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Allergenicity References

Fungal Glossary Allergenicity References as provided by Texas Tech University Health Sciences Center, Department of Microbiology and Immunology


1 Atlas of Clinical Fungi. 2nd edition. G.S. de Hoog, J.Guarro, J.Gene & M.J. Figuerras. - Centraalbureau voor Schimmelcultures/Universitat Rovira I Virgili Reus, Spain. - 2000. 
2Guide to Clinically Significant Fungi. Deanna A.Sutton, Annette W.Fothergill, Michael G.Rinaldi. - Williams & Wilkins A Wavely Company. - 1998. 
3Introduction to food and airborne fungi. Sixth Edition. Robert A. Samson, Ellen. S Hoekstra, Jens C. Frisvad, Ole Filtenborg.Centraalbureau Voor Schimmelcultures Utrecht. An Institute of the Royal Netherlands Academy of Arts and Sciences. Ponsen & Looyen. Wagemimgen, The Netherlands. - 2000. 
4Compendium of Soil Fungi. K.H. Domsch, W. Gams, Traute-Heidi Anderson. Reprint der Ausg. Von 1980 - 1993. 
5Hypersensitivity pneumonitis caused by a factory humidifier. A case report]. Sakurai M, Kinosita K, Kobayashi Y, Nishi Y, Nozawa M, Kawasaki M, Tabe K, Nagata M, Kuramitu K, Sakamoto Y, Shimizu Y. Nihon Kokyuki Gakkai Zasshi. 2001 Mar;39(3):190-4.A 64-year-old man was hospitalized for productive cough and dyspnea. Both chest radiographs and CT scans showed areas of ground-glass opacity in the middle and lower lung fields on both sides. The BAL and TBLB findings were compatible with hypersensitivity pneumonitis. The serum was negative for antibodies against Trichosporon species, and the result of a lymphocyte stimulating test for administered drugs including a Chinese medicine was also negative. A humidifier was suspected as the cause because it had been used for more than 10 years in the factory where the patient had been working. An inhalation test using the humidifier fluid successfully provoked dyspnea, fever and fine crackle, and laboratory tests demonstrated hypoxemia, reduction in vital capacity and the elevation of CRP. Agar gel diffusion using the patient's serum showed a precipitating line against Cephalosporium acremonium, but this line did not fuse with any precipitating line formed between the humidifier fluid and the serum, indicating that no Cephalosporium was present in the humidifier fluid. Since a high level of beta-D glucan was detected in the humidifier fluid, an unidentified fungus was suspected to be the antigen.
6Hypersensitivity pneumonitis associated with home ultrasonic humidifiers. Suda T, Sato A, Ida M, Gemma H, Hayakawa H, Chida K. Chest. 1995 Mar;107(3):711-7.We describe five patients with hypersensitivity pneumonitis (HP) that was related to using home ultrasonic humidifiers. All patients had micronodular infiltrates on their chest radiograph, and their lung biopsy specimens revealed alveolitis with or without epithelioid cell granulomas. Challenge tests were performed on two patients with the humidifier water and three patients using the humidifier. All patients tested exhibited a positive response. Tests for precipitating antibodies against an extract of the humidifier water gave strongly positive reactions in all patients tested. Precipitins to Cephalosporium acremonium and Candida albicans were also present in all cases, whereas precipitins to thermophilic actinomycetes were not detected. Although cultures of the water grew a variety of fungal and bacterial organisms, thermophilic actinomycetes could not be detected. These findings suggest that thermophilic organisms may not be the causative antigens of HP associated with ultrasonic humidifiers. All five patients had an increase in the bronchoalveolar lavage (BAL) lymphocytes that were predominantly CD4+ lymphocytes. The T helper cell count (CD4) to suppressor T cell count (CD8) ratio was significantly higher than that observed in summer-type HP, and lower than that observed in bird fancier's lung, indicating that the phenotypes of the BAL lymphocytes may vary with the type of HP.
7Antibody activity in sera of patients with humidifier disease: studies of the water supply as a source of antigens. Patterson R, Fink JN, Roberts M, Kelly JF, Sommers HM. J Allergy Clin Immunol. 1978 Aug;62(2):103-8.In 5 patients with respiratory symptoms consistent with humidifier or air conditioner disease, a hypersensitivity pneumonitis, no identifiable organism was cultured from the humidifier water (HW). The water source to the humidifier or air conditioner was investigated for possible antigens which might explain the occurrence of the disease. Three subjects who lived in the same city supplied by Lake Michigan had increased IgG antibody activity against the city water supply when compared with another patient from a different city and a control subject. Both of the latter lived in cities with water supplied from Lake Michigan. Two of the 5 patients showed definite inhibition by concentrated tap water (TW) of IgG antibody against HW. The source of antigens in water was not determined but must be considered in cases of this type of hypersensitivity pneumonitis. A sixth case consistent with humidifier disease had Cephalosporium cultured from her HW. On gel diffusion there was a band of identity with her serum against Cephalosporium extract and her own HW, and by radioimmunoassay (RIA) there was over 50% inhibition of her IgG antibody activity against HW by Cephalosporium. No antibody against her city TW was demonstrated.
8The major aeroallergens in Guangxi, China. Chen K, Liao YF, Zhang JT. Clin Allergy. 1988 Nov;18(6):589-96.Over a 2-year period we have identified pollen grains from 48 families of grasses, as well as mould spores and mite particles during air sampling in Guangxi Province. The major aeroallergens were Artemisia, Moraceae and Euophoribiacea, and the spores of Aspergillus, Penicillium, Cephalosporium and Helminthosporium. Mites were probably also one of the major outdoor aeroallergens. Our investigations also included inspection of the vegetation of the geographical area involved, as well as skin testing on 774 subjects using extracts of 37 aeroallergens. We believe that this work has provided fundamental information on seasonal allergy in Southern China and South-east Asia.
9Antibody activity in sera of patients with humidifier disease: studies of the water supply as a source of antigens. Patterson R, Fink JN, Roberts M, Kelly JF, Sommers HM. J Allergy Clin Immunol. 1978 Aug;62(2):103-8.In 5 patients with respiratory symptoms consistent with humidifier or air conditioner disease, a hypersensitivity pneumonitis, no identifiable organism was cultured from the humidifier water (HW). The water source to the humidifier or air conditioner was investigated for possible antigens which might explain the occurrence of the disease. Three subjects who lived in the same city supplied by Lake Michigan had increased IgG antibody activity against the city water supply when compared with another patient from a different city and a control subject. Both of the latter lived in cities with water supplied from Lake Michigan. Two of the 5 patients showed definite inhibition by concentrated tap water (TW) of IgG antibody against HW. The source of antigens in water was not determined but must be considered in cases of this type of hypersensitivity pneumonitis. A sixth case consistent with humidifier disease had Cephalosporium cultured from her HW. On gel diffusion there was a band of identity with her serum against Cephalosporium extract and her own HW, and by radioimmunoassay (RIA) there was over 50% inhibition of her IgG antibody activity against HW by Cephalosporium. No antibody against her city TW was demonstrated.
18Clinical importance of Alternaria exposure in children. Downs SH, Mitakakis TZ, Marks GB, Car NG, Belousova EG, Leüppi JD, Xuan W, Downie SR, Tobias A, Peat JK. Am J Respir Crit Care Med. 2001 Aug 1;164(3):455-9.The fungus Alternaria is known to be allergenic and is one of the most common fungi worldwide. We investigated the extent to which exposure to Alternaria increases the severity of asthma. We undertook a prospective cohort study in Australia of 399 school children who had positive skin tests to one or more aeroallergens. Airway responsiveness to histamine, wheeze, and bronchodilator use in 1 mo was measured five times between 1997 and 1999. Airway hyperresponsiveness was defined as PD(20)FEV(1) = 3.9 micromol histamine. Airborne concentrations of Alternaria spores were measured throughout the study, and mean daily concentrations over 1 mo ranged from 2.2 to 307.7 spores/m(3) of ambient air. Using generalized estimating equations, we found that airway responsiveness, wheeze, and bronchodilator use increased significantly in association with increased spore concentrations and that the increase in airway responsiveness was greater in children sensitized to Alternaria than in other children (p = 0.01). The odds ratio for airway hyperresponsiveness in children sensitized to Alternaria was 1.26 (95% CI, 1.14 to 1.39) after an increase in mean exposure of 100 spore/m(3)/d over 1 mo. These results suggest that Alternaria allergens contribute to severe asthma in regions where exposure to the fungus is high.
19Prevalence of sensitization to Alternaria in allergic patients in Italy. Corsico R, Cinti B, Feliziani V, Gallesio MT, Liccardi G, Loreti A, Lugo G, Marcucci F, Marcer G, Meriggi A, Minelli M, Gherson G, Nardi G, Negrini AC, Piu G, Passaleva A, Pozzan M, D'Ambrosio FP, Venuti A, Zanon P, Zerboni R. Ann Allergy Asthma Immunol. 1998 Jan;80(1):71-6.BACKGROUND: The actual prevalence of sensitization to Alternaria is not known, partly due to the unreliability of diagnostic extracts. OBJECTIVE: To assess skin positivity to extracts of Alternaria in a wide population of Italian patients suffering from respiratory symptoms using a biologically standardized extract. METHODS: A total of 2942 patients were skin prick tested with Alternaria, and a panel of common inhalant allergens. Blood samples for specific IgE quantitation were taken both from patients positive and from patients negative (control group) to Alternaria extract. RESULTS: Three hundred six patients (10.4%, ranging from 1.8% in Turin to 29.3% in Cagliari) were positive to Alternaria; 37 were sensitized to only this mold, while the remaining 269 were sensitized to at least one other allergen. Of the Alternaria-positive patients, 79.7% suffered from rhinitis and 53.3% from asthma, either alone or associated with other symptoms. CONCLUSIONS: We suggest that, at least in Italy and in countries with similar climatic and environmental situations, standardized Alternaria extract should be included in the panel commonly used in investigating the allergen responsible in patients suffering from respiratory allergy.
20Alternaria as a major allergen for asthma in children raised in a desert environment. Halonen M, Stern DA, Wright AL, Taussig LM, Martinez FD. Am J Respir Crit Care Med. 1997 Apr;155(4):1356-61.The relationships of asthma and allergic rhinitis with individual immediate skin test responses were examined for preferential associations and for changes with age in children raised in a semiarid environment. Prevalence of physician-diagnosed asthma was 9.8% at age 6 (n = 948) and 15.5% at age 11 (n = 895). Immediate skin test responses to Bermuda grass were the most prevalent among children with allergic rhinitis and control subjects, whereas responses to the mold, Altenaria alternata, were the most prevalent among asthmatics. Skin test responses for crude house dust, Dermatophagoides farinae, and cat had low prevalences in all groups. By logistic regression, Alternaria was the only allergen independently associated with increased risk for asthma at both ages 6 and 11. Allergic rhinitis showed independent association with sensitization to Bermuda grass and mulberry tree pollen at age 11 but did not show an independent relation to any single allergen at age 6. Logistic regression further revealed that persistent asthma (diagnosed before age 6) was independently associated with Alternaria skin tests at both ages 6 and 11, whereas new asthma (diagnosed after age 6) was associated with Alternaria skin tests at age 6 but not at age 11. We conclude that Alternaria is the major allergen associated with the development of asthma in children raised in a semiarid environment and that skin test responses at age 6 are more closely linked to asthma than those at age 11.
21Allergy to Alternaria. I. Clinical aspects. Granel C, Tapias G, Valencia M, Randazzo L, Anglada E, Olivé A. Allergol Immunopathol (Madr). 1993 Jan-Feb;21(1):15-9.We studied 66 patients allergic to mould Alternaria. 53% males and 47% females, with 60% diagnosed as having asthma versus 40% rhinitis, only 29% had allergy to Alternaria without any other cutaneous reactivity while 71% were polisensitized, more frequently to D. pteronyssinus, grass pollen, Cladosporium and cat epithelium. We compared the patients allergic to Alternaria with those allergic to grass pollen and D. pteronyssinus.
22Sensitization to environmental antigens in asthmatic children from a central Italian area. Verini M, Rossi N, Verrotti A, Pelaccia G, Nicodemo A, Chiarelli F. Sci Total Environ. 2001 Apr 10;270(1-3):63-9.This study was designed to evaluate the frequency of respiratory allergens in different age groups of asthmatic atopic children in the Chieti-Pescara area. We examined a pediatric population (507 children) aged between 1 to 17 years (mean 6.62 +/- 2.9). All the children were submitted to a panel of skin prick tests (SPT) for 12 common aeroallergens: Grass Pollens (G.), Parietaria (P.), Olive (O.), Artemisia (A.), Ragweed (R.), Dermatophagoides Pteronyssinus and Dermatophagoides Farinae (D.P. & D.F.), Cat and Dog dander (C.D.), Feathers (F.), Alternaria (Al.), Aspergillus (As.). All the subjects gave positive result to one or more allergens. The population was subdivided in to 4 groups according to their age (Group A: 1-3 years; Group B: 4-6 years; Group C: 7-9 years; Group D: 10-17 years). In each age group, we determined the number of subjects with 1, 2, 3, 4 or 5 and more than 5 positive SPT and the prevalence of positive SPT for different allergens. We found that 74% of 507 patients showed positive reaction to Dermatophagoides Pt, 71% to Dermatophagoides Fa, 45% to Grass, 23% to Parietaria, 21% to Olive, 17% to Artemisia, 17% to Cat's or Dog's danders, 13% to Alternaria, 5.9% to Ragweed, 5.9% to Feathers, and 4% to Aspergillus. In addition we detected that 12% of children examined were monosensitized; 56% were sensitized to 2 or 3 allergens; 22% were sensitized to 4 or 5 allergens, and then 8% were polysensitized to > 5 allergens. The allergy to grass pollens and to house dust mites was the most frequent in monosensitized. In the older patients, we found an increase in number of positives SPT to several allergens, and an increase in the frequency of Gr., P. and O. allergy, while the house dust mites sensitization remained constant in all groups and represented the dominant cause of asthmatic symptoms in this population. Our data confirm the importance of age in determining a respiratory polysensitization. In conclusion, our data suggest that house dust mites (D.P. and D.F.) and grass pollens are the most common allergens in asthmatic children of the Chieti-Pescara area.
23Clinical study on Alternaria spores sensitization. Negrini AC, Berra D, Campi P, Cinti B, Corsico R, Feliziani V, Gallesio MT, Liccardi G, Loreti A, Lugo G, Marcucci F, Marcer G, Minelli M, Nardi G, Piu G, Passaleva A, Pozzan M, Puccinelli P, Purello D'Ambrosio F, Venuti A, Zanon P.
Allergol Immunopathol (Madr). 2000 Mar-Apr;28(2):71-3.
BACKGROUND: sensitization to fungi spores is often associated with sensitization to other allergens and so it is difficult to estabilish the exact cause of illness. OBJECTIVE: the aim of the study was to evaluate a group of patients monosensitized to Alternaria and to establish the prevalence, periodicity and clinical profile of this kind of sensitization. METHODS: 37 subjects who were monosensitized to Alternaria (prick-test positive), according to a previous epidemiological study were evaluated. Clinical symptoms and the period of their occurrence were taken into consideration as well as immunological parameters (RAST). RESULTS: 20 patients (over 50%) included in the study proved to be affected by asthma associated with other allergic symptoms and 22 patients (60%) presented perennial symptoms. The RAST carried out on 34 monosensitized subjects proved positive in 11 and negative in 23. CONCLUSIONS: Alternaria sensitization is characterized by a perennial periodicity with severe respiratory symptoms (asthma) which occur primarily in children. Prick test is preferable to and more reliable than RAST as a diagnostic test.
36Respiratory disease of workers harvesting grain. Darke CS, Knowelden J, Lacey J, Milford Ward A. Thorax. 1976 Jun;31(3):294-302.The incidence of respiratory symptoms caused by grain dust during harvesting was surveyed in a group of Lincolnshire farmers. A quarter complained of respiratory distress after working on combine harvesters or near grain driers and elevators, with cough, wheezing, and breathlessness, sometimes so severe as to prevent work. The airborne dust around combine harvesters contained up to 200 million fungus spores/m3 air with Cladosporium predominant while drivers were exposed to up to 20 million spores/m3 air. Verticillium/Paecilomyces type spores, mostly from Verticillium lecanii, Aphanocladium album, and Paecilomyces bacillosporus, were abundant in the dust. Extracts of these species produced immediate weal reactions in skin tests, precipitin reactions with sera, and rapid decreases in FEV1 when inhaled by affected workers. There was no delayed reactions. Results suggest type I immediate hypersensitivity to the spores although the physical effect of a heavy dust deposit could be important. Drivers could be protected by cabs ventilated with filtered air.
44The dermatophytes . I Weitzman and RC Summerbell . Clin. Microbiol. Rev. 1995 8: 240-259.The etiologic agents of the dermatophytoses (ringworm) are classified in three anamorphic (asexual or imperfect) genera, Epidermophyton, Microsporum, and Trichophyton. Species capable of reproducing sexually belong in the teleomorphic genus, Arthroderma, of the Ascomycota. On the basis of primary habitat association, they may be grouped as geophilic (soil associated), zoophilic, and anthropophilic. Adaptation to growth on humans by most geophilic species resulted in diminished loss of sporulation, sexuality, and other soil-associated characteristics. The dermatophytes have the ability to invade keratinized tissue (skin, hair, and nails) but are usually restricted to the nonliving cornified layer of the epidermis because of their inability to penetrate viable tissue of an immunocompetent host. However, invasion does elicit a host response ranging from mild to severe. Acid proteinases, elastase, keratinases, and other proteinases reportedly act as virulence factors. The development of cell-mediated immunity correlated with delayed hypersensitivity and an inflammatory response is associated with clinical cure, whereas the lack of or a defective cell-mediated immunity predisposes the host to chronic or recurrent dermatophyte infection. Chronic dermatophytosis is mostly caused by Trichophyton rubrum, and there is some evidence that mannan produced by this fungus suppresses or diminishes the inflammatory response. Since dermatophytes cause a communicable disease, modes of transmission and control are discussed as well as a survey of recent trends in therapy. Collection of specimens, culture media, and tests for identification are also presented. Genetic studies have led to an understanding of incompatibility mechanisms, pleomorphism and variation, resistance to griseofulvin, and virulence. Molecular biology has contributed to our knowledge of the taxonomy and phylogenetic relationships of dermatophytes.
45Association of hypersensitivity and carriage of dermatophytes in clinically normal sites in patients with Tinea cruris.Chakrabarti A, Sharma SC, Handa S, Chander J, Kumar D, Sahgal R. Mycopathologia. 1995 Aug;131(2):71-4.Forty nine patients with mycologically confirmed Tinea cruris were investigated for the association of hypersensitivity to trichophytin and the isolation of dermatophytes from clinically normal sites with chronicity and recurrence of infection. At the end of six months following specific therapy, 24 patients returned for follow up and they were similarly studied. Dermatophytes were isolated from clinically asymptomatic sites in 46% patients before treatment and in 21% of the patients on follow up. Immediate weal reaction and increased concentration of IgE antibodies were seen in 73% and 80% of the patients respectively. However, the delayed hypersensitivity reaction was more associated with patients having lesions for more than 6 months (48%) in comparison with patients with a short history (17%). On follow up after 6 months, the different hypersensitivity reactions and IgE antibody concentration maintained more or less the same association. Therefore in persistent or recurrent Tinea cruris infection, besides potential carriage in clinically normal sites, hypersensitivity to antigens of dermatophytes possibly plays an important role in pathogenicity.
67Indoor exposure to molds and allergic sensitization. Jacob B, Ritz B, Gehring U, Koch A, Bischof W, Wichmann HE, Heinrich J. Environ Health Perspect. 2002 Jul;110(7):647-53.Evidence that indoor dampness and mold growth are associated with respiratory health has been accumulating, but few studies have been able to examine health risks in relation to measured levels of indoor mold exposure. In particular, little is known about the contribution of indoor molds to the development of allergic sensitization. As a part of an ongoing study examining the effects of ambient air pollutants on respiratory health and atopic diseases in German school children, we examined the relation between viable mold levels indoors and allergic sensitization in 272 children. We examined whether allergic sensitization in children is associated with higher fungal spore count in settled house dust sampled from living room floors. Adjusting for age, sex, parental education, region of residency, and parental history of atopy, we found that mold spore counts for Cladosporium and Aspergillus were associated with an increased risk of allergic sensitization. Sensitized children exposed to high levels of mold spores (> 90th percentile) were more likely to suffer from symptoms of rhinoconjunctivitis. We conclude that elevated indoor concentrations of molds in wintertime might play a role in increasing the risk of developing atopic symptoms and allergic sensitization not only to molds but also to other common, inhaled allergens. These effects were strongest in the group of children who had lived in the same home since birth.
68Correlation between positive skin tests to molds, total IgE, and specific IgE using ELISA and mold cultures from the environment of the pediatric allergy patient. García Caballero R, Nader O, Morfin Maciel B. Rev Alerg Mex. 2001 Sep-Oct;48(5):137-40.The aim of this study was to made a correlation between allergic symptoms, positive skin prick test to fungi, total and specific IgE and mold culture in the patient's environmental. There were included 35 children (3-16 years), with skin prick test positive to fungi. The most frequent were: Rhizopus, Aspergillus, Cladosporium and Candida. Total and specific IgE were measured with ELISA, with titers high in 77.2% and 31.4% respectively. Fungal cultures were collected from dwellings and schools. The most frequently isolated mold genera were Cladosporium, Alternaria and Penicillium in the same proportion in both places: dwellings and schools. We concluded fungi are commonly found in children's environment.
69Airborne viable fungi in Riyadh and allergenic response of their extracts. A-Suwaini AS, Bahkali AH, Hasnain SM. Mycoses. 2001 Nov;44(9-10):401-6.The allergenicity and antigenicity of various airborne fungi isolated from the atmosphere of Riyadh were studied. Protein nitrogen contents were estimated and found to range from 0.9 mg ml(-1) for Cladosporium to 2.1 mg ml for Aspergillus extracts. Sodium dodecyl sulphate-polyacrylamide gel electrophoresis analysis for those extracts exhibited a number of protein bands of higher molecular weight between 13 and 80 kDa for Alternaria, Ulocladium, Penicillium, Aspergillus and Cladosporium. Extracts in both aqueous and lyophilized forms were sterilized and tested for diagnostic skin prick test in 100 consecutive patients having bronchial asthma and allergic rhinitis. Overall, 13% of patients reacted positively to fungal extracts, revealing allergic sensitization to these fungi. These findings necessitate further investigation as regards the purification and characterization of these local extracts for better diagnostic use in patients in Saudi Arabia.
70Respiratory allergy to moulds among adults in Eskisehir Anatolia), Turkey] Harmanci E, Metintas M, Erginel S. Allerg Immunol (Paris). 2000 Feb;32(2):49-51Allergy to moulds has been known for several decades. But it is rarely isolated in contrast to the other pneumallergens. Prevalence of sensitization to moulds varies from one country to the another. We investigated the allergy to moulds using skin prick tests in adult patients with asthma and/or rhinitis in Eskisehir (Anatolia), Turkey. Cladosporium and Aspergillus were found to be the most common causes in the study population (115 patients). Isolated mould allergy was found as 4.3% with the exclusion of common non-fungal respiratory allergens, among them Cladosporium was the most common cause.
71Characterization of allergens of Penicillium and Aspergillus species. Shen HD, Han SH. J Microbiol Immunol Infect. 1998 Sep;31(3):141-5.Penicillium and Aspergillus species are common indoor airborne fungi and have been identified to be important causative agents of extrinsic bronchial asthma. However, little was known about allergens of these ubiquitous fungal species. Results from a survey conducted by us showed that P. citrinum was the most prevalent Penicillium species in the Taipei area. Characterization of allergens by SDS-PAGE-immunoblotting using sera from asthmatic patients showed that there was an IgE cross-reactivity among the 33 KDa group major allergens of P. citrinum, P. notatum and P. brevicompactum. Results obtained from N-terminal amino acid sequence analysis suggest that the 33 KDa major allergens of P. citrinum and P. brevicompactum may be the alkaline serine proteinase of individual Penicillium species. In addition, our results suggest that the 34 KDa major allergen of A. oryzae is also an alkaline serine proteinase. IgE cross-reactivity between the major serine proteinase allergens of A. oryzae and P. citrinum has also been detected. Furthermore, results from cDNA cloning suggest that the 68 KDa allergen of P. notatum is a beta-N-acetyl-glucosaminidase. Lastly, a heat shock protein in the hsp70 family has also been identified as an allergen of P. citrinum. Results obtained in these studies will provide important basis for clinical diagnosis and treatment of mould allergy.
72Indoor survey of moulds and prevalence of mould atopy in Israel. Katz Y, Verleger H, Barr J, Rachmiel M, Kiviti S, Kuttin ES. Clin Exp Allergy. 1999 Feb;29(2):186-92.BACKGROUND: Moulds are ubiquitous indoor as well as outdoor allergens and therefore potential candidates for indoor environmental control measures. However, very few studies have been performed to examine the significance of indoor moulds in allergic diseases and the effectiveness of measures to reduce the quantity of indoor moulds has not been established. OBJECTIVE: To determine the significance and the contribution of moulds to allergic manifestations. METHODS: Prevalence of allergic rhinitis and asthma in 395 members of a rural community were examined by questionnaire and examination of medical files. The atopic status in general and allergy to moulds was determined by skin-prick tests (SPTs) to a panel of aeroallergens including Aspergillus, Penicillium, Alternaria and Cladosporium. A study of indoor mould levels was performed by placing SDA plates in 59 houses. The type of fungi and the number of colonies from each species were recorded. RESULTS: Forty-two subjects, comprising 10.9% of the study group had positive SPT to moulds, 61.9% of those were classified as symptomatic. When taking into account individuals with a borderline positive SPT to moulds, an additional 23 had positive results. Of the 65 mould-positive subjects, 48% were symptomatic and of the 13 who were allergic to moulds alone, only two had allergic symptoms. Viable moulds were recovered from all 59 houses examined. The most common isolated genus was Aspergillus, followed by Penicillium, Alternaria and Cladosporium. Aspergillus was also the most abundant mould in houses. There was no significant correlation between the abundance of moulds, positive SPT to that mould and symptomatology. CONCLUSIONS: Viable moulds are common in houses in temperate climates. Allergy to moulds itself has a low predictive value to development of allergic symptoms, but allergy to moulds in otherwise atopic subjects increases the risk of symptomatic allergic disease.
73Prevalence of mold-specific immunoglobulins in a Midwestern allergy practice. Corey JP, Kaiseruddin S, Gungor A. Otolaryngol Head Neck Surg. 1997 Nov;117(5):516-20.Mold allergy surveys are an important part of the correct identification and treatment of mold allergies. This study included 100 patients who were referred to a Midwestern allergy clinic for the evaluation of rhinitis, suspected to be of allergic origin. An in vitro screening test for allergen-specific IgE (ImmunoCAP) comprised of 10 allergens, including Candida, Aspergillus, Helminthosporium, and Alternaria, was used. To assess the seasonal distribution of mold allergies, we randomly selected 8 patients out of the 100 from each season during which the clinical contact occurred, and we tested them for 14 varieties of mold. The overall incidence of mold allergy in atopic subjects was 44%. The most common molds were (in descending order of frequency) Alternaria, Helminthosporium, Aspergillus, Candida, and Curvularia. Mold allergy was diagnosed most frequently in the winter; the second highest period was the fall. Population surveys of IgE antibody sensitization by in vitro techniques can provide useful information about fungal allergy.
74Allergic fungal sinusitis. Corey JP. Otolaryngol Clin North Am. 1992 Feb;25(1):225-30.In summary, AFS is a newly recognized form of sinusitis, appearing in otherwise healthy young adults with a history of chronic bacterial or polypoid rhinosinusitis refractory to conventional therapy. Radiologic study may show patchy opacification or calcifications of the sinuses on CT. The patients have an elevated total IgE, peripheral eosinophilia, and positive skin tests for fungal antigens. They may also have elevated serum fungal allergen-specific IgE and IgG and precipitating antibodies to Aspergillus, Curvularia, or other fungi. Diagnostic and therapeutic surgical drainage of the sinuses will establish a definitive diagnosis by identifying the typical allergic mucin with eosinophils, Charcot-Leyden crystals, few fungal hyphae on silver stain, and a lack of tissue invasion. Treatment, other than surgical drainage, consists of systemic corticosteroids to prevent recurrence of disease.
76Clinical presentation of allergic fungal sinusitis in children. McClay JE, Marple B, Kapadia L, Biavati MJ, Nussenbaum B, Newcomer M, Manning S, Booth T, Schwade N.
Laryngoscope. 2002 Mar;112(3):565-9.
OBJECTIVE: To compare the differences in the clinical and radiographic presentation of allergic fungal sinusitis in children and adults. STUDY DESIGN: Retrospective chart and computed tomography review. METHODS: The settings included a tertiary care children's hospital, adult academic private hospital, and academic affiliated county hospital. All patients with documented allergic fungal sinusitis who underwent computed tomography evaluation and had surgical treatment of their disease from 1988 to 1999 were included in the study. In total, 151 patients aged 5 to 75 years; 44 of these patients were less than or equal to 17 years of age (children) and 107 were greater than 17 years of age (adults). Main outcome measures included 1) the presence of obvious bony facial abnormalities on presentation, 2) bilateral or unilateral sinus disease on presentation, 3) the presence of asymmetrical disease on presentation, 4) the presence of bony extension on computed tomography scan, and 5) type of fungus present. RESULTS: Fifteen of 36 (42%) pediatric patients and 10 of 103 (10%) adult patients had obvious alteration of their facial skeleton (proptosis, telecanthus, or malar flattening) on presentation (P <.05). Proptosis was the most common facial abnormality in both groups and was seen more often in children (8 of 36 [22%]) than in adults (9 of 103 [9%]) (P <.05). Twenty-eight of 40 (70%) pediatric patients and 37 of 100 (37%) adult patients presented with unilateral sinus disease (P <.05). Thirty-five of 40 (88%) pediatric patients and 58 of 100 (58%) adults presented with asymmetrical disease (P <.05). Computed tomography scans showed that 10 of 40 (25%) pediatric patients and 23 of 100 (23%) adult patients had bony erosion with extension of disease into surrounding structures (P >.05). Cultures from both adults and children showed mainly Bipolaris and Curvularia species in equal amounts (P >.05). Adults had a greater incidence of Aspergillus species. CONCLUSIONS: Presentation in pediatric patients with allergic fungal sinusitis is different from that in adults, with children having obvious abnormalities of their facial skeleton, unilateral sinus disease, and asymmetrical disease more often. Findings on computed tomography scan show an equal amount of bony erosion with extension of disease. The types of fungus cultured in the sinus cavities are similar in both groups.
77Allergical fungal sinusitis with intracranial abscess--a case report and literature review. Chang CZ, Hwang SL, Howng SL. Kaohsiung J Med Sci. 1997 Nov;13(11):685-9.Fungus infection of the sinunasal tract usually follows a slow, nonaggressive course. With massive bone destruction or along the foramen of skullbase, the disease may extend outside the confines of the sinunasal tract even into intracranum, causing cerebral epidural, subdural and intracerebral abscess. Recently, allergic fungal sinusitis (AFS) has been a described disease entity, usually occurring in immunocomponent individuals. Early reports cited Aspergillus as the causative organism. It is now recognized that the dematiaceous fungi, including Bipolaris, Curvularia, Exserohilum, and Alternaria are associated with AFS. The disease typically follows a slow, mild course and does not invade tissue, although pressure in the sinus can eventually cause expansion and erosion of the sinus walls. We report a case who was presented with right facial swelling and numbness, right vision loss, right hearing loss as well as deficit in cranial nerve III, IV, V, VI. A gangrene was found in right upper concha. A biopsy was done and fungal hyphae was noted. The brain MRI revealed right temperal tip abscess; he was then transfered to our ward for further surgeical treatment. The pathological findings revealed Aspergillus. A new diagnostic entity, "skull base allergical fungal sinusitis" (SBAFS) as issued, could corporate the histological diagnostic criteria and the computed tomography of bone erosion in this case. Biopsy in the sinus and the brain is necessary to rule out fungus or tumor invasion. The awareness and cooperation between otolaryngologists, ophthalmologists, and neurosurgeons with the disease can avoid delayed diagnosis and promote early treatment.
78Allergic fungal sinusitis. Schwietz LA, Gourley DS. Allergy Proc. 1992 Jan-Feb;13(1):3-6.Allergic fungal sinusitis (AFS) is a noninvasive disease first described as a distinctive clinical and histopathologic entity more than 10 years ago. The typical patient is immunocompetent, atopic, has chronic sinusitis refractory to medical therapy, and 100% of those we have diagnosed have nasal polyps. Because of the histopathologic similarity to mucoid impaction of the bronchi seen in allergic bronchopulmonary aspergillosis, Aspergillus species were initially suspected as the causative agent. Subsequent reports include a number of non-Aspergillus-related cases. Both we and others have found a 7% incidence of AFS among chronic sinusitis patients requiring surgery. Relapse after surgical debridement and aeration is common and often responds to systemic corticosteroids. The diagnosis of AFS should be considered in all atopic patients with nasal polyps and chronic sinusitis. The clinical and histopathologic features of this disorder are reviewed.
79The occurrence and nature of alveolitis-inducing substances in Aspergillus clavatus. Blyth W. Clin Exp Immunol. 1978 May;32(2):272-82.Five groups of antigens were identified in culture filtrates and extracts from spores and mycelia of Aspergillus clavatus fractionated by gel filtration, affinity chromatography, electrophoresis in polyacrylamide gels and chemical analysis. Some particulate and soluble fractions given by nasal inoculation provoked murine allergic alveolitis in non-sensitized and sensitized precipitin-negative, and sensitized, precipitin-positive, animals. Alveolitis-inducing substances appeared to be glycoprotein precipitinogens, which withstood proteolysis, were preferentially adsorbed by concanavalin A, but which were rendered almost inert by sodium periodate oxidation. Spore walls were particularly rich in allergenic substances extractable by alkaline hydrolysis. Delipidated dead spores provoked more severe disease in all immunological groups of mice than live spores. Polysacchraride extracts and acid hydrolysates of spore walls were unreactive.
80Extrinsic allergic alveolitis in Scottish maltworkers. Grant IW, Blackadder ES, Greenberg M, Blyth W. Br Med J. 1976 Feb 28;1(6008):490-3.In a survey of respiratory disease in the Scottish malting industry 5.2% of employees were found to have symptoms of extrinsic allergic alveolitis. In most cases the disease was mild and not associated with any serious respiratory disability. It was significantly less common where modern mechanical methods of malting were used. Mycological and serological studies suggested that it was usually caused by a type 3 allergic reaction to Aspergillus clavatus.
81Fungal antigens as a source of sensitization and respiratory disease in Scottish maltworkers.Blyth W, Grant IW, Blackadder ES, Greenberg M. Clin Allergy. 1977 Nov;7(6):549-62.Mycological and serological studies were carried out as part of a survey of respiratory disease in Scottish maltworkers. 70% of stained sputum smears from 574 workers showed the presence of higher plant cells and/or myclelia, and the spores of common environmental fungi. Penicillium spp. (90%), Rhizopus stolonifer (48%) and yeasts (53%) were the dominant fungi in 699 sputum cultures, and showed a similar proportional distribution in 327 samples of grain, malt, culms and dusts from fifty-six maltings. 57% of 711 men were serologically positive for fungi, 22% for Aspergillus fumigatus, 20% for A. clavatus, 10% for A. niger, 16% for Cladosporium herbarum and over 3% for Rhizopus stolonifer, 6% of 132 men were positive for Penicillium cyclopium. No precipitating antibodies to antigens from Alternaria tenuis, Aureobasidium pullulans, Candida albicans, Geotrichum candidum, Rhodotorula glutinis or Trichoderma viride were detected in tests of forty sera. Sera from the 5.2% of men with symptoms of extrinsic allergic alveolitis showed increased reactivity to mycelial antigens from Aspergillus clavatus. The fungus was cultured from 21% of maltings, 7% of all environmental samples and from the sputa of 8% of maltworkers.
93Allergic fungal rhinosinusitis: report of 4 cases from Saudi Arabia. Fadl FA, Hassan KM, Faizuddin M. Saudi Med J. 2000 Jun;21(6):581-4.Allergic fungal rhinosinusitis is a newly recognized clinical entity of chronic rhinosinusitis. Over the past 3 years, 4 such patients were treated in our hospital. The clinical and pathological features of these 4 cases which merited the criteria for such diagnosis, are described. All the 4 cases had history of nasal polyps, asthma, or both with radiographical evidence of pansinusitis. Histologically, the thick greenish-brown inspissated material specimens which were collected and submitted to the laboratory showed, eosinophils, Charcot-Leyden crystals but no fungal elements were detected on routine hematoxylin and eosin sections and no tissue invasion was noted. However, scanty Aspergillus hyphae were detected on sections stained with silver. All 4 cases grew Aspergillus flavus only from the swabs and no other fungi were seen and all were treated by surgical debridement, aeration, oral itraconazole with no steroids.
94Characterization of a novel allergen, a major IgE-binding protein from Aspergillus flavus, as an alkaline serine protease. Yu CJ, Chiou SH, Lai WY, Chiang BL, Chow LP. Biochem Biophys Res Commun. 1999 Aug 11;261(3):669-75.Aspergillus species of fungi have been known to be one of the most prevalent aeroallergens. One important A. flavus allergen (Asp fl 1) was identified by means of immunoblotting with a serum pool of allergic patients on a two-dimensional electrophoretic gel. The cDNA coding for Asp fl 1 was cloned and sequenced. The clone encodes a full-length protein of 403 amino acid precursors of 42 kDa. After cleavage of a putative signal peptide of 21 amino acids and a prepeptide of 100 amino acids, a mature protein of 282 amino acids was obtained with a molecular mass of 33 kDa and a pI of 6.3. A degree of identity was found in a range of 27 to 84% among related allergens derived from bacteria allergen subtilisin, mold allergen Pen c 1, and virulence factor of A. fumigatus. Recombinant Asp fl 1 (rAsp fl 1) was cloned into vector pQE-30 and expressed in E. coli M15 as a histidine-tag fusion protein and purified to homogeneity. The IgE binding capacity of rAsp fl 1 was tested by immunoblotting using a serum pool of Aspergillus-allergic patients. Recombinant allergen cross-reacted strongly with IgE specific for natural Asp fl 1 and Pen c 1, indicating that common IgE epitopes may exist between allergens of A. flavus and P. citrinum.
95The importance of serine proteinases as aeroallergens associated with asthma. Shen HD, Tam MF, Chou H, Han SH. Int Arch Allergy Immunol. 1999 Aug;119(4):259-64.Penicillium and Aspergillus species have been identified as prevalent indoor airborne fungi that are associated with extrinsic bronchial asthma. We have recently analyzed the IgE-binding components in 8 prevalent Penicillium and Aspergillus species (P. citrinum, P. notatum, P. oxalicum, P. brevicompactum, A. fumigatus, A. flavus, A. oryzae and A. niger) by immunoblotting and N-terminal amino acid sequence analysis. Our results show that the alkaline and/or vacuolar serine proteinases are the major allergens in these prevalent fungal species. IgE cross-reactivity among these major allergens was also detected. Results obtained provide an important basis for clinical allergy. In addition, monoclonal antibodies against alkaline and/or vacuolar serine proteinase allergens have been generated. These antibodies can be applied for the standardization of allergenic extracts.
96Sensitization to different species of Aspergillus in bakery workers and general atopic population. Singh A, Prakash D, Singh AB. Asian Pac J Allergy Immunol. 1998 Mar;16(1):5-15.Six species of Aspergillus predominant in the bakery environment--Aspergillus flavus, A. fumigatus, A. nidulans, A. ochraceous, A. sydowi and A. versicolor--were studied for their role in causing Type 1 hypersensitivity among bakery workers and atopic patients from the general population (PGP). Antigenic extracts from the above species were prepared for in vivo and in vitro studies. The IEF, SDS-PAGE, skin test, ELISA and immunoblot techniques were performed to detect the biochemical- and clinico-immunological characteristics of these species. Among those tested, the important fungal sensitizers among the bakery workers and patients from the general population were A. sydowi, A. fumigatus, A. nidulans and A. ochraceous. The protein fractions of different species were in the acidic region (pI 3.0-6.5) and in the molecular weight range of 13.0-91.0 kDa. The protein fraction of 44.0 kDA of A. flavus and 20.0 and 70.0 kDa for A. fumigatus showed IgE binding in the sera of bakery workers only. Significantly, raised IgG antibodies to different species were recorded among the bakery workers as compared to the PGP group. The study showed that different species of Aspergillus are of potential allergenic significance in bakery workers and the general atopic population.
97Allergic fungal sinusitis: clinicopathological characteristics. Chhabra A, Handa KK, Chakrabarti A, Mann SB, Panda N. Mycoses. 1996 Nov-Dec;39(11-12):437-41.Allergic fungal sinusitis is a comparatively new disease entity in paranasal sinus mycoses. It is not a very rare condition, but diagnosis is difficult to establish. Of 28 consecutive cases of allergic nasal polyposis during a 2-year period, 11 patients had allergic fungal sinusitis and the diagnosis was based on the presence of type I hypersensitivity, eosinophilic mucus without tissue invasion of fungi on histopathology and detection of septate hyphae on direct microscopy. On culture, Aspergillus flavus was isolated from nine patients and A. fumigatus and A. niger from one patient each. Among patients with allergic fungal sinusitis, five had asthma, four had proptosis, of whom two had impaired vision, and all 11 patients had nasal obstruction. Eight patients described a history of recurrence. All patients underwent surgical clearance of the diseased sinuses and were given post-operative topical steroids to prevent recurrence.
125Sensitization to recombinant Aspergillus fumigatus allergens in allergic fungal sinusitis. McCann WA, Cromie M, Chandler F, Ford J, Dolen WK. Ann Allergy Asthma Immunol. 2002 Aug;89(2):203-8.BACKGROUND: Allergic bronchopulmonary mycosis is primarily caused by Aspergillus fumigatus. Despite similarities, allergic fungal sinusitis (AFS) is thought to be caused by various fungi. OBJECTIVE: Identify fungal elements in AFS allergic mucin and determine the prevalence of specific immunoglobulin (Ig)E to recombinant A. fumigatus allergens (rAsp) in AFS patients. METHODS: Allergic mucin from 17 definitive and 10 probable AFS patients were histologically examined for fungal elements. Sera from 18 definitive AFS patients, 10 probable AFS patients, 6 chronic sinusitis patients, and 5 A. fumigatus-allergic patients were tested for specific IgE to A. fumigatus and five rAsps. RESULTS: Ten of the 17 definitive cases had hyphae morphologically resembling Aspergillus or Fusarium spp. One probable AFS patient had similar findings. Of definitive patients, 94% (17 of 18) showed A. fumigatus-specific IgE (> or = 0.35 kUa/L), and 67% were positive to one or more rAsp. Four of 10 probable patients demonstrated A. fumigatus-specific IgE, and 2 had IgE to one or more rAsp. The definitive group had greater mean A. fumigatus IgE (P < 0.05) versus the probable and chronic sinusitis groups. The definitive group's rate of IgE to the rAsps was statistically greater. All definitive patients with Aspergillus or Fusarium spp. in situ had A. fumigatus-specific IgE, and 7 of 10 had IgE to at least one rAsp. CONCLUSIONS: Most definitive AFS patients have A. fumigatus-specific IgE and many have specific IgE to rAsps. Many also demonstrate Aspergillus spp. or Fusarium spp. in situ. Findings suggests that A. fumigatus is an important causative agent in AFS in the southeast United States.
127Fungal allergens from important allergenic fungi imperfecti. Cruz A, Saenz de Santamaría M, Martínez J, Martínez A, Guisantes J, Palacios R. Allergol Immunopathol (Madr). 1997 May-Jun;25(3):153-8.Occurrence of several fungal species in the environment seems to be related to hypersensitivity disorders in humans. Fungal allergen studies reported in the literature are reviewed regarding to Aspergillus, Alternaria, Penicillium and Cladosporium genera. In this paper, we study by means of in vivo (Skin Prick Test) and in vitro (RAST and immunoblotting) the classical question of the best source of allergenic material using a population of asthmatic patients sensitized to different mould genera. In Alternaria alternata, RAST values are considerably higher in metabolic extracts (culture filtrate) than in somatic ones (myceliar). In Alternaria alternata and Penicillium chrysogenum, low molecular weight allergens (< 30 kDa) show higher IgE-binding activity in culture filtrate extracts. In Aspergillus fumigatus we find some relevant allergens in the mycellium. Different fractions have also been used in skin tests and culture filtrate extracts showing higher potency than myceliar ones, what is in agreement with the former results. We found in Penicillium chrysogenum that the 67 kDa allergen, similar to what described by Shen et al (1991), showed inespecific binding to anti-IgE conjugate used in the development of the immunoblotting technique. Whether or not this component could be a major allergen is discussed. We discuss about the importance of the biology of fungi in the sensitization and development of mould allergy.
128Humoral and cell-mediated autoimmunity in allergy to Aspergillus fumigatus. Crameri R, Faith A, Hemmann S, Jaussi R, Ismail C, Menz G, Blaser K. J Exp Med. 1996 Jul 1;184(1):265-70.A cDNA encoding an allergenic protein was isolated from an Aspergillus fumigatus (A. fumigatus) cDNA library displayed on the surface of filamentous phage. Serum immunoglobulin E (IgE) from A. fumigatus-sensitized individuals was used to enrich phage-expressing gene products binding to IgE. One of the cDNAs encoded a 26.7-kD protein that was identified as a manganese superoxide dismutase (MnSOD) sharing 51.5% identity and 67.2% homology to the corresponding human enzyme. Both human and A. fumigatus MnSOD coding sequences were expressed in Escherichia coli as [His]6-tagged fusion proteins and purified by Ni(2+)-chelate affinity chromatography. The two recombinant MnSODs were both recognized by IgE antibodies from subjects allergic to the A. fumigatus MnSOD and elicited specific immediate type allergic skin reactions in these individuals. Moreover, both human and A. fumigatus MnSOD induced proliferation in peripheral blood mononuclear cells of A. fumigatus-allergic subjects who showed specific IgE responses and reacted in skin tests to MnSOD. These observations provide evidence for autoreactivity to the human MnSOD in allergic persons sensitized to an environmental allergen from A. fumigatus who share a high degree of sequence homology to the corresponding human enzyme.
129Environmental exposure to Aspergillus fumigatus allergen (Asp f I). Sporik RB, Arruda LK, Woodfolk J, Chapman MD, Platts-Mills TA. Clin Exp Allergy. 1993 Apr;23(4):326-31.Asp f I is a major allergen produced by the mycelia of Aspergillus fumigatus. It is not present in spores and can be used as a specific marker for the detection of germination of this fungus. We investigated the domestic and outdoor concentration of Asp f I in Poole, U.K. and Charlottesville, VA, U.S.A. Asp f I was undetectable in 95% (281/296) of house dust extracts and present at low levels (< 0.17 micrograms/g of sieved dust, mean 0.038 micrograms/g) in the remainder. In contrast, Asp fI could be detected in 65% (15/23) of cultures of house dust, suggesting the presence of viable, but ungerminated, A. fumigatus in the majority of homes. Asp f I was detectable in 80% (28/35) of extracts of leaves and compost, but present in these outdoor samples at low levels (< 0.11 micrograms/g, mean 0.27 micrograms/g). Air sampling for Asp f I was undertaken before and after vigorous disturbances at indoor (n = 5) and outdoor (n = 6) sites. Airborne Asp f I was not detected in domestic samples or in undisturbed outdoor samples. Following disturbance it could be measured in outdoor samples (range 7.6-29 ng/m3). The results suggest that while exposure to A. fumigatus is common, exposure to Asp f I and germinating A. fumigatus is uncommon. It is probable that those individuals who develop antibody responses to Asp f I have been exposed to A. fumigatus which has germinated in their respiratory tract.
130"Aspergillus fumigatus"--a pathogen and allergen. Frankland AW. Allergol Immunopathol (Madr). 1977 Nov-Dec;5(6):681-8.Aspergillus fumigatus is being increasingly recognised as causing various pathological conditions in man, animals and birds. In man the use of antibiotics has increased the importance of fungi in various clinical situations as opportunistic infective agents. In man, cavities in the lung are often (20 per cent) colonised by Aspergillus species, nearly always A. fumigatus. The mycetoma so formed can be specifically diagnosed by finding precipitating antibodies to A. fumigatus in the serum. In an asthma clinic, the findings of an immediate positive prick skin test to A. fumigatus, with or without precipitating antibodies to the fungus, confirms the diagnosis of pulmonary aspergillosis. These asthmatic patients develop transient lung infiltrations and proximal bronchiectasis, so that they eventually develop some degree of irreversible airways obstruction. Except for a small number of old patients, there are usually multiple positive type I skin responses to other inhalant allergens which will include other aspergilli species. Basically the complaint is a complication of allergic asthma. When first seen the patients often have treated with repeated courses of antibiotics for presumed infective asthma. Some of the findings in 86 asthmatic patients suffering from pulmonary aspergillosis will be presented.

Hypersensitivity pneumonitis of a mushroom worker due to Aspergillus glaucus. Yoshida K, Ando M, Ito K, Sakata T, Arima K, Araki S, Uchida K. Arch Environ Health. 1990 Jul-Aug; 45(4):245-7.

We present the first reported case of hypersensitivity pneumonitis (HP) due to Aspergillus glaucus in a mushroom worker. The Aspergillus glaucus group is one of the most popular storage fungi and a possible subsidiary etiologic agent of farmer's lung, but no case of hypersensitivity pneumonitis (HP) due to A. glaucus has been reported. This first case may demonstrate the etiologic role of A. glaucus in HP and in farmer's lung.
163Characterization of the Aspergillus nidulans aspnd1 gene demonstrates that the ASPND1 antigen, which it encodes, and several Aspergillus fumigatus immunodominant antigens belong to the same family. Calera JA, Ovejero MC, López-Medrano R, Segurado M, Puente P, Leal F. Infect Immun. 1997 Apr;65(4):1335-44.For the first time, an immunodominant Aspergillus nidulans antigen (ASPND1) consistently reactive with serum samples from aspergilloma patients has been purified and characterized, and its coding gene (aspnd1) has been cloned and sequenced. ASPND1 is a glycoprotein with four N-glycosidically-bound sugar chains (around 2.1 kDa each) which are not necessary for reactivity with immune human sera. The polypeptide part is synthesized as a 277-amino-acid precursor of 30.6 kDa that after cleavage of a putative signal peptide of 16 amino acids, affords a mature protein of 261 amino acids with a molecular mass of 29 kDa and a pI of 4.24 (as deduced from the sequence). The ASPND1 protein is 53.1% identical to the AspfII allergen from Aspergillus fumigatus and 48% identical to an unpublished Candida albicans antigen. All of the cysteine residues and most of the glycosylation sites are perfectly conserved in the three proteins, suggesting a similar but yet unknown function. Analysis of the primary structure of the ASPND1 coding gene (aspnd1) has allowed the establishment of a clear relationship between several previously reported A. fumigatus and A. nidulans immunodominant antigens.
173Occupational IgE sensitisation to phytase, a phosphatase derived from Aspergillus niger. Doekes G, Kamminga N, Helwegen L, Heederik D. Occup Environ Med. 1999 Jul;56(7):454-9.OBJECTIVE: Phytase is a phosphatase derived from Aspergillus niger that enhances phosphate bioavailability in the gut, and therefore has been increasingly used as an animal feed additive since the early 1990s. The aim of this study was to assess whether work related respiratory symptoms among workers in a so called premix factory producing animal feed additives, could be due to type I (mediated by immunoglobulin E (IgE) allergic sensitisation to phytase. METHODS: Preparations of specific IgE against phytase as used in the factory were assessed by enzyme immunoassay (EIA) in serum samples of 11 exposed workers who regularly handled the enzyme, in 11 office and laboratory workers of the same plant (non-exposed internal controls), and in 19 laboratory animal workers as external controls. The factory workers also completed a questionnaire on common and work related respiratory symptoms. RESULTS: Depending on the cut off level in the EIA for IgE, and the preparation used as coated allergen, antiphytase sensitisation was found in one to four of the 19 external controls, in one to five of the 11 internal controls, and in four to 10 of the 11 exposed workers. Strongest IgE reactions were found in four exposed workers who reported work related respiratory symptoms, particularly wheezing, and in one internal control who possibly had become sensitised because the structure of the factory building did not preclude airborne exposure in the offices and corridors of the plant. Experiments with inhibition EIA for IgE showed that (a) phytase of another commercial source was only partially cross reactive with phytase as used in the premix factory, and (b) phytase used as an animal feed additive did not cross react with common mould extracts, except for extracts from the species of origin, Aspergillus niger. The amount of IgE binding phytase in Aspergillus niger was estimated to be between 0.1% and 1% of the extractable mould proteins. CONCLUSIONS: Phytase is a potentially important new occupational allergen causing specific IgE immune responses among exposed workers. Such IgE sensitisation could probably be the cause of work related asthmatic and other respiratory symptoms if no effective measures are taken to prevent airborne occupational exposure at sites where phytase is handled, particularly during addition of enzyme preparations to animal feed.
174Allergic bronchopulmonary aspergillosis due to Aspergillus niger without bronchial asthma. Hoshino H, Tagaki S, Kon H, Shibusa T, Takabatake H, Fujita A, Sekine K, Abe S. Respiration. 1999;66(4):369-72.A 65-year-old woman was admitted to our hospital with a dry cough and pulmonary infiltrates. Chest radiograph and CT revealed mucoid impaction and consolidations. Peripheral blood eosinophilia and elevated serum IgE were observed. Aspergillus niger was cultured repeatedly from her sputum, but A. fumigatus was not detected. Immediate skin test and specific IgE (RAST) to Aspergillus antigen were positive. Precipitating antibodies were confirmed against A. niger antigen, but not against A. fumigatus antigen. She had no asthmatic symptoms, and showed no bronchial hyperreactivity to methacholine. Thus, this case was diagnosed as allergic bronchopulmonary aspergillosis (ABPA) without bronchial asthma due to A. niger, an organism rarely found in ABPA. The administration of prednisone improved the symptoms and corrected the abnormal laboratory findings.
175Allergic bronchopulmonary aspergillosis among asthmatics. Attapattu MC. Ceylon Med J. 1991 Jun;36(2):45-51.Allergic bronchopulmonary aspergillosis (ABPA), an immunologically mediated lung disease is now well recognised as a significant cause of chronic lung disease in the West. This study aimed at determining the extent of this entity in 540 patients with severe bronchial asthma and 96 patients with mild or moderate asthma. Of these 134 were subjected to detailed examinations in the form of a skin test, serological test, sputum examination and peripheral blood eosinophil count. Eight patients (1.2% of the total and 6% of selected patients) had evidence of ABPA. A further 50 patients (8% of total and 37% of selected patients) had evidence of allergy to the fungus as depicted by positive skin test reactivity. The latter patients could be either early ABPA or potential candidates for the development of ABPA later. Skin test sensitivity to both Aspergillus fumigatus and A niger were demonstrated in Sri-Lankan asthmatics. Skin test sensitivity could be considered a screening test for the diagnosis of ABPA. A scheme for the diagnosis of ABPA using simple criteria could be devised keeping in mind the cost and availability of tests.
176A case of probable allergic bronchopulmonary aspergillosis due to Aspergillus niger] Shimada T, Matsumura K. Nihon Kyobu Shikkan Gakkai Zasshi. 1995 Mar;33(3):336-41.We report a case of probable allergic bronchopulmonary aspergillosis (ABPA) due to Aspergillus niger. An 80-year-old woman was admitted to our hospital because of wheezing, expectoration of a mucous plug and atelectasis of the right lower lobe as seen on a chest X-ray film. The patient had eosinophilia and immediate wheal-and-flare skin reactivity to A. fumigatus. Serum precipitating antibodies against A. niger and elevated serum IgE, however, were absent. Mucus impaction and bronchiectasis were revealed by both bronchoscopy and CT scanning. The mucous plug contained A. niger, numerous eosinophils and Charcot-Leyden crystals. Corticosteroid therapy ameliorated the symptoms and abnormal laboratory findings. Therefore, this was a rare, informative case of probable ABPA due to A. niger associated with a normal level of serum IgE and negative precipitation antibodies against A. niger antigen.
177Hilar adenopathy in allergic bronchopulmonary aspergillosis. Ann Allergy Asthma Immunol. 1999 May;82(5):504-6.BACKGROUND: A 20-year-old male student developed allergic bronchopulmonary aspergillosis (ABPA). Computed tomography (CT) of the thorax done to detect central bronchiectasis (CB) for confirmation of diagnosis revealed, in addition, right hilar lymphadenopathy. Hilar adenopathy is thought to be rare in ABPA and has been documented only once before. Because of the finding of hilar adenopathy, the earlier reported patient had to undergo an invasive surgical procedure. OBJECTIVE: To report a case of true hilar adenopathy in ABPA. METHODS: This is a single case report. Contrast enhanced CT of the thorax was done. Serum precipitating antibodies against Aspergillus fumigatus were tested using gel diffusion technique, and intradermal testing with antigens of Aspergillus species was performed. Specific IgG antibodies against A. fumigatus and total IgE levels were measured by ELISA. RESULTS: A review of serial chest radiographs over a period of 3 years demonstrated transient pulmonary infiltrates and right hilar prominence. Computed tomography of the thorax revealed right hilar lymphadenopathy along with bilateral central bronchiectasis and patchy infiltrates. Strong bands of precipitins were detected against A. fumigatus. Intradermal testing with antigens of Aspergillus species elicited strong type I (immediate) and type III (Arthus-type) hypersensitivity reactions to A. fumigatus and A. niger. Specific IgG antibodies against A. fumigatus was positive and total IgE level was significantly elevated. Peripheral blood eosinophilia was also detected. CONCLUSIONS: Although extremely rare, ABPA should be considered in the differential diagnosis of hilar adenopathy.
192Allergic bronchopulmonary aspergillosis caused by Aspergillus ochraceus. Novey HS, Wells ID. Am J Clin Pathol. 1978 Nov;70(5):840-3.A case with the characteristics of allergic bronchopulmonary aspergillosis is described. The species of Aspergillus involved, A. ochraceus, has not previously been found in this disorder. The organism had antigenic properties distinct from five other species of Aspergillus most commonly associated with allergic bronchopulmonary aspergillosis. The patient had immediate skin test, immunodiffusion, and radioallergosorbent reactivity to the species. Four per cent of 112 serum samples from others suspected of having allergic bronchopulmonary aspergillosis had precipitins to A. ochraceus only. It may be necessary in some cases to prepare and test extracts of the patient's Aspergillus isolate in order to confirm the diagnosis.
199Fungal allergy -clinical aspect-] Akiyama K. Nippon Ishinkin Gakkai Zasshi. 2001;42(3):109-11.Fungus is known to be one of the important causative allergens of allergic diseases such as bronchial asthma, allergic rhinitis and atopic dermatitis. Not only outdoor airborne fungi but also indoor fungi such as Aspergillus restrictus and Eurotium have recently received attention as causative fungal allergens of allergic diseases. In addition to careful history taking, in vivo testing methods such as skin test and conjunctival or bronchial provocation tests are sometimes necessary to diagnose the causative allergen. Problems requiring resolution are: 1. fungal allergens composed of multiple allergenic components, 2. difficulty of environmental monitoring of fungal allergens, 3. special characteristics as microorganisms, and 4. characteristics of normal flora allergy, etc.
200[The role of fungal allergy in bronchial asthma]. Akiyama K. Nippon Ishinkin Gakkai Zasshi. 2000;41(3):149-55.Fungus is known to be one of the causative allergens inducing bronchial asthma as are housedustmites, pollen and pet dander. Outdoor airborne fungi such as Cladosporium, Alternaria, Penicillium and Aspergillus are important inducing IgE antibody formation. In addition to these common fungi, the indoor fungi Aspergillus restrictus, Neurospora and Eurotium are important allergenic fungi which have recently been identified. The yeast Candida albicans, is a common commensal of the human oral and vaginal mucosae and gastrointestinal tract and part of the normal flora, is known as one of the main allergens causing bronchial asthma. We examined the allergenicity of mannan (Mn) as a cell-wall constituent and acid protease (CAAP) as a secreted enzyme of C. albicans. We previously reported cases of atopic asthma caused by CAAP and stressed the role of CAAP as an important allergen in mucosal allergy to C. albicans 9). The levels of the antibodies to these antigens in the sera of asthmatic patients who showed positive immediate intradermal response to crude C. albicans (n=86) were measured. Anti-Mn IgE and IgG antibody levels were measured by liquid-phase assay (AlaSTAT). Anti-CAAP and anti-crude C. albicans IgE and IgG antibody levels were measured by RAST and AlaSTAT. Anti-Mn A and anti-Mn B IgE antibody titers were strongly correlated (r=0.87), while anti-Mn A and anti-CAAP IgE titers were not correlated. However, all of the anti-Mn A IgE positive sera and all of the anti-CAAP IgE positive sera were positive for IgE to crude-C. albicans. This indicates that both Mn and CAAP are C. albicans-related allergens. Titers of IgG antibodies to Mn A and crude C. albicans were highly correlated (r=0. 90). Results of inhibition assays performed using other fungal antigens as inhibitors showed that Mn is a cross reactive allergen among different fungi and that CAAP is a C. albicans specific allergen causing human mucosal allergic reaction.
201[Allergenicity of the osmophilic fungus Aspergillus restrictus evaluated by skin prick test and radioallergosorbent test] Sakamoto T, Ito K, Yamada M, Iguchi H, Ueda M, Matsuda Y, Torii S.
Arerugi. 1990 Nov;39(11):1492-8.
Recently large amounts of Aspergillus restrictus, a species of osmophilic fungi, have been detected in house dust using culture media with low water activity. But little attention has been paid to this fungus as an allergen. In the present study, the authors examined the allergenic activity of A. restrictus by skin prick tests and radioallergosorbent tests (RAST) on 94 asthmatic patients (mean age 12.0, range 3-18). Aspergillus fumigatus, Alternaria alternata and house dust were used for comparison. In the skin prick tests, A. restrictus, A. fumigatus, A. alternata and house dust elicited positive reactions in 8 (8.5%), 8 (8.5%), 15 (16.0%) and 69 (73.4%) patients, respectively. RAST showed positive reactions in 27 (28.7%) subjects for A. restrictus, 22 (23.4%) for A. fumigatus, 35 (37.2%) for A. alternata, and 75 (79.8%) for house dust. These results indicated that some asthmatic individuals showed immediate-type hypersensitivity to A. restrictus, and the prevalence of hypersensitivity of A. restrictus determined by skin prick tests and RAST was comparable with that of A. fumigatus but lower than that of A. alternata or house dust. This indicates that this fungal species may be of importance as a causative agent in atopic diseases.
210[A case of allergic bronchopulmonary aspergillosis caused by Aspergillus terreus]. Oshima M, Soda H, Oda H, Watanabe A. Nihon Kyobu Shikkan Gakkai Zasshi. 1997 Dec;35(12):1418-24.A 66-year-old woman was admitted to our hospital with a cough, wheezing, and expectoration. Chest X-ray and CT scanning revealed atelectasis and infiltration of the middle lobe, but no central bronchiectatic change. The patient had eosinophilic infiltration elevated serum IgE, RAST against Aspergillus )(A.) fumigatus, a positive immediate skin reaction, and a positive test for antibodies against A. funmigatus. Bronchoscopy demonstrated mucoid impaction that plugged the middle lobe bronchus. The mucoid plug contained A. terreus and numerous eosinophils. Because the level of the precipitating antibody for counter immunoelectrophoresis against A. terreus was higher than that at A. fumigatus, allergic bronchopulmonary aspergillus caused be A. terreus was diagnosed. Oral and inhalation therapy of corticosteroids ameliorated the symptoms and abnormal laboratory findings.
211 Allergic bronchopulmonary aspergillosis caused by Aspergillus terreus presenting lobar collapse. Nakahara Y, Katoh O, Yamada H, Sumida I, Hanada M. Intern Med. 1992 Jan;31(1):140-2.A case of allergic bronchopulmonary aspergillosis (ABPA) is described which presents left upper lobe collapse caused by Aspergillus terreus, an organism rarely found in ABPA. It is unusual for initial radiographic findings of ABPA to include extensive collapse.
212 Allergic bronchopulmonary aspergillosis caused by Aspergillus terreus. Vincken W, Schandevul W, Roels P. Am Rev Respir Dis. 1983 Mar;127(3):388-9. 
213Allergic bronchopulmonary aspergillosis (ABPA) caused by Aspergillus terreus: specific lymphocyte sensitization and antigen-directed serum opsonic activity. Laham MN, Allen RC, Greene JC. Ann Allergy. 1981 Feb;46(2):74-80.A 16-year-old male presented with a history of asthma and recurrent pneumonia. A diagnosis of ABPA was based upon the typical clinical presentation, peripheral eosinophilia, elevated IgE and positive immediate skin tests to Aspergillus. Sputum cultures grew A. terreus, a rare cause of human disease. Soluble and particulate antigens were prepared from this organism. Precipitins against A. terreus, but not against A. fumigatus, were detected in the patient's serum. His lymphocytes proliferated markedly in vitro when exposed to soluble A. terreus but not A. fumigatus antigen. The lymphocyte responses correlated with disease activity. Functional serum opsonic activity was measured using the technique of stimulated polymorphonuclear leucocyte chemiluminescence. The nonspecific opsonic activity of the patient's serum was within high normal range when zymosan was employed as an alternative pathway activator. Specific opsonic activity against particulate Aspergillus antigen was significantly increased in the patient's serum when compared with control sera. Despite the presence of specific antibody and opsonic activity against A. terreus, the patient's serum levels of C3, C4, and total hemolytic complement were normal. These findings are consistent with in vivo sequestration of the organism.
231Common environmental allergens causing respiratory allergy in India. Singh AB, Kumar P.
Indian J Pediatr. 2002 Mar;69(3):245-50.
Respiratory allergy affects all age groups but the children are the worst affected by the respiratory allergy. Bioparticles from different biological sources are the main cause of allergy. Pollen grains, fungal spores, insect and other materials of biological origin form the most important allergen load in the air. For the efficient diagnosis of the allergy and its effective treatment it is very important to know about the prevalence, seasonal and annual variations of aeroallergens of the area. India being the climatically diversed country, there is diversity in the flora and fauna of different parts of the country. Atmospheric surveys carried out in different parts of India reveal that, Alanus nitida, Amarantus spinosus, Argemone mexicana Cocos nucifera, Betula utilis, Borasus flabellifer, Caraica papaya, Cedrus deodara, Cassia fistula, Parthenium, Chenopodium album, Dodonaea viscosa, Malotus phillipensis, Plantago ovata, Prosopis juliflora, Ricinus communis, Holoptelea intergifolia are the allergenically important pollens of the country. Among the fungal aeroallergens, Alternaria, Candida albicans, Aspergillus versicolor, Aspergillus terreus, Aspergillus japonicus, Cladosporium cladosporoides, Fusarium roseum, Ganoderma lucidum, Neurospora sitophila, Helminthosporium, Ustilago trtici, Uromyses are important allergens. Dust mites D. farinae, D.pteronyssinus are also important source of inhalant allergens particularly in the coastal areas of the country. Cockroaches, beetles, weevils, mosquitoes, house flies also contribute towards the aeroallergen load and are allergenically implicated. Avoidance of the indoor and outdoor aeroallergens is recommended for better management of respiratory allergy.
232Allergic respiratory disease and fungal remediation in a building in a subtropical climate.Jarvis JQ, Morey PR. Appl Occup Environ Hyg. 2001 Mar;16(3):380-8.An outbreak of allergic respiratory disease occurred in a new building that was characterized from initial occupancy by the presence of extensive visible mold (especially Aspergillus versicolor) on interior surfaces. Epidemiological study of the occupants of both the affected building and a comparison neighboring structure indicated high rates of respiratory and other symptoms among persons working in the affected building. Subsequent clinical evaluations of some persons occupying the building for up to five years identified several cases of building-related allergic respiratory disease, including asthma and hypersensitivity pneumonitis. Based on these findings, the building was evacuated before remediation began. The mycological goal of the three-year building restoration project was to reduce concentration of non-phylloplane fungi such as A. versicolor to the lowest feasible level. All visibly colonized materials in the building were discarded and all fine dust on interior surfaces was removed by vacuuming and/or damp wiping. A medical surveillance program utilizing serial self-reported questionnaires and readily available clinical evaluations was designed to monitor the health of building occupants after re-entry. Symptom rates just prior to building reentry were substantially lower than those found before evacuation and have remained unchanged after re-occupancy was completed. No new or recrudescent cases of illness are known to have occurred after building re-entry.
251[A boy highly suspected of hypersensitivity pneumonitis characterized by generalized mucosal lesions]Wada Y, Kitajima H, Kubo M. Nihon Rinsho Meneki Gakkai Kaishi. 1996 Oct;19(5):524-36.The case is a boy who developed progressive dyspnea and had since been followed over a long period time as a case of unknown fever without respiratory symptoms. He showed mucosal symptoms such as intraoral aphtha, eosinophilic pyuria and diarrhea and was clinically diagnosed as hypersensitivity pneumonitis. The affected child showed high levels of circulating immune complex, a decline in DLco on the respiratory function test and a decrease in CD 4/8 in bronchoalveolar lavage lymphocytes; furthermore, an antibody specific to Aureobasidium pullulans was positive in the precipitated antibody test. As for the immune function of the affected child during the follow-up, hypergammaglobulinemia and various immune abnormalities were observed. We thought the clinical feature of the affected child to be of pathophysiological value in dealing with unknown fever in childhood, so we reported our findings in this paper.
252[Role of fungi in house dust allergy in patients with bronchial asthma] Kosiński SW, Pałczyński C, Rozniecki J. Pneumonol Pol. 1989 Jun;57(6):351-6.The aim of the study was to evaluate the contribution of skin hyperreactivity to fungi in patients with bronchial asthma and demonstrating skin sensitivity to house dust. In 50 patients skin tests with 24 allergen solutions of fungi found most often in house dust. Positive skin tests were found in 92% of the evaluated patients. Reactions to fungi allergens were seen more often than to Dermatophagoides pteronyssimus. Most often skin reactivity toward the following fungal allergens were seen: Candida albicans, Aspergillus fumigatus, Fusarium culmorum and Aureobasidium pullulans. It seems that skin hypersensitivity to fungi is very common in patients with bronchial asthma and sensitive to house dust. Clinical verification of this hypersensitivity should be studied further.
253Allergic alveolitis as a result of mold on the bedroom wall] Török M, de Weck AL, Scherrer M. Schweiz Med Wochenschr. 1981 Jun 20;111(25):924-9.A 23-year-old woman patient became seriously ill with the typical signs and symptoms of allergic alveolitis and with deep hypoxemia during exercise. A broad spectrum of positive precipitating antibodies was found in the serum, mainly against Penicillium casei and Aureobasidium pullulans. Although she was intensively questioned on hobbies and on possible antigens at home and at work, it was only possible to trace an antigen source after a controlled antigen free period away from home in another environment and after a controlled reexposure experiment at home: it proved to be a patch of mould of 0.5 m2 on the bedroom wall. The filaments and the spores of the fungi of the mould were shown directly by microscope. Precipitating antibodies were also present against these fungi. After several antigen-free months (the patient moved into a dry and sunny new apartment) the threatening respiratory failure (severe hypoxemia during exercise) disappeared completely together with the clinical signs and symptoms. Thus, mould on bedroom walls may constitute a threat and should be considered in cases of allergic alveolitis of apparently unknown origin.
254[Mould allergy (author's transl)].Kersten W, Hoek GT. Wien Med Wochenschr. 1980 Apr 30;130(8):275-82.290 asthmatic patients with positive skin tests for mould allergens were analyzed retrospectively. The relationship between skin test and inhalative provocation test was investigated with regard to single allergens and polyvalent mould sensitivity. With 4 commercially available moulds the relationship between skin test, provocation test and RAST was investigated too. Alternaria alternata occupies a special position. Tests with Alternaria alternata, Aureobasidium pullulans, Penicillium notatum, Fusarium culmorum, Aspergilus fumigatus and Cladosporium herbarum showed the highest correlation correlation with clinical allergy. Allergic asthmatic patients are in about 10% sensitive for moulds. Penicillia tend to crossreaction; for other moulds no preferential combinations were found. Provocative inhalation tests have to be performed, if mould sensitivity is suspected. At present the results of RAST are mostly of no decisive diagnostic value.
255Outbreak of hypersensitivity pneumonitis in an industrial setting. Woodard ED, Friedlander B, Lesher RJ, Font W, Kinsey R, Hearne FT. JAMA. 1988 Apr 1;259(13):1965-9.Symptoms consistent with hypersensitivity pneumonitis developed in several workers in two multistory buildings in an industrial complex. A health questionnaire survey was conducted to determine the extent of the problem. Eighty-seven percent of the population of 1050 employees completed the health questionnaire. Serological testing identified 152 positive precipitin reactors to the fungus Aureobasidium pullulans; 115 reactors were symptomatic. The clinical and laboratory features at the time of the acute illness and during four years of follow-up are described. The agent, A pullulans, was identified as a contaminant of the heating-cooling ventilation units containing open waterspray chambers. Control was accomplished by replacement of the ventilation systems. A secondary source of antigen was found to be corrugated cardboard. Some sensitized employees required removal from work exposure to corrugated cardboard to prevent recurrent symptoms.
274Volumetric aerobiological survey of conidial fungi in the North-East Netherlands. II. Comparison of aerobiological data and skin tests with mould extracts in an asthmatic population. Beaumont F, Kauffman HF, de Monchy JG, Sluiter HJ, de Vries K. Allergy. 1985 Apr;40(3):181-6.A study was undertaken to see whether the principal airborne fungi in the North-East Netherlands were also found to be the most reactive in skin testing. Atmospheric samples were taken weekly with the Andersen sampler, from April 1981, up to and including, June 1983. At the same time skin tests of 833 patients referred to the outpatient Departments of Pulmonology and Allergology, because of recurrent bronchial obstructive complaints and a suspected allergy, were studied for strongly positive skin reactivity to fungi. 4.6% of the patients reacted with a wheal of 10 mm diameter or more to one or more of the tested fungi. Almost three-quarters of the airborne fungal "flora" was composed of seven genera, namely (in order of occurrence): Cladosporium (42.6%), Botrytis (8.6%), Yeasts (7%), Penicillium (5.8%), Basidiomycetes (5.7%), Aspergillus (3.7%), and Alternaria (0.9%). In skin-testing, however, a different order of occurrence existed: namely: Beauveria (6.8%), Botrytis (6.1%), Aspergillus (4.7%), Mucor (3.8%), Epicoccum (3%), Cladosporium (2.3%), and Alternaria (1.1%). It is concluded that the most prevailing airborne moulds are not necessarily the most potent allergens, at least in skin testing. Aspergillus and Botrytis showed a high sensitization rate, while Cladosporium and Alternaria did not. Botrytis deserves further study because of its frequent airborne occurrence and marked allergenic properties.
275Experimental study on farmer's lung-like lesions caused by Beauveria bassiana] Song JY. Zhonghua Bing Li Xue Za Zhi. 1989 Jun;18(2):111-4.113 lung specimens from rats and mice were observed under both LM and TEM, after inhalation of gonidiospores of Beauveria bassiana for 18 months 78.8% of the 113 cases developed chronic interstitial pneumonia (IP). There were desquamative pneumonitis mainly with macrophage; granuloma with multinucleate giant cells or fibrosis, and localized pulmonary edema. These lesions were firstly described to be caused by the spores here. It was considered that IF lesions might be related to types III, IV hypersensitivity reaction. The authors emphasized that these lesions might be similar to those observed in farmer's lung or extrinsic allergic alveolitis (EAA).
280Allergens of Bipolaris species. Lim SH, Chew FT, Sim SM, Huang YT, Goh DY, Tan HT, Tan TK, Lee BW. Asian Pac J Allergy Immunol. 1995 Dec;13(2):101-5Skin prick tests done previously revealed a significantly higher percentage of sensitization to an extract of Bipolaris sp. among atopic individuals (34/147, 23.1%) compared to non-atopic individuals. Bipolaris-specific IgE levels were quantified in sera from a representative group of 38 individuals using the Fluorescence Allergosorbent Test (FAST). Result obtained by FAST were found to be comparable to the skin prick test results (r2 = 0.60, p < 0.001 for IgE levels vs wheal sizes; r2 = 0.44, p < 0.001 for IgE levels vs erythema sizes). Characterisation of the extract's allergenic component by sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE) showed 28 protein bands with molecular weights (MW) ranging from 11 kDa to above 100 kDa. Immunoblotting with sera of 10 Bipolaris-sensitive (skin prick test, 3 +) individuals showed that Bipolaris spore extract contained at least 4 IgE binding proteins (MW 11-13 kDa, 16-17 kDa, 20-22 kDa and 36 kDa). All 10 sera reacted to the protein at MW 20-22 kDa, 2 sera with MW 11-13 kDa, 3 sera with 16-17 kDa and 6 sera with 36 kDa. This study has thus demonstrated that spores of Bipolaris sp. contain allergenic components which may elicit IgE-mediated reactions.
281Allergic bronchopulmonary disease caused by Bipolaris hawaiiensis presenting as a necrotizing pneumonia: case report and review of literature. Saenz RE, Brown WD, Sanders CV.
Am J Med Sci. 2001 Mar;321(3):209-12.
We report a case of allergic bronchopulmonary disease caused by Bipolaris hawaiisensis in an immunocompetent host, presenting with symptoms and radiographic findings suggestive of necrotizing pneumonia. Cultures of the plugs and bronchial washing yielded the pathogenic fungi. Laboratory tests revealed eosinophilia and elevation of serum IgE. This patient was successfully treated with steroids, amphotericin B lipid complex, and itraconazole. Review of 10 previously reported cases and their clinical manifestations and treatment are presented.
282Allergic fungal sinusitis in the southeastern USA: involvement of a new agent Epicoccum nigrum Ehrenb. ex Schlecht. 1824. Noble JA, Crow SA, Ahearn DG, Kuhn FA. J Med Vet Mycol. 1997 Nov-Dec;35(6):405-9.Alternaria alternata, Aspergillus spp., Bipolaris spicifera, Curvularia lunata, Epicoccum nigrum and Fusarium solani were isolated repeatedly from groups of patients among 96 diagnosed with allergic fungal sinusitis (AFS). Epicoccum nigrum was obtained consistently from four patients, one of whom yielded mycelial masses consistent in morphology with E. nigrum. Fifteen of the predominant fungi recovered from air samples from selected patients' residences included the same species isolated from the mucin of its inhabitants. Air samples from other buildings, whose occupants (non-AFS individuals) complained of poor indoor air quality or of symptoms of the sick building syndrome (SBS), yielded some of the same species involved in AFS. An association of SBS with AFS was not established. Eight of the species implicated in AFS were found to colonize the surfaces of indoor construction and finishing materials at sites other than the residence of the patient. To our knowledge, this is the first report that E. nigrum can colonize nasal sinuses and cause AFS.
283Allergic fungal sinusitis: a clinicopathologic study of 16 cases. Torres C, Ro JY, el-Naggar AK, Sim SJ, Weber RS, Ayala AG. Hum Pathol. 1996 Aug;27(8):793-9.Allergic fungal sinusitis (AFS) has been clinicopathologically defined as a noninvasive form of fungal infection. Etiologically, most reported cases have been attributed to pigmented dematiaceous fungi. The authors report 16 cases of AFS from our institution, along with a review of cases from the literature. The patients' age ranged from 8 to 71 years, with a mean age of 25 years. All patients were immunocompetent, although six had a strong history of atopy. Multiple sinuses were affected in all cases; nine patients had bilateral involvement, and seven patients manifested unilateral involvement. Histopathologically, all cases were characterized by the presence of "allergic mucin," with scattered fungal organisms without invasion of mucosa or bone. Fontana-Masson stain identified fungi in all but one case and assisted in distinguishing the pigmented dematiaceous organisms from other septated fungal forms. Accordingly, Fontana-Masson stain can be useful in confirming the diagnosis of AFS in the lack of tissue culture results. Fungal cultures performed on six cases grew Exserohilum (three cases), Bipolaris (one case), Drechslera (Bipolaris) (one case), and Curvularia (one case). All patients were treated with surgical debridement and sinus aeration. Follow-up of at least 6 months was obtained in six cases, of which four showed recurrent disease between 8 months and 4 years after the initial surgical procedure. A literature review showed that the most common etiologic agents were members of the dematiaceous family (81%), with the most common genus being Bipolaris (42%), followed by Curvularia (21.3%). It is believed that type I and III hypersensitivity reactions underlie the pathogenesis of this disease.
284Allergic bronchopulmonary fungal disease caused by Bipolaris and Curvularia. Lake FR, Froudist JH, McAleer R, Gillon RL, Tribe AE, Thompson PJ. Aust N Z J Med. 1991 Dec;21(6):871-4.Allergic bronchopulmonary fungal disease (ABPFD) usually manifests in asthmatics as allergic bronchopulmonary aspergillosis. In a few instances other fungi have been implicated. Serological testing in Western Australia between 1979 and 1986 revealed precipitins to Bipolaris and Curvularia species in 40 of 503 patients tested. Eight of these were patients with ABPFD due to Bipolaris and/or Curvularia and are reported here. Geographical location appeared to be significant as seven of eight of those with ABPFD (and at least 18 of 40 with positive serology) were living in the more remote and sub-tropical northern part of the state. ABPFD due to fungi other than Aspergillus species may be more common than previously recognised and further epidemiological assessment is warranted.
285Allergic fungal sinusitis. Report of three cases associated with dematiaceous fungi. Friedman GC, Hartwick RW, Ro JY, Saleh GY, Tarrand JJ, Ayala AG. Am J Clin Pathol. 1991 Sep;96(3):368-72Most reported cases of allergic sinusitis have been attributed to Aspergillus, based on the morphologic features of the organisms in tissue sections. However, in most cases, cultures have not been done. This is a report of three cases of non-Aspergillus allergic fungal sinusitis. The patients' ages were 11, 16, and 43; two were male and one was female. Histopathologic study disclosed fungal organisms resembling Aspergillus. However, cultures of these patients' nasal secretions grew Drechslera, Exserohilum, and Bipolaris fungal organisms. The non-Aspergillus nature of these infections was further supported by positive Fontana-Masson melanin staining. The authors conclude that allergic fungal sinusitis most likely results from non- Aspergillus organisms. For definitive fungal identification, tissue culture is mandatory. When tissue is not cultured or no organisms grow, a Fontana-Masson stain can be a useful adjunct in fungal identification.
286Culture-positive allergic fungal sinusitis. Manning SC, Schaefer SD, Close LG, Vuitch F. Arch Otolaryngol Head Neck Surg. 1991 Feb;117(2):174-8.Allergic Aspergillus sinusitis is a well-defined clinical and histologic entity, although surprisingly few reported cases have yielded any fungal growth on culture. Taking advantage of recent changes in the identification and classification of certain groups of fungi, we were able to identify a specific fungal organism in 19 of 22 consecutive patients with a histologic diagnosis of allergic fungal sinusitis over the past 2 1/2 years. Aspergillus was found in only one patient, while an organism in the family of dematiaceous fungi was found in 18 patients. Of these patients, the genus Bipolaris was the most commonly represented, while Exserohilum, Curvularia, and Alternaria species were seen with less frequency. Thus, it appears that Aspergillus may not be the most common etiologic agent in allergic "Aspergillus" sinusitis. Allergic fungal sinusitis is not unusual and its incidence may be increasing. On initial clinical evaluation it may be easily mistaken for malignancy or invasive fungal disease with the potential for overly aggressive treatment. Preoperative suspicion of allergic fungal sinusitis based on clinical and roentgenographic findings along with careful communication with the mycology laboratory about the possibility of dematiaceous fungal growth are necessary for proper diagnosis.
341Aeroallergen sensitivity of Thai patients with allergic rhinitis. Pumhirun P, Towiwat P, Mahakit P. Asian Pac J Allergy Immunol. 1997 Dec;15(4):183-5.The aim of this study was to determine the aeroallergen sensitivity of allergic rhinitis patients. A total of 100 cases (female: 59, male: 41, aged between 10-59 years, mean age 27.9 years) who were diagnosed with allergic rhinitis by history and clinical presentation, underwent a prick skin test with 30 aeroallergens, and the important sensitizing allergens were assessed. Skin test reactivity showing > or = 3 mm wheal with erythema as the positive skin test, was recorded. The results of patients with positive skin tests follow. TREES: acacia 19%, mango 16%, coconut 12%. GRASSES: bermuda 17%, johnson 21%, timothy 16%, bahia 16% orchard 18%. WEEDS: pigweed 16%, kochia 14%. MOLDS: alternaria 11%, cladosporium 11%, aspergillus 12%, penicillium 16%, helminthosporium 16%, botrytis 15%, rhodotorula 20%, fusarium 26%, curvularia 26%, smut mix 11%, rust 9%. EPIDERMALS: cat 29%, dog 28%, feathers 37%. INDOOR ALLERGENS: house dust 72%, D. pteronyssinus 76%, D. farinae 79%, American cockroach 60%, German cockroach 41%, kapok 30%. Eighty-five percent of patients sensitive to house dust mites were positive to both D. pteronyssinus and D. farinae, indicating substantial cross-reactivity. The study shows that the house dust mite and the cockroach are important aeroallergen sensitizers among the Thai population, since more than half the patients were skin-test positive to the house dust mite and the cockroach.
342Specific IgE antibodies to 16 widespread mold genera in patients with suspected mold allergy. Karlsson-Borgå A, Jonsson P, Rolfsen W. Ann Allergy. 1989 Dec;63(6 Pt 1):521-6.A panel of 55 sera from patients with suspected mold allergy from two different geographic areas, A and B, was investigated for specific IgE antibodies to 16 individual molds using Phadebas RAST technique. The molds investigated were Alternaria, Cladosporium, Aspergillus, Penicillium, Mucor, and Candida from the former RAST panel and ten additional new mold genera. The RAST screening revealed that 73% of patients had specific IgE antibodies to at least one of the 16 molds. Eighteen percent were negative to the six molds of the previous RAST panel but had specific IgE antibodies to at least one of the ten new molds. The highest frequency of IgE antibodies in the A group could be assigned to Cladosporium, followed by Botrytis and Helminthosporium. In group B, sensitivity to Botrytis and Phoma showed the highest frequencies. This study revealed that the relative importance of mold genera may vary greatly between patient groups from different geographic areas. Some of the species of the expanded RAST panel seem to be at least as important as Alternaria and Cladosporium. Multiple sensitivities seem to be caused by sensitization by many mold species rather than by cross-reactivity.
343[Determination of specific IgE against 16 widespread mould genera. Improvement of the efficacy of the diagnosis of allergy to moulds] Jonsson P, Rolfsen W, Yman L. Allerg Immunol (Paris). 1987 Dec;19(10):407-9.Serum samples from 55 Scandinavian and US patients with a clinical history of mould allergy were screened for specific IgE Ab against 16 different moulds, the 6 mould in the Phadebas RAST panel and 10 new moulds. The studies were performed using RAST-based techniques and the nitrocellulose immunoblotting method. The RAST screening of the patient panel, revealed that 42 patients (76%) had specific IgE to at least one of the 16 moulds. The two most frequent moulds were Rhizopus and Botrytis positive in 29 patients (53%) and 27 patients (42%), respectively. Top three in terms of frequency in the US patient group were: Rhizopus greater than Botrytis greater than Phoma and in the Scandinavian group: Cladosporium greater than Botrytis greater than Helminthosporium. 15 patients (27%) were negative against the moulds in the Phadebas RAST panel, but had specific IgE against one or more of the 10 new moulds. IgE Ab concentrations measured with different genera showed different degrees of positive concordance, e.g. Botrytis-Helminthosporium (79%) and Alternaria-Rhizopus (38%), indicating complex patterns of crossreacting and genus specific allergens. This was confirmed by immunoblotting with 22 (greater than 1 PRU/ml) of the 55 sera showing up to 25 IgE binding components. The results strongly suggest that the importance of some mould genera has been underestimated as allergens.
344 Concentrations of airborne Botrytis conidia, and frequency of allergic sensitization to Botrytis extract. Spieksma FT, Nolard N, Beaumont F, Vooren PH. Experientia Suppl. 1987;51:165-7. 
346Different age of asthmatic patients affected by different aeroallergens]Tsai JJ, Chen WC. J Microbiol Immunol Infect. 1999 Dec;32(4):283-8.A total of 1070 cases of bronchial asthma, aged from 3 to 70 years, were analyzed for their hypersensitivity to the four most common aeroallergens, Dermatophagoides pteronyssinus, German cockroaches, Penicillium notatum and Candida albicans. The severity of hypersensitivity was classified as mild, moderate and severe based on the concentration of allergen specific IgE in the sera. Results showed that there were 77.9% patients allergic to D. pteronyssinus, 40.0% to G. cockroaches, 9.6% to P. notatum and 10.4% to C. albicans. The incidence and severity varied with age. For D. pteronyssinus, the highest incidence was 96.8% with the age between 11 and 20 years. Seventy percent of them were severe hypersensitivity. For P. notatum, the highest incidence was 18.9% with the age above 61 years. None of them were severe hypersensitivity and 11.9% of them were moderate hypersensitivity. For C. albicans, the highest incidence was 27.3% with the age between 51 and 60 years. All of them were mild hypersensitivity. For G. cockroaches, the highest incidence was 55.4% with the age between 21 and 30 years. 76.8% of them were mild hypersensitivity and 23.2% were moderate hypersensitivity. We concluded that different age of asthmatic patients affected by different aeroallergens. D. pteronyssinus was the most potent aeroallergen. Most asthmatic patients sensitized by mite were severe, particularly those patients with the age below 20 years of age.
347Aeroallergens, skin tests and allergic diseases in 1091 patients]. Enríquez Palomec O, Hernández Chávez L, Sarrazola Sanjuan DM, Segura Méndez NH, Hernández Colín DD, Martínez-Cairo S. Rev Alerg Mex. 1997 May-Jun;44(3):63-6.To know the frequency of positively of several skin tests, data cards from patients, of the Allergy and Clinic Immunology Service of the Hospital de Especialidades del Centro Medico Nacional Siglo XXI (Mexico City), between January, 1989 and March, 1995, were reviewed. Aqueous extracts manufactures by our laboratory were applied, in a dilution of 1:1000 weight-volume. 1091 from 5,651 skin tests patients were positive. Asthma and rhinitis were diagnosed in 492, allergic rhinitis in 289, allergic asthma in 111, and other diagnosis in 199 cases. The most frequent inhalable aeroallergens were house dust and perennial Dermatophagoides p and f1 with predominance in the rainy season, followed by pollens from Fraxinus a. Quercus a and Capriola, with predominance in the rainy season. The most frequent fungi were Candida and Fusarium, with predominance in the dry season.
348Allergens of Pityrosporum ovale and Candida albicans. II. Physicochemical characterization. Doekes G, Kaal MJ, van Ieperen-van Dijk AG. Allergy. 1993 Aug;48(6):401-8.Pityrosporum ovale has recently been recognized as a source of allergens to which many patients with atopic dermatitis (AD) show type I skin reactions and specific IgE antibodies. In this study the IgE-binding components and/or epitopes in P. ovale extract were shown to be partially sensitive to pronase or trypsin treatment, whereas periodate oxidation resulted in a complete loss of IgE-binding capacity, thus suggesting the involvement of carbohydrate structures. In Con A affinity chromatography most of the IgE-binding capacity of crude P. ovale extract bound to the column, and could be eluted with mannoside. Gel filtration on Sephacryl S-400 revealed a marked heterogeneity with respect to molecular mass, with most of the IgE-binding activity associated with high-mol.-mass fractions (from 5 x 10(4) up to 2 x 10(6) Da). A similar heterogeneity was found after chromatofocusing, with IgE-binding in the whole pI-range from 7.0 to 4.0. Essentially identical results were obtained with extracts of Candida albicans, in agreement with the previously shown cross-reactivity of IgE-binding components in the two yeast extracts. In inhibition ELISA, gel filtration and chromatofocusing fractions containing components with widely different mol. mass or pI showed complete reciprocal cross-inhibition, and were all capable of inhibiting the binding of IgE to unfractionated extracts. We therefore conclude that the cross-reacting anti-P. ovale/anti-C. albicans IgE antibodies in the sera of AD patients are mainly directed at a restricted number of carbohydrate epitopes that are expressed on a heterodisperse range of high-mol.-mass components, probably mannans or mannoproteins.
396Delayed hypersensitivity cross-reactions between Sporothrix schenckii and Ceratocystis species in sporotrichotic patients. Ishizaki H, Nakamura Y, Kariya H, Iwatsu T, Wheat R. J Clin Microbiol. 1976 Jun;3(6):545-7.Cutaneous delayed hypersensitivity to antigens prepared from Sporothrix schenckii and several Ceratocystis species, including C. stenoceras, C. ulmi, C. ips, and C. minor, was tested in 14 patients with known cutaneous sporotrichosis. Extensive cross-reactions were observed. Nonsporotrichotic people (controls) did not react to these antigens. The correlation coefficient between antigens of S. schenckii and each Ceratocystis species was calculated from the areas of the cutaneous reactions. Among the Ceratocystis species tested, the correlation coefficient between S. schenckii and C. stenoceras was 0.91.
432Fungal spores in the environment of the asthmatic patient in a semi-desert area of Mexico] Martínez Ordaz VA, Rincón-Castañeda CB, Esquivel López G, Lazo-Sáenz JG, Llorenz Meraz MT, Velasco Rodríguez VM. Rev Alerg Mex. 2002 Jan-Feb;49(1):2-7.OBJECTIVE: To analyze the frequency and type of fungal spores in the habitat of sensitized asthmatic patients, its relationship with skin test reactivity to fungi and indoor factors favoring the fungi development. MATERIAL AND METHODS: Indoor airborne fungi were collected from the houses of 85 patients using fungal culture methods and adherent cover glasses. Data were analyzed as a cross sectional study. RESULTS: The prevalence of positive fungi skin test reactivity was 22%, the main reactivity was for Aspergillus (54%), Alternaria (51%) and Monilia (48%), and most frequent cultured fungi were: Cladosporium (76%), Alternaria (57.5%) and Aspergillus (51.3%). Another molds (Dreshlera, Rhodotorula) not included in the skin test reactivity panel nor immunotherapy plans were cultured. The fungus spores mean concentration was 1788/m3 +/- 1637 (930 to 10,230/m3) without qualitative or quantitative differences when several house areas were compared. The association of skin reactivity and indoor exposure were significant only for Aspergillus (RR 3.14, 95% CI 1.77-5.58). The use of ventilation-air-conditioning systems (42%), personal humidifier or nebulizers (43%), dampness inside the houses were important characteristics. CONCLUSIONS: Indoor fungus pollution is also important in semi-desert areas, due to high prevalence of many factors that contribute for its development and proliferation.
435Hypersensitivity pneumonitis related to a covered and heated swimming pool environment. Moreno-Ancillo A, Vicente J, Gomez L, Martin Barroso JA, Barranco P, Cabanas R, Lopez-Serrano MC. Int Arch Allergy Immunol. 1997 Oct;114(2):205-6.Hypersensitivity pneumonitis (HP) or extrinsic allergic alveolitis is a lung disease caused by a large group of inhaled antigens of various sources. The most common HP occurring in the farm environment is classically caused by exposure to various thermophilic actinomycetes and fungi that can grow in the farm environment. Pullularia species and thermophilic actinomycetes have been involved in HP related to humidifier water and saunas. Our case illustrates the value of a site visit in the diagnosis of HP. During a visit to the covered and heated swimming-pool where our patient used to swim we could see that favourable conditions to fungal growth existed. To determine the possible aetiological agents of a suspected HP, cultures from several parts of the swimming-pool were taken. These cultures showed an intense growth of thermophilic actinomycetes, Neurospora and Aspergillus species. Precipitating antibodies against Neurospora species and Mycropolyspora faeni were detected. A case of HP related to a covered and heated swimming-pool environment is reported. Thermophilic actinomycetes and Neurospora species may be the causing agents.
438Pulmonary colonization by Chrysosporium zonatum associated with allergic inflammation in an immunocompetent subject. Hayashi S, Naitoh K, Matsubara S, Nakahara Y, Nagasawa Z, Tanabe I, Kusaba K, Tadano J, Nishimura K, Sigler L. J Clin Microbiol. 2002 Mar;40(3):1113-5.We report a case of noninvasive pulmonary disease due to Chrysosporium zonatum in an immunocompetent male. The fungus colonized an existing tuberculous cavity and was isolated from transbronchial lavage fluid and from a percutaneous aspiration specimen. The disease was accompanied by the unusual feature of an allergic reaction. The fungus ball was successfully treated by intracavitary administration of amphotericin B. C. zonatum is the anamorph of the heterothallic ascomycete Uncinocarpus orissi, and the identity of the case isolate was verified by formation of ascospores in mating tests with reference isolates.
458A case report of allergic fungal sinusitis caused by Penicillium sp. and Cladosporium sp. Matsuwaki Y, Nakajima T, Iida M, Nohara O, Haruna S, Moriyama H. Nippon Jibiinkoka Gakkai Kaiho. 2001 Dec;104(12):1147-50.We report a case of allergic fungal sinusitis (AFS) caused by Penicillium sp. and Cladosporium sp. in a 57-year-old man satisfying the following diagnostic criteria: (1) chronic rhinosinusitis revealed by computed tomographic scan, (2) Japanese cedar pollinosis for 3 years, (3) positivity for Penicillium sp. and Cladosporium sp. by a skin test, (4) increased immunoglobulin E (IgE) specific to these fungi, (5) increased total IgE, (6) nasal polyps with severe eosinophilic invasion, (7) allergic mucin revealed by histopathological examination, (8) fungal hyphae revealed by histopathological examination and (9) detection of Penicillium sp. and Cladosporium sp. revealed by fungi culture. The patient was treated by endoscopic sinus surgery. Four weeks after surgery, nasal polyps recurred, but his condition was improved by oral administration of steroids and nebulizer treatment with steroids and fluconazole. Total IgE, specific IgE and eosinophil count in the peripheral blood decreased, apparently reflecting this improvement. After obtaining the patient's consent, we conducted an allergen provocation test, which is as highly diagnostic as a skin test, to test for an antigen causing type I hypersensitivity. The immediate phase response was positive, indicating that type I hypersensitivity intermediated by IgE was involved in AFS.
468Extraction of serologic and delayed hypersensitivity antigens from spherules of Coccidioides immitis. Galgiani JN, Dugger KO, Ampel NM, Sun SH, Law JH. Diagn Microbiol Infect Dis. 1988 Oct;11(2):65-80.We have used an aqueous toluene extraction procedure to obtain antigens from mature spherules of Coccidioides immitis. This extract contained many antigens as determined by immunoblotting and two-dimensional immunoelectrophoretic studies. These included antigens with specificity for tube precipitin-type antibodies having molecular weights greater than or equal to 100 KDa. The extract also displayed lymphocyte-transforming activity when tested on human peripheral blood mononuclear leukocytes from donors who react to coccidioidal skin tests but elicited no such stimulation of cells from persons whose coccidioidal skin tests were nonreactive. At high concentrations of the extract, lymphocyte transformation did not occur, a finding that could not be explained by nonspecific toxicity. When gel filtration was employed to separate antigens by size, tube precipitin-like activity and specific coccidioidal delayed-type hypersensitivity displayed overlap, although only the latter activity was apparent in lower molecular weight pools.
469Estimates of C. immitis infection by skin test reactivity in an endemic community. Dodge RR, Lebowitz MD, Barbee R, Burrows B. Am J Public Health. 1985 Aug;75(8):863-5.This report is a comparison of two delayed hypersensitivity skin test reagents, coccidioidin and Spherulin, available for detection of prior infection by Coccidioides immitis. Coccidioidin proved to be a somewhat more sensitive reagent (33.4 per cent positive, vs 29.6 per cent for Spherulin). This difference persisted in the subjects when grouped by age, sex, exposure history, or history of coccidioidomycosis. Skin test reactivity to both reagents declined with age. Independent of exposure history coccidioidin detected 7.3 per cent of the subjects who were not detected by Spherulin; Spherulin detected prior infection in only 3.5 per cent of the subjects not detected by coccidioidin. These results differ from those of previously reported studies.
510IgE, IgA, and IgG responses to common yeasts in atopic patients. Savolainen J, Kortekangas-Savolainen O, Nermes M, Viander M, Koivikko A, Kalimo K, Terho EO. Allergy. 1998 May;53(5):506-12.This study was undertaken to analyze the differences in exposure and sensitization to five common environmental yeasts. The responses of IgG, IgA, and IgE to Candida albicans, C. utilis, Cryptococcus albidus, Rhodotorula rubra, and Saccharomyces cerevisiae and purified S. cerevisiae enolase were analyzed by immunoblotting (IgE-IB), and the cross-reactivity of their IgE-binding components by IgE-IB inhibition. Twenty atopic subjects, with asthma, allergic rhinitis, or atopic dermatitis were included. In skin prick tests (SPT), 12 of the patients showed simultaneous reactivity to at least two of the five yeasts, four reacted to one of the yeasts, and four had no responses. Antigens run in SDS-PAGE and transferred to nitrocellulose were probed with enzyme-labeled IgA-, IgG-, and IgE-specific antibodies. The IgE immunoblotting revealed most IgE-binding bands in C. albicans (11 bands) followed by C. utilis (eight bands), S. cerevisiae (five bands), R. rubra (five bands), and Cr. albidus (four bands). Six of the IgE-binding bands of C. albicans and C. utilis shared molecular weight, and only two bands shared molecular weight with other yeasts. These were the 46-kDa band, shared by all five yeasts, and a 13-kDa band shared by four yeasts. Prominent IgE binding was seen to a 46-kDa band of C. albicans (seven patients), C. utilis (five patients), and S. cerevisiae (one patient) and to corresponding weak bands of Cr. albidus and R. rubra (one patient). The possible cross-reactivity of the 46-kDa band was analyzed by IgE-IB inhibition and densitometry, revealing clear C. albicans inhibition of C. utilis (80%) and enolase (98%) (autoinhibition 100%). The strongest IgG responses were seen against S. cerevisiae and C. albicans. The responses were mainly against mannans of C. albicans and S. cerevisiae, suggesting that most of the exposure is to these yeasts. Yeasts with different types of exposure, from saprophytic growth on human mucous membranes to exposure by air and food, were shown to cross-react at the allergenic level. Atopic patients primarily sensitized by C. albicans and S. cerevisiae may develop allergic symptoms by exposure to other environmental yeasts due to cross-reacting IgE antibodies.
511Cryptococcus albidus-induced summer-type hypersensitivity pneumonitis. Miyagawa T, Hamagami S, Tanigawa N. Am J Respir Crit Care Med. 2000 Mar;161(3 Pt 1):961-6.We studied summer-type hypersensitivity pneumonitis believed to be induced by Cryptococcus albidus in the home environments of the patients. All patients had antibodies that were reactive to Cryptococcus neoformans and Trichosporon cutaneum in sera and bronchoalveolar lavage (BAL) fluids. Cryptococcus albidus strains were isolated from 62.5% of the patient home environments. Trichosporon cutaneum was found in none of the patient homes. To study local antibody production in the lung, we cultured BAL cells to measure anti-C. neoformans and anti-T. cutaneum antibodies in the culture supernatants by the ELISA method. IgG, IgA, and IgM anti-Cryptococcus and anti-Trichosporon antibodies were found in all culture supernatants. A significant correlation was observed in antibody binding activity between Cryptococcus and Trichosporon antigen. However, the amount of IgA and IgM antibody bound to C. neoformans was significantly higher than was bound to T. cutaneum. Most anti-Cryptococcus and anti-Trichosporon antibody was absorbed by C. albidus. Our results suggest that C. albidus may be an etiologic agent in most of the cases we studied, and that IgA and IgM antibody in BAL fluid may be secreted by plasma cells in the lung.
512Hypersensitivity pneumonitis with antibodies to Cryptococcus neoformans. Miyagawa T, Ochi T, Takahashi H. Clin Allergy. 1978 Sep;8(5):501-9.Clinical and immunological studies were made in forty-two patients diagnosed as suffering from hypersensitivity pneumonitis at Osaka Prefectural Habikino Hospital between 1973 and 1977. All the sera from forty-one patients tested had high titres of antibody against Cryptococcus neoformans in indirect fluorescent antibody tests, and twelve also had precepitins against Cryptococcus neoformans polysaccharide. Only about 10% of control sera from patients with other lung diseases had low titres of antibody against Cryptococcus neoformans. Antibody against Cryptococcus neoformans was also found frequently in the sera of asymptomatic members of the families of the patients. A possible relationship of Cryptococcus neoformans to hypersensitivity pneumonitis is suggested.
556Skin test with aeroallergens untested in Mexico] Pérez Tovar MP, Castrejón Tovar M, Iza SV, González Ibarra M, Miranda Feria AJ. Rev Alerg Mex. 1995 Sep-Oct;42(5):86-8.This study was carried out to prove that some molds even not studied in Mexico can be able to incit a positive skin test. We tested 43 adults (15-45 years old), 34 of them suffering respiratory allergy verified by roentgenography and laboratory tests including traditional intradermic allergic test. 9 subjects served as control group. We used manual scarification to Ustilago maydis, Rhodotorula rubra, Puccinia graminis, Cunhigamella sp and Zyncephalastrum sp. Our patients showed a positive skin test in 26, 12, 12, 9 and 6% respectively. This Fisher exact test do not detects significative differences. We conclude this molds can be able to incit an immune reaction IgE mediated and the must be tested in allergic patients from farmer communities.
574Evaluation of the allergenicity of tropical pollen and airborne spores in Singapore. Chew FT, Lim SH, Shang HS, Dahlia MD, Goh DY, Lee BW, Tan HT, Tan TK. Allergy. 2000 Apr;55(4):340-7.BACKGROUND: Sensitization to pollen and spores of the Southeast Asian tropical region is not well documented. This study evaluated the allergenicity of the tropical airspora in Singapore. METHODS: On the basis of the results of an aerobiologic survey of the airspora profile of Singapore, crude extracts of 23 main spore (fungal and fern) and pollen types were prepared. A total of 231 patients with asthma and/or allergic rhinitis and 76 healthy controls were evaluated by skin prick test (SPT). Total and specific IgE levels were also quantified by the fluorescence allergosorbent test (FAST). RESULTS: All 23 allergenic extracts tested elicited positive SPT responses. Among the patients with atopic diseases, extracts of oil-palm pollen (Elaeis guineensis) were observed to have the highest frequency of positive reactions (40%), followed by extracts of resam-fern spores (Dicranopteris linearis) (34%) and sea-teak pollen (Podocarpus polystachyus) (33.8%). Fungal spores with the highest SPT responses were Curvularia spp. (26-32%) and Drechslera-like spores (31%). Positive responses to these extracts correlated with total serum IgE levels of the subjects and were significantly associated with the presence of atopic disease. CONCLUSIONS: We have documented sensitization to tropical pollen and spores in our population. Its association with atopy suggests that it has a role in allergic diseases in the tropics.
614Characterization of allergenic fractions from Drechslera monoceras. Menezes EA, Gambale W, Macedo MS, Castro F, Paula CR, Croce J. J Investig Allergol Clin Immunol. 1998 Jul-Aug;8(4):214-8.Drechslera monoceras, a fungus of the Deuteromycota phylum, is fairly frequent in Brazil, and is spread through the atmosphere. In previous studies done in the city of Sao Paulo, it was found that in relation to 42 other fungi extracts, the crude extract of this fungi demonstrated a more intense cutaneous reaction in patients with respiratory allergies. Biochemical, antigenic and allergenic evaluations were carried out at various growth stages of this fungus. Based on these facts, the purpose of this research was the fractionation and allergenic characterization of the allergenic extract of D. monoceras to be used in diagnosis and immunotherapy in patients with positive cutaneous reaction to this fungus. In the city of Sao Paulo, 13 of 248 patients with respiratory allergy (asthma and/or rhinitis) showed positive reaction following cutaneous tests (skin prick tests). The crude extract of D. monoceras was fractionated by SDS-PAGE. The visible fractions were then separated by electroelution to be inoculated into BALB/c mice to evaluate the production of IgE antibody. The IgE content was detected by passive cutaneous anaphylaxis test in Wistar rats, and two fractions of approximate molecular weights of 14.4 and 36 KDa reacted to the test. The in vitro allergenic characterization was carried out by Western blotting, and three fractions of approximate molecular weights of 14.4, 36 and 60 KDa were positive. It was concluded that the extract of D. monoceras has at least three allergenic determinants, which can be used for diagnosis and immunotherapy in patients with respiratory allergy to this fungi.
615Biochemical, antigenic and allergenic characterization of crude extracts of Drechslera (Helminthosporium) monoceras. Menezes EA, Gambale W, Macedo MS, Abdalla DS, Paula CR, Croce J. Mycopathologia. 1995 Aug;131(2):75-81.In a previous study with airborne mould extracts we verified that Drechslera (Helminthosporium) monoceras presented stronger reactions than those presented by 42 other moulds isolated in São Paulo city. In the present study, we evaluated the biochemical composition and the antigenicity of crude extracts obtained from vegetative and conidial stage of D. monoceras using Czapeck broth (CB) modified and tris-HCl for extraction. The maximum values of total proteins and lipids were verified in the crude extract obtained in the 28th day of growth, and maximum values of carbohydrates were observed in the extracts of the 16th, 22nd and 26th days. The fractionated proteins by SDS-PAGE presented bands with molecular weights between 14.4 to 67 Kd; the 28th day extract showed a larger number of bands. The carbohydrates and amino acids were characterized by thin-layer chromatography. The antigenicity of the crude extracts was verified by immunodiffusion reaction in agar against rabbit hyperimmune sera. Precipitation lines were observed in all studied extracts and common antigenic molecular populations. Based on the above results, the 28th day extract was selected to verify the induction of IgE antibody responses in immunizations of Balb/c and cAF-1 mice, and titer by passive cutaneous anaphylaxis test using Wistar rats. The maximum titers obtained were 160 in cAF-1 mice and 1.280 in Balb/c mice. The results suggest that the 28th day extract contains allergenic fractions and should be chosen for future studies related to fractionation, characterization and standardization in diagnostic methods and immunotherapy.
656The allergens of Epicoccum nigrum Link. I. Identification of the allergens by immunoblotting. Dixit AB, Lewis WH, Wedner HJ. J Allergy Clin Immunol. 1992 Jul;90(1):11-20.Two atmospheric isolates of Epicoccum nigrum (EN) were grown under sporulation conditions. Dialyzed extracts of spores, (greater than 95% pure) and pure mycelia were used for skin testing, sodium dodecyl sulfate-polyacrylamide gel electrophoresis, and immunoblotting. By skin testing, 49 of the 126 atopic patients were found to be sensitive to EN in St. Louis, Mo., and Corpus Christi, Texas, combined. On immunoblotting, which was performed on 17 sera, 44 bands (12.3 to 119.0 kd) were detected; six were unique to spore, four were unique to mycelium, and 34 were common to both. No single band bound IgE from all sera. The most frequent band corresponding to 42 kd occurred in 11 sera. Five other bands were recognized by more than one half, whereas the remainder bound fewer sera. All skin test-positive patients had positive immunoblots; the number of bands recognized varied from three to 25. Spore or mycelium-specific, as well as common bands were recognized by 13 of 17 sera. Two sera recognized only spore and mycelium-specific bands. Only spore-specific bands were bound by two sera. No strain differences were detected. The binding patterns were comparable in the sera from both St. Louis, Mo., and Corpus Christi, Texas. These data suggest that EN is a significant allergen in urban communities. Allergenic proteins occur in both spore and mycelium, suggesting that both must be included in the reagents for skin testing and immunotherapy.
657Antigenic and allergenic cross-reactivity of Epicoccum nigrum with other fungi. Bisht V, Singh BP, Arora N, Gaur SN, Sridhara S. Ann Allergy Asthma Immunol. 2002 Sep;89(3):285-91.BACKGROUND: Previous studies have identified Epicoccum nigrum (EN) as an important aeroallergen. Shared allergenicity among some fungi responsible for type I allergic disorders has been reported. OBJECTIVE: To study the cross-reactivity among different fungi and to identify immunoglobulin (Ig)G and IgE binding components shared between EN and 10 other fungi known to cause respiratory allergy. METHODS: Cross-reactivity studies were carried out by enzyme-linked immunoadsorbent assay (ELISA) and immunoblot inhibition using both rabbit antiserum raised against EN and pooled sera from patients' EN-positive skin test. RESULTS: A large number (82%) of EN-sensitive patients showed positive skin reactivity to other fungal extracts. ELISA inhibition revealed >50% inhibition in binding of EN-specific rabbit antibodies with Alternaria alternata, Curvularia lunata, Cladosporium herbarum, and Penicillium citrinum extract, whereas the other extracts showed only 20 to 40% inhibition. Rabbit antisera to A. alternata, C. herbarum, and C. lunata reacted with five to seven bands in EN, demonstrating the presence of shared antigens among these fungi. EN requires an amount of 100 ng for 50% IgE ELISA inhibition, whereas 175 ng of A. alternata, 160 ng of C. lunata, and 268 ng of C. herbarum and P. citrinum were required for the same. IgE immunoblot and immunoblot inhibition further revealed that 43-, 26-, and 17-kD allergenic bands were shared by EN and A. alternata, whereas the 80- and 37-kD bands were common to both EN and C. lunata. EN and C. herbarum shared 63- and 36-kD allergenic bands, whereas EN and P. citrinum shared the 34-kD band. CONCLUSION: EN showed maximum cross-reactivity with A. alternata followed by C. lunata, C. herbarum, and P. citrinum. This information will be useful in treating EN-allergic patients.
658Culture filtrate antigens and allergens of Epicoccum nigrum cultivated in modified semi-synthetic medium. Bisht V, Singh BP, Kumar R, Arora N, Sridhara S. Med Microbiol Immunol (Berl). 2002 May;191(1):11-5.Epicoccum nigrum (EN) is an important fungal allergen for nasobronchial allergy. Fungal extracts should contain all the relevant allergen components from spores, mycelium and culture medium for the purpose of allergy diagnosis and therapy. EN extract from spore-mycelial mass has been standardized, but the culture filtrate (CF) allergens of EN have not been studied as EN grows poorly in synthetic medium. The objective of the present study was to obtain a standard CF extract of EN by cultivating the source material in a modified semi-synthetic medium and to compare this with the EN cellular extract. Sabouraud's medium containing yeast extract (50 mg/l) was filtered using 10-kDa cut-off membrane and the lower molecular mass media components were used to cultivate EN. The CF obtained after removing the spore-mycelia was dialyzed to remove media components. The CF extract was characterized by sodium dodecylsulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and immunoblot. It was compared with EN spore-mycelial extract by enzyme-linked immunosorbent assay (ELISA), ELISA inhibition and by intradermal testing on allergy patients. The CF extract of EN resolved into 30 protein bands on SDS-PAGE. About 27 IgG bands were detected using anti-EN rabbit antibodies and 12 IgE bands by EN-sensitive pooled patients' sera. Periodate modification of CF proteins showed that the carbohydrate moieties are not important for IgE binding. Protein components of 26, 34 and 43 kDa were recognized as the major CF allergens. Three different batches of CF extract required 7.5-9 ng of self protein for 50% inhibition of binding to anti-EN rabbit antibodies in ELISA. Intradermal testing with CF extract showed comparable allergenic potency to standardized EN spore-mycelial extract, although it contained some allergenic proteins in higher amounts as compared to the spore-mycelial extract. In summary, the semi-synthetic medium has been suitably modified for obtaining EN CF antigens. This medium can be an important substitute for producing potent CF allergens of fungi that grow poorly in synthetic medium. The EN CF extract elicited good allergenic reactivity and may be used for allergy diagnosis along with spore-mycelial extract.
659Allergens of Epicoccum nigrum grown in different media for quality source material. Bisht V, Singh BP, Arora N, Sridhara S, Gaur SN. Allergy. 2000 Mar;55(3):274-80.BACKGROUND: The Epicoccum nigrum (EN) extract used in allergy disorders exhibits batch-to-batch variations in protein composition and allergenic potency. In this study, the allergens of EN grown in different media were investigated. METHODS: EN was grown in five different nutrient media as stationary cultures at 25 degrees C for 5-23 days. The growth pattern was characterized by measuring dry weight, protein and carbohydrate content. The antigenic and allergenic content of EN extract was evaluated with EN-positive patients' sera and antibodies raised in rabbit. RESULTS: The growth of EN in Czapeck Dox medium yielded insufficient material, while Sabouraud's broth with yeast extract (SBY) gave maximum spore-mycelial mass and protein content. Potato dextrose broth (PDB) and potato dextrose agar (PDA) showed higher dry weight and protein in 7-9-day cultures. SDS-PAGE resolved 26, 22, and 21 protein bands in EN extracts from cultures of day-13 SBY, day-7 PDB, and day-9 PDA, respectively. IgE/IgG immunoblots showed more allergenic (25)/antigenic (25) bands in EN cultured in SBY than in the others. Specific IgE ELISA and intradermal tests showed EN extract from day-13 culture in SBY to be the most potent. CONCLUSIONS: The day-13 culture of EN in SBY was the most potent and may be selected for preparing EN extracts for diagnosis of allergy and future studies.
660Basement shower hypersensitivity pneumonitis secondary to Epicoccum nigrum. Hogan MB, Patterson R, Pore RS, Corder WT, Wilson NW. Chest. 1996 Sep;110(3):854-6.Two children developed hypersensitivity pneumonitis after extensive exposure to an unventilated basement shower. Commercial precipitin panels were negative. After home inspection, individual mold species were isolated from the household and extracted. Precipitating antibodies to Epicoccum nigrum were found in both children. Resolution of the hypersensitivity pneumonitis occurred with avoidance and glucocorticosteroid therapy. E nigrum is a newly identified etiologic agent for hypersensitivity pneumonitis found in a mold-contaminated home.
661Epicoccum allergy: skin reaction patterns and spore/mycelium disparities recognized by IgG and IgE ELISA inhibition. Portnoy J, Chapman J, Burge H, Muilenberg M, Solomon W. Ann Allergy. 1987 Jul;59(1):39-43.Comparable degrees of skin reactivity were observed towards spore and mycelium extracts from two isolates of Epicoccum and to one preparation of Alternaria in 35 rural and 120 university patients. The best experimental extracts detected Epicoccum sensitivity in 70% of the group tested while the commercial extract detected sensitivity in only 6%. Skin reaction correlations were greatest within isolates (eg, spore-A/mycelium-A), then for specific fungus parts (eg, spore-A/spore-B), then between isolates and parts (spore-A/mycelium-B). High correlations were found between individual IgG and IgE ELISA values for all antigens using serum from Epicoccum skin-reactive patients. ELISA inhibition results suggested that significant cross-reactivity exists between Epicoccum and Alternaria antigens recognized by IgG but not by IgE. ELISA inhibition cross-reaction patterns among Epicoccum antigens were comparable to skin reactions while IgG patterns showed little variability. Further characterization of spore/mycelium and interstrain recognition patterns among different immunoglobulin isotypes will be necessary before complete standardization of extracts from different parts of fungi will be possible. The use of spore material for skin testing and treatment of Epicoccum sensitivity appears to be both premature and unnecessary at this time.
666 Comparison of antigens and allergens in Aspergillus fumigatus and Epidermophyton floccosum. Longbottom JL, Pepys J. Int Arch Allerg 1962;20:370-1. 
667Chronic asthma and rhinitis due to Candida albicans, epidermophyton, and trichophyton. Gumowski P, Lech B, Chaves I, Girard JP. Ann Allergy. 1987 Jul;59(1):48-51.Asthma and rhinitis due to Candida albicans is well known. Trichophyton and Epidermophyton are not usually considered as causal agents for these diseases. During the years 1982 and 1983 all of the cases of chronic asthma or rhinitis exhibiting a positive immediate skin response (greater than or equal to 10 mm) to one of these three antigens were selected for this study (60 asthma and 75 rhinitis). They all went through nasal and bronchial provocation tests with the specific antigen. Late reactions were also registered. A RAST was performed in some of the patients reacting to Candida albicans. Following inhalation challenge with antigens, an immediate response was obtained in 91 cases (asthma 30, rhinitis 51). A dual response was observed in 17 cases of asthma and in 13 cases of rhinitis. A RAST-Candida albicans was done in 64 cases. Results were positive in 52 patients. In 46 cases there was a correlation between the RAST and the provocation tests. Hyposensitization treatment was given to 92 patients. After 2 years of treatment, a good to excellent response could be observed in almost 60% of the treated cases. A rough estimation of the incidence of immediate bronchial and nasal hypersensitivity among patients with chronic asthma and rhinitis to the three yeasts gives the approximate figure of 8% to 10%.
724Evaluation of skin test for chromoblastomycosis using antigens prepared from culture filtrates of Fonsecaea pedrosoi, Phialophora verrucosa, Wangiella dermatitidis and Exophiala jeanselmei. Iwatsu T, Miyaji M, Taguchi H, Okamoto S. Mycopathologia. 1982 Jan 15;77(1):59-64.Antigenic substances were prepared from culture filtrates of Fonsecaea pedrosoi, Phialophora verrucosa, Wangiella dermatitidis and Exophiala jeanselmei. These antigenic substances were evaluated for detecting cutaneous delayed hypersensitivity in rats experimentally-infected with F. pedrosoi, P. verrucosa. W. dermatitidis, E. jeanselmei, Cladosporium carrionii and Fonsecaea compactum and in patients with chromoblastomycosis caused by F. pedrosoi. The F. pedrosoi antigen elicited positive reactions in all of the animals infected with F. pedrosoi and in 5 of 6 patients. The P. verrucosa, W. dermatitidis and E. jeanselmei antigens elicited positive reactions in all of the animals infected with the homologous species. These antigens displayed cross-reactivity in some of the animals and patients, whereas more than half of them exhibited positive reactions only to the antigens prepared from the homologous species. These results suggest that a delayed-type skin test using the antigens prepared by the authors may be useful not only for the diagnosis of chromoblastomycosis but also for the identification of species of the causative agent.
725Skin test-active substance prepared from culture filtrate of Fonsecaea pedrosoi. Iwatsu T, Miyaji M, Taguchi H, Okamoto S, Kurita N. Mycopathologia. 1979 May 31;67(2):101-5.Ethanol-precipitated substance (EP) was prepared from culture filtrate of Fonsecaea pedrosoi. EP was separated into two components by passing through a Sephadex G-50 column; the faster passing component was referred to as EP-1, the slower as EP-2. EP-1 and EP-2 were evaluated as an antigen for detecting cutaneous delayed hypersensitivity in patients with chromomycosis. EP-1 elicited positive delayed skin reactions in all of 8 patients with chromomycosis, of which 7 caused by F. pedrosoi and one by Exophiala jeunselmei. Healthy subjects, patients with sporotrichosis and patients with tinea barbae failed to react to EP-1. These results indicate that EP-1 is a useful tool for detecting cutaneous delayed hypersensitivity in patients with chromomycosis caused by F. pedrosoi. It was found that precipitin test using EP-1 as an antigen had little diagnostic value in chromomycosis. EP-2 did not show antigenic activity in both skin and precipitin reactions.
735[Hypersensitivity to airborne allergens common in the central region of Coahuila]. Ramos Morín CJ, Canseco González C. Rev Alerg Mex. 1994 May-Jun;41(3):84-7.A retrospective review of 247 clinical files of patient that have responded to the office allergy and immunology since 1990 to 1993 in Monclova, Coah., for allergy illness. This study was to determine the frequency of Aeroalergens and foods sensitization in Monclova, Coahuila, mediated Allergy Test Skin (intradermo reactions, and Prick) and MAST immuno Systems (Multiple Allergy System Test). The patients were highly sensitive to house dust (13.5%) others aeroalergen pollen grains, were; rusian thistle (7.1%), Pigweed (5.4%), Cynodon Dactylon (4.9%), Pecan (4.8%), Ragweed Mix (4.8%), Rye grass (4.8%) other pollen (32.4%). The molds: Candida (3.2%), Alternaria (2.7%), Rhizopus (3.6%), Penicillium (2.1%), Fusarium (2.1%), other molds (8.7%). The foods more important were: Wheat (21.3%), Cheese (10.0%), Shellfish Mix (10.0%), Pork (8.8%), Egg Yolk (7.5%).
736Fusarium solani major allergen peptide IV-1 binds IgE but does not release histamine. Verma J, Sridhara S, Singh BP, Pasha S, Gangal SV, Arora N. Clin Exp Allergy. 2001 Jun;31(6):920-7.BACKGROUND: Fusarium solani (FS) is an important allergen source afflicting 4% of the nasobronchial allergy patients. Fus s I3596*, a 65 kDa major glycoprotein allergen of FS reacts with 95% fungus sensitive patients. OBJECTIVES: To purify and characterize a potent peptide from Fus s I3596* which may be useful for therapeutic purposes. METHODS: The 65 kDa protein was sequentially cleaved with trypsin and cyanogen bromide (CNBr). The cleaved products were purified on reverse phase high performance liquid chromatography (rpHPLC) column and functionally characterized by in vitro and in vivo methods for its IgE binding and histamine release. RESULTS: The protein on cleavage showed 11 peaks (I to XI). Of these, peaks I, III, IV and V were highly allergenic as determined by IgE ELISA. These peaks were further purified and peptide IV-1 was most potent in comparison to other peptides by ELISA-inhibition. This peptide showed IgE binding but could not evoke intradermal response in Fusarium-sensitive patients. Heparinized blood challenged with peptide IV-1 does not release histamine. Preincubation of heparinized blood with peptide IV-1 and challenging with crude extract blocked histamine release in a dose dependent manner. CONCLUSION: Peptide IV-1 binds to IgE but does not release histamine, demonstrating its potential use in therapy of Fusarium-allergic patients.
737Purification and characterization of Fus sI3596*, a 65 kd allergen of Fusarium solani. Verma J, Pasha S, Gangal SV. Mol Cell Biochem. 1994 Feb 23;131(2):157-66.A component of Fusarium solani (F. solani), identified as the major allergen, Fus sI3596* was purified to homogeneity from culture filtrate (CF) by means of anion-exchange column chromatography, gel filtration and FPLC. The homogeneity of Fus sI3596* was assessed by IEF, PAGE, SDS-PAGE (non-reducing), immunoblot and HPLC. Fus sI3596* was isolated as a glycoprotein of MW 65 kd and pI 3.6. The IgE ELISA-inhibition assay after periodate treatment of the fraction showed a lower IgE binding capacity suggesting involvement of carbohydrate moiety in IgE binding reactions of the allergen. Peptide fragments of Fus sI3596* obtained after CNBr and trypsin treatment were analysed by immunoblotting for their allergenicity. This study indicated that there could be at least 3 allergenic determinants in the major allergen, Fus sI3596* of F. solani CF.
738Fusarium solani: immunochemical characterization of allergens. Verma J, Gangal SV. Int Arch Allergy Immunol. 1994;104(2):175-83.Allergenic components of the fungus Fusarium solani were isolated using (NH4)2SO4 precipitation and ion-exchange column chromatography. The allergenicity of fractions was studied by enzyme-linked immunosorbent assay and radioallergosorbent test inhibition techniques. Proteins of culture filtrate (CF), mycelium (MY), and spore (SP) extracts of F. solani were characterized by isoelectrofocusing, sodium dodecyl sulphate-polyacrylamide gel electrophoresis, and IgE-specific immunoblotting. CF antigen of F. solani contained more allergenic proteins than MY and SP, visible on immunoblot analysis using allergenic serum pool. A 65-kD protein component of CF was found to be a major allergen, as it was strongly visible on immunoblots of all 15 patient sera tested. Crossed immunoelectrophoresis and enzyme-linked immunosorbent assay inhibition using rabbit antibodies raised against F. solani CF demonstrated shared antigenicity between CF, MY, and SP extracts. It was observed that F. solani is a significant allergen, and most of the allergens of MY and SP extracts were found in CF extract. Therefore, CF alone can be used in the preparation of a standard extract. However, few unique allergenic proteins were observed in MY as well as in SP extracts of F. solani. Hence, the use of combined CF, MY, and SP extracts of F. solani is recommended for diagnosis and immunotherapy.
739Studies on shared antigenic/allergenic components among fungi. Verma J, Sridhara S, Singh BP, Gangal SV. Allergy. 1995 Oct;50(10):811-6.Fungal allergens have been found to be one of the most prevalent aeroallergens in India. Knowledge of shared/unique components among different fungi is necessary for proper diagnosis and treatment of patients allergic to fungi. In the present study, crude extracts (CE) of 11 common fungi (Alternaria alternata, Aspergillus flavus, Asp. fumigatus, Asp. niger, Asp. tamarii, Asp. versicolor, Cladosporium herbarum, Curvularia lunata, Mucor hiemalis, Penicillium citrinum, and Fusarium solani) were characterized by isoelectric focusing (IEF), SDS-PAGE, and immunoblot. On IEF (pI 3-9), the number of protein bands was found to be greatest (46) in M. hiemalis extract. SDS-PAGE exhibited a varied number of bands, generally 18-40, with mol. mass ranging from 14 to 100 kDa. IgG-specific immunoprint using rabbit anti-F. solani CF antibodies demonstrated a mol. mass distribution of shared antigenic proteins of 14-100 kDa in most of the fungi. Shared allergenicity was observed in a number of allergenic proteins in fungal extracts with mol. mass ranging between 14 and 70 kDa on IgE-specific immunoblot using pooled sera of patients allergic to Fusarium. A 45-kDa protein was found to be common among these fungi on immunoblot with patients as well as with rabbit antibodies. F. solani CF extract contained more antigenic/allergenic proteins than F. solani CE. It was concluded that F. solani CF shared several antigenic/allergenic components with CE of other common fungi. This fact needs to be taken into account when fungal extracts are used in diagnosis and immunotherapy of allergic patients.
809 A New Intestinal Fungal Allergen: Geotrichum. Castets,Geyer, Sourreil, Fruchard J. Bull Soc Fr Dermatol Syphiligr 1964 Jul-Aug;71:540-1. 
810 The role of yeast-like fungi of the genera Candida and Geotrichum in the development of allergic dermatoses] Zabolotskaia EV. Vrach Delo. 1972 Sep;9:129-32. 
811Allergic alveolitis due to wood-rot fungi. Bryant DH, Rogers P. Allergy Proc. 1991 Mar-Apr;12(2):89-94.Farmer's lung is rare in Australia whereas allergic alveolitis due to domestic fungal exposure ("domestic allergic alveolitis") is common. However there has been no systematic analysis of the fungi responsible for domestic allergic alveolitis in Australia. The aim of this study was to determine the sources and types of fungi that cause this type of alveolitis in Australia. Twelve subjects with recently diagnosed, biopsy proved, alveolitis thought on clinical grounds to be due to domestic fungal exposure were studied. The houses of all subjects were inspected, and fungal samples were taken. All lived in substandard inner city dwellings. Extensive wood decay was found in 10/12 while 4/12 also had obvious fungal growth on damp walls. Twelve fungal species were identified including Serpula lacrymans (8/12), Paecilomyces variottii (6/12), Aspergillus fumigatus (5/12), and Leucogyrophana pinastri (2/12). No single fungal group predominated. Nine of 12 patients showed positive precipitin results to one or more of the isolated fungi. Inhalation tests were done with extracts of Serpula lacrymans, Geotrichum candidum, and Aspergillus fumigatus in six of the patients and a positive late response to one or more of the fungi was observed in five of these. Relocation of the patients to a new dwelling resulted in improvement in each case.
812[Bronchopulmonary pathology with hypereosinophilia of fungal origin (excluding allergic bronchopulmonary aspergillosis)]Lahoute C, Tonnel AB, Fournier E, Ramon P, Voisin C. Poumon Coeur. 1983;39(2):87-93.Five cases of eosinophil lung are reported in which the fungus responsible for the affection was not Aspergillus. Documented data include reports on 19 similar cases with a clinical picture suggestive of allergic bronchopulmonary aspergillosis but with negative tests for Aspergillus. The various fungal species isolated included Candida albicans, Penicillium, Geotrichum candidum, Stemphylium lanuginosum, Culvularia lunata, and Drechsleria hawaïensis. Diagnostic criteria are discussed, with particular emphasis on the importance of the inhalation provocation test, as well as possible efficacy of antifungal treatment.
851 Allergic bronchopulmonary helminthosporiosis. Halloran TJ. Am Rev Respir Dis. 1983 Sep;128(3):578. 
852 Skin test reactions to Helminthosporium maydis and Helminthosporium interseminatum. Prince HE, Henry LD, Ailts BH, Browning WH, Parsons DJ, Rohr JH, Youngman RA, Geoeger RJ, Steen WB, Meyer GH, Morrow MB. J Asthma Res. 1972 Jun;9(4):251-4. 
853 Allergic bronchopulmonary helminthosporiosis. Hendrick DJ, Ellithorpe DB, Lyon F, Hattier P, Salvaggio JE. Am Rev Respir Dis. 1982 Nov;126(5):935-8. 
870Delayed hypersensitivity responses of experimental animals to histoplasmin from the yeast and mycelial phases of Histoplasma capsulatum. Scalarone GM, Levine HB, Chaparas SD. Infect Immun. 1978 Sep;21(3):705-13.Controlled yeast lysate (CYL) and controlled mycelial lysate (CML) histoplasmins were produced from Histoplasma capsulatum grown in a nutritionally lean, chemically defined medium. The lysates were assayed for skin-test activity in guinea pigs sensitized by infection with the homologous organism. In some studies, nonliving vaccine preparations were employed also. Inter-lot biological variation was minimal, and 20 lots of the CYL reagent elicited strong dermal reactions with high specificity. Further, CYL reagents were nonreactive in guinea pigs infected with Coccidioides immitis, whereas the commercial Food and Drug Administration preparations cross-reacted to some degree. The CML histoplasmins were generally less reactive than the CYL preparations and exhibited somewhat more inter-lot variation in sensitivity and specificity. No correlation between potency and protein:polysaccharide ratios were observed with either reagent. An intradermal test with the CYL reagent did not induce significant changes in the complement-fixing titer of sensitized guinea pigs. Such changes in sensitized animals were elicited by a skin test with commercial histoplasmin.
871Skin and serum reactivity among humans to histoplasmin in the vicinity of a natural focus of Histoplasma capsulatum var. duboisii. Muotoe-Okafor FA, Gugnani HC, Gugnani A. Mycopathologia. 1996;134(2):71-4.The epidemiology of histoplasmosis duboisii (African histoplasmosis) is not well understood. The present study was carried out to investigate the prevalence of skin sensitivity and to determine by immunodiffusion the presence of antibodies among humans to histoplasmin around a recently discovered natural focus of Histoplasma capsulatum var. duboisii in a bat cave in Ogbunike in the Anambra State of Nigeria. Out of the 40 subjects, all young adults aged 18-30 years, comprising cave guides, traders and farmers examined in the immediate vicinity of the cave, 14 (35.0%) gave a positive skin test. In another population of the same age group, comprising 620 persons, viz. traders, farmers, palm oil workers and some patients attending rural clinics, examined in other nearby areas in Anambra State, 55 (8.8%) reacted positively to histoplasmin. In the immunodiffusion tests, 2 (2.08%) of the 96 school children and 17 (9.4%) of the 181 young adults, including farmers, palm oil workers and traders tested amongst the population around the cave, demonstrated precipitating antibodies to histoplasmin in their sera. Only 5 (0.79%) of the 630 adults of the same age group with similar occupations examined from other areas in Anambra State had precipitating antibodies. Out of another 50 subjects examined, viz.; wood workers, traders, farmers, and school teachers in Nsukka in the Enugu State, two (4.0%) demonstrated antibodies. It is suggested that asymptomatic infections due to the duboisii variety of H. capsulatum may be common in the human population around the cave. A diligent search with the help of local hospitals and public health officials may reveal clinical cases of histoplasmosis duboisii with cutaneous and systemic lesions.
872Delayed hypersensitivity responses of experimental animals to histoplasmin from the yeast and mycelial phases of Histoplasma capsulatum. Scalarone GM, Levine HB, Chaparas SD. Infect Immun. 1978 Sep;21(3):705-13.Controlled yeast lysate (CYL) and controlled mycelial lysate (CML) histoplasmins were produced from Histoplasma capsulatum grown in a nutritionally lean, chemically defined medium. The lysates were assayed for skin-test activity in guinea pigs sensitized by infection with the homologous organism. In some studies, nonliving vaccine preparations were employed also. Inter-lot biological variation was minimal, and 20 lots of the CYL reagent elicited strong dermal reactions with high specificity. Further, CYL reagents were nonreactive in guinea pigs infected with Coccidioides immitis, whereas the commercial Food and Drug Administration preparations cross-reacted to some degree. The CML histoplasmins were generally less reactive than the CYL preparations and exhibited somewhat more inter-lot variation in sensitivity and specificity. No correlation between potency and protein:polysaccharide ratios were observed with either reagent. An intradermal test with the CYL reagent did not induce significant changes in the complement-fixing titer of sensitized guinea pigs. Such changes in sensitized animals were elicited by a skin test with commercial histoplasmin.
899Microbial aerosols and actinomycetes in etiological considerations of mushroom workers' lungs. Kleyn JG, Johnson WM, Wetzler TF. Appl Environ Microbiol. 1981 Jun;41(6):1454-60.Spent steamed compost, phase II compost, and dust emanating from spent compost during dumping of stationary-bed mushroom houses were examined bacteriologically. The total count for spent compost was 16 X 10(8) microorganisms per g. The total count for dust was 333 microorganisms per liter of air. Actinomycetes belonging to the genus Streptomyces often constituted 90% or more of isolates from dust, whereas mold spores constituted approximately 5%. Dust weight averaged 3.4 mg/liter of air and contained approximately 33% inanimate and 67% animate (microbial) particles. Spent compost and casing contained approximately 60% moisture; the average pH of compost was 6.93, and that of casing was 7.70. Ouchterlony precipitin results with antisera from workers afflicted with either farmer's or mushroom worker's lung were positive for Bacillus licheniformis, Micropolyspora faeni, Thermoactinomyces vulgaris, Aspergillus fumigatus, Humicola grisea var. thermoidea, spent compost, and phase II compost. Their usefulness in determining the etiology of this and related forms of allergic alveolitis is questioned and discussed. The relationship of dust particle size; microbial species, prevalence and antigenicity; and compost antigenicity to the etiology of mushroom worker's lung is discussed. The microbial ecology of mushroom compost and moldy hay associated with farmer's lung is compared.
925Antigenic components of Malassezia species for immunoglobulin E antibodies in sera of patients with atopic dermatitis. Koyama T, Kanbe T, Ishiguro A, Kikuchi A, Tomita Y. J Dermatol Sci. 2001 Jul;26(3):201-8.Antigenic components of Malassezia furfur, M. globosa, M. restricta, M. slooffiae, and M. sympodialis were studied for immunoglobulin E antibodies in sera of patients with atopic dermatitis (AD). Antigenic components were extracted from Malassezia cells by treatment with beta-mercaptoethanol, referred to as 2-ME extract. CBB staining and lectin blots using Con A, LCA, PHA-E4, PNA or RCA120 showed that the 2-ME extracts contained several species-dependent components that differed quantitatively and qualitatively among the Malassezia species at the protein level. In the Western blot with the 2-ME extracts, of 54 sera of the patients with AD (54 patients), the patients' IgE antibodies most frequently recognized components showing molecular weights of 43-46 kDa for M. slooffiae, 12-22 kDa for M. sympodialis, 35-40 kDa for M. restricta, 45-50 kDa for M. globosa, and of 67-72 kDa for M. furfur, respectively. In the correlative study, in which the total band intensities generated for each extract in Western blot were compared among the Malassezia species, the intensity for M. globosa was well correlated with that for M. sympodialis (r=0.756). In the Western blot inhibition test, the 2-ME extract of M. globosa partially inhibited the reaction of the antigenic components of other Malassezia species with the patient's IgE antibodies. These results indicated that Malassezia species contained both species-specific and common antigenic components at the IgE antibody level.
926IgE antibodies to Malassezia furfur, M. sympodialis and Pityrosporum orbiculare in patients with atopic dermatitis, seborrheic eczema or pityriasis versicolor, and identification of respective allergens. Mayser P, Gross A. Acta Derm Venereol. 2000 Sep-Oct;80(5):357-61.Malassezia yeasts may be a trigger factor for atopic dermatitis. Following the recent reclassification of the genus, the presence of specific IgE antibodies was examined in the sera of patients with atopic dermatitis (n = 223), pityriasis versicolor (n = 83), seborrheic eczema (n = 50) and hymenoptera allergy (n = 39) and in controls without skin diseases (n = 50). In addition to using the commercially available radioallergosorbent test (RAST) for Pityrosporum orbiculare couplings were also made against the reference strains for M. furfur and M. sympodialis. To characterize the specificity and molecular weight of corresponding epitopes identical material was used for production of an immunoblot. Despite high total levels of IgE, controls and patients with pityriasis versicolor showed no specific IgE antibodies. Six patients (12%) with seborrheic eczema were positive while 78 patients (35%) with atopic dermatitis had specific IgE antibodies in higher RAST classes that differed between the Malassezia species. The molecular weights of the main antigens of M. sympodialis and M. furfur were determined to be 15, 22, 30, 37, 40, 58, 79, 92, 99 and 124 kDa and 15, 25, 27, 43, 58, 92, 99 and 107 kDa, respectively. Evaluated according to the location of their disease, patients with head and neck lesions most frequently showed Malassezia-specific IgE antibodies. However, there were differences between the Malassezia species tested, the previously used strain P. orbiculare being assignable to the species M. sympodialis.
927Cloning, characterization and expression of complete coding sequences of three IgE binding Malassezia furfur allergens, Mal f 7, Mal f 8 and Mal f 9. Rasool O, Zargari A, Almqvist J, Eshaghi H, Whitley P, Scheynius A. Eur J Biochem. 2000 Jul;267(14):4355-61.Malassezia furfur, formerly known as Pityrosporum orbiculare or P. ovale, is a yeast that colonizes human skin. Normally, this yeast is nonpathogenic but under the influence of predisposing factors it may induce IgE reactivity in patients with atopic dermatitis. Approximately 40-65% of atopic dermatitis patients have IgE antibodies and/or skin reactivity against M. furfur and a higher T-cell response against this yeast is found in atopic dermatitis patients than in healthy individuals. By making a cDNA library displayed on a phage surface, we previously cloned five different IgE-binding proteins, Mal f 5, Mal f 6, MF 7, MF 8 and MF 9, from this yeast. The cDNAs encoding these allergens were sequenced and expressed in Escherichia coli. The sequences of MF 7, MF 8 and MF 9 were not full length (missing their 5'-ends) giving only partial gene products. To obtain complete cDNA sequences, we performed RACE-PCR to amplify the 5'-ends of each cDNA. These PCR products were sequenced and analyzed. The coding sequences of Mal f 7, Mal f 8 and Mal f 9 encode proteins with ORFs of 141 (16.2 kDa), 179 (19.2 kDa) and 126 (14.0 kDa) amino-acid residues, respectively. None of the putative proteins showed significant sequence homology with other known proteins in the searched database. The proteins encoded by the complete cDNA sequences were expressed in E. coli as recombinant proteins. Immunoblotting and radioallergosorbant test data showed that all of the expressed recombinant proteins have the ability to bind serum IgE from atopic dermatitis patients and furthermore, the M. furfur extract could specifically inhibit this IgE binding.
928Identification and cloning of two novel allergens from the lipophilic yeast, Malassezia furfur. Yasueda H, Hashida-Okado T, Saito A, Uchida K, Kuroda M, Onishi Y, Takahashi K, Yamaguchi H, Takesako K, Akiyama K. Biochem Biophys Res Commun. 1998 Jul 20;248(2):240-4.Two novel allergens, designated Mal f 2 and Mal f 3 according to the WHO/IUIS Allergen Nomenclature Subcommittee recommendation, were isolated from the lipophilic yeast Malassezia furfur cell extracts and the genes coding for those were cloned. Mal f 2 and Mal f 3 had apparent molecular weights of 21 kDa and 20 kDa, respectively, on SDS-PAGE under reducing conditions. The identified cDNA clone of Mal f 2 encoded an open reading frame of 177 amino acid residues. Fifty-one percent identity was found between the Mal f 2 and Mal f 3 sequences. Comparison of the Mal f 2 and Mal f 3 sequences with known protein sequences revealed that they had sequence homology with two peroxisomal membrane proteins of Candida boidinii and an Aspergillus fumigatus allergen, Asp f 3. In RAST, both Mal f 2- and Mal f 3-specific IgE antibodies could be detected in approximately 70 % of sera from M. furfur sensitized patients with atopic dermatitis.
945Comparison of respiratory responses to Metarhizium anisopliae extract using two different sensitization protocols.Ward MD, Madison SL, Andrews DL, Sailstad DM, Gavett SH, Selgrade MJ.Metarhizium anisopliae, an entomopathogenic fungus, is a prototypic microbial pesticide licensed for indoor control of cockroaches, a major source of allergens. We have previously demonstrated allergy and asthma-like responses in BALB/c mice intraperitoneally (IP) sensitized in the presence of adjuvant and intratracheally (IT) challenged with the soluble factors from M. anisopliae crude antigen (MACA) (Ward et al., 1998, 2000). This protocol has been used frequently to establish animal models of allergenicity. However, the sensitization protocol is artificial and not representative of an environmental exposure. Concern has been raised that this protocol might produce allergic responses that would not occur under normal environmental exposure conditions. The objective of this study was to compare responses in mice to MACA by two exposure protocols: (1) exclusive respiratory exposures without adjuvant (representative of environmental exposures) and (2) intraperitoneal sensitization in the presence of adjuvant followed by IT challenge (the traditional approach). The intratracheal protocol consisted of four IT exposures of 10 microg MACA in 50 microl HBSS each over a 4-week period. A vehicle control group of mice was exposed IT to HBSS. The intraperitoneal protocol consisted of IP sensitization with 25 microg MACA in 0.2 ml of 1.3% alhydrogel (aluminum hydroxide) followed 14 days later with an IT challenge (10 microg MACA/50 microl HBSS). Airway reactivity responsiveness to methacholine was assessed, serum and bronchoalveolar lavage fluid (BALF) samples were obtained, and the lungs were fixed for histopathology at 1, 3, and 8 days following the last MACA IT challenge. Both groups exhibited immune and pulmonary responses typical of allergic asthma. In general, local responses in the lung, including inflammatory responses (eosinophils, lymphocytes, and macrophages), BALF IgE, and functional responses to methacholine were greater in the IT sensitized group compared to the IP sensitized group, whereas the systemic IgE response was greater in the IP sensitized group. The BALF IL-5 cytokine levels were elevated before and throughout the eosinophil influx. IL-4 was detected in the BALF of IP sensitized, but not IT sensitized mice. Histopathologic changes in the two groups were similar in nature but more severe in the IT mice. The results suggest that the IP sensitization protocol does not induce the level of respiratory responsiveness that results from sensitization by a physiologically relevant route of exposure. Thus total serum IgE levels, which were greater following IP sensitization, may not be the best indicator of allergen potency, at least with respect to respiratory responses.
946Allergic responses to the biopesticide Metarhizium anisopliae in Balb/c mice. Ward MD, Sailstad DM, Selgrade MK. Toxicol Sci. 1998 Oct;45(2):195-203.Metarhizium anisopliae is used as a microbial pesticide to control cockroaches and other insects. M. anisopliae has demonstrated neither infectivity nor toxicity in mammals. However, allergenicity has not been assessed. M. anisopliae is a prototype for other organisms released into the environment for pesticide or other beneficial applications. Hence this study is part of an effort to develop methods for screening such organisms for allergenic potential. Soluble factors from fungal components were combined in equal protein amounts to form a crude fungal antigen (MACA). Balb/c mice were intratracheally (IT) challenged with 25 micrograms fungal antigen 13 days post intraperitoneal sensitization with the fungal antigen in alhydrogel adjuvant. Additionally, mice were sensitized with adjuvant alone or chitin media in adjuvant as experimental controls. Serum and bronchoalveolar lavage fluid (BALF) were harvested prior to challenge and at 1 and 7 days post IT challenge (DPIT). These mice exhibited immune and pulmonary inflammatory responses to MACA characteristic of allergy. Total serum IgE for antigen-sensitized animals increased 7.6- and 14.7-fold over that for chitin media and adjuvant controls, respectively, at 7 DPIT. Less striking increases were seen at 24 DPIT and prior to challenge. BALF IL-4 was dramatically elevated only in MACA-sensitized and challenged mice and only at 1 DPIT. Additionally, there was a dose-dependent increase in BALF eosinophils from MACA-sensitized mice at both 1 and 7 DPIT. While lymphocyte counts were increased for all treatment groups at 1 DPIT, by 7 DPIT lymphocyte counts for MACA-sensitized mice only were significantly elevated compared to controls. Pulmonary inflammation, edema, and cell damage were apparent at 1 DPIT (25 micrograms MACA), as indicated by a neutrophilic influx and elevated levels of total protein and LDH, in both sensitized and control groups. These effects were significantly decreased, but not eliminated by reduction of the challenge dose to either 10 or 5 micrograms MACA. While BALF IL-4 was also reduced at the lower challenge doses, eosinophilia and total IgE were unchanged. The data suggest that the crude fungal extract MACA contains one or more potent allergens and that total IgE may be useful in the identification of the allergen(s).
947Allergen-triggered airway hyperresponsiveness and lung pathology in mice sensitized with the biopesticide Metarhizium anisopliae. Ward MD, Madison SL, Sailstad DM, Gavett SH, Selgrade MK. Toxicology. 2000 Feb 21;143(2):141-54.Metarhizium anisopliae is an entomopathogenic fungus recently licensed for indoor control of cockroaches, a major source of allergens. While M. anisopliae has been shown to be non-infectious and non-toxic to mammals there has been only limited research on potential allergenicity. Using a mouse model, we previously demonstrated allergic immune and inflammatory responses to this agent. The present study was designed to determine whether these responses were associated with changes in pulmonary responses, lung pathology, and the cytokine profile in bronchoalveolar lavage fluid (BALF). Soluble factors from fungal components were combined in equal protein amounts to form M. anisopliae crude antigen (MACA). BALB/C mice were intratracheally (i.t.) challenged with 10 microg MACA 14 days post intraperitoneal sensitization with 25 microg fungal antigen in aluminum hydroxide adjuvant. Physiological and cellular changes were examined. The mice were tested for airway hyperresponsiveness before (No Chal) and after (1, 3, and 8 days post challenge (DPIT)) MACA IT challenge. Subsequently, serum, BALF and the lungs were harvested. All treatment groups concurrently demonstrated significant non-specific pulmonary inflammation (neutrophil influx) and increased pulmonary sensitivity to methacholine (Mch) at 1 DPIT MACA challenge. Where as both adjuvant treated and naïve mice airway responses had returned to near normal levels by 3 DPIT, mice which were previously sensitized with MACA were still hyperresponsive to Mch challenge at 3 and 8 DPIT. This hyperresponsiveness correlates with eosinophil and lymphocyte influx, which is maximal at 3 DPIT and still elevated at 8 DPIT. Interleukin (IL) 5 was elevated for all treatment groups at 1 DPIT but only the MACA sensitized mice maintained elevated levels for both 3 and 8 DPIT. Furthermore, MACA sensitized mice had a more extensive inflammatory histopathology at all examined time points with peribronchial and perivascular infiltrates, like those associated with allergic responsiveness, peaking at 3 DPIT. These pulmonary pathologic changes appeared to be consistent with elevated levels of serum and BALF total IgE, BALF IL-4, eosinophils, and lymphocytes following MACA IT challenge in MACA sensitized mice. There were no significant differences among the three treatment groups with regard to BALF interferon (IFN) gamma. The cytokines profiled indicate a Th2-type response, which is reflected in the cellular influx and total IgE induction. These data further indicate that immune inflammatory responses, observed in mice following MACA sensitization and challenge, are associated with physiologic changes and histopathology characteristic of allergic disease.
985Monascus purpureus: a new fungus of allergenic relevance.] Hipler UC, Wigger-Alberti W, Bauer A, Elsner P. Mycoses. 2000;43 Suppl 2:29-31.Anaphylactic reactions to food containing allergens in the consumption or preparation of food are well known. However, allergy in the preparation of sausages have rarely been described. In the present study a 26-year-old butcher was investigated who had a severe anaphylactic reaction developing sneezing, rhinitis, conjunctivitis, generalised pruritus, followed by widespread urticaria, Quincke's oedema and dyspnoe after starting to prepare sausages containing red yield rice. Red yield rice is produced from polished and washed rice by means of the fungus Monascus purpureus. It was the first time that Monascus purpureus could be shown as allergic agent by means of prick-to-prick test, Cellular Antigen Stimulation Test (CAST) and different other immunoblots.
986Case report. Monascus purpureus--a new fungus of allergologic relevance. Hipler UC, Wigger-Alberti W, Bauer A, Elsner P. Mycoses. 2002 Feb;45(1-2):58-60.Anaphylactic reactions to food containing allergens in the consumption or preparation of food are well known. However, allergy in the preparation of sausages has rarely been described. In the present study a 26-year-old-butcher was investigated who had a severe anaphylactic reaction developing sneezing, rhinitis, conjunctivitis, generalised pruritus, followed by widespread urticaria, Quincke's oedema and dyspnoe after starting to prepare sausages containing red yield rice. Red yield rice is produced by the fungus Monascus purpureus. It was the first time that Monascus purpureus could be shown as allergic agent by means of prick-to-prick test, Cellular Antigen Stimulation Test (CAST) and different immunoblots.
990Hypersensitivity pneumonitis in peat moss processing plant workers. Cormier Y, Israel-Assayag E, Bedard G, Duchaine C. Am J Respir Crit Care Med. 1998 Aug;158(2):412-7.A nonsmoking 54-yr-old man, employed in a peat moss packaging plant, developed dyspnea and recurrent fever. The diagnosis of hypersensitivity pneumonitis (HP) was made. Thirteen of 14 coworkers and 13 nonexposed control subjects were studied. Five workers were nonsmokers, two were minimal smokers, and six were smokers. HP was found in another subject. Monocillium sp. and Penicillium citreonigrum, 4.6 x 10(7) CFU/g, were found in the peat moss. Three nonsmokers, the two minimal smokers (including the subject with HP), and the index case had antibodies to these microorganisms; none of the six heavy smokers had antibodies. Serum TNF-alpha was higher in the workers than in the control subjects (0.930 +/- 0.177 versus 0. 350 +/- 0.076). Three of the four asymptomatic seropositive workers and two seronegative smokers were further evaluated. All three seropositive workers had normal lung functions and CT but they all had a lymphocytic alveolitis (30, 34, and 68% lymphocytes in their bronchoalveolar lavage [BAL]). The smokers had normal lung functions, CT, and percentage of BAL lymphocytes (3 and 13%). This study identified a previously unrecognized work environment that can lead to HP and documented a protective effect of smoking on the response to antigens.
996The role of imperfect fungi in etiopathogenesis of allergic rhinitis] Namysłowski G, Rogala B, Mrówka-Kata K, Ponińska-Polańczuk J. Otolaryngol Pol. 1998;52(3):277-80.In this paper the role of imperfect fungi in etiopathogenesis of perennial rhinitis was examined. In a group of 26 patients the concentration of total IgE and IgE specific of Candida albicans, Aspergillus fumigatus, Alternaria alternata, Mucor racemosus and Cladosporum herbarum was signified. Oversensibility to imperfect fungi was confirmed in 30.8% of patients: to Candida albicans in 3.8%, to Aspergillus fumigatus in 11.5%, to Alternaria alternata in 3.8%, to Mucor racemosus in 7.6% and to Cladosporum herbarum in 3.8%.
998Skin hypersensitivity: intradermal hypersensitivity to allergen extracts and its relation to the place of residence] Espinosa Morales SM, Bolaños Ancona JC, Miranda Feria AJ. Rev Alerg. 1992 Nov-Dec;39(6):115-9.A retrospective review of 308 clinical files of patient to respond at immunological and clinical allergic service of the Centro Medico 20 de Noviembre, ISSSTE for suffer with allergica illnes, realized by aeroalergens sensitization and determination frequency (intradermoreactions mediated) and relation to area living. The patients was highly sensitive at dust and dermatophagoides (75 and 40% respectively) others aeroalergen caused sensitization in the Capriola dactylon (37%), Amarantus palmieri (35.5%), Fracxinus (34.6%), Ambrosia elatior (33%), Candida (21.4%), Penicillium (18.1%), Mucor y Rizopus (17.8% each one).
999Immediate skin test reactivity to common aeroallergens in patients with respiratory allergies: a comparative analysis of allergen-induced skin reactions and their histamine controls. Lopez LR, Noriega Y, Losno R. J Allergy Clin Immunol. 1988 Jun;81(6):1143-8.The results of the immediate skin test response to a panel of 16 common aeroallergens performed in a group of 659 consecutive patients with symptoms suggestive of a respiratory allergy were analyzed. A group of 108 healthy individuals served as control subjects. Ninety-four percent of the patients and 87% of the control subjects had at least one allergen-induced reaction (wheal greater than or equal to 2 by 2 mm). The prevalence of positive skin reactions to each aeroallergen was equally high in both groups. However, if a skin reaction is considered as positive only when an allergen-induced wheal is equal or larger compared to the 50% of the wheal obtained with the histamine control in that individual, 70% of the patients had positive skin reactions and only 38% of the control subjects were positive (p less than 0.05). Similarly, the prevalence rates to five aeroallergens (pollen, Fusarium, Mucor, Pullularia, and Curvularia) in the patient group were reduced to those levels observed with the control group, suggesting they are clinically less important. The age and not the sex influenced both the prevalence rates (p less than 0.001) and the mean size (p less than 0.01) of allergen and histamine-induced skin reactions. Lower prevalence rates and mean size values were observed in the youngest group (0 to 9 years). Moreover, there was an inverse relationship between lower skin reactivity with more younger subjects in our patient population. These results indicate that patients and healthy individuals have similar mechanisms for skin reactivity.(ABSTRACT TRUNCATED AT 250 WORDS)
1000Detection of the incidence of increased sensitization to molds in patients with bronchial asthma and allergic rhinitis] Kautz S, Bergmann I, Dehnert I, Fischer JF, Frenzel K, Leupold W, Meister W, Schuster R, Zochert J. Z Erkr Atmungsorgane. 1984;163(1):24-31.The incidence of sensibilization against extracts of moulds produced by VEB SSW Dresden was investigated by intracutaneous tests in 354 persons (controls and patients - adults and children - with bronchial asthma and allergic rhinitis). Even in the nonallergic controls the tests were positive in 20-30%. Patients with asthma and rhinitis were significantly more often positive than controls with Mucor, Cladosporium and mixed-mould. There was no difference between the groups with Aspergillus and Penicillium. Testing with extract of mixed-mould is not effective. Positive results with the individual moulds were not excluded although the test with mixed-mould was negative. There was no essential difference in the incidence of sensibilization between adults and children with bronchial asthma using mould extracts of VEB SSW Dresden.
1061First report of involvement of Nodulisporium species in human disease. Cox GM, Schell WA, Scher RL, Perfect JR. J Clin Microbiol. 1994 Sep;32(9):2301-4.Allergic fungal sinusitis is a common disease that results from a hypersensitivity reaction mounted by the host against fungi living in the paranasal sinuses. We have recently treated a patient with allergic fungal sinusitis due to a Nodulisporium species. This is the first description of a Nodulisporium species involved in human disease. The genus Nodulisporium contains both dematiaceous and nondematiaceous members. These fungi occur worldwide in nature, often as accompanying conidial anamorphs of certain wood decay ascomycetes. Clinical mycology laboratories may encounter this new agent of phaeohyphomycosis.
1086Infectious-allergic bronchopulmonary paecilomycosis] Akhunova AM. Ter Arkh. 1991;63(10):19-24.Primary or secondary infection of the lungs with fungi of the Paecilomyces family (P. variotii and P. viridis) gives rise to the development of infectious allergic bronchopulmonary paecilomycosis characterized by the presence of chronic allergic interstitial pneumonia and obstructive bronchitis, bronchial asthma, total and pulmonary eosinophilia, the presence of the tissue parasitic form of the fungus in sputum, blood, pulmonary tissue, the presence of allergen-specific IgE and/or IgG antibodies in patients' sera, immediate or double (20 min and 6 h) reaction of the skin to administration of allergen of Paecilomyces, by not infrequent combination of lung damage and impairment of other organs as well as by chronic relapses.
1087Allergenic properties of a feed protein of microfungal origin. Kauppinen K, Kuuliala O, Björkstén F. Clin Allergy. 1983 Jan;13(1):69-73.We studied thirty-five process and laboratory workers occupationally exposed to Paecilomyces varioti protein. The protein, used as an animal feed, is prepared industrially by fermentation in pulp waste liquor. Skin tests and radioallergosorbent tests (RAST) to detect specific IgE antibodies showed positive results to Paecilomyces antigen among the workers and among the atopic control persons not occupationally exposed to Paecilomyces protein. Also IgG antibodies to Paecilomyces protein could be detected in workers and in controls in similar amounts in both groups. In no worker could clinical symptoms due to Paecilomyces protein allergy be found. We conclude that positive skin tests and RASTs indicate that immediate hypersensitivity to Paecilomyces antigens occurs. Clinical allergy probably has been prevented by the closed manufacturing process, which keeps occupational exposure at a low level.
1116Delayed-type hypersensitivity response in an isogenic murine model of paracoccidioidomycosis. Fazioli Rdos A, Singer-Vermes LM, Kashino SS, Burger E, De Franco MF, Moscardi-Bacchi M, Calich VL. Mycopathologia. 1994 Jun;126(3):137-46.The specific delayed-type hypersensitivity (DTH) response was evaluated in resistant (A/SN) and susceptible (B10.A) mice intraperitoneally infected with yeasts from a virulent (Pb18) or from a non-virulent (Pb265) Paracoccidioides brasiliensis isolates. Both strains of mice were footpad challenged with homologous antigens. Pb18 infected A/SN mice developed an evident and persistent DTH response late in the course of the disease (90th day on) whereas B10.A animals mounted a discrete and ephemeral DTH response at the 14th day post-infection. A/SN mice infected with Pb265 developed cellular immune responses whereas B10.A mice were almost always anergic. Histological analysis of the footpads of infected mice at 48 hours after challenge showed a mixed infiltrate consisting of predominantly mononuclear cells. Previous infection of resistant and susceptible mice with Pb18 did not alter their DTH responses against heterologous unrelated antigens (sheep red blood cells and dinitrofluorobenzene) indicating that the observed cellular anergy was antigen-specific. When fungal related antigens (candidin and histoplasmin) were tested in resistant mice, absence of cross-reactivity was noted. Thus, specific DTH responses against P. brasiliensis depend on both the host's genetically determined resistance and the virulence of the fungal isolate.
1117Immunohistochemical characterization of mononuclear cells in delayed hypersensitivity reactions to Paracoccidiodes brasiliensis (paracoccidioidin test). Marques M, Moscardi-Bacchi M, Marques S, Franco M. Mycopathologia. 1993 Oct;124(1):7-11.The density and distribution of T cells, T helper cells, macrophages and B cells at the site of skin tests with a cytoplasmic Paracoccidioides brasiliensis antigen (paracoccidioidin) was studied at 24 and 48 h post-challenge in 10 patients with the chronic form of paracoccidioidomycosis and in 5 non-infected individuals. The in situ study was carried out using immunoperoxidase techniques and monoclonal antibodies. The controls showed negative skin test. In the patients, the great majority of the cells in the perivascular foci were T cells (CD43-positive cells) making up 47% and 48.6% of the total number of cells at 24 and 48 h respectively. Most of the T cells showed a T helper phenotype (CD45RO-positive cells). Approximately 25% of the cells were macrophages (CD68-positive cells) and there were very few B lymphocytes (CD20-positive cells). The present data on the microanatomy of paracoccidioidin skin test sites were consistent with a delayed type hypersensitivity pattern. Our results were comparable to those reported on skin tests for other granulomatous chronic diseases.
1118Hypersensitivity pneumonitis to Paracoccidioides brasiliensis antigens in mice. Defaveri J, Coelho KI, Rezkallah-Iwasso MT, Franco M. J Med Vet Mycol. 1989;27(2):93-104.Hypersensitivity pneumonitis was induced in mice immunized with Paracoccidioides brasiliensis and challenged, one week later, with soluble (SPbAg) or particulate (PPbAg) antigen (formalin-killed yeast cells), administered by the intratracheal route. Between 24 and 48 h post-challenge, animals developed an interstitial and intra-alveolar pneumonitis. Macrophages and lymphocytes arranged focally into loose or mature granulomata were observed by light and electron microscopy. The distribution and fate of antigens was studied by immunofluorescence. Three hours after challenge with SPbAg the lungs showed linear fluorescent deposits, whereas after challenge with PPbAg the pattern was globular, corresponding to the particulate antigen. After 24 and 48 h, the pattern was diffuse and finely granular in both groups, with a decreasing number of animals showing detectable fluorescence. Immunization induced a positive footpad swelling test (FPT) in all animals. After pulmonary challenge, there was a significant decrease in FPT indices, interpreted as desensitization due to trapping of specifically sensitized lymphocytes in the lungs. In conclusion, immunization induced a marked cellular immune response, the inflammatory pattern and the tempo of the induced pneumonitis being compatible with delayed hypersensitivity in the lungs. Immunized mice also cleared the injected antigens rapidly. These data suggest that hypersensitivity pneumonitis may be an expression of pulmonary resistance to infection with P. brasiliensis.
1127 Identification and expression of Pen c 2, a novel allergen from Penicillium citrinum. Chow LP, Su NY, Yu CJ, Chiang BL, Shen HD. Biochem J. 1999 Jul 1;341 ( Pt 1):51-9.The mould genus, Penicillium, is known to be a significant source of environmental aero-allergens. One important allergen from Penicillium citrinum, Pen c 2, has been identified by means of two-dimensional immunoblotting using IgE-containing patients' sera. This novel allergen was cloned, sequenced and expressed in Escherichia coli. The cloned cDNA encodes a large 457-amino acid protein precursor containing a 16-amino acid signal peptide, a 120-amino acid propeptide and the 321-amino acid mature protein. Comparison of the Pen c 2 sequence with known protein sequences revealed shared high sequence similarities with two vacuolar serine proteases from Aspergillus niger and Saccharomyces cerevisiae. Asp-46, His-78 and Ser-244 were found to constitute the catalytic triad of the 39-kDa Pen c 2. The DNA coding for Pen c 2 was cloned into vector PQE-30 and expressed in E. coli as a His-tag fusion protein that bound serum IgE from Penicillium-allergic patients on immunoblots. Recombinant Pen c 2 could therefore be used effectively for diagnosis and also potentially for the treatment of mould-derived allergic disorders.
1128Allergenic components in three different species of Penicillium: crossreactivity among major allergens. Shen HD, Lin WL, Tsai JJ, Liaw SF, Han SH. Clin Exp Allergy. 1996 Apr;26(4):444-51.BACKGROUND: Penicillium species have been considered as important causative agents of extrinsic bronchial asthma. However, little is known about the allergens of these ubiquitous airborne fungal species. OBJECTIVE: This study compares the allergenic profiles and allergenic crossreactivity among allergens of three prevalent airborne Penicillium species. METHODS: IgE-binding Penicillium components were identified by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE)-immunoblotting using sera from 67 asthmatic patients. The presence of allergenic crossreactivity was analysed by immunoblot inhibition. RESULTS: Among the 67 serum samples tested, 15, 14 and 11 samples showed IgE reactivity to components of P. citrinum, P. notatum and P. brevicompactum, respectively. All 15 P. citrinum-positive serum samples showed IgE-binding to a 33 kDa extract component of this species. Thirteen (93%) of the 14 P. notatum-positive serum samples and 10 (91%) of the 11 P. brevicompactum-positive sera also showed IgE reactivity to components with a molecular weight of about 33 kDa in individual Penicillium species. All of the 10 P. brevicompactum 33 kDa component-positive serum samples showed IgE reactivity to the 33 kDa components of the other two Penicillium species tested. Dose-dependent inhibition of IgE-binding to these major allergens was observed when the positive serum sample was absorbed with different amounts of individual allergenic extract as well as with different amounts of extracts prepared from the other two Penicillium species. CONCLUSION: Although different allergenic profiles were observed in the three different Penicillium species tested, results showed that there was an IgE crossreactivity among the 33 kDa group major allergens of P. citrinum, P. notatum and P. brevicompactum.
1194Evaluation of skin test for chromoblastomycosis using antigens prepared from culture filtrates of Fonsecaea pedrosoi, Phialophora verrucosa, Wangiella dermatitidis and Exophiala jeanselmei. Iwatsu T, Miyaji M, Taguchi H, Okamoto S. Mycopathologia. 1982 Jan 15;77(1):59-64Antigenic substances were prepared from culture filtrates of Fonsecaea pedrosoi, Phialophora verrucosa, Wangiella dermatitidis and Exophiala jeanselmei. These antigenic substances were evaluated for detecting cutaneous delayed hypersensitivity in rats experimentally-infected with F. pedrosoi, P. verrucosa. W. dermatitidis, E. jeanselmei, Cladosporium carrionii and Fonsecaea compactum and in patients with chromoblastomycosis caused by F. pedrosoi. The F. pedrosoi antigen elicited positive reactions in all of the animals infected with F. pedrosoi and in 5 of 6 patients. The P. verrucosa, W. dermatitidis and E. jeanselmei antigens elicited positive reactions in all of the animals infected with the homologous species. These antigens displayed cross-reactivity in some of the animals and patients, whereas more than half of them exhibited positive reactions only to the antigens prepared from the homologous species. These results suggest that a delayed-type skin test using the antigens prepared by the authors may be useful not only for the diagnosis of chromoblastomycosis but also for the identification of species of the causative agent.
1273Cell-mediated immune responses (CMIR) to Rhinosporidium seeberi in mice. Jayasekera S, Arseculeratne SN, Atapattu DN, Kumarasiri R, Tilakaratne WM. Mycopathologia. 2001;152(2):69-79.There is no published data on Cell Mediated Immune Responses in experimental animals to Rhinosporidium seeberi the causative agent of human and animal rhinosporidiosis. The quantitative mouse foot-pad model was used to assay the Delayed-Type Hypersensitivity (DTH) cell-mediated immune response to extracts of purified endospores and sporangia of R. seeberi. Histological examination was used to confirm that the foot-pad reactions were compatible with DTH reactions in the mouse. We report that sonically disintegrated rhinosporidial endospores/sporangia induced DTH responses in the foot-pads of sensitized mice which were comparable in intensity and histological profile to that induced by sheep red blood cells in SRBC sensitized mice. Anti-rhinosporidial antibody was also induced. Filtrates of the soluble antigens in sonicated suspensions failed to evoke a DTH-foot-pad (DTH-FP) response in sensitized mice although an anti-rhinosporidial antibody response to this preparation was detected. Prolonged pre-treatment with sonicated suspensions of endospores and sporangia resulted in a decrease of DTH reactivity as compared with reactions following pre-treatment of a shorter duration.
1283 Allergic Rhizomucor sinusitis. Goldstein MF, Dvorin DJ, Dunsky EH, Lesser RW, Heuman PJ, Loose JH. J Allergy Clin Immunol. 1992 Sep;90(3 Pt 1):394-404. 
1291Immunochemical investigation of allergens from Rhizopus nigricans. Sridhara S, Gangal SV, Joshi AP. Allergy. 1990 Nov;45(8):577-86.The allergenic proteins of mould, Rhizopus nigricans extract (RNE) were identified and characterized by crossed immunoelectrophoresis (CIE), thin-layer isoelectrofocusing (TLIEF) and RAST inhibition. CIE revealed that the extract contained at least 31 distinct antigens. On TLIEF the extract resolved into 22 bands in pI 3.5-6.8. Two important allergens, Rhiz IIIb and VIb were purified by a combination of ammonium sulfate precipitation, anion exchange chromatography on DEAE-Sephadex column and gel filtration. Twenty and 12 micrograms of Rhiz IIIb and Rhiz VIb were sufficient to give 50% RAST inhibition as against 43 micrograms of crude RNE. Rhiz IIIb and Rhiz VIb were found to be glycoproteins with molecular weights of 12,400 daltons and 14,200 daltons, respectively. Rhiz IIIb was found to be homogeneous on polyacrylamide gel electrophoresis (PAGE) and TLIEF with a pI of 4.8, while Rhiz VIb gave a single band on PAGE and resolved into two Coomassie blue stained bands with pI 3.6 and 3.8. It was possible to separate the components of RNE on fast protein liquid chromatography (FPLC) using an anion exchanger Mono Q column. The identification and characterization of the antigenic and allergenic proteins in the extract will be useful in standardization of RNE and in preparation of an in-house reference standard.
1313Extrinsic allergic alveolitis after exposure to the yeast Rhodotorula rubra. Siersted HC, Gravesen S. Allergy. 1993 May;48(4):298-9.A case of extrinsic allergic alveolitis following exposure to the red yeast Rhodotorula rubra is reported--to our knowledge, for the first time. Extensive growth of the yeast in the patient's environment was demonstrated, explaining an elevated titer of Rhodotorula-specific precipitating antibodies in his serum. A bronchial provocation test confirmed the diagnosis.
1328Saccharomyces-induced hypersensitivity pneumonitis in a dairy farmer: a case report] Yamamoto Y, Osanai S, Fujiuchi S, Akiba Y, Honda H, Nakano H, Ohsaki Y, Kikuchi K. Nihon Kokyuki Gakkai Zasshi. 2002 Jun;40(6):484-8.A 58-year-old man, a dairy farmer, was admitted to Engaru Kosei Hospital because of cough, fever and dyspnea following repeated exposure to moldy silage in a silo. Chest radiography showed ground-glass opacity and tiny nodules in both lung fields. Arterial blood gas analysis showed severe hypoxia (PaO2, 30.8 torr). The patient was referred to Asahikawa Medical College Hospital for a diagnostic evaluation. At the time of admission, his symptoms were slightly resolved and the lung density on the chest radiograph was decreased. Pulmonary function tests revealed restrictive ventilatory impairment with a reduction in diffusing capacity. Bronchoscopic examination revealed mild lymphocytosis in the bronchoalveolar lavage fluid (BALF). Neither bacteria nor fungi were cultured from the BALF. Transbronchial lung biopsy specimens showed alveolitis with lymphocyte infiltration. The symptoms and signs disappeared spontaneously without any specific treatment, such as corticosteroids or antibiotics. A provocation test consisting of silage handling elicited recurrence of his symptoms, a decrease in diffusing capacity, and hypoxia. A definitive diagnosis of hypersensitivity pneumonitis (HP) was made from these findings. Samplings from the silage revealed a gross growth of the yeast Saccharomyces cerevisiae. A serum-precipitating antibody gave a positive reaction for an extract of S. cerevisiae. These results suggested that repetitive exposure to S. cerevisiae had led to sensitization through the patient's occupational environment, resulting in the development of HP.
1329Skin prick test response to enzyme enolase of the baker's yeast (Saccharomyces cerevisiae) in diagnosis of respiratory allergy. Nittner-Marszalska M, Wójcicka-Kustrzeba I, Bogacka E, Patkowski J, Dobek R. Med Sci Monit. 2001 Jan-Feb;7(1):121-4.BACKGROUND: The aim of the study is to prove that Saccharomyces cerevisiae enolase, the major allergen of the baker's yeast, induces allergic immediate response in patients with inhalant allergy sensitized to Candida albicans extract. MATERIAL AND METHODS: The study was performed in three groups of patients: I. 20 atopic patients with respiratory allergy sensitized to Candida albicans and inhalant allergens (mite, feather, pollens) II. 30 patients with respiratory allergy, positive skin tests to inhalant allergens but negative skin tests to Candida albicans and other fungi; III. 20 nonatopic, healthy individuals. Skin prick test of purified enolase from Saccharomyces cerevisiae (bakers yeast) at concentration 1 and 10 mg/ml was performed in all groups. The results were documented planimetrically. RESULTS: 95% of patients sensitized to Candida albicans extract showed positive skin reactions to Saccharomyces cerevisiae enolase, 10% of patients of group II and none of the patients of the control group had positive skin responses to enolase. The mean wheal size (mm2) in skin prick test to Candida albicans, Saccharomyces cerevisiae enolase at concentration 10 mg/ml was x = 15.17 +/- 11.08, 15.76 +/- 19.67 and at concentration 1 mg/ml 10.02 +/- 10.49, respectively. CONCLUSIONS: 1. Saccharomyces cerevisiae enolase induces an immediate allergic reaction in skin in subjects with respiratory allergy and positive skin prick test results to Candida albicans and other fungi. 2. Enolase can be an important allergenic component of the Candida albicans extract.
1330IgE, IgA, and IgG responses to common yeasts in atopic patients. Savolainen J, Kortekangas-Savolainen O, Nermes M, Viander M, Koivikko A, Kalimo K, Terho EO. Allergy. 1998 May;53(5):506-12.This study was undertaken to analyze the differences in exposure and sensitization to five common environmental yeasts. The responses of IgG, IgA, and IgE to Candida albicans, C. utilis, Cryptococcus albidus, Rhodotorula rubra, and Saccharomyces cerevisiae and purified S. cerevisiae enolase were analyzed by immunoblotting (IgE-IB), and the cross-reactivity of their IgE-binding components by IgE-IB inhibition. Twenty atopic subjects, with asthma, allergic rhinitis, or atopic dermatitis were included. In skin prick tests (SPT), 12 of the patients showed simultaneous reactivity to at least two of the five yeasts, four reacted to one of the yeasts, and four had no responses. Antigens run in SDS-PAGE and transferred to nitrocellulose were probed with enzyme-labeled IgA-, IgG-, and IgE-specific antibodies. The IgE immunoblotting revealed most IgE-binding bands in C. albicans (11 bands) followed by C. utilis (eight bands), S. cerevisiae (five bands), R. rubra (five bands), and Cr. albidus (four bands). Six of the IgE-binding bands of C. albicans and C. utilis shared molecular weight, and only two bands shared molecular weight with other yeasts. These were the 46-kDa band, shared by all five yeasts, and a 13-kDa band shared by four yeasts. Prominent IgE binding was seen to a 46-kDa band of C. albicans (seven patients), C. utilis (five patients), and S. cerevisiae (one patient) and to corresponding weak bands of Cr. albidus and R. rubra (one patient). The possible cross-reactivity of the 46-kDa band was analyzed by IgE-IB inhibition and densitometry, revealing clear C. albicans inhibition of C. utilis (80%) and enolase (98%) (autoinhibition 100%). The strongest IgG responses were seen against S. cerevisiae and C. albicans. The responses were mainly against mannans of C. albicans and S. cerevisiae, suggesting that most of the exposure is to these yeasts. Yeasts with different types of exposure, from saprophytic growth on human mucous membranes to exposure by air and food, were shown to cross-react at the allergenic level. Atopic patients primarily sensitized by C. albicans and S. cerevisiae may develop allergic symptoms by exposure to other environmental yeasts due to cross-reacting IgE antibodies.
1331Immediate hypersensitivity to bakery, brewery and wine products in yeast-sensitive atopic dermatitis patients. Kortekangas-Savolainen O, Savolainen J, Lantto R, Kalimo K. Clin Exp Allergy. 1994 Sep;24(9):836-42.Ultrafiltered (> 1000 Da) samples of beer, aged red wine, young white wine, sparkling wine and extracts of fresh wheat bread and dried rye bread were analysed by skin-prick test (SPT), radioallergosorbent test (RAST) inhibition, sodium dodecylsulphate-polyacrylamide gel electrophoresis (SDS-PAGE) and immunoblotting to find out if they contain Saccharomyces cerevisiae (S. cerevisiae, baker's yeast) allergens. Serum pool consisting of S. cerevisiae positive sera was used in the assays. The results were compared with freeze-dried reference S. cerevisiae and cereal antigens. The beer, bread, red wine and sparkling wine extracts elicited immediate reactions. However, no evident correlation with suspected symptoms was observed. White wine extract caused reactions in four out of six atopic dermatitis (AD) patients with symptoms, and in five out of seven symptom-free AD patients and in two of the 24 controls. In SDS-PAGE, protein bands were found in wheat and rye bread extracts and beer. In IgE immunoblotting, however, no staining was seen with the S. cerevisiae positive sera suggesting that they were of cereal origin. In white wine and champagne extracts a non-specific staining was seen in the region 20 kDa representing, e.g. lectin-like activity. No baker's yeast antigen could be detected in brewery and bakery products with IgE-immunoblotting even in the excessively concentrated extracts. The IgE mediated allergy to baker's yeast alone should thus not lead to denial of bakery, brewery and wine products.
1332Skin prick test reactions to brewer's yeast (Saccharomyces cerevisiae) in adult atopic dermatitis patients. Kortekangas-Savolainen O, Lammintausta K, Kalimo K. Allergy. 1993 Apr;48(3):147-50.the sensitizing capacity of brewer's yeast (Saccharomyces cerevisiae) was studied with the skin prick test method in 449 subjects, including 226 atopic dermatitis (AD) patients, 50 patients with allergic rhinitis (AR) and/or asthma (A), and 173 nonatopic controls. A positive SPT reaction (> or = + +) was seen in 94% of patients with severe AD, in 76% with moderate AD, and in 25% with mild AD or no history of AD. Patients with AR and/or A and nonatopic controls displayed a positive reaction in only 8 and 2% of cases, respectively. There was also a parallel skin prick test reactivity with other yeasts including Pityrosporum ovale and Candida albicans, suggesting cross-reactivity. Parallel skin reactivity was observed also with molds and animal dander but not with pollen or house-dust mite. A significant correlation was also found between total serum IgE level and skin prick test (SPT) results with S. cerevisiae.
1349Clinical significance of Scedosporium apiospermum in patients with cystic fibrosis. Cimon B, Carrère J, Vinatier JF, Chazalette JP, Chabasse D, Bouchara JP. Eur J Clin Microbiol Infect Dis. 2000 Jan;19(1):53-6.The incidence of airway colonization by Scedosporium apiospermum and of related sensitization was investigated prospectively in 128 patients with cystic fibrosis over a 5-year period, and results were compared with clinical data. Scedosporium apio-spermum, recovered from sputum samples in 11 of 128 (8.6%) patients, was the most frequent filamentous fungus after Aspergillus fumigatus. Counterimmuno-electrophoresis, used to detect scedosporiosis serologically, was positive in 27 of 128 (21.1%) patients. The discrepancy between the mycological and serological results may be related to immune cross-reactions between Scedosporium apiospermum and Aspergillus fumigatus. However, symptoms of allergic bronchopulmonary disease were observed in two patients chronically colonized by Scedosporium apiospermum. The results clearly demonstrate that the frequency of this fungus is largely underestimated and that it may trigger an inflammatory response, thus suggesting a pathogenic role in patients with cystic fibrosis.
1372[A case of mucoid impaction of bronchi (MIB) due to Schizophyllum commune] Itou Y, Sasaki S, Watanabe S, Kawamura T, Nakahara Y, Mochizuki Y, Kamei K. Nihon Kokyuki Gakkai Zasshi. 2001 Apr;39(4):266-70.A 51-year-old woman was admitted because of a productive cough. Atelectasis of the left upper lobe and eosinophilia were noted. The atelectasis was resolved after bronchoscopic removal of the mucous plug. Pathologically, it consisted of eosinophil accumulation with hyphae. Cultures of sputum samples revealed Schizophyllum commune. We diagnosed this case as mucoid impaction of bronchi due to S. commune. Eight months later, a productive cough developed again. Chest radiography showed atelectasis of the right middle lobe. Cultures of bronchial washings yielded S. commune and Aspergillus niger. The atelectasis was resolved by four months of administration of itraconazole (200 mg daily).
1373Allergic bronchopulmonary mycosis caused by the basidiomycetous fungus Schizophyllum commune. Kamei K, Unno H, Nagao K, Kuriyama T, Nishimura K, Miyaji M. Clin Infect Dis. 1994 Mar;18(3):305-9.We describe, to our knowledge, the first case of allergic bronchopulmonary mycosis (ABPM) caused by the basidiomycetous fungus Schizophyllum commune in an otherwise healthy woman. Bronchoscopic analysis repeatedly disclosed S. commune hyphae in the bronchi of the lingular lobe; these hyphae were originally misidentified as Aspergillus because the presence of clamp connections was overlooked. A lingular infiltrate with ectatic proximal bronchi, eosinophilia, an elevated serum level of IgE, and antibodies to S. commune supported the diagnosis. It is sometimes difficult to isolate and identify S. commune in clinical specimens, and hence only a limited number of cases of ABPM might have been correctly diagnosed in the past. We suspect, therefore, that some cases of ABPM caused by an allergic reaction to S. commune may be misdiagnosed as allergic bronchopulmonary aspergillosis or eosinophilic pneumonia of unknown origin. The significance of S. commune in allergic bronchopulmonary diseases is discussed.
1382Hypersensitivity pneumonitis among workers cultivating Tricholoma conglobatum (shimeji). Akizuki N, Inase N, Ishiwata N, Jin Y, Atarashi K, Ichioka M, Yoshizawa Y, Marumo F. Respiration. 1999;66(3):273-8.We report five cases of hypersensitivity pneumonitis among workers cultivating Tricholoma conglobatum (shimeji). After having worked for 5 to 20 years, they began to notice symptoms of cough, sputum, and dyspnea. They were diagnosed as having a hypersensitivity pneumonitis based on clinical features, bronchoalveolar lavage and transbronchial lung biopsy. By the double immunodiffusion test, precipitating lines between shimeji spore antigen and sera were observed in all of the patients. By enzyme-linked immunosorbent assay, the antibody activities against shimeji and three species of fungi (Cladosporium sphaerospermum, Penicillium frequentans, and Scopulariopsis species) were significantly higher in the sera of the patients than in those of normal subjects who were cultivating shimeji. Although it is not clear what causes this disease, these findings may be helpful in determining the specific antigen.
1412Sporobolomyces: a possible cause of extrinsic allergic alveolitis. Cockcroft DW, Berscheid BA, Ramshaw IA, Dolovich J. J Allergy Clin Immunol. 1983 Sep;72(3):305-9.A 28-year-old horseback rider presented with symptoms, chest radiograph, and pulmonary function tests suggestive of extrinsic allergic alveolitis related to exposure to a horse barn. Exposure to the barn produced symptoms, fever, and a fall in VC commencing 4 hr after exposure. Precipitins were positive against Sporobolomyces, suggesting this might be the causative agent; precipitins were negative against other fungi and horses. Lymphocyte stimulation to Sporobolomyces in vitro was positive in the patient and negative in two control subjects. Sporobolomyces was grown from straw in the barn. Cessation of exposure to this barn (but continued exposure to horses) has resulted in improvement in clinical condition. A survey for immunologic sensitivity to Sporobolomyces revealed that eight of 30 atopic subjects had positive wheal-and-flare prick skin tests to Sporobolomyces antigen, whereas none of 30 laboratory controls or 30 grain handlers had precipitins against Sporobolomyces. Sporobolomyces is a common fungus in cereal grain growing areas. Its spore size is less than 5 micron, consistent with other causative agents of this disorder. In this patient, positive precipitins and lymphocyte stimulation to Sporobolomyces and negative precipitins to other known causes of extrinsic allergic alveolitis provide circumstantial evidence that Sporobolomyces was the cause of the syndrome.
1416Delayed hypersensitivity cross-reactions between Sporothrix schenckii and Ceratocystis species in sporotrichotic patients. Ishizaki H, Nakamura Y, Kariya H, Iwatsu T, Wheat R. J Clin Microbiol. 1976 Jun;3(6):545-7.Cutaneous delayed hypersensitivity to antigens prepared from Sporothrix schenckii and several Ceratocystis species, including C. stenoceras, C. ulmi, C. ips, and C. minor, was tested in 14 patients with known cutaneous sporotrichosis. Extensive cross-reactions were observed. Nonsporotrichotic people (controls) did not react to these antigens. The correlation coefficient between antigens of S. schenckii and each Ceratocystis species was calculated from the areas of the cutaneous reactions. Among the Ceratocystis species tested, the correlation coefficient between S. schenckii and C. stenoceras was 0.91.
1417Detection of cellular immunity with the soluble antigen of the fungus Sporothrix schenckii in the systemic form of the disease. Carlos IZ, Sgarbi DB, Angluster J, Alviano CS, Silva CL. Mycopathologia. 1992 Mar;117(3):139-44.Sporothrix schenckii is the etiologic agent of sporotrichosis, a mycosis of world-wide distribution more commonly occurring in tropical regions. The immunological mechanisms involved in the prevention and control of sporotrichosis are not fully understood but apparently include both the humoral and cellular responses. In the present investigation, cellular immunity was evaluated by in vivo and in vitro tests in mice infected with yeast-like forms of S. schenckii. The disease developed systemically and cellular immunity was evaluated for a period of 10 weeks. The soluble antigen utilized in the tests was prepared from yeast form of the fungus through the sonication (20 min: 10 sonications at 50 W at 2-min intervals). Delayed hypersensitivity and lymphocyte transformation tests showed that the cellular immune response was depressed between the 4th and 6th week of infection when the animals were challenged with the soluble fungal antigen. This depression frequently indicates worsening of the disease, with greater involvement of the host. This is a promising field of research for a better understanding of the pathogeny of this mycosis.
1440Stachybotrys: relevance to human disease. Terr AI. Ann Allergy Asthma Immunol. 2001 Dec;87(6 Suppl 3):57-63.LEARNING OBJECTIVES: Recent public concern about the danger of environmental fungi has focused attention on one particular mold, Stachybotrys. The purpose of this review is to examine and critique the published literature on Stachybotrys for objective scientific and clinical evidence of disease caused by the presence of this fungal organism in the environment. DATA SOURCES: Data were obtained from all published research and reviews of Stachybotrys indexed in MEDLINE since 1966. STUDY SELECTION: The publications used for this review were those that contained information about human health effects of this microorganism. The critique of these publications is the author's. RESULTS: Stachybotrys is a minor component of the indoor mycoflora, found on certain building material surfaces in water-damaged buildings, but airborne spores are present in very low concentrations. Published reports fail to establish inhalation of Stachybotrys spores as a cause of human disease even in water-damaged buildings. A possible exception may be mycotoxin-caused pulmonary hemorrhage/hemosiderosis in infants, although scientific evidence to date is suggestive but not conclusive. Based on old reports ingestion of food prepared from Stachybotrys-contaminated grains may cause a toxic gastroenteropathy. No convincing cases of human allergic disease or infection from this mold have been published. CONCLUSIONS: The current public concern for adverse health effects from inhalation of Stachybotrys spores in water-damaged buildings is not supported by published reports in the medical literature.
1441Serum IgE specific to indoor moulds, measured by basophil histamine release, is associated with building-related symptoms in damp buildings. Lander F, Meyer HW, Norn S. Inflamm Res. 2001 Apr;50(4):227-31.OBJECTIVE: To study the relationship between basophil histamine release (HRT) to indoor moulds, indicating specific IgE, and building-related symptoms (BRS), asthma, and hay fever in individuals working in damp and mouldy buildings. METHODS: A cross-sectional study was performed among 86 school staff members, who on average had worked 143 months (range: 3-396) in moist buildings with mould growth in the constructions. A questionnaire concerning mucous membrane symptoms, facial skin symptoms, central nervous system symptoms, hay fever, and asthma was fulfilled by the participants, and blood samples were taken. Eight mould species growing on building constructions were identified and cultivated to obtain allergenic materials for testing. The presence in serum of IgE specific to moulds was verified by histamine release test (HRT) based on passive sensitization of basophil leukocytes. The validity of the method was confirmed by parallel testing of patients allergic to grass- and birch pollen and by the shift from positive to negative response after removal of serum IgE and by using sham sensitization. RESULTS: The prevalence of most BRS was between 32% and 62%. Positive HRT, showing serum IgE specific to one or more of the moulds, was observed in 37% of the individuals. The highest frequency of positive HRT was found to Penicillium chrysogenum and then to Aspergillus species, Cladosporium sphaerospermum and Stachybotrys chartarum. A significant association was found between most BRS and positive HRT, whereas no association was observed between positive HRT to moulds and self reported hay fever or asthma. CONCLUSION: Positive HRT to indoor moulds, showing the presence in serum of IgE specific to the fungi, was found to be related to BRS in individuals working in damp and mouldy buildings. Whether the association is of causal character is a question for further studies. The test may be useful in the evaluation and study of possible mould induced BRS.
1457IgE-reactive proteins from Stachybotrys chartarum. Barnes C, Buckley S, Pacheco F, Portnoy J. Ann Allergy Asthma Immunol. 2002 Jul;89(1):29-33.BACKGROUND: Stachybotrys chartarum has been associated with idiopathic pulmonary hemorrhage in infants. This is thought to be mycotoxin-related. There are increasing numbers of reports linking this fungus to the indoor environment of patients with other pulmonary problems, including allergies and asthma. OBJECTIVE: Given the potential significance of this fungus as a pulmonary pathogen, this work evaluates the antigenic proteins of S. chartarum as to their molecular size and the prevalence of immunoglobulin (Ig)E and IgG directed against them in the general population. METHODS: S. chartarum was isolated from a local home. S. chartarum for extract production was grown on minimum salts and glucose. Plasma from 132 healthy individuals was evaluated for IgE and IgG directed against S. chartarum using direct and inhibition enzyme immunoassay. The number and molecular size of those proteins that were bound by IgE from pooled sera known to contain IgE to S. chartarum were determined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis immunoblotting. RESULTS: Enzyme immunoassay indicated 65 of 132 (49.2%) sera tested contained IgG against S. chartarum and 13 of 139 (9.4%) sera tested contained IgE against S. chartarum. Pooled sera identified two IgE-binding proteins from extracts of S. chartarum spores and mycelia. These proteins are 34 and 52 kDa by sodium dodecyl sulfate-polyacrylamide gel electrophoresis immunoblot. CONCLUSIONS: We conclude sensitivity to S. chartarum is potentially much more widespread than previously appreciated. This fungus may impact the asthmatic and allergic population through both immunologic and toxic mechanisms. Its significance in the milieu of allergenic fungi may need to be re-evaluated.
1462Shared allergenic and antigenic determinants in Alternaria and Stemphylium extracts. Agarwal MK, Jones RT, Yunginger JW. J Allergy Clin Immunol. 1982 Dec;70(6):437-44.Alternaria and Stemphylium extracts were compared by means of various immunochemical and biologic methods. Skin-test responses to Alternaria and Stemphylium in allergic patients were positively correlated, and RAST binding values with the sera of 30 patients utilizing solid-phase Alt-I, Alternaria (70% ammonium sulfate--precipitable fraction), and Stemphylium allergens showed significant correlation, giving evidence for the presence of common allergenic determinants among these three extracts. In RAST inhibition assays, Alternaria and Stemphylium extracts exhibited dose-related inhibiton with solid-phase Stemphylium, Alternaria, and Alt-I, confirming the presence of Alt-I as the major shared allergenic fraction in the two extracts. In repetitive absorption experiments, both Alt-I and Alternaria solid-phase allergens absorbed Stemphylium-specific IgE antibodies from a 12-person serum pool. Similarly, Stemphylium solid-phase allergen absorbed both Alternaria- and Alt-I--specific IgE antibodies. Double-antibody radioimmunoassay for Alt-I showed higher Alt-I activity in Stemphylium than in Alternaria extract. In double-immunodiffusion experiments with rabbit anti--Alt-I antibodies, both Stemphylium and Alternaria extracts produced precipitin lines of identity with Alt-I. The antigenic relationship of the two crude extracts was further confirmed by crossed and crossed-line immunoelectrophoresis experiments. Our results showed that Alternaria and Stemphylium extracts contain multiple shared allergenic and antigenic determinants, including Alt-I.
1463Allergic bronchopulmonary stemphyliosis. Benatar SR, Allan B, Hewitson RP, Don PA. Thorax. 1980 Jul;35(7):515-8.A patient is described in whom a clinical picture resembling allergic bronchopulmonary aspergillosis was found to be caused by hypersensitivity to the fungus Stemphylium lanuginosum. Bronchopulmonary reactions to antigens other than Aspergillus may be more frequent than is currently believed.
1464Does immediate-type respiratory allergy occur regarding Stemphylium? Evaluation of 39 challenge tests. Lelong M, Henard J, Wattre P, Duprey J, Thelliez P, Miersman R. Allerg Immunol (Paris). 1986 Oct;18(8):21, 23, 25-6.Does immediate respiratory allergy with stemphylium exist? About 39 provocation tests. We present 39 children with positive cutaneous and/or RAST tests for stemphylium mold. Provocation tests individualize 19 patients (14 boys and 4 girls, 10 to 16 years old in 17/19) with a respiratory sensitivity: 6/10 by passive anterior rhinomanometry and 13/15 by bronchial tests. Clinical symptoms are asthma and spasmodic rhinitis (14/19), predominantly from june to august. We noted a mite allergy in 11 cases and a grass pollenosis in 13 children. Positive cutaneous and/or RAST tests are found for alternaria mold in 13/19 cases. We undertook a specific hyposensitization in 14 children with a three years experience in 10 cases. Tolerance is excellent. This provocation respiratory exploration shows the important role played by stemphylium mold in the etiology of recurring respiratory incidents in children.
1481Extrinsic allergic alveolitis and asthma in a sawmill worker: case report and review of the literature. Halpin DM, Graneek BJ, Turner-Warwick M, Newman Taylor AJ. Occup Environ Med. 1994 Mar;51(3):160-4.A 34 year old sawmill maintenance engineer developed a dry cough that was associated with widespread wheezes and crackles in his lungs. His symptoms worsened, with work related lethargy, fever, and breathlessness, and the loss of a stone in weight. At that time, while still at work, he had a neutrophil leucocytosis and increased concentration of gamma globulins. When seen subsequently some two months after stopping work, his chest radiograph and lung function tests were normal, but the cells recovered at bronchoalveolar lavage showed an increase in lymphocytes and mast cells, a pattern consistent with extrinsic allergic alveolitis. Serum precipitins were identified to extracts of sawdust, wood chips, and bark from the sawmill, and to eight species of mould grown from these samples. Specific IgG binding inhibition studies suggested that a common epitope present on Trichoderma koningii might be responsible for the cross reactivity of the patient's serum with the wood and fungal extracts. A diagnosis of wood associated extrinsic allergic alveolitis was made and since changing his job the patient has remained well. Wood associated allergic alveolitis has not previously been described in British sawmill workers, but has been reported in Sweden, with a prevalence of 5%-10% in exposed workers. A review of published data suggests extrinsic allergic alveolitis in wood workers is primarily caused by inhalation of the spores of contaminating fungi, but inhaled wood dust may exert a synergistic effect.
1482Case report and review of literature on seasonal distribution and pathogenesis of acute eosinophilic pneumonia in Japan] Mouri M, Nambu Y, Horii H, Kobayashi Y, Yamanouchi K, Sakurai S, Toga H, Ohya N. Nihon Kyobu Shikkan Gakkai Zasshi. 1993 Dec;31(12):1578-84.A 49-year-old female was admitted because of high grade fever and dyspnea. Chest roentgenogram revealed diffuse reticulo-linear shadows. Laboratory findings showed peripheral blood eosinophilia, and blood gas analysis demonstrated severe hypoxemia. A few days after admission, her symptoms and signs improved, and the abnormal shadows on the chest roentgenograms decreased without treatment. To determine the diagnosis and evaluate the pathological findings and pathogenesis, we performed open lung biopsy. Bronchoalveolar lavage at the operation revealed increased total cell count and increased markedly, number of eosinophils, and the open lung biopsy specimen showed acute interstitial pneumonia with eosinophilic infiltration. We performed a study of precipitating antibodies against fourteen kinds of fungi and environmental provocation tests, with all results being negative. We diagnosed this case as having acute eosinophilic pneumonia clinicopathologically (Allen, 1989). We reviewed 22 cases with acute eosinophilic pneumonia previously reported in Japan including our case. These 22 cases demonstrated a seasonal tendency of onset in spring and summer. Eleven of 22 cases were tested for precipitating antibodies to several fungi, 3 of which showed positive results against Trichosporon cutaneum, Trichoderma viride and Aspergillus species. The clinical features of acute eosinophilic pneumonia resemble those of summer type hypersensitivity pneumonitis. Therefore, it is important to diagnose AEP on the basis of clinical symptoms, and precipitating antibody, viral titer and pathological findings.
1506Asthma induced by allergy to Trichophyton rubrum. Elewski BE, Schwartz HJ. J Eur Acad Dermatol Venereol. 1999 May;12(3):250-3.The worldwide incidence of asthma and of allergic respiratory diseases is increasing (Akiyama K. 'Environmental allergens and allergic diseases.' Rinsho Byori 1997;45(1):13. D'Amato G, Liccardi G, D'Amato M. Environment and development of respiratory allergy. II. Indoors. Monaldi Arch Chest Dis 1994;49(5):412. Weeke AR. Epidemiology of allergic diseases in children. Rhinol Suppl 1992;13:5. Ulrik CS, Backer V, Hesse B, Dirksen A. Risk factors for development of asthma in children and adolescents: findings from a longitudinal population study. Respir Med 1996;90(10):623.) This has been attributed to several factors, including lifestyle changes and an expanding variety of potential causative allergens. Management of asthma entails preventive and acute medications, immunologic therapies, and removal of the identified allergen(s) from the patient's environment. Without the latter, patients may not experience full symptomatic relief. This case report describes a patient who developed bronchial asthma subsequent to an infection of tinea pedis and pedal onychomycosis; antifungal management resulted in full resolution of his tinea pedis, onychomycosis and asthma.
1507Trichophyton sensitivity in allergic and nonallergic asthma. Mungan D, Bavbek S, Peksari V, Celik G, Gugey E, Misirligil Z. Allergy. 2001 Jun;56(6):558-62.BACKGROUND: Although the role of inhaled fungi in inducing asthma has been repeatedly confirmed, there are few reports about the association of asthma with dermatophyte sensitivity and the causal role of Trichophyton allergy in asthma. The objective was to investigate the presence of Trichophyton sensitivity among patients with allergic and nonallergic asthma in combination with tinea, and to compare the situation with several control groups in order to evaluate the factors determining Trichophyton sensitivity. METHODS: A total of 86 subjects (55 female, 31 male) with a mean age of 38.6 +/- 11.1 years were included in the study. The patients were divided into five groups: 1) nonallergic asthma plus tinea (n = 19) 2) allergic asthma plus tinea (n = 15) 3) asthma without tinea (n = 22) 4) tinea without asthma (n = 17) 5) healthy controls (n = 13). Skin tests with standardized extracts of T. rubrum and specific IgE measurements were performed in all subjects. All patients were also subjected to microscopic evaluation and fungal culture for dermatophyte infection. RESULTS: The skin test positivity rate to Trichophyton extract of groups 1 (63.1%), 2 (46.7%), and 4 (47.1%) was higher than that in groups 3 (4.4%) and 5 (7.7%) (P < 0.05). Although not significant, the rates of sensitivity to T. rubrum (63.1%) and of severe asthma (31.6%) were higher in the group with nonallergic asthma with tinea (group 1) than in other groups. Among 51 patients in whom direct microscopic evaluation revealed dermatophyte infection, 60.8% had positive fungal cultures for T. rubrum (58.1%), T. mentagrophytes (35.5%), and Candida (6.4%). CONCLUSION: According to our data, the presence of fungal infection seems to be an important determinant in hypersensitivity to Trichophyton whether or not the subject is asthmatic and/or allergic. Since a greater proportion of patients with nonallergic asthma--in whom the rate of severe asthma was also higher - showed positive skin tests to Trichophyton extracts in this study, we believe that patients with severe, intrinsic asthma should be examined for signs of fungal infection and tested to determine immediate hypersensitivity to dermatophyte antigens.
1508Trichophyton antigens associated with IgE antibodies and delayed type hypersensitivity. Sequence homology to two families of serine proteinases. Woodfolk JA, Wheatley LM, Piyasena RV, Benjamin DC, Platts-Mills TA. J Biol Chem. 1998 Nov 6;273(45):29489-96.The dermatophyte fungus Trichophyton exhibits unique immunologic properties by its ability to cause both immediate and delayed type hypersensitivity. An 83-kDa Trichophyton tonsurans allergen (Tri t 4) was previously shown to elicit distinct T lymphocyte cytokine profiles in vitro. The homologous protein, Tri r 4, was cloned from a Trichophyton rubrum cDNA library, and the recombinant protein was expressed in Pichia pastoris. This 726-amino acid protein contained an arrangement of catalytic triad residues characteristic of the prolyl oligopeptidase family of serine proteinases (Ser-Asp-His). In addition, a novel Trichophyton allergen, encoding 412 amino acids, was identified by its human IgE antibody-binding activity. Sequence similarity searches showed that this allergen, designated Tri r 2, contained all of the conserved residues characteristic of the class D subtilase subfamily (41-58% overall sequence identity). Forty-two percent of subjects with immediate hypersensitivity skin test reactions to a Trichophyton extract exhibited IgE antibody binding to a recombinant glutathione S-transferase fusion protein containing the carboxyl-terminal 289 amino acids of Tri r 2. Furthermore, this antigen was capable of inducing delayed type hypersensitivity skin test reactions. Our results define two distinct antigens derived from the dermatophyte Trichophyton that serve as targets for diverse immune responses in humans.
1509Trichophyton-specific IgE in patients with dermatophytosis is not associated with aeroallergen sensitivity. Escalante MT, Sanchez-Borges M, Capriles-Hulett A, Belfort E, Di Biagio E, Gonzalez-Aveledo L. J Allergy Clin Immunol. 2000 Mar;105(3):547-51.BACKGROUND: It has been proposed that Trichophyton infection is associated with atopy and allergy. OBJECTIVES: Our purpose was (1) to confirm whether atopy predisposes to chronic dermatophytosis and (2) to investigate whether Trichophyton infection induces atopic disease. METHODS: Patients attending dermatology clinics and suspected of having dermatomycosis underwent in a prospective manner fungal culture and Trichophyton and inhalant skin tests, and blood serum was collected for total IgE and Trichophyton radioallergosorbent testing. Personal and family history of atopic diseases was also investigated. RESULTS: According to mycologic culture, atopic history, and inhalant skin test results, patients were classified into 4 groups: (1) atopy plus mycosis (n = 28), (2) atopy (n = 26), (3) mycosis (n = 35), and (4) no atopy, no mycosis (n = 33). Patients with active mycosis (groups 1 and 3) demonstrated significantly increased positivity of Trichophyton skin tests compared with patients without fungal infection (groups 2 and 4), regardless of their atopic status, whereas atopic patients (those in groups 1 and 2) had significantly increased levels of total serum IgE compared with nonatopic subjects. Trichophytosis was not more prevalent in atopic than in nonatopic subjects, and atopic diseases were not more frequent in culture-positive than in culture-negative patients. CONCLUSIONS: Our results indicate that Trichophyton -specific IgE is observed in patients with trichophytosis regardless of atopy.
1513Two patients with summer-type hypersensitivity pneumonitis in Nagano Prefecture] Koizumi T, Yamazaki Y, Kaneki T, Hirai K, Kubo K, Kobayashi T, Sekiguchi M, Yoshimura K. Nihon Kyobu Shikkan Gakkai Zasshi. 1997 Aug;35(8):921-5.We encountered two patients with summer-type hypersensitivity pneumonitis that developed in Nagano Prefecture. Patient 1 was a 61-year-old man who had worked in warm and humid environments as painter. He was referred to our hospital because of fever, coughing and exertional dyspnea. Respiratory symptoms developed during work but were gone within in few weeks. Patient 2 was a 50-year-old housewife who was admitted to our hospital because of persistent coughing and a low-grade fever. In both patients, chest roentgenograms and computed tomograms showed bilateral, small, nodular and reticular shadows. Examination of a specimen obtained from patient 2 by transbronchial lung biopsy revealed alveolitis. In both patients, bronchoalveolar lavage fluid had low CD4/8 ratios, but in patient 1 the lymphocyte fraction was high and in patient 2 the neutrophil fraction was high. A steroid drug was given to patient 1 because of the patients symptoms and prolonged abnormal roentgenographic findings. Patient 2 reacted positively on a provocation test when returned to her house. Serum from both patients contained antibodies to Trichosporon mucoides and T. asahii. We know of no previous reports of summer-type hypersensitivity pneumonitis that developed in Nagano prefecture.
1514Familial summer-type hypersensitivity pneumonitis in a grandfather and his two-and-a-half-year-old grandson] Ubukata M, Takayanagi N, Matsushima H, Sakamoto T, Motegi M, Yanagisawa T, Sugita Y, Kawabata Y, Kanazawa M. Nihon Kokyuki Gakkai Zasshi. 2000 Dec;38(12):923-7.We encountered a family in which two of the six members, the grandfather and his grandson, had summer-type hypersensitivity pneumonitis in late summer. Chest computed tomography of these patients showed small, diffuse nodular shadows in both lung fields, with mosaic-like opacities in the grandfather and ground glass opacity of both lung fields in the grandson. Bronchoalveolar lavage fluid from the grandfather disclosed high total cell counts, high percentages of lymphocytes, and a low ratio of CD 4+ cells to CD 8+ cells. Transbronchial lung biopsy specimens obtained from the same patient revealed alveolitis with non-caseous epithelioid cell granulomas in the interstitium and Masson bodies in the alveolar septa. These two patients recovered spontaneously after hospital admission. They had positive results in provocation tests for their home and were positive for serum anti-Trichosporon cutaneum (T. asahii, T. mucoides) antibodies. Both cases were accordingly diagnosed as summer-type hypersensitivity pneumonitis.
1515Trichosporon asahii-induced asthma in a family with Japanese summer-type hypersensitivity pneumonitis. Hirakata Y, Katoh T, Ishii Y, Kitamura S, Sugiyama Y. Ann Allergy Asthma Immunol. 2002 Mar;88(3):335-8.BACKGROUND: Trichosporon species frequently induce summer-type hypersensitivity pneumonitis (SHP), which is the most prevalent type of hypersensitivity pneumonitis (HP) in Japan, but have not been reported to induce asthma. OBJECTIVE: Evaluation of a case of asthma induced by Trichosporon asahii. METHODS AND RESULTS: This report describes a 46-year-old Japanese man who developed asthma induced by T. asahii, following symptoms of HP attributable to the same pathogen, in a case of familial occurrence of SHP. This patient lacked typical findings of HP in his radiograph but had an elevated level of eosinophils in his bronchoalveolar lavage fluid. Open lung biopsy, however, revealed typical pathologic findings of HP when he was free of asthmatic symptoms. His serum was also positive for anti-T asahii antibody, as are the sera of SHP patients. Nevertheless, provocation tests, including returning home and inhalations of T. asahii antigen, reproduced asthmatic features such as airway hyperresponsiveness and reversible bronchoobstruction, but not the features of HP. A skin test with the same antigen also evoked an immediate allergic reaction. An IgE mechanism was suspected but could not be proven by radioallergosorbent test. The patient's son and daughter displayed typical features of SHP, associated with compatible results in their radiographs, bronchoalveolar lavage fluid analysis, serologic and pathologic examinations, and provocation and skin tests. CONCLUSIONS: To our knowledge, this is the first case of extrinsic asthma, and of coexistent asthma and HP, induced by T. asahii. The patient initially displayed symptoms typical of SHP, which were subsequently replaced by more typical asthmatic symptoms.
1526Hypersensitivity pneumonitis induced by a smut fungus Ustilago esculenta.Yoshida K, Suga M, Yamasaki H, Nakamura K, Sato T, Kakishima M, Dosman JA, Ando M. Thorax. 1996 Jun;51(6):650-1; discussion 656-7.A case of hypersensitivity pneumonitis caused by a smut fungus Ustilago esculenta is presented.
1530 Verticillium lecanii. Allergological and toxicological studies on work exposed personnel. Eaton KK, Hennessy TJ, Snodin DJ, McNulty DW. Ann Occup Hyg. 1986;30(2):209-17. 
1539Studies on the osmophilic fungus Wallemia sebi as an allergen evaluated by skin prick test and radioallergosorbent test. Sakamoto T, Urisu A, Yamada M, Matsuda Y, Tanaka K, Torii S. Int Arch Allergy Appl Immunol. 1989;90(4):368-72.Recently, Wallemia sebi, a species of osmophilic fungi, has been abundantly detected in house dust using low water activity media. In this study, allergenic activity of W. sebi was assessed by skin prick test and radioallergosorbent test (RAST) in 74 asthmatic patients ranging from 6 to 32 years of age. Aspergillus fumigatus and house dust were used for comparison. In skin prick test, W. sebi extract, A. fumigatus extract and house dust extract elicited positive reactions in 4 (5.4%), 4 (5.4%) and 51 (68.9%) patients, respectively. RAST showed positive results in 14 subjects (18.9%) for W. sebi extract, in 8 (10.8%) for A. fumigatus extract and in 59 (79.7%) for house dust extract. These results indicated that some asthmatic individuals showed immediate-type hypersensitivity to W. sebi, and which means this fungal species may be of importance to atopic diseases as a causative agent.
1540Allergenic and antigenic activities of the osmophilic fungus Wallemia sebi asthmatic patients] Sakamoto T, Torii S, Yamada M, Urisu A, Iguchi H, Ueda M, Matsuda Y. Arerugi. 1989 Apr;38(4):352-9.Recently large amounts of Wallemia sebi, a species of osmophilic fungi, have been detected in house dust by low water activity media. The allergenic activity of W. sebi was examined by skin prick tests and radioallergosorbent tests (RAST) in 74 asthmatic patients (mean age 11.7, range 6-32). Aspergillus fumigatus and house dust were used for comparison. In the skin prick tests, W. sebi extract, A. fumigatus extract and house dust extract elicited positive reactions in 4 (5.4%), 4 (5.4%) and 51 (68.9%) patients, respectively. RAST showed positive results in 14 subjects (18.9%) for W. sebi extract, in 8 (10.8%) for A. fumigatus extract and in 59 (79.7%) for house dust extract. These results indicated that some asthmatic individuals showed immediate type hypersensitivity to W. sebi, which means this fungal species may be important as a causative agent in atopic diseases. Additionally, the authors measured W. sebi-specific IgG by enzyme-linked immunosorbent assay in asthmatic (n = 28) and non-atopic patients (n = 28). W. sebi-specific IgG was found in sera from all subjects in each group. W. sebi-specific IgG in asthmatics (mean +/- SD = 0.686 +/- 0.160) was significantly higher than that in non-atopics (mean +/- SD = 0.572 +/- 0.188) (p less than 0.01).
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