Fungal Infections

 

For skin testing, please see here.

IgE testing

Fungal allergy is partly mediated through IgE binding to mast cells leading to histamine release, recognized as immediate-type hypersensitivity. Delayed-type hypersensitivity is not mediated through IgE, but eosinophils and possibly basophils appear to be important mediators of inflammation. IgE can directed at a specific fungus and/or the total IgE can be elevated. A key diagnostic criterion of ABPA is an elevated total serum IgE. Different cut-off levels have been identified or proposed for different conditions, and may also vary by test manufacturer. Commercial assays for total IgE are available from ALercheck,inc; abcam; Cortez diagnostics, Elabscience, Aviva systems; Siemens; Thermo Scientific; Stallergenes

A detectable Aspergillus specific IgE is another key diagnostic criterion ABPA (and allergic Aspergillus sinusitis) and defines Aspergillus sensitization which is associated with reduced lung function in cystic fibrosis, chronic obstructive pulmonary disease and following pulmonary tuberculosis. Immediate skin prick tests against Aspergillus (see more), also detect Aspergillus IgE, but there is imperfect concordance between serum detection of Aspergillus IgE and skin testing. 

ABPA marker

Europe

India

Adult asthma

Adult CF

Adult asthma

Aspergillus IgE

detectable

>5.7 kUA/L

>1.91 kUA/L

Total IgE

>1,000 kIU/L

>185 kIU/L

>2347 IU/mL

Many different fungi, and other allergens, can induce sensitization. Fungal sensitisation in childhood (especially Alternaria) is associated with persistent asthma later in life. Elevated fungal specific IgE is one of the diagnostic criterion for SAFS, and may be elevated in fungal rhinosinusitis. Fungal-specific serum assays are available from Thermo-Fisher and Siemens. Skin prick testing for fungal-specific immediate hypersensitivity (or IgE) also defines fungal sensitisation. A rapid screening kit for 12 of the most common inhaled allergens is available from FastCheck.

Geographical distribution of fungal allergies

Fungal allergy represents a worldwide health problem. The world map below (1) highlights in yellow all countries in which sensitisation to fungi has been described.

References

(1). Twaroch, T. E., Curin, M., Valenta, R., & Swoboda, I. (2015). Mold allergens in respiratory allergy: from structure to therapy. Allergy, asthma & immunology research7(3), 205-220. (Article here)

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