Clinical Evaluation and Management of Patients with Suspected Fungus Sensitivity.

Document Type

Article

Publication Date

5-2016

Identifier

DOI: 10.1016/j.jaip.2015.10.015

Abstract

Fungus-sensitized patients usually present with symptoms that are similar to symptoms presented by those who are sensitized to other aeroallergens. Therefore, diagnosis and management should follow the same pathways used for patients with allergic conditions in general. The physician should consider that a relationship between fungal exposure and symptoms is not necessarily caused by an IgE-mediated mechanism, even when specific fungal IgE is detected. Until recently, IgE-mediated allergy has been documented only for a limited number of fungi. We propose a series of questions to be used to identify symptoms that occur in situations with high fungal exposure and a limited skin-prick-test panel (Alternaria, Cladosporium, Penicillium, Aspergillus, Candida) that can be amplified only in cases of high suspicion of other fungal exposure (eg, postfloods). We also review in vitro testing for fungi-specific IgE. Treatment includes environmental control, medical management, and, when appropriate, specific immunotherapy. Low-quality evidence exists supporting the use of subcutaneous immunotherapy for Alternaria to treat allergic rhinitis and asthma, and very low quality evidence supports the use of subcutaneous immunotherapy for Cladosporium and sublingual immunotherapy for Alternaria. As is the case for many allergens, evidence for immunotherapy with other fungal extracts is lacking. The so-called toxic mold syndrome is also briefly discussed.

Journal Title

J Allergy Clin Immunol Pract

Volume

4

Issue

3

First Page

405

Last Page

414

MeSH Keywords

Allergens; Fungi; Humans; Hypersensitivity; Immunoglobulin E; Immunotherapy; Syndrome

Keywords

Alternaria; Cladosporium; Mold allergy; Toxic mold

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