Mold allergy is an allergic reaction that develops when mold spores enter the body. The pathological process is more often localized in the respiratory tract, leading to the development of allergic rhinoconjunctivitis and bronchial asthma, allergic bronchopulmonary aspergillosis and exogenous allergic alveolitis. Less common is a lesion of the skin with a picture of atopic dermatitis. Diagnosis is based on the collection of anamnesis, clinical examination, laboratory tests and skin samples. Treatment involves the elimination of contact with the allergen, the use of antimycotic drugs, antihistamines, allergen-specific immunotherapy.
ICD 10
J45.0 B44.1 J30.4
General information
Mold allergy is the occurrence of hypersensitivity to pathogenic and conditionally pathogenic mold fungi that enter the body with inhaled atmospheric air, household dust, and food. According to statistics, mold fungi Cladosporium, Penicillium, Aspergillus and Alternaria account for approximately 75% of the total spore mass contained in atmospheric air and indoor air. Clinical manifestations of mold allergy increase in the warm season in the presence of high humidity. As for fungi of the genus Aspergillus and Penicillium, they are more active in autumn and winter inside residential premises. Mycogenic infection, for example, bronchopulmonary aspergillosis, is particularly dangerous for people with immunodeficiency conditions.
Causes
The main causative agents of fungal infection that cause the development of allergic reactions are mold fungi Cladosporium (the maximum concentration is observed in the atmospheric air in summer), Penicillium (64% of the total spore mass of residential premises), Aspergillus (48% of all spores located indoors) and Alternaria. Warm air and high humidity are ideal conditions for mold propagation in the atmospheric air, on walls and in the indoor air, as well as on food.
- Cladosporium herbarum is the most common type of fungal mold. It reproduces on plants, in spring and summer it forms spores that penetrate into the upper respiratory tract with inhaled air, leading to allergic rhinitis, bronchial asthma.
- Penicillum notatum is a common cause of mold allergy. This type of fungus was discovered by the inventor of penicillin Fleming. Penicillum is more often found in dwellings – on the walls of premises, wallpaper, in house dust persists all year round. Causes damage to the respiratory tract and skin.
- Aspergillus fumigatus is another representative of mold fungi, a strong allergen. It is often found on vegetables and fruits that have mechanical damage: pomegranate, carrots, tomatoes, causing their rapid rotting with the formation of a black fluffy plaque (black rot). When using such fruits, fumigoclavin, an alkaloid with a pronounced hemolytic effect, enters the digestive tract. Aspergillus fumigatus is often parasitic in animals and humans. It is the causative agent of allergic bronchopulmonary aspergillosis. Possible cross-allergy to mold contained in cheeses, wine, yeast dough.
- Alternaria tenuis – (black rot) is a frequent inhabitant of our bathrooms and shower rooms, especially dangerous in summer and autumn. The resulting allergic reactions can lead to the development of bronchial asthma and atopic dermatitis.
Pathogenesis
In the mechanism of development of mold allergy, both immediate and delayed reactions to fungal allergens, as well as their combination, can be observed. In addition to the reaction of the immune system, which causes inflammation of the mucous membrane of the respiratory tract and skin, the adverse effect is enhanced by the release of proteolytic enzymes that damage cells, as well as various toxic substances by mold fungi during their vital activity.
Symptoms of mold allergy
The clinical symptoms of mold allergy depend on the type of pathogenic fungus and the organ that it affects in the first place. Allergic inflammation of the bronchial mucosa and lung tissue is most common. At the same time, bronchospasm may develop with difficulty breathing, shortness of breath, dry unproductive cough and repeated attacks of suffocation. Bronchial asthma is the most common manifestation of mold allergy.
Along with this, when exposed to the mucous membrane of the respiratory tract of the mold fungus Aspergillus fumigatus, a disease such as allergic bronchopulmonary aspergillosis often develops. As a rule, it occurs in patients suffering from bronchial asthma. At the same time, simultaneously with the symptoms of bronchial obstruction in the cold season, patients have fever, chest pains, cough, hemoptysis, the general condition is disturbed with pronounced weakness, fatigue, decreased performance, weight loss.
Fungal allergens Aspergillus fumigatus, Alternaria tenuis and other mold fungi can lead to the development of exogenous allergic alveolitis, which is characterized by allergic lung tissue damage (“mushroom grower’s disease”, “farmer’s lungs”, bagassosis). The disease occurs acutely and proceeds with symptoms of bilateral pneumonia. In the chronic course of alveolitis, the main complaints are shortness of breath, which increases with physical exertion, decreased appetite, weight loss.
Allergy to mold with lesions of the nasal cavity (rhinitis, allergic rhinoconjunctivitis) and skin (hyperemia, swelling, maceration, papular and vesicular rash on the skin of the face, trunk and extremities) is more common as a result of exposure to Penicillum and Alternaria fungi.
Diagnostics
The diagnosis of mold allergy is based on a thorough collection of anamnestic data, examination of the patient by an allergist-immunologist, dermatologist, pulmonologist, otolaryngologist, infectious disease specialist and other specialists, conducting a complex of laboratory tests and allergy tests, additional diagnostic methods (ultrasound, chest X-ray, CT of the lungs, spirography, endoscopic examination of the nasopharynx, bronchi).
To clarify the diagnosis and determine a specific allergen, such common methods in clinical allergology as skin allergy tests with fungal allergens, determination of the level of total immunoglobulin IgE in blood serum, as well as specific immunoglobulins (IgE, IgG, IgA and IgM) to the most common mold fungi are used. Sometimes, in complex diagnostic cases, it is possible to conduct a provocative inhalation test with fungal allergens (performed only in a specialized allergological center).
Differential diagnosis of mold allergy is carried out with allergic diseases and fungal infection of other etiology, viral rhinoconjunctivitis, bronchitis and pneumonia, bronchial asthma, skin diseases.
Treatment of mold allergy
The principles of mold allergy treatment are based on the maximum possible exclusion of contact with a significant fungal allergen, the use of corticosteroids and antihistamines, as well as antifungal drugs in the acute period. Good results in treatment can be achieved with the help of allergen-specific therapy, which should be carried out for several years and can significantly reduce sensitization to the fungal allergen.
Prognosis and prevention
Since this kind of allergy often occurs chronically and is not diagnosed for a long time, the quality of life and working capacity suffer significantly. After the identification and elimination of a causally significant allergen, well-being improves, but morphological changes that have developed in the lungs remain irreversible. Preventive measures to prevent mold allergies include the exclusion of prolonged contact with mold fungi at work and at home, the refusal to eat products with mold (some types of cheeses, fermented wines, sauerkraut, etc.), vegetables and fruits with traces of damage, careful removal of foci of fungal infection in residential premises, the fight against increased humidity, strengthening the body’s defenses.
