Mari A, Schneider P, Wally V, Breitenbach M, Simon-Nobbe B
Allergy Unit, National Health Service, Rome, Italy.
Clin Exp Allergy. 2003 Oct;33(10):1429-38. doi: 10.1046/j.1365-2222.2003.01783.x.
Several fungal species are known to cause severe respiratory and cutaneous allergic diseases. Extracts from several allergenic fungi are used for in vivo and in vitro tests, as standard preparations are still not available.
The aims are to define the pattern of in vivo and in vitro IgE reactivity to fungal species in an allergic population with respiratory symptoms; to determine the influence of different extract preparations on diagnostic results; and to evaluate whether there exists a relationship between the diagnostic pattern of reactivity and the pattern of specific IgE reactivity in immunoblots.
Skin prick tests were applied to a cohort of 4962 respiratory subjects, aged 3-80 years. Fungal extracts from Alternaria, Aspergillus, Candida, Cladosporium, Penicillium, Saccharomyces, and Trichophyton were used, along with extracts from pollens, mites, and animal dander. Demographical and diagnostic data were recorded. IgE detection was carried out with the same allergenic extracts plus Malassezia. Comparative skin tests and IgE detection were carried out using extracts from three commercial suppliers. IgE immunoblots were carried out with the same panel of commercial fungal extracts and were compared with in-house extracts. Data analysis was carried out by grouping the population on the basis of their reactivity to a single, to two or to more than two, mould species.
Nineteen percent of the allergic population reacted to at least one fungal extract by means of the skin test. Alternaria and Candida accounted for the largest number of positive tests, and along with Trichophyton they were the main sensitizers in the subset of patients with an isolated sensitization. The prevalence of skin test reactivity increased for these three fungi in the subsets with two associated reactivities and, furthermore, in the subset showing reactivity to more than two mould species. In the latter group, a steady increase of the skin test reactivity was recorded for all the other fungal sources, suggesting a clustered reactivity. Comparative skin and IgE testing with different groups of subjects with a simple pattern of skin reactivity resulted in sensitivity differences between in vivo and in vitro tests, whereas discrepant results were recorded in the subsets of patients with multiple fungi sensitization. Although hampered by the limited reliability of fungal extracts, IgE immunoblots revealed differing patterns of reactivity when sera from the three subsets were used. This suggests a link between the diagnostic reactivity pattern and the IgE sensitization to extracts' components. Age and gender distribution differed among the Alternaria-, Candida-, and Trichophyton-sensitized subjects, but not in the subset with more than two fungi sensitizations.
The preliminary assessment of a new classification of the mould-sensitized population has been reached. The limiting quality of fungal extracts requires future studies using an allergenic molecule-based approach. The diagnostic process and the definition of the reactivity pattern would thus be easy, and it could lead to a novel specific immunotherapy approach.
已知几种真菌可引发严重的呼吸道和皮肤过敏性疾病。由于仍没有标准制剂，几种变应原真菌的提取物被用于体内和体外试验。
旨在确定有呼吸道症状的过敏人群体内和体外对真菌的IgE反应模式；确定不同提取物制剂对诊断结果的影响；评估免疫印迹中反应性诊断模式与特异性IgE反应模式之间是否存在关联。
对4962名年龄在3至80岁的呼吸道疾病受试者进行了皮肤点刺试验。使用了链格孢属、曲霉属、念珠菌属、枝孢属、青霉属、酿酒酵母属和毛癣菌属的真菌提取物，以及花粉、螨虫和动物皮屑的提取物。记录人口统计学和诊断数据。使用相同的变应原提取物加马拉色菌进行IgE检测。使用来自三个商业供应商的提取物进行比较皮肤试验和IgE检测。使用相同的一组商业真菌提取物进行IgE免疫印迹，并与内部提取物进行比较。通过根据人群对单一、两种或两种以上霉菌物种的反应性进行分组来进行数据分析。
19%的过敏人群通过皮肤试验对至少一种真菌提取物有反应。链格孢属和念珠菌属的阳性试验数量最多，与毛癣菌属一起，它们是单一致敏患者亚组中的主要致敏原。在有两种相关反应性的亚组中，以及在对两种以上霉菌物种有反应的亚组中，这三种真菌的皮肤试验反应性患病率增加。在后者组中，记录到所有其他真菌来源的皮肤试验反应性稳步增加，表明存在聚集反应性。对皮肤反应模式简单的不同组受试者进行比较皮肤和IgE检测，体内和体外试验之间存在敏感性差异，而在多种真菌致敏的患者亚组中记录到不一致的结果。尽管真菌提取物的可靠性有限，但使用来自三个亚组的血清进行IgE免疫印迹显示出不同的反应模式。这表明诊断反应模式与对提取物成分的IgE致敏之间存在联系。链格孢属、念珠菌属和毛癣菌属致敏的受试者之间年龄和性别分布不同，但在两种以上真菌致敏的亚组中没有差异。
已对霉菌致敏人群的新分类进行了初步评估。真菌提取物的质量限制需要未来使用基于变应原分子的方法进行研究。这样，诊断过程和反应模式的定义将变得容易，并且可能会导致一种新的特异性免疫治疗方法。
