Aspergillus Sensitization and Allergic Bronchopulmonary Aspergillosis in Asthmatic Children: A Systematic Review and Meta-Analysis

Abstract

Background: The prevalence of aspergillus sensitization (AS) and allergic bronchopulmonary aspergillosis (ABPA) in asthmatic children remains unclear. Objective: To systematically review the literature to estimate the prevalence of AS and ABPA in children with bronchial asthma. Methods: We searched the PubMed and Embase databases for studies reporting the prevalence of AS or ABPA in pediatric asthma. The primary outcome was to assess the prevalence of AS, while the secondary outcome was to evaluate the prevalence of ABPA. We pooled the prevalence estimates using a random effects model. We also calculated the heterogeneity and publication bias. Results: Of the 11,695 records retrieved, 16 studies with 2468 asthmatic children met the inclusion criteria. Most studies were published from tertiary centers. The pooled prevalence of AS in asthma (15 studies; 2361 subjects) was 16.1% (95% confidence intervals [CI], 9.3–24.3). The prevalence of AS was significantly higher in prospective studies, studies from India, and those from developing countries. The pooled prevalence of ABPA in asthma (5 studies; 505 children) was 9.9% (95% CI, 0.81–27.6). There was significant heterogeneity and publication bias for both outcomes. Conclusions: We found a high prevalence of AS and ABPA in asthmatic children. There is a need for community-based studies from different ethnicities using a standard methodology to ascertain the true prevalence of AS and ABPA in pediatric asthma.

Revised ISHAM-ABPA working group clinical practice guidelines for diagnosing, classifying and treating allergic bronchopulmonary aspergillosis/mycoses

“…Thus, evaluation for sensitisation to other fungi may be reserved for difficult-to-treat asthma patients who do not have A. fumigatus sensitisation. The literature on fungal sensitisation in children is predominantly for A. fumigatus [ 51 ] and data on other fungi are scarce [ 52 ]. The experts agreed that among children, only those with difficult-to-treat asthma require screening for A. fumigatus sensitisation rather than all asthmatic children [ 53 ].…”

Gaps in asthma diagnosis and treatment in low- and middle-income countries

“…Biomass fuel was responsible for lack of asthma control and increased severity of asthma in Nigeria ( 27 ). Poor indoor air quality, higher prevalence of fungal sensitization, presence of damp walls, presence of molds, third hand smoking are all associated with development of, and poor control of asthma ( 28 , 29 ). Maternal smoking was the only independent risk factor associated with hospital admissions due to asthma exacerbation in children in Columbia ( 30 ).…”

Unveiling Asthma’s Complex Tapestry: Insights from Diverse Perspectives

“…Lastly, a systematic review by Ritesh Agarwal et al [5] delves into the prevalence of aspergillus sensitization and allergic bronchopulmonary aspergillosis in pediatric asthma. By illuminating the epidemiological dimensions, this research emphasizes the need for nuanced community-based studies to comprehend the true prevalence, thus steering more informed clinical decisions.…”