Diagnosis and Immunotherapy of Mould Allergy

Abstract

In order to screen for mould allergy, extracts of five common atmospheric moulds (Cladosporium, Alternaria, Penicillium, Aspergillus and Mucor) from various manufacturers were investigated in 130 patients (5-60 years old) with clinical symptoms indicating possible mould allergy. The patients were screened by skin prick test (SPT) and radioallergosorbent test (RAST). SPT seemed to be more sensitive than RAST as a diagnostic screening procedure (80% positive reactions to one or more species compared to 50%). With a partially purified, standardized preparation of Cladosporium herbarum more positive reactions were obtained than with crude extracts without evidence of any unspecific reactions. The difference between commercial and standardized extracts is most probably a result of a variation of both the biological potency of allergenic determinants and the allergenic composition. A considerable number of negative RAST reactions with standard discs were found in patients with positive skin reactions to partially purified Cladosporium, but RAST seemed to be more sensitive than SPT with the other commercial mould extracts. Based on the screening, a very convincing tendency to IgE-reactivity to other moulds was found in patients reacting to Cladosporium, the most common cause of mould allergy. The results confirm the inadequacy of most mould extracts used in diagnostic procedures and strengthen the value of using standardized extracts.

Mould Allergy in Schoolchildren in Relation to Airborne Fungi and Residential Characteristics in Homes and Schools in Northern Norway

“…The disparity between SPT results and clinical symptoms may depend on poor quality and potency of the extracts used for testing (Aas et al, 1980;Aukrust and Aas, 1978;Malling et al, 1985). There may also be a lower tendency to develop mould allergy than allergy to pollen (Aas et al, 1980;Malling et al, 1985).…”

“…The disparity between SPT results and clinical symptoms may depend on poor quality and potency of the extracts used for testing (Aas et al, 1980;Aukrust and Aas, 1978;Malling et al, 1985). There may also be a lower tendency to develop mould allergy than allergy to pollen (Aas et al, 1980;Malling et al, 1985). Moreover, the threshold concentration for evoking allergic symptoms is estimated to be 100 spores/m3 for Alternuria and 3000 spores/ m3 for Cladosporium (Gravesen, 1979), which is considerably higher than those measured in our study.…”

“…University,9037 Tromsn,Norway. 2Department of Microbiology,Tromsn University,Norway commercially available extracts (Malling et al, 1985). Much of the clinical knowledge in this field has been based on the experience of skilled clinicians, e.g.…”

Fungal allergy in children

“…Clinical recognition of specific atopic allergies is to a high degree based on reliable testing procedures. Testing for fungal allergy has been associated with considerable uncertainty, primarily due to the difficulties of raising high quality fungal allergen extracts (1). Extract inadequacies are reflected in high false negative rates both with tests in vivo and in vitro (1).…”

“…Testing for fungal allergy has been associated with considerable uncertainty, primarily due to the difficulties of raising high quality fungal allergen extracts (1). Extract inadequacies are reflected in high false negative rates both with tests in vivo and in vitro (1). Much of the clinical knowledge in this field is based on anecdote and skilled clinicians' experience (2,3) and only few systematic studies have been performed (4).…”