Fungal Vaccines: What New Research Could Mean for Aspergillosis Patients

Based on the 2025 Journal of Clinical Investigation commentary on emerging fungal vaccine science

jci-135-199451


Why fungal vaccines matter

Fungal infections remain a major global health problem, causing an estimated 3.8 million deaths per year. Yet despite this huge burden, there are currently no licensed vaccines to prevent or treat fungal disease.

For people living with aspergillosis—including chronic pulmonary aspergillosis (CPA), allergic bronchopulmonary aspergillosis (ABPA), severe asthma with fungal sensitisation (SAFS), and Aspergillus bronchitis—this gap is very real.
Treatments often involve long-term antifungal medications, steroids, or biologics, and symptoms may recur despite therapy.

A new scientific commentary in the Journal of Clinical Investigation highlights major progress in fungal vaccine research and suggests that vaccines may become important tools for both prevention and treatment in the future.


A new breakthrough: the Eng2 fungal antigen

Researchers studying serious fungal infections in North and South America have identified an enzyme called endoglucanase-2 (Eng2) that triggers a strong immune response:

  • It protected mice from Blastomyces, Histoplasma, and Coccidioides infections.

  • People recovering from these infections show memory CD4 T-cell responses to Eng2.

This suggests two important possibilities:

1. A preventive vaccine

A future vaccine could reduce the risk of developing serious fungal infections—especially in people with weakened immune systems or chronic lung disease.

2. A therapeutic vaccine

Unlike most vaccines, a therapeutic vaccine would be given after infection to support the immune system and help clearance—similar to how post-exposure rabies or hepatitis A vaccines work.

This second application is particularly relevant to aspergillosis.


Why fungal vaccines may be especially useful in Aspergillus disease

Although the study did not focus on Aspergillus specifically, the commentary highlights several reasons why Aspergillus vaccines are scientifically realistic.

1. Fungi are surprisingly easy to vaccinate against in animal studies

Many fungal antigens have already shown strong protective effects in experimental models.

Unlike viruses such as HIV or tuberculosis—where vaccines are extremely difficult—fungal pathogens often respond well to:

  • Antibody-based immunity

  • T-cell immunity

Both would be valuable in Aspergillus-related disease.

2. Aspergillosis mainly affects people with weakened or inflamed lungs

This makes it exactly the kind of disease where a vaccine could:

  • Reduce fungal burden in the airways

  • Decrease inflammation

  • Support existing treatments

  • Reduce flare-ups and symptoms

3. A therapeutic vaccine may arrive before a preventive vaccine

Chronic fungal diseases (especially CPA and Aspergillus bronchitis) develop slowly and persist for months or years.
This gives time for a vaccine to stimulate the immune system during ongoing treatment.

A therapeutic vaccine could:

  • Enhance the effect of antifungal drugs

  • Reduce the amount of fungus growing in cavities or bronchiectatic airways

  • Lower inflammation and antibody levels

  • Potentially reduce the need for long-term steroids or biologics in ABPA

4. A combination (“multivalent”) vaccine is possible

The Eng2 research shows that one antigen may not protect against all fungal species.
However, a “cocktail” vaccine—using several fungal proteins—could cover multiple fungi, including Aspergillus.


What this could mean for different aspergillosis conditions

For CPA (Chronic Pulmonary Aspergillosis)

A therapeutic vaccine might help:

  • Reduce fungal load in cavities

  • Improve long-term control

  • Support patients who can’t tolerate antifungals

  • Reduce reliance on prolonged azole therapy

For ABPA (Allergic Bronchopulmonary Aspergillosis)

ABPA is an allergic reaction rather than a true infection.
But reducing the amount of Aspergillus in the airways could:

  • Decrease IgE levels

  • Reduce flare frequency

  • Lower the need for steroids

  • Improve asthma control

For SAFS and Aspergillus bronchitis

A vaccine could potentially:

  • Reduce airway colonisation

  • Improve symptom control

  • Reduce the cycle of infection → inflammation → airway damage


What this means for patients today

It is important to be clear:

There is no Aspergillus vaccine available yet.

However, the science is moving faster than ever.
The commentary highlights:

  • Multiple experimental vaccines have already worked in animals

  • Some fungal vaccines have reached early human trials

  • mRNA technology (used for COVID vaccines) could accelerate development

  • High-risk groups—including people with chronic lung disease—would be early candidates

For the aspergillosis community, this research is a major step forward, offering hope for safer and more effective long-term management.


For clinicians: why this matters now

Non-specialist clinicians may want to be aware that:

  • Vaccine-based immunotherapy may become part of fungal disease management

  • Therapeutic vaccines could work alongside antifungals, rather than replacing them

  • Advances in antigen identification (e.g., Eng2) create realistic pathways for Aspergillus-specific research

  • Patient groups with chronic fungal or allergic disease may benefit significantly from immunological boosting

As fungal disease continues to rise worldwide, vaccination represents a promising future tool in managing both invasive and chronic fungal illnesses.


Looking ahead

While fungal vaccines are “so needed, so feasible, and yet still far off,” the momentum is building.
For people living with aspergillosis—often for many years—the possibility of vaccines offers genuine hope for:

  • Better control

  • Improved quality of life

  • Reduced treatment burden

  • Less risk of long-term complications

This new research marks an important step on that journey.


🌐 Promoting the NHS National Aspergillosis Centre (NAC)

Nationally Commissioned Service • Specialist Advice • Remote MDT • Patient Support

Chronic and allergic aspergillosis remain significantly under-recognised across the UK — despite their substantial burden on respiratory, infectious disease, and immunology services.

As the NHS England–commissioned National Aspergillosis Centre (NAC), based at Wythenshawe Hospital (Manchester University NHS Foundation Trust), we provide national expertise, remote support, and shared-care pathways for clinicians managing these complex conditions.


📊 Why This Matters

Chronic pulmonary aspergillosis (CPA) affects an estimated 3–4 per 100,000 people in the UK, with far higher rates in those with:

  • Previous tuberculosis

  • COPD

  • Non-tuberculous mycobacterial (NTM) lung disease

  • Sarcoidosis

  • Bronchiectasis

Allergic bronchopulmonary aspergillosis (ABPA) may affect:

  • 2.5% of adult asthmatics

  • Up to 15% of people with cystic fibrosis

Yet both conditions are frequently undiagnosed or misdiagnosed, leading to delayed treatment and avoidable morbidity.


🏥 How NAC Supports Clinicians Across the UK

As the nationally commissioned centre for chronic aspergillosis, we offer:

🩺 Specialist clinical care

Face-to-face and remote clinics with structured long-term follow-up in partnership with local teams.

👥 National Aspergillosis MDT via Teams Remote Communication

A dedicated MDT where clinicians can refer and discuss complex diagnostic or therapeutic cases.

📧 Consultant-led advice & guidance

Available via phone & email, including:

  • Diagnostic support

  • Interpretation of IgE/IgG and fungal microbiology

  • Antifungal prescribing advice

  • Case planning for ABPA, CPA, SAFS and Aspergillus bronchitis

🔬 Access to advanced diagnostics

Including Aspergillus-specific IgE/IgG, culture, imaging, and molecular testing (e.g. antifungal resistance).

💬 Patient support & education (NAC CARES)

Moderated online groups, weekly patient meetings, webinars, and comprehensive educational resources — helping patients understand their condition and remain safely supported close to home.


🤝 We Welcome Collaboration

We’d be pleased to connect with respiratory, ID, immunology, and internal medicine teams to discuss:

  • Shared-care pathways

  • Diagnostic support

  • Service guidance

  • Virtual or in-person educational sessions

  • Case-specific MDT referrals


📄 Further information

Referral pathways, service scope and patient resources:
👉 https://mft.nhs.uk/wythenshawe/services/infectious-diseases/national-aspergillosis-centre/


Dr Chris Kosmidis
Clinical Lead, NHS National Aspergillosis Centre
Manchester University NHS Foundation Trust


🌡️ Understanding Body Temperature in Aspergillosis: Why Your Fever May Look Different

Many people living with aspergillosis—including allergic bronchopulmonary aspergillosis (ABPA), chronic pulmonary aspergillosis (CPA), severe asthma with fungal sensitisation (SAFS) and Aspergillus bronchitis—notice that their body temperature behaves differently from what doctors call “normal.”

This is especially common in people who are:

  • On long-term steroids

  • Tapering steroids

  • Living with adrenal insufficiency

  • Older adults

  • On biologics

  • Managing chronic lung disease

This guide explains why your temperature may run lower, why fevers can appear smaller or absent, and how to safely manage this.


🔶 1. Many aspergillosis patients have a lower baseline temperature

Although “37.0°C” is often quoted, most patients actually sit anywhere between 35.5–36.5°C.
Reasons include:

✔ Long-term steroids

Prednisolone, methylprednisolone, hydrocortisone, and even high-dose inhaled steroids can blunt the immune response and lower your resting temperature.

✔ Adrenal insufficiency

If your adrenal glands are suppressed, your body’s ability to raise temperature is reduced.
You may get no fever at all, even with infections.

✔ Chronic lung disease

Living with ABPA, CPA or bronchiectasis can change how your body regulates heat.

✔ Biologic treatments

Some biologics influence inflammatory signalling and may soften fever responses.

✔ Age

Older adults naturally have:

  • Lower metabolism

  • Lower baseline temperature

  • Reduced ability to generate fever (“immune senescence”)

Many older aspergillosis patients sit around 35.7–36.2°C when completely well.


🔶 2. Fever is a rise from your normal — not a single number

For someone with a naturally low temperature, a fever may look very different.

A useful rule:

A fever = a rise of 1°C above your personal baseline,
even if the thermometer is below 38°C.

Example

  • Your baseline = 35.8°C

  • Your fever may begin at 36.8–37.0°C

You may feel shivery, hot, exhausted or “flu-ish” long before hitting 38°C.


🔶 3. Why fevers are often “muted” in aspergillosis

✔ Steroids

Reduce the body’s ability to trigger a strong fever.

✔ Adrenal insufficiency

Greatly reduces your ability to raise temperature; infections may show as fatigue, dizziness, nausea or sudden weakness instead.

✔ Age

Older adults may have:

  • No fever

  • A tiny rise

  • Confusion or breathlessness as the only sign of infection

✔ Chronic disease

Your temperature regulation system may simply behave differently because of long-term inflammation.


🔶 4. What YOU can do to manage this safely

Know your personal baseline

Measure your temperature twice daily for 5–7 days when well.
Record the average — this is your true normal.

Treat a 1°C rise as your own fever

Don’t wait for the thermometer to reach 38°C.

Watch symptoms more than the number

Seek medical advice if you notice:

  • Feeling feverish or shivery

  • Breathing worsening

  • New chest or flank pain

  • Sudden exhaustion

  • Increased heart rate

  • Confusion, dizziness or “not right”

  • New cough or change in sputum

These can indicate infection even without a high temperature.

Keep a symptom + temperature chart

Especially if you:

  • Are on steroids

  • Have adrenal insufficiency

  • Are tapering

  • Are on biologics

  • Have recurrent infections

Even simple notes help clinicians hugely.

Tell every clinician your temperature baseline

Not all doctors will know your usual pattern, so tell them:

“My normal temperature is around X°C.
I don’t get high fevers because of chronic illness/steroids/adrenal suppression.
A small rise is significant for me.”

This is important in GP appointments, A&E, respiratory clinics and hospital admissions.


🔶 5. Extra precautions if you have adrenal insufficiency

People with steroid-induced adrenal suppression must be especially careful:

  • A small temperature rise + feeling unwell may mean you need stress-dose steroids

  • Vomiting, dizziness, intense fatigue or confusion are warning signs

  • Always follow your adrenal emergency plan

  • Always carry your Steroid Emergency Card and hydrocortisone emergency injection if prescribed


🔶 6. Do doctors understand this?

Most clinicians understand the general rules:

  • Older adults often do not mount high fevers

  • Steroids blunt fever

  • Adrenal insufficiency changes the febrile response

  • Infection may present atypically

However, few clinicians know your personal baseline unless you tell them.

Sharing your own numbers helps them interpret your symptoms safely and accurately.


🟩 Summary for Aspergillosis Patients

  • Many people with aspergillosis have a naturally lower temperature.

  • Steroids, adrenal insufficiency and age can all reduce your ability to produce a fever.

  • A rise of 1°C above YOUR normal may be your fever.

  • Focus on overall symptoms, not just the thermometer.

  • Tell every clinician your baseline temperature.

  • Take extra care if you have adrenal insufficiency.


⭐ Recent Aspergillosis Research Updates (Week 48)

24 Nov 2025 — Collated new articles (curated highlights)

Top takeaways (clinician focus)

  • Burden & mortality: US death‑certificate analysis reinforces substantial aspergillosis‑attributable mortality; IA codes dominate—useful for advocacy and service planning (Walsh et al., CID 2025; PMID 41284728).
  • Diagnostics (CPA/ABPA & TB‑survivors): Senegalese post‑TB cohort preprint compares ELISA vs rapid serology for chronic Aspergillus infection—signals for programmatic screening but peer review pending (medRxiv PPR1125158).
  • Therapeutics & TDM: Multiple papers underscore voriconazole therapeutic drug monitoring nuances (beyond‑therapeutic levels; contribution of N‑oxide metabolite); anticipate practice pearls for ICU and complex cases.
  • Immunology & host‑directed therapy: IL‑37 review summarises antifungal‑modulating effects (↓NLRP3 signalling in murine aspergillosis). Casadevall editorial argues fungal vaccines are feasible (incl. aspirational protection for transplant recipients).
  • Comorbidity interfaces: Case data link ABPA with pleuro‑parenchymal Aspergillus infection; ECMO after heart transplant carries notable IA risk; A. niger conidia seen intracellularly in lung‑Tx cytology—diagnostic clue.
  • Antifungal susceptibility: Eastern India cohort provides local susceptibility mapping across ABPA/CPA/aspergilloma/IPA phenotypes—supports regional stewardship.
  • Policy/consensus: Asia Fungal Working Group Delphi consensus for mold pneumonia in resource‑limited settings—helpful for regional protocols.

Organised evidence table (with copy‑ready links)

  1. Aspergillosis‑attributable mortality (USA) — administrative/death‑certificate study
    Clin Infect Dis (2025) — Walsh TJ et al.
    PMID: 41284728
    https://pubmed.ncbi.nlm.nih.gov/41284728/
  2. Post‑TB cohort screening for chronic Aspergillus infection (ELISA vs RDT) — preprint
    medRxiv (2025) — Mariama T et al.
    PPR: PPR1125158
    https://www.medrxiv.org/ (search PPR1125158)
  3. Voriconazole TDM — beyond‑therapeutic levels in ICU IFI
    BMC Infect Dis (2025) — Lee YC et al.
    PMID: 41275081
    https://pubmed.ncbi.nlm.nih.gov/41275081/
  4. Voriconazole N‑oxide metabolite in TDM (case)
    Farm Hosp (2025) — Orozco Cifuentes I et al.
    PMID: 41274859
    https://pubmed.ncbi.nlm.nih.gov/41274859/
  5. Antifungal susceptibility of respiratory Aspergillus isolates (Eastern India)
    MicrobiologyOpen (2025) — Nikhil A et al.
    PMID: 41250899; PMCID: PMC12624224
    https://pubmed.ncbi.nlm.nih.gov/41250899/
    https://europepmc.org/article/PMC/12624224
  6. IL‑37 in respiratory disease (incl. aspergillosis models) — review
    Front Immunol (2025)
    PMCID: PMC12640846
    https://europepmc.org/article/PMC/12640846
  7. Fungal vaccines — feasibility editorial (aspergillosis included)
    J Clin Invest (2025) — Casadevall A
    PMID: 41243962; PMCID: PMC12618062
    https://pubmed.ncbi.nlm.nih.gov/41243962/
    https://europepmc.org/article/PMC/12618062
  8. Expert consensus: off‑label/novel antimicrobials (aspergillosis contexts cited)
    JAC Antimicrob Resist (2025)
    PMCID: PMC12641089
    https://europepmc.org/article/PMC/12641089
  9. ABPA with pleuro‑parenchymal aspergillus infection — case
    J Postgrad Med (2025) — Spalgais S et al.
    PMID: 41277380
    https://pubmed.ncbi.nlm.nih.gov/41277380/
  10. Aspergillus endophthalmitis post‑phaco — failed salvage — case
    Int Ophthalmol (2025) — Huang Z
    PMID: 41247646
    https://pubmed.ncbi.nlm.nih.gov/41247646/
  11. Heart Tx on ECMO — infections incl. IA — cohort
    Transplant Direct (2025) — Swiss Transplant Cohort
    PMID: 41268061; PMCID: PMC12629377
    https://pubmed.ncbi.nlm.nih.gov/41268061/
    https://europepmc.org/article/PMC/12629377
  12. Mold pneumonia in resource‑limited Asia — Delphi consensus
    Med Mycol (2025) — Asia Fungal Working Group
    PMID: 41251327
    https://pubmed.ncbi.nlm.nih.gov/41251327/
  13. A. niger conidia intracellular in AMs — lung Tx cytology clue — case
    Acta Microbiol Immunol Hung (2025)
    PMID: 41269231
    https://pubmed.ncbi.nlm.nih.gov/41269231/
  14. Out‑of‑pocket expenditure & QoL in CPA vs PTLD — comparative study
    J Infect Chemother (2025) — Titiyal R et al.
    PMID: 41274342
    https://pubmed.ncbi.nlm.nih.gov/41274342/
  15. Destroyed lung pneumonectomy — complications; CPA/haemoptysis associations
    J Surg Res (2025) — Yu L et al.
    PMID: 41270587
    https://pubmed.ncbi.nlm.nih.gov/41270587/
  16. Severe asthma immunity — activation signature independent of fungal sensitisation
    Mucosal Immunol (2025) — Plumpton EL et al.
    PMID: 41270906
    https://pubmed.ncbi.nlm.nih.gov/41270906/
  17. COVID‑19 & aspergillosis context — perspective linking co‑infection to chronicity risks
    Elife (2025) — Henrich TJ et al.
    PMID: 41247781; PMCID: PMC12622966
    https://pubmed.ncbi.nlm.nih.gov/41247781/
    https://europepmc.org/article/PMC/12622966
  18. NTM lung disease outcomes (Italian tertiary centre) — comorbidity context
    Sci Rep (2025) — Carli SM et al.
    PMID: 41249256; PMCID: PMC12623857
    https://pubmed.ncbi.nlm.nih.gov/41249256/
    https://europepmc.org/article/PMC/12623857
  19. Mixed mucor + IA coinfection in aplastic anaemia — fatal case
    J Med Case Rep (2025) — Javaherchian P et al.
    PMID: 41272805; PMCID: PMC12639702
    https://pubmed.ncbi.nlm.nih.gov/41272805/
    https://europepmc.org/article/PMC/12639702
  20. Sporotrichosis host genes; IA incidence observation — methods paper
    Sci Rep (2025) — Tang Z et al.
    PMID: 41272147; PMCID: PMC12638995
    https://pubmed.ncbi.nlm.nih.gov/41272147/
    https://europepmc.org/article/PMC/12638995
  21. SFTS complicated by IPA — prediction nomogram
    BMC Infect Dis (2025) — Yan R et al.
    PMID: 41275152
    https://pubmed.ncbi.nlm.nih.gov/41275152/
  22. Data resources landscape incl. Aspergillosis datasets — review
    J Med Syst (2025) — Pokutnaya D et al.
    PMID: 41273456; PMCID: PMC12640313
    https://pubmed.ncbi.nlm.nih.gov/41273456/
    https://europepmc.org/article/PMC/12640313
  23. Cell metabolism study using CAPA cohort as comparator
    Cell Mol Life Sci (2025) — Vasilogiannakopoulou T et al.
    PMID: 41258438; PMCID: PMC12630439
    https://pubmed.ncbi.nlm.nih.gov/41258438/
    https://europepmc.org/article/PMC/12630439
  24. Preprint: antibiotics → impaired neutrophil anti‑Aspergillus immunity (mouse)
    BioRxiv (2025) — Aufiero MA & Hohl TM
    PPR: PPR1122060
    https://www.biorxiv.org/ (search PPR1122060)
  25. Preprint: HosA HDAC in A. fumigatus virulence
    BioRxiv (2025) — Liu H et al.
    PPR: PPR1121973
    https://www.biorxiv.org/ (search PPR1121973)
  26. Pulmonary mucormycosis with necrotising pneumonia — differential includes aspergillosis
    BMC Pulm Med (2025) — Duong‑Minh N et al.
    PMID: 41254633; PMCID: PMC12625637
    https://pubmed.ncbi.nlm.nih.gov/41254633/
    https://europepmc.org/article/PMC/12625637
  27. Clove (S. aromaticum) essential oil in rabbit aspergillosis — preclinical
    Research Square (2025) — Shokrpoor S et al.
    PPR: PPR1121622
    https://www.researchsquare.com/ (search PPR1121622)
  28. Cross‑country multimodal evidence: Aspergillus & biliary atresia — hypothesis‑generating
    Gut Pathog (2025) — Huang SW et al.
    PMID: 41250124; PMCID: PMC12621361
    https://pubmed.ncbi.nlm.nih.gov/41250124/
    https://europepmc.org/article/PMC/12621361

🌿 Biologics when ABPA and CPA overlap: What Patients Need to Know

Understanding how they work, when they’re helpful, and when extra care is needed

Biologic medicines (such as omalizumab, mepolizumab, benralizumab, dupilumab and newer options like tezepelumab) are increasingly used to treat Allergic Bronchopulmonary Aspergillosis (ABPA) and severe asthma. They can be life-changing for some people.

However, their place in Chronic Pulmonary Aspergillosis (CPA) — especially in people who have both ABPA and CPA together — is more complicated and needs careful specialist supervision.

This article explains what we know so far.


🌟 1. ABPA and CPA are different conditions — but some people have both

  • ABPA is mainly an allergic reaction to Aspergillus in the airways.

  • CPA is a chronic fungal infection that causes cavities, scarring, and long-term lung damage.

  • Some people start with ABPA and later develop CPA, or the two conditions overlap.

  • The 2024 international ABPA guidelines now recognise this overlap as real and important.

Because biologics target allergy pathways rather than fungal infection, treatment decisions must look at both sides of the disease.


🌿 2. Biologics in ABPA: the evidence is strong and growing

Biologics can help patients with ABPA or severe asthma by:

  • reducing steroid use

  • improving breathing

  • decreasing mucus plugging

  • lowering flare-ups

  • improving quality of life

Biologics most commonly used in ABPA include:

Biologic Target Notes
Omalizumab IgE Well established, helps many ABPA patients
Mepolizumab IL-5 Helps eosinophilic inflammation
Benralizumab IL-5Rα Similar to mepolizumab; long-acting
Dupilumab IL-4Rα Very promising for allergic disease; growing evidence for ABPA
Tezepelumab TSLP Very new; limited ABPA data so far

For many people with ABPA, biologics are safe and effective when monitored.


⚠️ 3. Biologics and CPA: much less evidence

  • CPA is caused by persistent fungal infection and structural lung damage.

  • Biologics do not treat fungal infection, and they do not prevent cavities.

  • In CPA, the mainstay of treatment is still:

    • antifungal medication (usually itraconazole, voriconazole or posaconazole)

    • careful imaging (CT scans)

    • airway clearance

    • sometimes surgery or bronchoscopy

There is no strong evidence that biologics help CPA itself.


🔄 4. What about patients who have both ABPA and CPA?

This is where things become more complex.

Biologics may help the allergic part (ABPA), but:

  • they do not treat fungal infection

  • they do not stop fungal cavities from progressing

  • they may reduce inflammation that normally helps the body contain infection

If antifungal treatment is interrupted or not strong enough, fungal activity may increase while the allergic symptoms improve — so regular monitoring is essential.

Specialist centres (like the NAC) now emphasise:

✔️ Continue antifungals if CPA is active
✔️ Watch cavities with regular CT scans
✔️ Monitor Aspergillus IgG/IgE and fungal cultures
✔️ Check whether symptoms are from allergy, infection, or both
✔️ Make joint plans between asthma/airway doctors and mycology specialists


5. Are some biologics better than others for ABPA/CPA overlap?

There is no official guidance yet, but early observations suggest:

Most promising for ABPA:

  • Dupilumab seems particularly effective for allergic disease (IgE, mucus, airflow), though still off-label for ABPA.

Increasing interest:

  • Tezepelumab works outside the eosinophil pathway and may be useful in some asthma types, but research in ABPA is only just starting.

Useful in selected cases:

  • Anti-IL-5 biologics (mepolizumab, benralizumab) help airway eosinophils but may not help every ABPA patient.

⚠️ Uncertain in CPA:

  • None of the biologics treat fungal infection or cavities directly.

  • Their role in active CPA remains unclear and requires careful oversight.


🧭 6. What this means for patients

If you have ABPA only, biologics may be an excellent option — especially if:

  • steroids cause side-effects

  • your asthma is uncontrolled

  • you have frequent flare-ups

  • your IgE levels are very high

  • mucus plugging or wheezing continues despite treatment

If you have CPA or cavities, treatment needs to be more cautious:

  • antifungal medication usually needs to continue

  • biologics may still help if the allergic component is significant

  • CT scans must be repeated to make sure cavities are not progressing

  • specialists must weigh benefits vs. risk for each patient individually


💬 7. Summary

  • Biologics can be extremely helpful for ABPA.

  • They do not treat CPA, and cannot replace antifungal medicines.

  • In patients with both ABPA and CPA, the approach must be personalised.

  • Dupilumab and (possibly) tezepelumab are emerging biologics with promise, but evidence is still developing.

  • Decisions should always be made with a specialist centre such as the National Aspergillosis Centre (NAC).


🌍 Does where you live affect aspergillosis or ABPA?

UK-focused guidance, with additional advice on overseas locations

People with ABPA, CPA, fungal allergy, SAFS or bronchiectasis often wonder whether certain regions — in the UK or abroad — are better or worse for their lungs. The truth is:

Aspergillus is everywhere worldwide

No country, region or climate is fungus-free.
What matters most is:
the quality of the home + humidity + air quality + healthcare access.

Below is a clear guide.


🇬🇧 UK Locations (summary)

The property matters more than the postcode.
But here is the quick UK overview:

👍 Often easier for lung conditions:

  • South West England (cleaner air, milder climate)

  • Rural East Anglia

  • Parts of Northumberland

  • Coastal areas with modern, well-insulated homes

👀 More challenging for some patients:

  • Older stone houses in wet regions (Scotland west coast, Wales)

  • Inner-city pollution corridors (London, Birmingham, Manchester)

  • Homes near major roads (M25, M6, M1)


✈️ Overseas Locations Potentially Better for Aspergillosis or ABPA

The goal is lower humidity, good air quality, dry housing, and strong healthcare access.

🌞 1. Dry Mediterranean climates (often helpful)

Examples:

  • Southern Spain (Andalusia, Murcia)

  • Portugal (Algarve, Alentejo inland)

  • Southern Italy (Puglia, Sicily in the drier months)

  • Greece (many islands have low humidity outside peak summer)

  • Cyprus (very dry outside Jan–Feb)

Why beneficial:

  • Lower humidity → less indoor mould growth

  • Plenty of ventilation and sunlight

  • Good modern building standards (if choosing newer homes)

Watch out for:

  • Very high summer temperatures

  • Saharan dust events (e.g., in Spain, Cyprus, Greece)

  • Avoid older damp stone buildings


🏜️ 2. Dry, warm desert or semi-desert climates (excellent for humidity control)

Examples:

  • Arizona (USA)

  • New Mexico (USA)

  • Utah (USA)

  • Certain parts of Australia (inland areas with low humidity)

Why beneficial:

  • Very low humidity (mould struggles to grow indoors)

  • Strong sunlight

  • Good ventilation

Watch out for:

  • Wildfire smoke in some regions

  • Dust storms (mainly in the US Southwest)

  • Healthcare insurance considerations (especially in the US)


🌊 3. Mild coastal regions with good air quality

Examples:

  • New Zealand (South Island especially)

  • Canada’s west coast (Vancouver Island outside wildfire season)

  • Northern Spain / Basque Coast (clean air, moderate climate)

Benefits:

  • Clean air

  • Access to high-quality healthcare

  • Good housing standards

Watch out:

  • Wildfire season in Canada

  • Damp winters in some coastal climates

  • Avoid older wooden properties with poor ventilation


🔥 Overseas Locations That May Be More Challenging

🌧️ 1. Extremely humid tropical climates

Examples:

  • Singapore

  • Malaysia

  • Indonesia

  • Thailand

  • Caribbean islands

  • Florida (USA)

  • Queensland (Australia’s tropical belt)

Why problematic:

  • High humidity all year → indoor mould grows very easily

  • Air conditioning constantly needed

  • Outdoor fungal levels very high

  • More airborne allergens overall


🌲 2. Areas with frequent wildfires or smoke seasons

Examples:

  • California

  • British Columbia

  • Eastern Australia

  • Mediterranean wildfire zones (Greece, Spain, Italy in summer)

Smoke exposure is a major trigger for asthma, ABPA and bronchiectasis.


🍃 3. Locations with heavy pollution

Examples:

  • India (Delhi, Kolkata)

  • China (some industrial regions)

  • Eastern Europe (coal-heavy areas)

  • Middle East cities with dust + pollution

Pollution is often a bigger trigger than Aspergillus.


❤️ What matters most: Your home + your lifestyle, not the country

A “safe” home for aspergillosis or ABPA is:

✔️ dry
✔️ modern or well-renovated
✔️ free from mould
✔️ with mechanical ventilation or good airflow
✔️ away from busy roads
✔️ in a low-pollution area
✔️ without damp basements, cellars, old timber, or overgrown foliage touching the house

Regardless of UK or overseas, these matter 10× more than the region.


📌 Summary for Aspergillosis Patients

  • Aspergillus exists everywhere — no location is completely safe or dangerous.

  • Low humidity, good air quality and dry modern housing are the key factors.

  • Mediterranean climates, dry inland regions, and moderate coastal areas can be good choices.

  • Very humid tropical climates are the most challenging.

  • Pollution and wildfires are often bigger risks than fungal spores.


🎄 Why Christmas Decorations Can Trigger Symptoms

An explainer for people living with aspergillosis, asthma, ABPA, CPA and bronchiectasis

Many people with aspergillosis notice a sudden increase in sneezing, coughing, wheezing or chest tightness when unpacking Christmas decorations. This is extremely common and usually caused by environmental triggers, not new infection.

✅ What’s on decorations after a year in storage?

When decorations, artificial trees, or boxes have been stored for months, they often collect:

  • Dust

  • Fungal spores, including Aspergillus

  • Dampness or musty smells

  • Particles from cardboard

  • Fibres from artificial branches

For people with allergic aspergillosis (ABPA), severe asthma or sensitive airways, this sudden exposure can cause an allergic flare or airway irritation.

🎄 Why this affects aspergillosis patients more

  • Airways may already be inflamed or mucus-filled, so irritants cause quicker reactions.

  • People with ABPA or SAFS react strongly to environmental allergens.

  • People with chronic pulmonary aspergillosis (CPA) or bronchiectasis may have reduced clearance, so spores or dust linger longer in the lungs.

This does not usually indicate infection — it’s most often an irritation flare.

🛡️ How to protect yourself next time

A few simple steps make a big difference:

  • Wear a mask (FFP2) when opening boxes or shaking dust off.

  • Take boxes outside, or open near an open window.

  • Wipe decorations with a damp cloth rather than brushing them.

  • Rinse or wipe artificial trees, especially branches.

  • Use sealed plastic containers rather than cardboard for storage.

  • Avoid shaking items indoors, as this scatters spores.

🌬️ If you’ve already had a flare

Most people settle within hours to a few days. You can try:

  • Your usual inhalers (especially preventers).

  • Airway clearance if you normally use it.

  • Saline nebulisers/inhalers, which can soothe irritated airways.

  • Rest, fluids, and avoiding further triggers for a short while.

Seek medical advice if symptoms are unusual for you, don’t settle, or you are already unwell.

💬 The key message

Decorations don’t cause new aspergillus infection — but they can release a burst of irritants and spores that your lungs react to. Taking a few precautions can help you enjoy the season without a flare.


Side effects from Biologic Medication

It’s completely understandable to feel unsure before starting a biologic — especially when you’ve heard different experiences from different people.
Most patients with ABPA or severe Aspergillus-related asthma do very well on biologics. Side effects can happen, but they’re usually mild and settle quickly.

🌟 Most people report very few problems

Patients often say:

  • The injections are straightforward

  • They feel the same or better within days or weeks

  • There’s little or no impact on daily life

🌟 Common, mild side effects

These are the ones we hear most often across omalizumab, benralizumab, dupilumab and tezepelumab:

📌 Injection-site reactions

  • Redness

  • Itching

  • A small tender lump

  • Bruising
    These usually disappear within 24–48 hours.

📌 Mild tiredness

Some people feel slightly “wiped out” after the first few doses.

📌 Headache

Very common with the first injection. Less so afterwards.

📌 Minor joint or muscle aches

A bit like the feeling after a flu jab.

📌 Nasal or sinus changes

Occasional mild dryness or congestion, especially with dupilumab.

🌟 Less common (still mild)

  • Mild tummy upset

  • Sore throat

  • A brief “flu-ish” feeling

  • Temporary increase in eczema (mainly with dupilumab)

  • Slight mood dip for a day or two (rare)

🌟 Rare but important

These are very uncommon, and your team will explain what to look out for:

  • Allergic reaction shortly after an injection
    (This is why your first dose is supervised.)

  • Eye inflammation — mostly linked to dupilumab, usually mild and treatable

Your team will give you clear advice on what to do if anything unusual happens.

🌟 What ABPA patients often notice

People with ABPA frequently describe:
👉 Fewer allergic symptoms
👉 Clearer breathing
👉 Much less mucus
👉 Fewer flare-ups and fewer steroids

But biologics don’t help everyone — which is why the first few months are monitored closely.

🌟 Final reassurance

For many aspergillosis patients, biologics are far easier than long-term steroids or antifungals. Most say the benefits outweigh the side effects — but every person’s experience is individual.


Could this new gene-therapy technology help aspergillosis patients?

Hunter syndrome stem cell treatment

Not directly now — but potentially yes in the longer term.

The gene therapy in the BBC story works because Hunter syndrome is caused by a single faulty gene. Doctors can take stem cells, insert a missing gene, and put them back into the body — and the body starts producing the enzyme that was missing.

Aspergillosis is different.
It isn’t caused by a single gene error — it’s caused by:

  • An over-reaction of the immune system in ABPA

  • Underlying lung damage or structural disease in CPA

  • A combination of genetics, environment, allergens and fungal exposure

  • Sometimes problems with mucus clearance

So gene therapy is not close to being used for aspergillosis in the same direct way.


But here’s why the technology could help in the future

The breakthrough still matters because it shows what is becoming possible:

1. Fixing immune-pathway problems

Some people with ABPA or severe asthma have genetic variants in pathways such as:

  • IL-4 / IL-5 / IgE regulation

  • Mucus clearance

  • Immune “switch-off” mechanisms

In the future, gene therapy could correct faulty immune pathways so the lungs stop over-reacting to Aspergillus.

2. Improving mucus-clearance biology

A big part of aspergillosis is mucus sticking in the airways. If gene therapy can one day boost the function of cilia or mucus-clearing enzymes, that would be a major benefit.

3. Helping people born with lung-structure problems

Some patients develop aspergillosis because they were born with subtle airway abnormalities or genetic bronchiectasis tendencies. Future gene therapies might stabilise or prevent these problems.

4. Fungal infection + rare-disease overlaps

Some immunodeficiency disorders (e.g., CARD9 deficiency) lead to severe fungal infections. This type of therapy is much closer to helping those patients already — because those are single-gene defects.


Realistic timeline

For ABPA or CPA specifically:

  • Short term (0–10 years): No direct gene therapy.

  • Medium term (10–20 years): Possible targeted immune-pathway correction for asthma/ABPA.

  • Long term (20+ years): Potential lung-repair gene therapies, airway-regeneration therapies, or personalised immune-modifying gene treatments.

So this breakthrough doesn’t change aspergillosis care today — but it shows that the tools are coming that could one day target immune-driven diseases much more precisely.


**Adrenal Insufficiency & Steroid Tapering:

A Complete Patient Guide**

People taking long-term steroids (prednisolone, methylprednisolone, hydrocortisone, dexamethasone) can develop adrenal insufficiency because their adrenal glands “go to sleep” and stop making cortisol.
During tapering, the body must slowly “wake up” again — and this needs careful monitoring.

This guide explains the symptoms, tests, warning signs, and emergency precautions to keep you safe.


⭐ 1. Why adrenal insufficiency happens

Long-term steroid use suppresses the HPA axis (hypothalamus–pituitary–adrenal system).
When daily steroid doses are reduced, your body must produce more of its own cortisol. This takes time.

If the steroid reduction is too quick, or the body is under stress, low cortisol symptoms appear.


⭐ 2. Symptoms to watch for during steroid tapering

These are early signs that your body may not be keeping up with the reduction.

Early, mild symptoms

  • Fatigue / sudden exhaustion

  • Muscle weakness

  • Dizziness when standing

  • Nausea or reduced appetite

  • Flu-like aching

  • Low mood, anxiety, irritability

  • Brain fog

  • Feeling unusually cold

  • Worsening joint or muscle pain

These often improve if the taper is slowed or paused.


⭐ 3. More serious symptoms of low cortisol

These symptoms suggest steroid levels are too low and the taper needs urgent review:

  • Vomiting

  • Persistent dizziness

  • Very low blood pressure

  • Severe fatigue (unable to function normally)

  • Salt cravings

  • Ongoing nausea preventing eating

  • Faintness or near-collapse

These require medical advice (same day).


⭐ 4. Emergency symptoms — possible adrenal crisis

Call 999 or go to A&E immediately if you develop:

  • Severe vomiting or diarrhoea

  • Collapse or inability to stand

  • Severe dehydration

  • Confusion

  • Sudden severe abdominal or back pain

  • Pale, clammy skin

  • Rapid breathing

  • Loss of consciousness

This is a medical emergency.
Patients normally receive 100 mg hydrocortisone IM/IV, but patients allergic to hydrocortisone require a pre-agreed emergency alternative — your endocrinologist must document this clearly.


⭐ 5. Symptoms that mean you may need a temporary “stress dose” of steroids

Your cortisol requirement increases during physical stress.
If you have adrenal suppression, your body cannot produce this extra cortisol.

You may need a temporary increase in dose if you have:

✔ Illness

  • Fever

  • Chest infection

  • Flu-like illness

  • COVID

  • Urinary infection

  • Gastroenteritis

  • Diarrhoea

  • Persistent nausea

✔ Physical stress

  • Injury

  • Significant fall

  • Severe pain

  • Dental surgery

  • Medical or surgical procedures

✔ Emotional stress

  • Bereavement

  • Panic attacks

  • Trauma

If vomiting prevents taking steroids → seek emergency help immediately.


⭐ 6. Tests used to monitor adrenal function during tapering

Doctors rely on a combination of symptoms and laboratory tests.


Morning cortisol (8–9 am)

A key test to assess recovery.

Typical interpretation:

  • > 400–500 nmol/L → likely normal function

  • 150–350 nmol/L → recovering / borderline

  • < 100 nmol/L → adrenal insufficiency

(Exact thresholds vary.)


ACTH level

Shows whether the pituitary is trying to stimulate the adrenals.

  • Low ACTH → still suppressed

  • High ACTH → trying to wake adrenals

  • Normal ACTH + low cortisol → gland slow to respond


Short Synacthen Test (SST)

Gold standard.
A small ACTH injection tests whether your adrenal glands can produce cortisol.

Used when:

  • taper reaches low doses

  • symptoms appear

  • deciding if steroids can be stopped


Electrolytes (U&Es)

Low cortisol may cause:

  • Low sodium

  • High potassium (less common in steroid-induced insufficiency)


Blood pressure monitoring

Low cortisol → low BP, dizziness, faintness.


Glucose levels

Low-normal glucose and shakiness may occur during withdrawal.


Clinical symptom review

Symptoms are sometimes more sensitive than tests.

Doctors track:

  • fatigue

  • appetite

  • dizziness

  • illness triggers

  • salt cravings

  • mental state

  • recovery after small dose increases


⭐ 7. How tapering decisions are made

Tapering depends on:

  • how long steroids have been taken

  • current dose

  • symptoms

  • test results

  • presence of illness

  • rate at which symptoms develop

  • allergy restrictions (pred/hydrocortisone allergy requires specialist handling)

General principles (not schedules):

  1. Higher doses can reduce more quickly.

  2. Taper slows dramatically near physiological levels
    (~4–6 mg pred-equivalent).

  3. If symptoms appear → pause, slightly increase, or slow taper.

  4. SST is used near the end to confirm recovery.


⭐ 8. When to contact your medical team

Same day advice needed

  • worsening dizziness

  • persistent nausea

  • new vomiting

  • symptoms appear with each taper step

  • fainting

  • new severe fatigue

  • any infection (urinary, chest, flu)

Urgent / A&E

  • collapse

  • severe vomiting/diarrhoea

  • confusion

  • severe abdominal pain

  • unable to take oral steroids

  • suspected adrenal crisis


⭐ 9. What patients should do to stay safe

  • Carry a Steroid Emergency Card at all times

  • Keep emergency instructions from your endocrinologist

  • Know your Sick Day Rules

  • Ensure A&E or ambulance crews know about corticosteroid allergy

  • Keep a written record of tapering plan

  • Never stop steroids suddenly

  • Be cautious during illness

  • Know your emergency steroid plan (alternative if allergic to hydrocortisone)


⭐ Final reassurance

Adrenal insufficiency during tapering is common, manageable, and often reversible.
By monitoring symptoms, using regular blood tests, and following specialist guidance, tapering can be done safely.

You are not alone — your endocrine team will guide every step, especially if allergies (to prednisolone or hydrocortisone) make your case more complex.

With careful observation and a clear emergency plan, serious complications are rare and preventable.