Журнал микробиологии, эпидемиологии и иммунобиологии. 2020; 97: 119-124
Сенсибилизация к аллергенам плесневых грибов у пациентов с респираторной аллергией. Оптимизация диагностического процесса
https://doi.org/10.36233/0372-9311-2020-97-2-119-124Аннотация
Актуальность. В Болгарии часто встречается аллергия на плесневые грибы, сенсибилизация к различным аллергенам грибов обнаруживается у многих пациентов с атопией.
Цель данного исследования — установить чувствительность к наиболее распространенным видам плесневых грибов в Болгарии и определить с помощью компонентной диагностики наличие сенсибилизации к Alt a1 - одному из главных аллергенов Alternaria alternata.
Материалы и методы. В обследование включен 21 пациент с респираторной аллергией в возрасте 5-40 лет. Сенсибилизация к микстам грибковых аллергенов, содержащих Alternaria alternata, Aspergillus sp., Cladosporium herbarum, Penicillium notatum, у всех пациентов доказана посредством диагностики in vivo и in vitro. Кроме того, все пациенты тестированы с помощью «ImmunoCAP» на наличие аллергенспецифических IgE к отдельным грибковым аллергенам: m1 Penicillium notatum, m2 Cladosporium herbarum, m3 Aspergillus fumigatus и m6 Alternaria alternata. У 10 из обследованных пациентов с повышенным sIgE к m6 Alternaria alternata проведена компонентная диагностика с помощью Alt a1.
Результаты. Все обследованные пациенты имели повышенный уровень sIgE к Alternaria alternata. Из них 10 (48%) пациентов проявили чувствительность только к Alternaria alternata. У 8 (38%) пациентов выявлена сенсибилизация к Penicillium notatum, у 11 (52%) - к Cladosporium herbarum и у 10 (48%) - к Aspergillus fumigatus; 9 (90%) пациентов с сенсибилизацией к Alternaria alternata имели повышенный уровень IgE к Alt a1.
Выводы. Alternaria alternata чаще других видов плесневых грибов вызывает сенсибилизацию у пациентов с респираторной аллергией в Болгарии. Компонентная аллергодиагностика с использованием Alt a1 - главного аллергена плесени - дает полное доказательство видоспецифической сенсибилизации к Alternaria alternata.
Список литературы
1. Crameri R., Weichel M., Flückiger S., Glaser A.G., Rhyner C. Fungal allergies: yet unsolved problem. Chem Immunol. Allergy. 2006; 91: 121-33. DOI: http://doi.org/10.1159/000090276
2. Nikolov G., Kandova Y., Hristova R., Nedyalkov M., Petrunov B. The role of fungal allergens in respiratory diseases in Bulgaria. In: Allergy, Asthma & Immunology: From Basic Science to Clinical Application. Proceedings of the V World Asthma and COPD Forum. New York; 2012: 47-54.
3. Horner W.E., Helbling A., Salvaggio J.E., Lehrer S.B. Fungal Allergens. Clin. Microbiol. Rev. 1995; 8(2): 161-79.
4. Bush R.K., Portnoy J.M. The role and abatement of fungal allergens in allergic diseases. J. Allergy Clin. Immunol. 2001; 107(3 Suppl.): S430-40. DOI: http://doi.org/10.1067/mai.2001.113669
5. Achatz G., Oberkofler H., Lechenauer E., Simon B., Unger A., Kandler D., et al. Molecular characterization of Alternaria alternata and Cladosporium herbarum allergens. Adv. Exp. Med. Biol. 1996; 409: 157-61.DOI: http://doi.org/10.1007/978-1-4615-5855-2_21
6. Shreffler W.G. Microarrayed recombinant allergens for diagnostic testing. J. Allergy Clin. Immunol. 2011; 127(4): 843-9. DOI: http://doi.org/10.1016/j.jaci.2011.02.011
7. Twaroch T.E., Curin M., Valenta R., Swoboda I. Mold allergensin respiratory allergy: from structure to therapy allergy. AllergyAsthma Immunol. Res. 2015; 7(3): 205-20. DOI: http://doi.org/10.4168/aair.2015.7.3.205
8. Mari A., Schneider P., Wally V., Breitenbach M., Simon-Nobbe B. Sensitization to fungi: epidemiology, comparative skin tests, and IgE reactivity of fungal extracts. Clin. Exp. Allergy. 2003; 33(10): 1429-38. DOI: http://doi.org/10.1046/j.1365-2222.2003.01783.x
9. Asturias J.A., Ibarrola I., Ferrer A., Andreu C., Lopez-Pascual E., Quiralte J., et al. Diagnosis of Alternaria alternata sensitization with natural and recombinant Alt a 1 allergens. J. Allergy Clin. Immunol. 2005; 115(6): 1210-7. DOI: http://doi.org/10.1016/j.jaci.2005.02.012
10. Malling H.J., Dreborg S., Weeke B. Diagnosis and immunotherapy of mould allergy. III. Diagnosis of Cladosporium allergy by means of symptom score, bronchial provocation test, skin prick test, RAST, CRIE and histamine release. Allergy. 1986; 41(1): 57-67. DOI: http://doi.org/10.1111/j.1398-9995.1986.tb00276.x
11. Yunginger J.W., Jones R.T., Nesheim M.E., Geller M. Studies on Alternaria allergen, III. Isolation of a major allergenic fraction (ALT-I). J. Allergy Clin. Immunol. 1980; 66(2): 138-47. DOI: http://doi.org/10.1016/0091-6749(80)90061-5
12. Chruszcz M., Chapman M.D., Osinski T., Solberg R., Demas M., Porebski P.J., et al. Alternaria alternata allergen Alt a 1: A unique β-barrel protein dimer found exclusively in fungi. J. Allergy Clin. Immunol. 2012; 130(1): 241-7. DOI: http://doi.org/10.1016/j.jaci.2012.03.047
13. Duffort O., Barber D., Polo F. Quantification assay for the major allergen in Alternaria alternata, Alt a1. Alergol. Inmunol. Clin. 2002; 17(3): 162-172.
14. Kustrzeba-Wójcicka I., Siwak E., Terlecki G., Wolańczyk-Mędrala A., Mędrala W. Alternaria alternata and its allergens: a comprehensive review. Clin. Rev. Allergy Immunol. 2014; 47(3): 354-65. DOI: http://doi.org/10.1007/s12016-014-8447-6
15. Gabriel M.F., Postigo I., Tomaz C.T., Martínez J. Alternaria alternata allergens: Markers of exposure, phylogeny and risk of fungi-induced respiratory allergy. Environ. Int. 2016; 89-90: 71-80. DOI: http://doi.org/10.1016/j.envint.2016.01.003
16. Twaroch T.E., Focke M., Fleischmann K., Balic N., Lupinek C., Blatt K., et al. Carrier-bound Alt a 1 peptides without allergenic activity for vaccination against Alternaria alternata allergy. Clin. Exp. Allergy. 2012; 42(6): 966-75. DOI: http://doi.org/10.1111/j.1365-2222.2012.03996.x
17. Sanchez H., Bush R.K. A review of Alternaria alternata sensitivity. Rev. Iberoam Micol. 2001; 18(2): 56-9.
18. Simon-Nobbe B., Probst G., Kajava A.V., Oberkofler H., Susani M., Crameri R., et al. IgE-binding epitopes of enolases, a class of highly conserved fungal allergens. J. Allergy Clin. Immunol. 2000; 106(5): 887-95. DOI: http://doi.org/10.1067/mai.2000.110799
19. Gupta R., Singh B.P., Sridhara S., Gaur S.N., Kumar R., Chaudhary V.K., et al. Allergenic cross-reactivity of Curvularia lunata with other airborne fungal species. Allergy. 2002; 57(7): 636-40. DOI: http://doi.org/10.1034/j.1398-9995.2002.03331.x
Journal of microbiology, epidemiology and immunobiology. 2020; 97: 119-124
Sensitization to fungal allergens in patients with respiratory allergy – accuracy in diagnostic process
https://doi.org/10.36233/0372-9311-2020-97-2-119-124Abstract
Introduction. In Bulgaria, mold allergies are common, and sensitization to different fungal species is found in many patients with atopy.
The objective of this study is to explore sensitization to the most widespread mold species in Bulgaria, and to determine the extent of sensitization to Alt a1, a major allergen of Alternaria alternata, by using component-resolved diagnosis.
Materials and Methods. 21 patients (14 males and 7 females, age range 5-40 years), with respiratory allergy participated in the study. All patients are sensitized to mix of fungal allergens containing: Alternaria alternata, Aspergillus sp., Cladosporium herbarum, Penicillium notatum, proved by in vivo and in vitro methods. All patients underwent the ImmunoCAP test and were assessed for sIgE to individual fungal allergens: m1 Penicillium notatum, m2 Cladosporium herbarum, m3 Aspergillus fumigatus and m6 Alternaria alternata. The component-resolved diagnosis to Alt a1 was performed for 10 patients with increased sIgE to m6 Alternaria alternata.
Results. All studied patients (100%) had elevated sIgE to Alternaria alternata. Eight (38%) patients were sensitized to Penicillium notatum. 11 (52%) and 10 (48%) patients were sensitized to Cladosporium herbarum and to Aspergillus fumigatus, respectively. Ten patients (48%) were monosensitized to Alternaria alternata. Nine (90%) patients with sensitization to Alternaria alternata demonstrated elevated levels of IgE to Alt a1.
Conclusion. Alternaria alternata most often causes sensitization in patients with respiratory allergy. The component-resolved diagnosis using Alt a1 is a precision marker to prove species-specific sensitization to Alternaria alternata.
References
1. Crameri R., Weichel M., Flückiger S., Glaser A.G., Rhyner C. Fungal allergies: yet unsolved problem. Chem Immunol. Allergy. 2006; 91: 121-33. DOI: http://doi.org/10.1159/000090276
2. Nikolov G., Kandova Y., Hristova R., Nedyalkov M., Petrunov B. The role of fungal allergens in respiratory diseases in Bulgaria. In: Allergy, Asthma & Immunology: From Basic Science to Clinical Application. Proceedings of the V World Asthma and COPD Forum. New York; 2012: 47-54.
3. Horner W.E., Helbling A., Salvaggio J.E., Lehrer S.B. Fungal Allergens. Clin. Microbiol. Rev. 1995; 8(2): 161-79.
4. Bush R.K., Portnoy J.M. The role and abatement of fungal allergens in allergic diseases. J. Allergy Clin. Immunol. 2001; 107(3 Suppl.): S430-40. DOI: http://doi.org/10.1067/mai.2001.113669
5. Achatz G., Oberkofler H., Lechenauer E., Simon B., Unger A., Kandler D., et al. Molecular characterization of Alternaria alternata and Cladosporium herbarum allergens. Adv. Exp. Med. Biol. 1996; 409: 157-61.DOI: http://doi.org/10.1007/978-1-4615-5855-2_21
6. Shreffler W.G. Microarrayed recombinant allergens for diagnostic testing. J. Allergy Clin. Immunol. 2011; 127(4): 843-9. DOI: http://doi.org/10.1016/j.jaci.2011.02.011
7. Twaroch T.E., Curin M., Valenta R., Swoboda I. Mold allergensin respiratory allergy: from structure to therapy allergy. AllergyAsthma Immunol. Res. 2015; 7(3): 205-20. DOI: http://doi.org/10.4168/aair.2015.7.3.205
8. Mari A., Schneider P., Wally V., Breitenbach M., Simon-Nobbe B. Sensitization to fungi: epidemiology, comparative skin tests, and IgE reactivity of fungal extracts. Clin. Exp. Allergy. 2003; 33(10): 1429-38. DOI: http://doi.org/10.1046/j.1365-2222.2003.01783.x
9. Asturias J.A., Ibarrola I., Ferrer A., Andreu C., Lopez-Pascual E., Quiralte J., et al. Diagnosis of Alternaria alternata sensitization with natural and recombinant Alt a 1 allergens. J. Allergy Clin. Immunol. 2005; 115(6): 1210-7. DOI: http://doi.org/10.1016/j.jaci.2005.02.012
10. Malling H.J., Dreborg S., Weeke B. Diagnosis and immunotherapy of mould allergy. III. Diagnosis of Cladosporium allergy by means of symptom score, bronchial provocation test, skin prick test, RAST, CRIE and histamine release. Allergy. 1986; 41(1): 57-67. DOI: http://doi.org/10.1111/j.1398-9995.1986.tb00276.x
11. Yunginger J.W., Jones R.T., Nesheim M.E., Geller M. Studies on Alternaria allergen, III. Isolation of a major allergenic fraction (ALT-I). J. Allergy Clin. Immunol. 1980; 66(2): 138-47. DOI: http://doi.org/10.1016/0091-6749(80)90061-5
12. Chruszcz M., Chapman M.D., Osinski T., Solberg R., Demas M., Porebski P.J., et al. Alternaria alternata allergen Alt a 1: A unique β-barrel protein dimer found exclusively in fungi. J. Allergy Clin. Immunol. 2012; 130(1): 241-7. DOI: http://doi.org/10.1016/j.jaci.2012.03.047
13. Duffort O., Barber D., Polo F. Quantification assay for the major allergen in Alternaria alternata, Alt a1. Alergol. Inmunol. Clin. 2002; 17(3): 162-172.
14. Kustrzeba-Wójcicka I., Siwak E., Terlecki G., Wolańczyk-Mędrala A., Mędrala W. Alternaria alternata and its allergens: a comprehensive review. Clin. Rev. Allergy Immunol. 2014; 47(3): 354-65. DOI: http://doi.org/10.1007/s12016-014-8447-6
15. Gabriel M.F., Postigo I., Tomaz C.T., Martínez J. Alternaria alternata allergens: Markers of exposure, phylogeny and risk of fungi-induced respiratory allergy. Environ. Int. 2016; 89-90: 71-80. DOI: http://doi.org/10.1016/j.envint.2016.01.003
16. Twaroch T.E., Focke M., Fleischmann K., Balic N., Lupinek C., Blatt K., et al. Carrier-bound Alt a 1 peptides without allergenic activity for vaccination against Alternaria alternata allergy. Clin. Exp. Allergy. 2012; 42(6): 966-75. DOI: http://doi.org/10.1111/j.1365-2222.2012.03996.x
17. Sanchez H., Bush R.K. A review of Alternaria alternata sensitivity. Rev. Iberoam Micol. 2001; 18(2): 56-9.
18. Simon-Nobbe B., Probst G., Kajava A.V., Oberkofler H., Susani M., Crameri R., et al. IgE-binding epitopes of enolases, a class of highly conserved fungal allergens. J. Allergy Clin. Immunol. 2000; 106(5): 887-95. DOI: http://doi.org/10.1067/mai.2000.110799
19. Gupta R., Singh B.P., Sridhara S., Gaur S.N., Kumar R., Chaudhary V.K., et al. Allergenic cross-reactivity of Curvularia lunata with other airborne fungal species. Allergy. 2002; 57(7): 636-40. DOI: http://doi.org/10.1034/j.1398-9995.2002.03331.x
