Analysis of the Serum Levels of Fungi-Specific Immunoglobulin E in Patients with Allergic Diseases

Abstract

Background: Atopic patients are exceptionally sensitive to airborne allergens. Sensitization to fungal allergens may be associated with respiratory allergic disease (RAD) and atopic dermatitis (AD). This study investigates the relationship between sensitization to different fungal allergens and the clinical manifestations of atopic disease. Methods: We retrospectively reviewed the medical records of atopic patients from the National Taiwan University Hospital from 2004 to 2009. A total of 133 atopic patients were found who were sensitive to at least 1 of the 3 most common fungi (Candida albicans, Aspergillus fumigatus, Penicillium chrysogenum) in Taiwan and were enrolled in the study. These patients were further divided into subgroups of isolated AD, isolated RAD and AD + RAD. The association between sensitization to fungi and allergic disease was analyzed by logistic regression analysis. Results: The sensitization rate to Candida-specific IgE was 81.2%, followed closely by Aspergillus at 69.2% and Penicillium at 63.2%. Isolated AD was the most common diagnosis. The levels of specific IgE antibodies against Aspergillus, Candida and Penicillium were highest in patients with isolated AD. Logistic regression revealed that isolated AD was highly associated with sensitization to Candida [odds ratio (OR) 10.45, 95% confidence interval (CI) 2.37–45.9]. In contrast, sensitization to Penicillium (OR 0.34, 95% CI 0.13–0.87)and Candida (OR 0.30, 95% CI 0.10–0.92) showed a negative association with isolated RAD. Conclusions: Fungal sensitization is more closely associated with AD than RAD. Our results suggest that specific sensitization to fungal allergensplays a critical role in the pathogenesis of atopic disease.

Sensitization to Skin-associated Microorganisms in Adult Patients with Atopic Dermatitis is of Importance for Disease Severity

“…Nevertheless, it is notable that the level of total IgE correlated with increasing skin prick test positive reactions to aeroallergens (pollen, animal dander and dust mite). Airborne allergens, such as antigens from dust mite, are additional factors predisposing to allergic diseases, and a common pattern in atopic patients seems to be reactivity to many allergens (21). Sensitization to Candida allergens in AD has been related to positive nasopharyngeal and gastrointestinal cultures (10), but Candida may also colonize the skin in AD (37).…”

“…Epidermal and systemic IL-18 are associated with AD severity, and S. aureus colonization appears to be correlated with epidermal IL-18 production in patients with AD (15,16) The level of specific IgE antibodies to S. aureus antigens is reported to correlate with total IgE levels and disease severity in patients with AD (17). Moreover, Malassezia can induce specific IgE responses in AD patients with head and neck dermatitis, which are rarely seen in other atopic patients (18)(19)(20) and sensitization to Candida allergens contributes to the pathogenesis of AD (21).…”

Filaggrin and Skin Infections

“…A signifi cant proportion of AD patients have demonstrated positive results with skin prick tests, intradermal tests, and atopy patch tests to Malassezia antigens [ 52 , 55 ]. An increased reaction of specifi c IgE to Malassezia furfur in AD patients is also known to occur, when compared to healthy controls [ 56 ], suggesting that IgE-mediated sensitization to Malassezia has a role in the pathogenesis of AD [ 57 ]. Notably, Candida albicans is also a potent intrinsic factor in inducing AD skin lesions, attributed to the IgE-mediated hypersensitivity of the Candida albicans antigen [ 58 ].…”

The IgE-microarray testing in atopic dermatitis

“…Fungi represent common and important airborne allergens, and fungal sensitization to Candida albicans, Alternaria alternata, Trichophyton rubrum, Penicillium chrysogenum, Aspergillus fumigatus, and Malassezia furfur is often observed in atopic dermatitis patients [56,57 ]. Furthermore, IgE sensitization to Malassezia allergens is recorded in atopic dermatitis and not in patients with allergic rhinitis or asthma without atopic dermatitis [58,59].…”