Reviews and feature articleFungi and allergic lower respiratory tract diseases
Section snippets
Prevalence of fungal sensitivity
The precise prevalence of fungal sensitivity is unclear. The National Health and Nutrition Examination Survey III study11 reported that among US citizens aged 6 to 59 years, 12.9% have positive skin prick test (SPT) responses to Alternaria species, whereas in another US study 21% of 102 atopic subjects had positive skin test results to 1 or more fungal allergens.12 In European studies 78% of 824 Spanish patients with allergic respiratory symptoms had positive SPT responses to Alternaria species.
Development of sensitization
Sensitization arises from a combination of genetic factors and exposure. Sensitization to Alternaria species has been associated with increased risk of maternal sensitization in patients’ offspring to this allergen, although the risk of asthma is unknown.20 Environmental exposure to fungi occurs both indoors and outdoors. A recent study showed that in fungus-sensitized asthmatic children, outdoor mold exposure rather than indoor mold exposure was linked with asthma exacerbations.21
Role of climate change in fungus-related respiratory tract diseases
Further factors that might influence the frequency of fungal sensitization and lower respiratory tract disease in the future are the effects of global climate change.30, 31 There is growing evidence of the effect of climate change on other aeroallergens, including mold sporulation.32, 33, 34, 35, 36 The plant response to increasing CO2 concentrations includes greater biomass and a greater carbon/nitrogen ratio of plant tissues; thus fungi growing on plant materials encounter changes in
Fungi associated with lower airway allergy
Aerobiological studies have shown the majority of fungal spores in outdoor air to be from the phyla Ascomycota and Basidiomycota (Table I).43 The most commonly studied allergenic fungi are conidia-producing anamorphs of ascomycetes, such as Alternaria, Aspergillus, Botrytis, Cladosporium, Epicoccum, Fusarium, and Penicillium species. Asexually produced conidia represent 30% to 60% of the spores present in outdoor air, the remainder being comprised mostly of teleomorphic (sexual) spores of the
Fungal allergens
Most fungi possess multiple and diverse allergens. Some are metabolic products secreted outside the organism; others are cytoplasmic and structural components released on lysis or autolysis of the fungal cell. On the basis of the catalog of fungal allergens approved by the Allergen Nomenclature Sub-committee of the International Union of Immunological Societies (IUIS),67 allergens that are fully characterized are listed in Table II. This listing includes isoallergens and variants from 25 fungal
ABPA and related conditions
First described in 1952, ABPA is commonly caused by A fumigatus, an ubiquitous mold common indoors and frequently found around farm buildings and compost heaps.80, 81, 82, 83, 84, 85 ABPA is characterized by exacerbations of asthma, recurrent transient chest radiographic infiltrates, and peripheral and pulmonary eosinophilia, especially during an exacerbation. ABPA is a TH2 hypersensitivity lung disease caused by bronchial colonization with A fumigatus that affects approximately 0.7% to 3.5% of
β-Glucan and dectin receptors
(1→3)-β-D-glucans are part of the carbohydrate structures in the cell walls of molds, some bacteria, and plants; up to 60% of the dry weight of the cell wall of fungi might be glucans.102 An association between high β-glucan levels and increased peak expiratory flow variability has been observed in children with asthma.103 The presence of visible mold and exposure to β-glucan in infancy appear to be risk factors for asthma by age 3 years.104 On the other hand, high levels of β-glucan exposure
ABPA
Exacerbations of ABPA are best treated with a course of oral steroids over 3 to 6 weeks (Table III).132 No prospective studies with corticosteroids have been conducted to evaluate efficacy rates, optimum dose, and duration or relapse rates. There are conflicting data concerning the clinical utility of inhaled corticosteroids in reducing exacerbation frequency, but they are important in controlling underlying asthma (Table III).133, 134 The potential utility of systemic antifungal therapy for
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Series editors: Donald Y. M. Leung, MD, PhD, and Dennis K. Ledford, MD