740 Buy Metrics Abstract Purpose of review Fungal sensitization may contribute to the development of asthma as well as asthma severity. The purpose of this review is to summarize existing knowledge about the pathophysiology, diagnosis, and management of fungal sensitization in asthma and highlight unmet needs and target areas for future investigation. Recent findings Fungal sensitization may occur by a normal or aberrant immune response. Allergic sensitization to fungi is mediated by the adaptive immune response driven by TH2 cells and the innate immune response driven by the innate lymphoid cells group 2. Diagnosis of fungal sensitization can be made by either skin prick testing or measurement of fungal-specific serum IgE. Fungal sensitization in asthma has been associated with worse disease severity, including reduced lung function, increased risk of hospitalizations, and life-threatening asthma. A spectrum of disease related to fungal sensitization has been described in asthma including allergic bronchopulmonary mycosis and severe asthma with fungal sensitization (SAFS). The role of antifungals and targeted biologic therapy in asthma with fungal sensitization need further investigation. Summary There is increasing awareness of the contribution of fungal sensitization to asthma severity. However, there are no therapies with proven efficacy. Randomized clinical trials are needed to further investigate the role of biologics. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.