Conclusion
Functional cellular assays are emerging biomarkers for the diagnosis of allergic mycoses. Whereas, IgE and IgG sensitization, which may result from a normal contact with airborne environmental molds, are indirect biomarkers with insufficient specificity, the ex vivo functional cellular activity is a direct marker of in vivo mechanisms. Because basophils are involved in lung tissue damage, a strong ex vivo basophil activation might not only be an indirect marker of an IgE-linked immune reaction, but also a direct marker of lung disease. Conversely, because T lymphocytes are involved in the initiation, development, and maintenance of the lung Th2-immune response, a major ex vivo T cell activation might occur in patients with sub-clinical disease that possibly would progress to overt ABPM. The major weakness of our study is the low number of ABPA cases, due to the prospective design. The major strength is the investigation by means of innovative diagnostic tools.