Allergy to Alternaria alternata: Comprehensive review from the origin to the therapeutic approach
Main Article Content
Keywords
Alternaria alternata, Alt a 1, pediatric allergy, allergic rhinitis, asthma, mold sensitization, immunotherapy
Abstract
Alternaria alternata is an ubiquitous mold commonly found in both outdoor and indoor environments. It is a common airborne mold recognized as a significant aeroallergen linked to pediatric allergic rhinitis and asthma. Although sensitization rates in children vary regionally, evidence suggests that A. alternata allergy significantly impacts pediatric respiratory health and as its exposure worsens, respiratory outcomes in susceptible pediatric populations Alternaria. Children are especially vulnerable due to their developing immune and respiratory systems and greater exposure to environmental allergens. This narrative review aims to summarize current knowledge on A. alternata as an allergenic source in children, including its biology, allergenic components (especially Alt a 1), interactions with immune system, airway epithelium interacting with other allergens, and clinical relevance. We also discuss the allergen-specific immunotherapy strategies with standardized extracts that are effective and safe in pediatric patients. Understanding the role of Alternaria in allergic disease is essential for early and accurate diagnosis (including component-resolved methods), effective intervention, and improving long-term outcomes in affected children. Future research should focus on novel vaccine technologies and standardized pediatric-specific treatment protocols.
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2 Phukhamsakda C, Nilsson RH, Bhunjun CS, de Farias ARG, Sun YR, Wijesinghe SN, et al. The numbers of fungi: Contributions from traditional taxonomic studies and challenges of metabarcoding. Fungal Divers. 2022;114(1):327–86. 10.1007/s13225-022-00502-3
3 Twaroch TE, Curin M, Valenta R, Swoboda I. Mold allergens in respiratory allergy: From structure to therapy. Allergy Asthma Immunol Res. 2015;7(3):205. 10.4168/aair.2015.7.3.205
4 Arbes Jr. SJ, Gergen PJ, Elliott L, Zeldin DC. Prevalences of positive skin test responses to 10 common allergens in the US population: Results from the Third National Health and Nutrition Examination Survey. J Allergy Clin Immunol. 2005;116(2):377–83. 10.1016/j.jaci.2005.05.017
5 Oliveira M, Oliveira D, Lisboa C, Boechat JL, Delgado L. Clinical manifestations of human exposure to fungi. J Fungi. 2023;9(3). 10.3390/jof9030381
6 Rick E, Woolnough K, Pashley C, Wardlaw A. Allergic fungal airway disease. J Investig Allergol Clin Immunol. 2016;26(6):344–54. 10.18176/jiaci.0122
7 Vicencio AG, Santiago MT, Tsirilakis K, Stone A, Worgall S, Foley EA, et al. Fungal sensitization in childhood persistent asthma is associated with disease severity. Pediatr Pulmonol. 2014;49(1):8–14. 10.1002/ppul.22779
8 López Couso VP, Tortajada-Girbés M, Rodriguez Gil D, Martínez Quesada J, Palacios Pelaez R. Fungi sensitization in Spain: Importance of the Alternaria alternata species and its major allergen alt a 1 in the allergenicity. J Fungi. 2021;7(8):631. 10.3390/jof7080631
9 Hughes KM, Price D, Torriero AAJ, Symonds MRE, Suphioglu C. Impact of fungal spores on asthma prevalence and hospitalization. Int J Mol Sci. 202223(8):4313. 10.3390/ijms23084313
10 Zureik M, Neukirch C, Leynaert B, Liard R, Bousquet J, Neukirch F, et al. Sensitisation to airborne moulds and severity of asthma: Cross sectional study from European Community respiratory health survey. BMJ. 2002;325(7361):411–7. 10.1136/bmj.325.7361.411
11 Plaza V, Serrano J, Picado C, Cosano J, Ancochea J, de Diego A, et al. Características clínicas de las crisis de asma de riesgo vital en los pacientes sensibilizados a Alternaria alternata. Med Clin. 2003;121(19):721–4. 10.1016/S0025-7753(03)74076-7
12 Barnes C. Fungi and atopy. Clin Rev Allergy Immunol. 2019;57(3):439–48. 10.1007/s12016-019-08750-z
13 Després VR, Huffman JA, Burrows SM, Hoose C, Safatov AS, Buryak G, et al. Primary biological aerosol particles in the atmosphere: A review. Tellus B: Chem Phys Meteorol. 2012;64(1):15598. 10.3402/tellusb.v64i0.15598
14 Olsen Y, Skjøth CA, Hertel O, Rasmussen K, Sigsgaard T, Gosewinkel U. Airborne Cladosporium and Alternaria spore concentrations through 26 years in Copenhagen, Denmark. Aerobiologia. 2020;36(2):141–57. 10.1007/s10453-019-09618-7
15 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. 10.1046/j.1365-2222.2003.01783.x
16 D’Amato G, Spieksma FThM. Aerobiologic and clinical aspects of mould allergy in Europe. Allergy. 1995;50(11):870–7. 10.1111/j.1398-9995.1995.tb02492.x
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