Asthma and chronic sinusitis are fungal driven in the majority of cases, and patients with allergic airway disease improve dramatically with antifungal therapy, according to a study presented at the American Academy of Allergy, Asthma & and Immunology this week.

“The majority of patients with allergic airway disease (asthma, chronic rhinosinusitis, etc.) demonstrate growth of fungus in their airway (over 80%) in our population,” Evan Li, MD, of the Baylor College of Medicine in Houston said in a prepared statement about the study. “Conventional methods for culturing sputum are highly insensitive in detecting fungal growth. With our novel, improved culture method, we are able to achieve near 100% sensitivity in detecting airway mycosis.”

Li and his team collected data from patients who visited the Michael E. Debakey VA Allergy Clinic between 2012 and 2015 and provided sputum samples for fungal cultures. Of the 134 patients included in the study, 112 (83.5%) had positive fungal cultures. 

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Seventy-five (62 after 13 were lost to follow-up) of these patients with either asthma, chronic sinusitis, or both were treated with either voriconazole, terbinafine, fluconazole or some combination of these antifungals.

Of the antifungal-treated patients who had follow up data available, the majority saw improvements. 

The investigators noted that more than 80% of patients with asthma and/or chronic sinusitis in the study demonstrated improvement after antifungal therapy.

“Allergic airway disease, immunoglobulin E production, and allergies in general may all be driven by airway fungal infection,” Li said. “Future prospective, randomized controlled trials using anti-fungals in allergic individuals need to be performed to confirm our findings as well as to elucidate optimal treatment protocols.”


1. Li E, et al. A Retrospective Study of the Effect of Antifungal Therapy on a Cohort with Asthma and Chronic Rhinosinusitis. Presented at: The 2016 Annual Meeting of the American Academy of Allergy, Asthma & Immunology, March 4-7. Los Angeles.