Epidemiology of allergic disease: the fungi

Summary In indoor aerial environments and in particular that of homes, the number and type of fungal spores present in the air depend, more than on air exchange with the outside atmosphere, on the presence of sources or dispersion within the building itself. The concentration of spores is half that normally recorded outside the building, withAspergillus, Penicillium, Cladosporium, Alternaria, Mucor, Rhizopus andOidiodendron as the dominating genera. Aerosporological investigations carried out in homes should ideally be done at night, with the exposition of cultural dishes. The repetitive isolation of the same fungus may be particularly important in the etiology of allergic manifestation in man. Particular environments, if insufficiently aerated, with high levels of relative humidity and insufficient illumination, may become ecological niches particularly well suited to fungi, both during its latent form or during a phase of rapid development. Together with rapidly developing fungi, for instanceMucor andRhizopus, slow developing moulds such asPenicillium, Aspergillus andTrichoderma may also be found, characterized however by a production of a great number of easily dispersed conidia. Etiological research into the allergic manifestations of patients continuously inhaling spores responsible for particular allergies appears to be insufficiently developed.     

House-dust mites and mold fungi as a source of indoor allergens

In this work information on the biology and ecology of synanthropic mites and mold fungi, proved to be the sources of indoor allergens in different premises, is presented. The authors propose the algorithm of the ecological monitoring of dwellings, developed on the basis their investigations. The types of dwellings, the time and situations when ecological monitoring should be carried out are analyzed. Grounds for the necessity of controlling the number of mites and the concentration of Micromyces spores, as well as their elimination from the environment, are given.     

真菌过敏性哮喘的治疗研究进展

真菌过敏性哮喘是由环境中真菌致敏原暴露诱导的一种呼吸道慢性炎症性疾病。真菌过敏哮喘患者肺部炎症细胞、结构细胞及细胞组分间有复杂的相互作用,使得患者气道壁重塑并伴渐进性肺功能障碍,表现为喘息、胸闷、呼吸困难等症状,对患者的工作和生活造成严重影响,而目前糖皮质激素及抗菌药物等传统疗法对其治疗效果欠佳。近年来,很多研究开始致力于对真菌过敏性哮喘新的治疗方法进行积极探索,使得真菌过敏性哮喘的治疗除应用糖皮质激素等传统方法外,在抗真菌感染及其免疫学治疗控制真菌过敏性哮喘方面取得一定新进展。     

Nonpathogenic, environmental fungi induce activation and degranulation of human eosinophils

Eosinophils and their products are probably important in the pathophysiology of allergic diseases, such as bronchial asthma, and in host immunity to certain organisms. An association between environmental fungal exposure and asthma has been long recognized clinically. Although products of microorganisms (e.g., lipopolysaccharides) directly activate certain inflammatory cells (e.g., macrophages), the mechanism(s) that triggers eosinophil degranulation is unknown. In this study we investigated whether human eosinophils have an innate immune response to certain fungal organisms. We incubated human eosinophils with extracts from seven environmental airborne fungi (Alternaria alternata, Aspergillus versicolor, Bipolaris sorokiniana, Candida albicans, Cladosporium herbarum, Curvularia spicifera, and Penicillium notatum). Alternaria and Penicillium induced calcium-dependent exocytosis (e.g., eosinophil-derived neurotoxin release) in eosinophils from normal individuals. Alternaria also strongly induced other activation events in eosinophils, including increases in intracellular calcium concentration, cell surface expression of CD63 and CD11b, and production of IL-8. Other fungi did not induce eosinophil degranulation, and Alternaria did not induce neutrophil activation, suggesting specificity for fungal species and cell type. The Alternaria-induced eosinophil degranulation was pertussis toxin sensitive and desensitized by preincubating cells with G protein-coupled receptor agonists, platelet-activating factor, or FMLP. The eosinophil-stimulating activity in Alternaria extract was highly heat labile and had an M(r) of approximately 60 kDa. Thus, eosinophils, but not neutrophils, possess G protein-dependent cellular activation machinery that directly responds to an Alternaria protein product(s). This innate response by eosinophils to certain environmental fungi may be important in host defense and in the exacerbation of inflammation in asthma and allergic diseases.     

Occurrence of mites and fungi in the homes of patients with allergic manifestations

This survey was carried out to evaluate mites and moulds concentrations in the homes of patients with allergic manifestations and positive skin-test for mites and/or fungi. The home environments of 277 patients were evaluated by questionnaire, by sampling of airborne fungal spores and by determining the occurrence of mites and moulds in dust samples. Among the 277 patients examined, 83% reacted positively to house dust mites. The fungal allergen most frequently responsible for skin positivity was Alternaria tenuis. The prevalent airborne fungi were Cladosporium, Penicillium and Alternaria, followed by Aspergillus and Aureobasidium. The other genera were found in less than 50% of the homes. The presence of domestic mites in dust was documented in more than 85% of the homes sampled. The occurrence of fungi in dust was generally higher than in the air. The most common genera recovered were Penicillium, Candida, Aspergillus, Aureobasidium, Alternaria and Cladosporium. The homes investigated were divided into two groups, damp and dry, on the basis of the reported presence of wet or damp spots on inside surfaces and moulds growing inside the home. Our results showed that the concentration of mites and moulds in dust was significantly higher (p < 0.01) in damp homes as compared to dry ones.In general, a good agreement between skin positivity and presence of the same allergens in patients' home environment was observed for mites and, among fungi, for Alternaria, Cladosporium and Aspergillus. Our results seem to confirm that the study of mycoaeroflora and the quantification of mites and moulds in dust samples of allergic patients' homes could lead to more precise diagnoses and therefore to better prophylactic and therapeutic programs for each individual patient.     

Recovery of germinating fungal conidia from the nasal cavity after environmental exposure

Background The expression of fungal allergens is increased by the germination of conidia. We assessed the state of germination of fungal conidia recovered by nasal lavage after environmental exposure. Methods Nasal lavage was performed on twenty adults at three stages: the start of the experiment, after 1 h indoors, and after 1 h outdoors. One half of the lavage liquid was immediately treated to prevent in-vitro germination and stained with periodic acid Schiff (PAS) to enable identification of germinated and ungerminated conidia. The untreated half of the lavage liquid was cultured on nutrient agar plates to enumerate and identify viable fungi. Results PAS staining showed that both ungerminated and germinated conidia, and hyphal fragments, were present in the nasal cavity. The most prevalent fungi recovered were Aspergillus, Alternaria, Cladosporium, Epicoccum, Penicillium, and Yeast species. The number of viable fungi recovered after 1 h indoors was significantly less than after 1 h outdoors (P < 0.01). Conclusions Viable fungi and germinating conidia, in addition to ungerminated conidia and hyphal fragments, were present in the nasal cavity after both indoor and outdoor exposure. This provides novel insight into the pathogenicity of exposure to fungal aeroallergens.     

Airborne fungi in an Italian rice mill

Summary Studies employing volumetric spore trap (VSP) and gravity settling culture plates (GSC) were conducted in order to analyse the air spora of a rice mill at Pavia, Italy, from October-December 1988. Results revealed a variety of fungal spores belonging to different genera and including recognized rice pathogenic fungi. The most frequent genera by GSC method includedAcremonium, Alternaria, Aspergillus, Aureobasidium, Cladosporium, Epicoccum, Fusarium, Helminthosporium, Mucor, Nigrospora, Penicillium, Rhizopus, Trichoderma, Trichothecium, and some unidentified fungi. Environmental assessment of fungal spores by VSP revealed that the most prevalent fungi were:Alternaria, Cladosporium, Epicoccum, Helminthosporium, Nigrospora, Pyricularia, Tilletia and hyaline, dark and coloured types of ascospores and basidiospores. Airborne fungal spore concentrations were particularly high (5,000–6,000 spores/m³) in the rooms of the rice mill where the initial stages of rough rice transformation take place, and dropped to 2,500 spores/m³ in the last room, where workers are. During a temporary interruption of the working processes, air spora concentration dropped below 1,000 spores/m³.Cladosporium, Epicoccum andNigrospora spores were predominant in all subdivisions of the indoor environments of the rice mill.     

病原性真菌蛋白酶致病机制研究进展

蛋白酶在真菌的生存和生长过程中具有重要作用,同时也被认为是病原真菌重要的毒力因子之一。病原真菌的蛋白酶可能参与真菌在宿主的黏附、定植和播散以及逃避宿主的免疫应答过程。部分蛋白酶还被认为是变应原,可诱发哮喘和过敏性疾病。在不同的病原真菌中,蛋白酶作用也不同。研究蛋白酶的致病机制,可进一步了解真菌感染机制,为诊断及治疗真菌感染提供线索。     

Allergenicity of airborne basidiospores and ascospores: need for further studies

Many known fungal species are grouped among basidiomycetes and ascomycetes. Active mechanisms of spore release into air currents are among the main features of these fungi. Aerobiological studies have described their presence in many regions worldwide. In some areas, fungi have been described as the predominant outdoor airborne biological particulate with much higher concentrations than pollen. Other studies have determined that among the fungal aerospora, the highest concentrations belong to basidiospores and ascospores. Nevertheless, the allergenic potential of spores from basidiomycetes and meiotic forms of ascomycetes has not been studied to the extent of mitosporic fungi and allergens from other sources. The need to further evaluate the role of basidiomycetes and meiotic ascomycetes in allergies is evidenced by the few genera with characterized allergens and limited studies that had demonstrated levels of sensitization similar or higher to that of mitosporic fungi and other allergens. In this review, based on the existing aerobiological, epidemiological, immunological, and molecular biology studies, we provide evidence that the role of basidiomycetes and ascomycetes deserves more attention with respect to their roles as potential aeroallergens.     

T cell responses to known allergen proteins are differently polarized and account for a variable fraction of total response to allergen extracts

A panel of 133 allergens derived from 28 different sources, including fungi, trees, grasses, weeds, and indoor allergens, was surveyed utilizing prediction of HLA class II-binding peptides and ELISPOT assays with PBMC from allergic donors, resulting in the identification of 257 T cell epitopes. More than 90% of the epitopes were novel, and for 14 allergen sources were the first ever identified to our knowledge. The epitopes identified in the different allergen sources summed up to a variable fraction of the total extract response. In cases of allergens in which the identified T cell epitopes accounted for a minor fraction of the extract response, fewer known protein sequences were available, suggesting that for low epitope coverage allergen sources, additional allergen proteins remain to be identified. IL-5 and IFN-γ responses were measured as prototype Th2 and Th1 responses, respectively. Whereas in some cases (e.g., orchard grass, Alternaria, cypress, and Russian thistle) IL-5 production greatly exceeded IFN-γ, in others (e.g., Aspergillus, Penicillum, and alder) the production of IFN-γ exceeded IL-5. Thus, different allergen sources are associated with variable polarization of the responding T cells. The present study represents the most comprehensive survey to date of human allergen-derived T cell epitopes. These epitopes might be used to characterize T cell phenotype/T cell plasticity as a function of seasonality, or as a result of specific immunotherapy treatment or varying disease severity (asthma or rhinitis).     

Fungal Proteases and Their Pathophysiological Effects

Proteolytic enzymes play an important role in fungal physiology and development. External digestion of protein substrates by secreted proteases is required for survival and growth of both saprophytic and pathogenic species. Extracellular serine, aspartic, and metalloproteases are considered virulence factors of many pathogenic species. New findings focus on novel membrane-associated proteases such as yapsins and ADAMs and their role in pathology. Proteases from fungi induce inflammatory responses by altering the permeability of epithelial barrier and by induction of proinflammatory cytokines through protease-activated receptors. Many fungal allergens possess proteolytic activity that appears to be essential in eliciting Th2 responses. Allergenic fungal proteases can act as adjuvants, potentiating responses to other allergens. Proteolytic enzymes from fungi contribute to inflammation through interactions with the kinin system as well as the coagulation and fibrinolytic cascades. Their effect on the host protease–antiprotease balance results from activation of endogenous proteases and degradation of protease inhibitors. Recent studies of the role of fungi in human health point to the growing importance of proteases not only as pathogenic agents in fungal infections but also in asthma, allergy, and damp building related illnesses. Proteolytic enzymes from fungi are widely used in biotechnology, mainly in food, leather, and detergent industries, in ecological bioremediation processes and to produce therapeutic peptides. The involvement of fungal proteases in diverse pathological mechanisms makes them potential targets of therapeutic intervention and candidates for biomarkers of disease and exposure.     

Phenotypic and genotypic diversity of airborne fungal spores in Demänovská Ice Cave (Low Tatras,Slovakia)

This paper is the first aero-mycological report from Demänovská Ice Cave. Fungal spores were sampled from the internal and external air of the cave in June, 2014, using the impact method with a microbiological air sampler. Airborne fungi cultured on PDA medium were identified using a combination of classical phenotypic and molecular methods. Altogether, the presence of 18 different fungal spores, belonging to 3 phyla, 9 orders and 14 genera, was detected in the air of the cave. All of them were isolated from the indoor samples, and only 9 were obtained from the outdoor samples. Overall, airborne fungal spores belonging to the genus Cladosporium dominated in this study. However, the spores of Trametes hirsuta were most commonly found in the indoor air samples of the cave and the spores of C. herbarum in the outdoor air samples. On the other hand, the spores of Alternaria abundans, Arthrinium kogelbergense, Cryptococcus curvatus, Discosia sp., Fomes fomentarius, Microdochium seminicola and T. hirsuta were discovered for the first time in the air of natural and artificial underground sites. The external air of the cave contains more culturable airborne fungal spores (755 colony-forming units (CFU) per 1 m³ of air) than the internal air (from 47 to 273 CFU in 1 m³), and these levels of airborne spore concentration do not pose a threat to the health of tourists. Probably, the specific microclimate in the cave, including the constant presence of ice caps and low temperature, as well as the location and surrounding environment, contributes to the unique species composition of aeromycota and their spores in the cave. Thus, aero-mycological monitoring of underground sites seems to be very important for their ecosystems, and it may help reduce the risk of fungal infections in humans and other mammals that may arise in particular due to climate change.     

Relevance of airborne fungi and their secondary metabolites for environmental,occupational and indoor hygiene

Airborne fungal contaminants are increasingly gaining importance in view of health hazards caused by the spores themselves or by microbial metabolites. In addition to the risk for infection, the allergenic and toxigenic properties, as well as the inflammatory effects are discussed in this review as possible health impacts of bioaerosols. A major problem is the lack of threshold values for pathogenic and non-pathogenic fungi, both in the workplace and in outdoor air. While the relevance of mycotoxins has been intensely studied in connection with contamination of food and feed, the possible respiratory uptake of mycotoxins from the air has so far not been sufficiently taken into account. Toxic secondary metabolites are expected to be present in airborne spores, and may thus occur in airborne dust and bioaerosols. Potential health risks cannot be estimated reliably unless exposure to mycotoxins is determined qualitatively and quantitatively. Microbial volatile organic compounds (MVOC) have been suggested to affect human health, causing lethargy, headache, and irritation of the eyes and mucous membranes of the nose and throat. The production of MVOC by fungi has been discussed in connection with domestic indoor microbial pollution, but the relevance of fungal metabolites in working environments remains insufficiently studied.     

Respiratory fungal allergy

Fungal allergy including allergic rhinitis, conjunctivitis, bronchial asthma, and allergic bronchopulmonary mycoses results from exposure to spores. In this review we have dealt with the common allergenic fungi and allergens, immunopathogenesis, diagnostic assays, and the possible control of allergy in the future based on epitope-specific immunotherapy and vaccination.     

Considerations in the grouping of plant and fungal taxa for an epidemiologic study

Although exposure to airborne pollen grains and fungal spores has been implicated as a causative factor for acute exacerbation of asthma, the few epidemiologic studies that have attempted to evaluate the relationship between these bioaerosols and asthma have used only total counts (ignoring the relative importance of different taxa) or a few predominant pollen or spore types (ignoring less abundant but potentially relevant groups). This paper reports the development of hypothesis‐driven exposure metrics (based on known aeroallergen associations with allergic asthma and other hypersensitivity diseases, pollen allergen cross‐reactivity, and the presence of local sources in the city of Fresno, California, USA) for a 3.5 year epidemiologic study of childhood asthma. Outdoor regional and neighborhood concentrations of pollen and spores were measured using Hirst‐type, 7‐day samplers. Indoor and outdoor residential concentrations were measured at 84 selected homes with similar 24‐hour slit impactors. All pollen and spore concentrations were recorded in 2‐hour intervals to assist in understanding diurnal fluctuations in aeroallergen concentrations, identify exposures during the time periods that children are outdoors, and study interaction between aeroallergens and other air contaminants, which were the primary focus of the study. The 124 pollen taxa that were observed were reduced to 15 categories and the 66 fungal and algal taxa were reduced to five categories that will be used in microenvironmental models to generate individual daily exposure estimates for each of the 315 children. These new exposure metrics will allow examination of health effects for taxa traditionally associated with allergy and those with locally elevated concentrations in combination with exposures to other indoor and outdoor air contaminants.     

The incidence of fungal spores in the ambient air and inside homes: Evidence from London

Little research has been carried out in London concerning fungal spore prevalence yet this information may help to elucidate geographical patterns of asthma and hay fever. Although many types of spore reach peak concentrations outdoors in late-summer, the incidences in the indoor environment may be more important through the winter because of heating and poor ventilation. Daily average concentrations of fungal spores in the ambient atmosphere were monitored with a Burkard volumetric spore trap on an exposed roof in North London from autumn 1991 until the summer of 1992. Indoor spore measurements were taken in 19 homes in the vicinity through the winter months, both by direct air sampling using a portable Burkard sampler and by dust culture. Trends in the occurrence and concentrations of fungal spores indoors and outdoors were examined. Relationships between the abundance of selected allergenic fungi and features of the houses were analysed including age of dwelling, dampness, cleanliness and presence of pets.Aspergillus andPenicillium were the most frequently occurring spore types in the homes. Overall, high spore incidence was associated with dampness and dust accumulation. The outdoor spore samples revealed generally low concentrations through the winter until March when concentrations of many types includingCladosporium, Epicoccum andAlternaria increased in abundance in response to the warmer weather. Even during the late-spring and early-summer, concentrations of most fungal spores were notably below those reported for rural sites.     

Studies on the air-borne fungal spores in Amritsar: Their role in keratomycosis

An aerial survey for fungal spores in Amritsar has been carried out by petri plate exposure method for a period of one year. A total of 23 fungi appeared in the plates. Out of these Aspergillus was the commonest fungus representing 21.69% of the total colony count followed by Alternaria, Curvularia and Fusarium. There was seasonal variation in the prevalence of fungal spores. A comparison of the prevalence of fungi in diseased and healthy eyes and the atmosphere of Amritsar appeasrs to support the view that these fungi are transient residents in the eyes depending on their availability in the atmosphere.Part of the data presented at the XXXVIII All India Ophthalmological Conference held at Amritsar from January 5–8, 1979.     

NAGase activity in airborne biomass dust and relationship between NAGase concentrations and fungal spores

Inhalation of airborne fungal spores or fungalenzymes may cause adverse pulmonary healtheffects. The enzyme NAGase(N-acetyl--D-glucosaminidase) is achitinase presumed to be secreted by all fungi. In this study, NAGase activities andconcentrations of fungi are estimated inairborne biomass dust to acquire knowledgeabout the level of NAGase activity and therelationship between NAGase activity andconcentrations of airborne fungal spores.NAGase was sampled on both teflon andpolycarbonate filters, and polycarbonatefilters proved to be better for extraction ofNAGase than teflon filters. NAGase was foundin airborne dust at a biofuel plant and in dustgenerated from biomass. At a biofuel plant, themedian level of exposure to NAGase was 21 pmols^–1 m^–3. Significant correlationswere found between NAGase activities, totalnumber of fungal spores and CFU of fungi, withthe highest degree of correlation being betweenthe total number of fungal spores and theNAGase activity (r = 0.802, n = 76). Furthermore,when dust was stored for different periods, theculturability of fungal spores was stronglyreduced and the NAGase activity was not or onlyslightly reduced after up to 40 days ofstorage. Accordingly, NAGase activity may beused as a rapid method to get an estimate ofthe exposure level to airborne fungal spores.Whether pure NAGase or the NAGaseconcentrations observed here cause any healtheffects is not known, although it has beenshown that other fungal enzymes can causerespiratory disorders and a chitinase isdescribed as an allergen.     

Airborne fungal spores in the Campus of Anchieta (La Laguna,Tenerife/Canary Is.)

A quantitative and qualitative study was carried out of the atmospheric fungal propagules in two university buildings in the Campus of Anchieta (La Laguna, Tenerife, Canary Islands, Spain) and in the outdoor atmosphere, in order to ascertain the most abundant fungi and the concentration of spores in the air, as possible sources of respiratory allergies caused by this type of aeroallergens. Sampling was carried out using two kinds of traps (Burkard Personal Culture Sampler and Burkard Personal Slide Sampler), as well as adhesive tape. Sample 1, indoor, identified between 650-320 CFU m -3 depending on the culture medium, with outdoor values between 670-440 CFU m -3 ; sample 2, recorded between 630-80 CFU m -3 inside and 580-300 CFUm -3 in the outdoor atmosphere. The most represented genera were Cladosporium and Penicillium , although the following were also identified: Agaricales, Alternaria, Aspergillus, Botrytis, Drechslera, Coprinus, Curvularia, Chaetomium, Exserohilum, Fusarium, Helminthosporium, Leptosphaeria , Myxomycetes, Paecilomyces, Pleospora, Stemphylium, Tetraploa, Torula and Ulocladium .     

Particle-size distributions and seasonal diversity of allergenic and pathogenic fungi in outdoor air

Fungi are ubiquitous in outdoor air, and their concentration, aerodynamic diameters and taxonomic composition have potentially important implications for human health. Although exposure to fungal allergens is considered a strong risk factor for asthma prevalence and severity, limitations in tracking fungal diversity in air have thus far prevented a clear understanding of their human pathogenic properties. This study used a cascade impactor for sampling, and quantitative real-time PCR plus 454 pyrosequencing for analysis to investigate seasonal, size-resolved fungal communities in outdoor air in an urban setting in the northeastern United States. From the 20 libraries produced with an average of ∼800 internal transcribed spacer (ITS) sequences (total 15 326 reads), 12 864 and 11 280 sequences were determined to the genus and species levels, respectively, and 558 different genera and 1172 different species were identified, including allergens and infectious pathogens. These analyses revealed strong relationships between fungal aerodynamic diameters and features of taxonomic compositions. The relative abundance of airborne allergenic fungi ranged from 2.8% to 10.7% of total airborne fungal taxa, peaked in the fall, and increased with increasing aerodynamic diameter. Fungi that can cause invasive fungal infections peaked in the spring, comprised 0.1–1.6% of fungal taxa and typically increased in relative abundance with decreasing aerodynamic diameter. Atmospheric fungal ecology is a strong function of aerodynamic diameter, whereby through physical processes, the size influences the diversity of airborne fungi that deposit in human airways and the efficiencies with which specific groups of fungi partition from outdoor air to indoor environments.