Fungal Diseases

Some Topics

Fungi and Allergy

My impression is that respiratory allergy to environmental molds is common. Tests using fungal antigens are routine in allergy practice. Skin prick tests and serum IgE tests are performed with inhalant and food allergens, molds and yeasts. These tests reveal immediate hypersensitivity, but do not show delayed hypersensitivity to fungi that is more important in the production of diseases, especially chronic lung disease. There are no easy, reliable tests. There are many problems when you try to connect a test result to a disease. Fungi are so abundant and there are so many varieties in every environment that it is seldom easy to pick just one cause among many. Fungi are inhaled and ingested. Foods always contain fungal spores and even actively growing molds. Symptoms from fungal presence may involve allergy, infection or a combination of both.

Immediate Hypersensitivity

Airola et al described a mold-sensitized patient who developed anaphylactic reactions after ingesting yeast preparations used by the food industry as flavoring in, for example, powdered and ready-made sauces. Skin prick and serum IgE test results were positive to several molds (Cladosporium herbarum, Alternaria alternata, Aspergillus fumigatus, and Penicillium notatum), baker's yeast (Saccharomyces cerevisiae), Malassezia furfur, and champignon and to the 2 pasta sauces, the yeast ingredient, and a food-quality yeast extract. Radioallergosorbent test inhibition studies confirmed that the sauces contain cross-reacting yeast and mold allergens. Any part of the respiratory tract may be involved but the nose and nasal sinuses are most exposed. Allergic fungal sinusitis (AFS) is now recognized as a common problem. The sinus cavities tend to be chronically inflamed with fungal debris and mucin filling the cavity. Skin tests may be positive to some fungi but other undetected fungi may contribute to or cause chronic inflammation.

Delayed Hypersensitivity

Airborne molds are implicated as the cause of asthma and hypersensitivity pneumonitis. Chronic nose and sinus inflammation have been linked to airborne fungi. Shin et al, for example, demonstrate and immune response to Alternaria by finding elevated levels of IL-5 and IL-13. Green et al suggested that 100 genera of fungal conidia are currently recognized as sources of allergens, but the number could be greater: different components of fungal growth such as fungal hyphae and fragmented conidia are airborne and may become allergenic.

Rural agricultural workers are exposed to many air pollutants. Airborne fungal spores trigger immune reactions in the airway and lungs causing alveolitis, pulmonary edema and pulmonary fibrosis. At risk are 6.5 million farm workers and those who process, handle, transport, and service food products. Also at risk are residents of rural areas who are exposed to dusts distributed by winds, sometimes hundreds of kilometers distant from the source of airborne contamination.

See Airborne Diseases in Agricultural Workers.

Fungi Everywhere

A profusion of fungi exists in the environment. Some fungi are able to cause an invasive infection in otherwise healthy individuals. Other fungi are opportunistic fungi that become invasive when immune defenses are compromised. Diagnosis of fungal infection is difficult. There are many problems when you try to connect a test result to a disease. Fungi are so abundant and there are so many varieties in every environment that it is seldom easy to pick just one cause among many. Fungi are inhaled and ingested. Foods always contain fungal spores and actively growing molds. Attempts to culture fungi often fail; only a small number grow in the culture media commonly used. Some new methods of detecting fungal DNA may be useful but development of reliable tests is slow and expensive.

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