Sensitization to fungal allergens in patients with respiratory allergy – accuracy in diagnostic process

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.