Allergic reactions to fungi were described 300 years ago, but the importance of allergy to fungi has been underestimated for a long time. Allergens from fungi mainly cause respiratory and skin symptoms in sensitized patients. In this review, we will focus on fungi and fungal allergens involved in respiratory forms of allergy, such as allergic rhinitis and asthma. Fungi can act as indoor and outdoor respiratory allergen sources, and depending on climate conditions, the rates of sensitization in individuals attending allergy clinics range from 5% to 20%. Due to the poor quality of natural fungal allergen extracts, diagnosis of fungal allergy is hampered, and allergen-specific immunotherapy is rarely given. Several factors are responsible for the poor quality of natural fungal extracts, among which the influence of culture conditions on allergen contents. However, molecular cloning techniques have allowed us to isolate DNAs coding for fungal allergens and to produce a continuously growing panel of recombinant allergens for the diagnosis of fungal allergy. Moreover, technologies are now available for the preparation of recombinant and synthetic fungal allergen derivatives which can be used to develop safe vaccines for the treatment of fungal allergy.

/pdf/mold-allergens-in-respiratory-allergy-from-structure-to-m4d63iqqo5.pdf

Mold Allergens in Respiratory Allergy: From Structure to Therapy

Weinmayr G, Weiland SK, Bjorksten B, et al. Am J Respir Crit Care Med. 2007;176(6):565–574 PURPOSE OF THE STUDY. The International Study of Asthma and Allergies in Childhood (ISAAC I) found that the prevalence of asthma symptoms varies >15-fold among various countries. ISAAC II was designed to identify why such differences occur. STUDY POPULATION. Studied were a random sample of 8- to 12-year-old children (n = 54 439) in 22 countries worldwide. METHODS. Data were collected by parental questionnaires (n = 54 439) and skin-prick tests (n = 31 759). Economic development was assessed by gross national income per capita. RESULTS. Prevalence of current wheeze (wheeze during the last year) ranged from 0.8% (Ecuador) to 25.6% (Brazil). The prevalence of skin-prick test reactivity ranged from 1.7% (Ghana) to 45.3% (Hong Kong). The association between current wheeze and skin-prick test reactivity was stronger in affluent countries (odds ratio: 4.0 [95% confidence interval: 3.5–4.6]) than nonaffluent countries (odds ratio: 2.2 [95% confidence interval: 1.5–3.3]). The population attributable fraction (PAF), or fraction of current wheeze attributable to skin-prick test reactivity, ranged from 0% (Turkey) to 59.6% (Hong Kong). Overall, the combined PAFs were substantially higher in affluent countries (40.7%) than in nonaffluent countries (20.3%). CONCLUSIONS. The authors concluded that the link between atopic sensitization and asthma symptoms in children differs strongly between populations and increases with economic development. REVIEWER COMMENTS. The variation in rates of asthma and allergy around the world are striking, and the fact that the relationship between allergy and asthma seems related to the level of economic development in any given country is fascinating. The authors speculated that this may be a result of exposures or other factors that are different for children in more or less affluent countries that make it more or less likely that allergy would lead to asthma. Such factors could include greater exposure to helminth infections or different commensal bacteria in poorer countries and higher rates of urbanization and obesity in wealthier countries.

https://pediatrics.aappublications.org/content/pediatrics/122/Supplement_4/S180.2.full.pdf

Atopic Sensitization and the International Variation of Asthma Symptom Prevalence in Children

Purpose
Determining the culprit allergen is important for the diagnosis and management of allergic diseases. The skin prick test (SPT) has been widely used to identify culprit allergens. Skin reactivity to allergens has changed due to changes in lifestyle and outdoor environments. Therefore, the aim of the present paper was to examine changes in allergen sensitization in Korea.

/pdf/changes-in-allergen-sensitization-over-the-last-30-years-in-1oozpmayel.pdf

Changes in Allergen Sensitization Over The Last 30 Years in Korea Respiratory Allergic Patients: A Single-Center

Background
Spanish population is rather homogeneous in its genetic and sociocultural characteristics, but allergen sensitization shows wide geographical variations. We aimed at assessing whether sensitization to different allergens in the diverse geographical areas induced different clinical and quality-of-life characteristics in adult patients with a first-time diagnosis of rhinitis and/or asthma.

Methods
Two sequential, identically designed studies were carried out to evaluate such associations (PERFILAR I and II). PERFILAR II was an extension of PERFILAR I with additional allergens being included. Both phases were epidemiological, descriptive, cross-sectional, nonintervention multicenter studies. Participants were required to have lived for at least the last 2 years in the geographical zone. Asthma control assessment was based on ACQ-5. Health-related quality of life was evaluated with validated scales for rhinitis (ESPRINT-15) and asthma (Mini-AQLQ). Skin prick tests were used to identify sensitization to involved allergens.

Results
A total of 301 physicians recruited 2711 patients for PERFILAR I+II. Sensitization to allergens was significantly different in patients with rhinitis with/without asthma. Seasonal allergens were associated with rhinitis, a longer time to asthma development, and more severe and commonly intermittent rhinitis. HDM were associated with more common rhinitis, and Alternaria was associated with asthma. The study confirms an association of geographical areas with relevant allergens and allergic clinical picture.

Conclusion
Different types of aeroallergens and specific sensitization profiles are associated with different allergic clinical pictures (rhinitis with/without asthma), different clinical symptoms, and different levels of severity. This could have implications to predict later clinical course and to select appropriate management approaches.

Allergic respiratory disease: Different allergens, different symptoms.

Despite making up a significant proportion of airborne allergens, the relationship between fungal spores and asthma is not fully explored. Only 80 taxa of fungi have so far been observed to exacerbate respiratory presentations, with Cladosporium spp., Aspergillus spp., Penicillium spp., and Alternaria spp. found to comprise the predominant allergenic airborne spores. Fungal spores have been found in indoor environments, such as hospitals and housing due to poor ventilation. Meanwhile, outdoor fungal spores exhibit greater diversity, and higher abundance and have been associated with hospitalizations from acute asthma presentations. In addition, fungal spores may be the underlying, and perhaps the “missing link”, factor influencing the heightened rate of asthma presentations during epidemic thunderstorm asthma events. To improve our knowledge gap on fungal spores, airborne allergen monitoring must be improved to include not only dominant allergenic fungi but also provide real-time data to accurately and quickly warn the general public. Such data will help prevent future asthma exacerbations and thus save lives. In this review, we examine the health risks of prominent allergenic fungal taxa, the factors influencing spore dispersal and distribution, and why improvements should be made to current sampling methods for public health and wellbeing.

/pdf/impact-of-fungal-spores-on-asthma-prevalence-and-1tcvd0wb.pdf

Impact of Fungal Spores on Asthma Prevalence and Hospitalization

Background: Each region should know which its predominant allergens are. However, in addition to the differences that exist between different geographical areas, variations within the same area should be determined. Objectives: To review the predominant allergens in the paediatric population suffering from asthma or rhinitis in our region and analyse the internal variations and associated factors. Methods: A cross-sectional, descriptive study reviewing all the patients having a diagnosis of asthma or rhinitis in the paediatric allergy units of three hospitals in a coastal region in the south-east of Spain between 2001 and 2006. Results: Data on 3066 patients, 2202 (72 %) of whom were atopic, were collected. Atopy was present in 63 % of asthmatics, 90 % of those with rhinitis and 95 % of those with both asthma and rhinitis. The percentage of atopic patients increased with age. Egg was the main allergen in the first 3 years of life, followed by milk. Aeroallergen sensitization started in the second year of life and increased rapidly in subsequent years. The main aeroallergens in our region, in descending order, were: olive, mites, Salsola, Alternaria, cat, dog and grasses. With the five main aeroallergens, 98 % of atopic patients between 6 and 14 years of age, and 94 % of those between 3 and 5 years of age are detected. In children under the age of three it is necessary to combine food and aeroallergens in order to detect most of the atopic patients. Sensitization to Alternaria occurred at an early age but stabilized before that caused by other aeroallergens. Sensitization to mites was very high along the coastline (83 %) but at only 5-30 km inland it decreased by half. On the other hand, sensitization to pollen and Alternaria increased sharply as we move away from the coast. Conclusions: We have described the main allergens in children with asthma and rhinitis in a Mediterranean region in Spain, and have found marked differences depending on age and proximity to the coast. The local importance of Salsola, the early sensitization to Alternaria, and the surprisingly short reach of the influence of the coast in favouring sensitization to mites and protecting from sensitization to pollens and Alternaria are noteworthy.

Allergen sensitization in children with asthma and rhinitis: marked variations related to age and microgeographical factors.

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Allergen sensitization in children with asthma and rhinitis: marked variations related to age and microgeographical factors.