Fungi and Allergy
My impression is that respiratory allergy to environmental molds is common.
Tests using fungal antigens are routine in allergy practice. Skin prick
tests and serum IgE tests are performed with inhalant and food allergens, molds
and yeasts. These tests reveal immediate hypersensitivity, but do not show delayed
hypersensitivity to fungi that is more important in the production of diseases,
especially chronic lung disease. There are no easy, reliable tests. There are many problems when you try to connect a test result to a disease.
Fungi are so abundant and there are so many varieties in every environment that
it is seldom easy to pick just one cause among many. Fungi are inhaled and
ingested. Foods always contain fungal spores and even actively growing molds.
Symptoms from fungal presence may involve allergy, infection or a combination of
Airola et al described a mold-sensitized patient who developed anaphylactic
reactions after ingesting yeast preparations used by the food industry as
flavoring in, for example, powdered and ready-made sauces. Skin prick and serum
IgE test results were positive to several molds (Cladosporium herbarum,
Alternaria alternata, Aspergillus fumigatus, and Penicillium notatum), baker's
yeast (Saccharomyces cerevisiae), Malassezia furfur, and champignon and to the 2
pasta sauces, the yeast ingredient, and a food-quality yeast extract.
Radioallergosorbent test inhibition studies confirmed that the sauces contain
cross-reacting yeast and mold allergens. Any part of the respiratory tract may be involved but the nose and nasal
sinuses are most exposed. Allergic fungal sinusitis (AFS) is now recognized as a
common problem. The sinus cavities tend to be chronically inflamed with fungal
debris and mucin filling the cavity. Skin tests may be positive to some fungi
but other undetected fungi may contribute to or cause chronic inflammation.
Airborne molds are implicated as the cause of asthma and hypersensitivity
pneumonitis. Chronic nose and sinus inflammation have been linked to airborne
fungi. Shin et al, for example, demonstrate and immune response to Alternaria by
finding elevated levels of IL-5 and IL-13. Green et al suggested that 100 genera
of fungal conidia are currently recognized as sources of allergens, but the
number could be greater: different components of fungal growth such as fungal
hyphae and fragmented conidia are airborne and may become allergenic.
Rural agricultural workers are exposed to many air pollutants. Airborne
fungal spores trigger immune reactions in the airway and lungs causing
alveolitis, pulmonary edema and pulmonary fibrosis. At risk are 6.5 million farm
workers and those who process, handle, transport, and service food products.
Also at risk are residents of rural areas who are exposed to dusts distributed
by winds, sometimes hundreds of kilometers distant from the source of airborne
See Airborne Diseases in