Hydrophilic Fungi and Ergosterol Associated with Respiratory Illness in a Water-Damaged Building

Park, Ju‐Hyeong; Cox‐Ganser, Jean M.; Kreiss, Kathleen; White, Sandra; Rao, Carol Y.

doi:10.1289/ehp.10355

Cited by 100 publications

(97 citation statements)

References 29 publications

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“…Several studies in both pediatric and adult populations have associated outdoor and indoor fungal exposure with asthma requiring hospital admission [78][79][80][81], decreased lung function, increased use of asthma medication, and greater risk of cough [82][83][84][85][86][87][88][89].…”

Section: Asthmamentioning

confidence: 99%

Allergic Fungal Airway Disease

Rick¹,

Woolnough²,

Pashley³

et al. 2016

J Investig Allergol Clin Immunol

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Fungi are ubiquitous and form their own kingdom. Up to 80 genera of fungi have been linked to type I allergic disease, and yet, commercial reagents to test for sensitization are available for relatively few species. In terms of asthma, it is important to distinguish between species unable to grow at body temperature and those that can (thermotolerant) and thereby have the potential to colonize the respiratory tract. The former, which include the commonly studied Alternaria and Cladosporium genera, can act as aeroallergens whose clinical effects are predictably related to exposure levels. In contrast, thermotolerant species, which include fungi from the Candida, Aspergillus, and Penicillium genera, can cause a persistent allergenic stimulus independent of their airborne concentrations. Moreover, their ability to germinate in the airways provides a more diverse allergenic stimulus, and may result in noninvasive infection, which enhances inflammation. The close association between IgE sensitization to thermotolerant filamentous fungi and fixed airflow obstruction, bronchiectasis, and lung fibrosis suggests a much more tissue-damaging process than that seen with aeroallergens. This review provides an overview of fungal allergens and the patterns of clinical disease associated with exposure. It clarifies the various terminologies associated with fungal allergy in asthma and makes the case for a new term (allergic fungal airway disease) to include all people with asthma at risk of developing lung damage as a result of their fungal allergy. Lastly, it discusses the management of fungirelated asthma. Key words: Thermotolerant fungi. Allergic fungal airway disease (AFAD). ABPA. SAFS. Asthma. Allergic fungal rhinosinusitis (AFRS). Immune responses. Diagnosis. Treatment. ResumenLos hongos son obicuos y forman su propio reino. Hasta 80 géneros de hongos han sido asociados con la enfermedad alérgica tipo I; sin embargo, los reactivos comerciales para testar las sensibilizaciones a los mismos, se encuentran disponibles para un número relativamente pequeño de especies. En cuanto al asma, es importante distinguir entre especies incapaces de crecer en temperatura ambiente y aquellas que son termotolerantes y que, por lo tanto, tienen una capacidad potencial para colonizar el tracto respiratorio. Los primeros, que incluyen los géneros comúnmente estudiados Alternaria y Cladosporium, pueden actuar como aeroalérgenos y sus efectos clínicos están relacionados con los niveles de exposición. En contraste, las especies termotolerantes, que incluyen hongos del género Candida, Aspergillus y Penicillium, pueden causar un estímulo alergénico persistente independiente de su concentración en el aire. Además, su capacidad para germinar en las vías aéreas da lugar a estímulos alergénicos más diversos y puede dar como resultado infecciones no invasivas que facilitan la inflamación. La estrecha asociación entre sensibilización dependiente de IgE a hongos filamentosos termotolerantes y la obstrucción del flujo aéreo, bronquiectasias y fib...

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Section: Asthmamentioning

confidence: 99%

Allergic Fungal Airway Disease

Rick¹,

Woolnough²,

Pashley³

et al. 2016

J Investig Allergol Clin Immunol

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“…Fungi and mold exposure has been associated with coughing, wheezing, chest tightness, shortness of breath, allergic reactions, hypersensitivity pneumonitis, and has been shown to exacerbate respiratory symptoms in sensitized asthmatics [3]. Importantly, mold levels in dust were associated with new-onset asthma among employees in a water-damaged building [5,6]. The mechanisms by which mold and fungi induce asthma and allergic reactions have not been fully elucidated.…”

Section: Introductionmentioning

confidence: 99%

Adjuvant effect of zymosan after pulmonary treatment in a mouse ovalbumin allergy model

Young

Wolfarth

Roberts

et al. 2013

Experimental Lung Research

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An association has been observed between indoor mold contamination and lung allergy and asthma. This relationship is not fully understood. 1→3-β-Glucan is the major cell wall component of fungi and a good marker of fungi exposure. The objective was to evaluate the adjuvant effect of zymosan, a crude yeast cell wall preparation of 1→3-β-glucan, during ovalbumin (OVA) sensitization in an allergy model. BALB/c mice were sensitized by pharyngeal aspiration with saline, 50 µg of OVA, or OVA with 1, 10, 50, or 75 µg of zymosan on days 0, 7, and 14. One week after sensitization, each sensitized animal group was challenged with an aspiration dose of 50 µg of OVA once a week for 2 weeks. At 1 day after the last aspiration, bronchoalveolar lavage fluid and blood was collected, and markers of lung allergy and inflammation were assessed. An adjuvant effect of zymosan on OVA allergy during sensitization was observed as indicated by significant elevations in lung eosinophils, serum OVA-specific IgE, and lung IL-5 in the groups sensitized with zymosan and OVA. Pulmonary treatment with zymosan also amplified lung inflammation. Elevations were observed in lung neutrophils, TNF-α, and parameters of lung injury in the groups primed with both zymosan and OVA. In nearly all parameters, a non-linear dose-response relationship was observed in the groups primed with OVA and zymosan. The optimum adjuvant dose of zymosan was 10 µg. This study demonstrated an adjuvant effect of zymosan when exposures occurred during the sensitization phase in an OVA-induced allergy model in BALB/c mice.

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“…Such conclusions have also been reached in a large European collaborative epidemiological survey [25]. Exposure to hydrophilic moulds seems to present a greater health hazard than exposure to mesophilic moulds [26]. This result favours mould identification during housing inspection, which is not a common practice nowadays.…”

Section: Current Achievementsmentioning

confidence: 60%

Environmental home inspection services in Western Europe

Charpin

Baden

Bex³

et al. 2010

Environ Health Prev Med

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This review deals with environmental home inspection services in Western Europe provided for patients at the request of attending physicians to improve patient management. Such requests are usually motivated by respiratory or general symptoms which occur or worsen at home. The visit includes a standardised questionnaire as well as environmental sampling such as mite-allergen measurement, mould identification and volatile organic compound (VOC) measurements. Besides, some nonrespiratory indoor risks are also taken into account. Following the visit, a report is sent to the family and the attending physician. These services have been developed since the early 1990s, but evaluation of their efficacy is still limited. Some studies have demonstrated a reduction in mite-allergen levels and clinical improvement following the visit and implementation of advice provided to the family. However, more studies are needed to further document efficacy and also perform cost-benefit analysis of these services.

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Hydrophilic Fungi and Ergosterol Associated with Respiratory Illness in a Water-Damaged Building

Cited by 100 publications

References 29 publications

Allergic Fungal Airway Disease

Allergic Fungal Airway Disease

Adjuvant effect of zymosan after pulmonary treatment in a mouse ovalbumin allergy model

Environmental home inspection services in Western Europe

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