Skin Hypersensitivity and Precipitating Antibodies Against Allergic Bronchopulmonary Aspergillosis

Allergic bronchopulmonary aspergillosis (ABPA) is a very fatal disease and more than four million people have been affected. We collected data of forty-five patients and a skin hypersensitivity test was performed. We also evaluated precipitating antibodies against Aspergillus fumigatus. Instant hypersensitivity reactions were recorded in 22.22% of patients and 6.66% displayed delayed type III reaction. 4.44% of patients exhibited precipitin bands and three infections of ABPA among 45 infected people. A literature survey was also made to understand Aspergillus fumigatus. Article History: Received 04 Aug 2021 Revised 08 Sep 2021 Accepted 10 Sep 2021 Available online 12 Sep 2021 ____________________ Keyword: Allergic, Aspergillus fumigatus, Education, Health, Lung. ASEAN Journal of Science and Engineering Journal homepage: http://ejournal.upi.edu/index.php/AJSE/ © 2021 Universitas Pendidikan Indonesia ASEAN Journal of Science and Engineering 1(2) (2021) 127-134


A B S T R A C T S A R T I C L E I N F O
Allergic bronchopulmonary aspergillosis (ABPA) is a very fatal disease and more than four million people have been affected. We collected data of forty-five patients and a skin hypersensitivity test was performed. We also evaluated precipitating antibodies against Aspergillus fumigatus. Instant hypersensitivity reactions were recorded in 22.22% of patients and 6.66% displayed delayed type III reaction. 4.44% of patients exhibited precipitin bands and three infections of ABPA among 45 infected people. A literature survey was also made to understand Aspergillus fumigatus.

INTRODUCTION
Allergic bronchopulmonary aspergillosis (ABPA) is a severe and scarce disease that exists not only in Pakistan but all over the world. Prior bronchial asthma (BA) is the key agent for the occurrence of the disease and Aspergillus fumigatus generates the hypersensitivity of the skin. Mostly, BA patients are infected with this disorder and also those patients who are suffering from cystic fibrosis. Pulmonary insinuates bronchospasm and immunological indications prove the existence of Aspergillus class antigens (Patterson & Strek, 2010;Stevens et al., 2000;Beswick et al., 2020;Murrison et al., 2019).
Aspergillus species are present in the surroundings universally and affect the natural habitats in various positive and negative ways including humans. There are more than hundreds of species of Aspergillus that exist in the universe and only some species cause diseases in humans, animals, and plants. Humans are infected broadly by the Aspergillus infections and the host immune system is responsible to respond to these infections if the host immune system will be strong, the reaction will not be severe and if it will be weak, hypersensitivity reaction will be fatal (Paulussen et al., 2017;Rokas et al., 2020). ABPA is mostly caused by the Aspergillus fungal agent which is a very communal aerial fungus. It reaches easily to the pulmonary tracts and attaches there because of its very small size and diameter and causes infection. Asthmatic people are very affected by the ABPA and also those who have some sort of allergy to Aspergillus. These fungal spores are strongly attached to the inner pulmonary lining due to the thick mucus in the airways (Denning et al., 2011;Kramer et al., 2015;Knutsen et al., 2012;Denning et al., 2006). Genetic variations, associations, and environmental factors also affect the ABPA infection level and asthma condition. ABPA disease is present in all the induvial irrespective of age but mostly it affects more to peoples at the 3rd to 5th stage of life. Children are also infected by this disease. Asthmatic patients with severe conditions are mostly suffering from the fatal disease of ABPA. Figure 1 helps to understand the main features of the Aspergillus disease (Eng et al., 2016;Agarwal et al., 2013;Polosa et al., 2008).
There is not all demonstration of the Aspergillus pathogen is present in the literature it is not easy to understand pathogenicity effect in the patients (Carsin et al., 2017). The spores which are inserted inside the pulmonary veins through inhalation caused allergic effects. The advanced studies also show that people with strong immune can eradicate these fungal microbes and remain healthy. In contrast, people with weak immune are not able to eliminate and these infect the allergic effect causing the development of IgG and IgE antibodies, and hypersensitivity effect is induced by the helping T cells. The reaction of hypersensitivity is stimulated and promoted by the pro-inflammatory cytokines transfer that disarrays the protecting layer of the cell and causes cell damage (Humbert et al., 2019).
There is a multifaceted cytoplasmic association, a remarkable morphological expression array, and an astounding assorted and malleable metabolism. The fungus is capable of attack tissue following inward breath. Hyphal sections hold fast to endothelial cells and discharge an assortment of chemicals that aid further tissue intrusion and obtaining of supplements. During propagation, foundation, and attack, Aspergillus retort and adjust to different sorts of stressors, oxygen, and nitrogen deficiency (Abad et al., 2010).
The nature of unrefined concentrates for finding and treatment is exceptionally unacceptable in the contagious concentrate's incidents. Right now, the nature of form extricates fluctuates drastically between entrepreneurs' suppliers since no typical excerpts are present (Agarwal et al., 2016). The explanations behind the deficient quality are complex. From one viewpoint, unrefined concentrates from various growths have been appeared to differ significantly in their protein synthesis. These issues are brought about by varieties among strains and bunch-to-clump varieties (Tracy et al., 2016). Furthermore, mild extracts might be delivered from mycelial cells or potentially spores, which may change in their protein design. In the development conditions, protein extraction strategies and capability situations are basic regarding the amount and even presence of individual antigens. Conclusively, disparagement of the extricated proteins may happen (Øya et al., 2019).
Somewhat, the issues with fungal extracts might be overwhelmed by the utilization of recombinant antigens. The significant points of interest of recombinant proteins over unrefined parasitic extracts are triple. Firstly, the protein arrangements are reproducible. Secondly, the creation of enormous amounts of unadulterated proteins is conceivable. Thirdly, utilizing recombinant allergens, it is conceivable to separate among co-appearance, co-refinement, and cross-reactivity (Asano et al., 2021).
Over time, diagnostic studies have analyzed recombinant parasitic proteins and rough shape extricates as for their negative and positive consistency of form sharpening and sickness. There is an enormous number of antigens have been disseminated for the Aspergillus fumigatus. Since Aspergillus fumigatus is especially known for its wide range of human problems, numerous specialists have expected to discover a connection between a given infection and the patients' reactivity example to singular recombinant allergens.
One-fourth of asthmatic and half of the cystic fibrosis infected individuals are allergic to Aspergillus but ABPA is not considerably ubiquitous. ABPA is a very fatal disease and more than 40 lacs people have been infected till now. The organism which mostly causes the ABPA is known as Aspergillus fumigatus. This fungus remains at the dead hydrocarbons of organic substances and endures. The highest infection rate in the world is recorded in the winter season after the falling leaves from the trees. There are a lot of ABPA cases are reported every season. Our study also demonstrates the hypersensitivity stimulation and frequency of the individual's group to Aspergillus fumigatus.

MATERIAL AND METHODS
Forty individuals having bronchial asthma were selected for the study and all were adults. Every case was completely examined, studied and a brief history of the patient was evaluated. Brown plugs history was observed in the sputum recurrent febrile and variation in the radiological forms were inquired and evaluated. Other allergic syndromes were also noted in all the patients for better results and cross-examination. The intake of corticosteroids was also noticed in the current or past duration. Chest skiagram was performed to count all leucocytes with sputum culture and the entire count of eosinophil. The intracutaneous injection was inserted on the forearm by using Aspergillus fumigatus to accomplish the skin tests. Steroid intake was stopped before 7 days of the skin test while anti asthmatics drugs were not taken for two to three days. The reaction was controlled by expanding the buffer of saline. Ouchterlonys gel diffusion technique was used to determine precipitins' presence in sera of infected individuals against the antigens of Aspergillus niger, Aspergillus flavus, and Aspergillus fumigatus. Rosenberg criteria were used for the diagnose of ABPA and lgE levels were not recorded.

RESULTS
We examined the forty-five patients and among these 45 patients, 25 males and 20 females were investigated. 60% of patients belonged to the urban area while 40% were from rural backgrounds. Mean of all the patient's ages measured which value was 31 ranging from lower age limit of 20 to the highest age limit of 55 years. The average period of asthmatic disease was six years. Allergic associations were present in eighteen patients (40%), two had urticaria (4.44%), and three had eczema (6.66%).
We summarized all the clinical and laboratory evidence of the patients in Table 1. Ten out of forty-five infected peoples (22.22%) had positivity in skin infection tests and type III reaction was deferred in three patients (6.66%) among these patients. More than two precipitin bands of Aspergillus fumigatus were found in three out of forty-five patients (6.66%) and precipitins alongside Aspergillus fumigatus were discovered in two cases (4.44%) and one (2.22%). against the Albicans.
Four patients report showed that they had positivity of precipitin and skin reactivity and in this way, a combined dual result was measured. The sputa of 22 patients were imperiled to fungal culture and candida Albicans were generated in the five cases. Aspergillus was produced in the three patients. The laboratory findings and clinical data of three patients (6.66%) out of forty-five cases are summarized in Table 2

DISCUSSION
Although, many data and reports have been published in the Pakistani literature about the ABPA existence and infections in the people in the country. We have also collected and published a small data report because of the increase in Aspergillus infections and the number of patients has raised a lot. There is a positive rate of 40-60% skin hypersensitivity to Aspergillus found in the literature of various countries. ABPA is an extreme kind of hypersensitive asthma that happens in around 10% of patients with stern asthma. Although a mixture of foundational corticosteroids and against parasitic specialists is a standard treatment, there is a danger of side effects with long-term utilization of fundamental corticosteroids (Bourdin et al., 2020). Our study did not reveal the relationship with age, gender, asthma period, and treatment with steroid and plasma eosinophils. Specifically, our data showed that there were three potential cases (6.66%) of unfavorably susceptible bronchopulmonary aspergillosis among these 45 patients and less manifestation of the precipitin positivity was due to steroid consumption.

CONCLUSION
We collected data of forty-five patients and a skin hypersensitivity test was performed. We also evaluated precipitating antibodies against Aspergillus fumigatus. Instant hypersensitivity reactions were recorded in 22.22% of patients and 6.66% displayed delayed type III reaction. 4.44% of patients exhibited precipitin bands and three infections of ABPA among 45 infected people. A literature survey was also made to understand Aspergillus fumigatus.

AUTHORS' NOTE
The authors declare that there is no conflict of interest regarding the publication of this article. Authors confirmed that the paper was free of plagiarism.