Association of Aspirin-Exacerbated Respiratory Disease with Airway Mycosis

RATIONALE: Aspirin-exacerbated respiratory disease (AERD) is characterized by chronic and often severe upper and lower airway inflammation of unclear etiology. Fungal involvement has previously been suggested in the pathogenesis of AERD, but the nature of such involvement is currently unknown. We tested the hypothesis that rather than fungal hypersensitivity, AERD may be induced through airway mycosis (airway fungal infection without invasion), which we have previously linked etiologically to asthma and chronic rhinosinusitis.

METHODS: We conducted a retrospective chart review of all patients who had been seen in the Michael E. DeBakey VA Allergy & Immunology Clinic and who had submitted a sputum sample for fungal culture. Charts were screened for a diagnosis of AERD (asthma, chronic rhinosinusitis with nasal polyposis, and COX-1 inhibitor intolerance) and measurements of fungal hypersensitivity (fungus-specific IgE by ImmunoCAP, skin prick test (SPT), or intradermal testing).

RESULTS: Of seven identified patients, six patients (86%) had a sputum culture positive for fungi. Of these six patients, two (33%) had positive SPT or intradermal results for fungi, and none had positive fungus-specific IgE. Six of seven (86%) patients had a positive SPT or detectable serum specific IgE for an aeroallergen, and five (71%) had a serum IgE level greater than 150 IU/mL.

CONCLUSIONS: Rather than specific hypersensitivity, our findings more strongly link AERD to airway mycosis, suggesting a role for antifungals in disease management. Prospective studies are warranted to confirm and extend these preliminary observations.