Assessment and control of fungal allergens

Alternaria Allergy and Immunotherapy

BACKGROUND

Allergen immunotherapy (AIT) is the only known causative treatment for Alternaria allergy, but the difficulty in standardizing Alternaria extracts hampers its effectiveness and safety.

SUMMARY

Alternaria, a potent airborne allergen, has a high sensitization rate and is known to trigger the onset and exacerbation of respiratory allergies, even inducing fungal food allergy syndrome in some cases. It can trigger a type 2 inflammatory response, leading to an increase in the secretion of type 2 inflammatory cytokines and eosinophils, which are the culprits behind allergic symptoms. Diagnosing Alternaria allergy is a multistep process, involving a careful examination of clinical symptoms, medical history, skin prick tests, serum-specific IgE detection, or provocation tests. Alt a1, the major component of Alternaria, is a vital player in diagnosing Alternaria allergy through component-resolved diagnosis. Interestingly, Alternaria can reduce the protein activity of other allergens like pollen and cat dander when mixed with them. In order to solve the problems of standardization, efficacy and safety of traditional Alternaria AIT, novel AIT methods targeting Alt a1 and innovative vaccines such as epitope, DNA, and mRNA vaccines seem promising in bypassing the standardization issue of Alternaria extracts. But these studies are in early stages, and most researches are still focused on animal models, calling for more evidence to validate their use in humans.

KEY MESSAGES

This review delves into the various aspects of Alternaria allergy, including characteristics, epidemiology, immune mechanisms, diagnosis, clinical manifestations, and the application and limitations of Alternaria AIT, aiming to provide a foundation for the management of patients with Alternaria allergy.

Immunotherapy of mold allergy: A review

Mold allergies are common, mainly target the respiratory tract and present as allergic rhinitis and/or bronchial asthma. Molds include a large group of different allergens that induce all types of allergic reactions. Allergen specific immunotherapies (AITs) to molds are common; however, at the present time, they are limited to Alternaria. This review presents not only the benefits but also the problems with such types of AIT based on the literature and our experience.

Lipoic Acid as a Potential First Agent for Protection from Mycotoxins and Treatment of Mycotoxicosis

Mycotoxins--toxic substances produced by fungi or molds--are ubiquitous in the environment and are capable of damaging multiple biochemical mechanisms, resulting in a variety of human symptoms referred to collectively as "mycotoxicosis." In fact, mycotoxins mimic multiple xenobiotics, not only with respect to their ultimate damage, but also in their routes of detoxification. This suggests potential therapeutic options for the challenging treatment of mycotoxicosis. In this brief review, the author examines the use of lipoic acid as an example of an inexpensive and available nutrient that has been shown to protect against, or reverse, the adverse health effects of mycotoxins.

Fungal contamination of elementary schools: a new environmental hazard

BACKGROUND

Sensitivity to fungi is a significant cause of allergic diseases, and prolonged indoor exposure to fungi is a growing health concern.

OBJECTIVE

This study evaluates the health effects of mold-contaminated schools on students and teachers. A discussion of the effectiveness of current methods for evaluating these schools, with a focus on the importance of using total mold spore counts, is also provided.

METHODS

Two Connecticut public schools were tested using multiple air quality testing methods, with the standard for a healthy indoor environment being total mold spore counts lower than 1,000 spores/m3. The health impact of the mold exposure at each school was evaluated using the validated Rhinitis Outcomes Questionnaire.

RESULTS

The testing of the first school found indoor mold counts ranging from 6,000 to 50,000 spores/m3. Eighty-five of the students and teachers reported significant allergic symptoms to the school nurse. This school is currently being demolished. More than 2 years after the exposure ended, a number of occupants of the school continue to have elevated symptoms compared with before their exposure to the school. The testing of the second school revealed total mold spore counts ranging between 2,000 and 9,000 spores/m3, qualifying it an unhealthy environment in need of immediate remediation. Students reported significant allergic symptoms from exposure to certain rooms that are currently being remediated.

CONCLUSIONS

Because of the negative impact on health that indoor mold exposure has, particularly in atopic patients, schools should be routinely tested for fungal contamination. Total mold spore counts should be performed using volumetric air sampling such as the Allergenco MK-3 (Allergenco, San Antonio, TX) because testing air quality via semiquantitative culture sampling alone does not give a true reflection of the extent of fungal contamination. Finally, the standard for a healthy indoor environment should be defined as having <1,000 spores/m3.

Health effects of mold exposure in public schools

This paper profiles the impact of mold exposure on the health of students, teachers, and staff in two public elementary schools in Connecticut, and explains how the air quality in each school was tested, and how the health of teachers and students was assessed. It also proposes standards for testing indoor air quality and evaluating the health impact of indoor mold exposure on students, teachers, and staff members.