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Many forms of the disease can occur, and complex mixtures are not uncommon; here we artificially separated the cases into four groups: (i) inhalant allergy, (ii) fungal sensitization with or without colonization (including <jats:styled-content style=\"fixed-case\">ABPA<\/jats:styled-content>); (iii) severe sinusitis with or without aspirin\u2010exacerbated respiratory disease (<jats:styled-content style=\"fixed-case\">AERD<\/jats:styled-content>), and (iv) non\u2010inflammatory cases, including those associated with severe obesity and vocal cord dysfunction (<jats:styled-content style=\"fixed-case\">VCD<\/jats:styled-content>). The reason for focusing on these groups is because they illustrate how much the specific management depends upon correct classification. Inhalant allergy can present as chronically severe asthma. However, severe attacks of asthma requiring hospital admission can occur in cases which are generally only mild or moderate. The best recognized and probably the most common cause of these acute episodes is acute infection with a rhinovirus. Recent evidence suggests that high titre IgE, particularly to dust mite, correlates to exacerbations of asthma related to rhinovirus infection. Although it is well recognized that the fungus <jats:italic>Aspergillus<\/jats:italic> can colonize the lungs and cause severe disease, it is less well recognized that those cases may not have full criteria for diagnosis of <jats:styled-content style=\"fixed-case\">ABPA<\/jats:styled-content> or may involve other fungi. Identifying fungal cases is important, because treatment with imidazole antifungals can provide significant benefit. Taken together, specific treatment using allergen avoidance, immunotherapy, anti\u2010IgE, or antifungal treatment is an important part of the successful management of severe asthma, and each of these requires correctly identifying specific sensitization.<\/jats:p>","DOI":"10.1111\/j.1365-2222.2011.03944.x","type":"journal-article","created":{"date-parts":[[2012,4,20]],"date-time":"2012-04-20T06:36:55Z","timestamp":1334903815000},"page":"659-669","source":"Crossref","is-referenced-by-count":46,"title":["The role of allergy in severe asthma"],"prefix":"10.1111","volume":"42","author":[{"given":"J. L.","family":"Kennedy","sequence":"first","affiliation":[{"name":"University of Virginia Asthma and Allergic Diseases Center Charlottesville VA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P. 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