Fungal Allergy ainshams university2024.pptx

fungal allergy

1. Fungal Allergy By Professor Zeinab Ahmed Ashour Professor of internal medicine allergy and clinical immunology Ain Shams University

2. Objectives Introduction. Living Environment of Fungi. Molds most likely to trigger an allergic response . Major fungal-related hypersensitivity diseases. Diagnosis and Treatment of fungal hypersensitivity . Mechanism of Sensitization to Fungal Allergens. FFAS after ingestion of fungus-related foods. Summary.

3. Introduction Fungi are  eukaryotic  organisms; i.e., their cells contain membrane-bound organelles and clearly defined nuclei. Historically, fungi were included in the  plant  kingdom; however, because fungi lack  chlorophyll  and are distinguished by unique structural and physiological features (i.e., components of the cell wall and cell membrane), they have been separated from plants. Fungi grow from the tips of filaments ( hyphae ) that make up the bodies of the organisms ( mycelia ), and they digest organic matter externally before absorbing it into their mycelia . Fungi reproduce through the formation of spores .

4. Fungi widely live in nature and are one of the main airborne allergens. Fungi are classified by domain, Kingdom, phylum, class, order, family, genus, and species . Three phyla of fungi are specifically relevant to hypersensitivity disorders : Zygomycota, Ascomycota, and Basidiomycota among which the ascomycetes including Alternaria alternata, Aspergillus, Cladosporium, and Penicillium are mainly allergen sources .

5. Molds most likely to trigger an allergic response include the following: • Alternaria :outdoor mold , can be with severe asthma. • Aspergillus : common indoor and outdoor mold • Aureobasidium : outdoor mold, found on paper, lumber , painted surfaces. • Cladosporium : The most common airborne outdoor mold. • Epicoccum : in agricultural areas. • Fusarium : . found on rotting plants. • Helmin-thosporium : in warmer climates. • Rhizopus and Mucor : Commonly found on decaying leaves and damp indoor areas.. • Pencillium : A common indoor mold. Asthma and Allergy Foundation of America New England Chapter.2019

6. https://en.wikipedia.org/wiki/Aspergillus_fumigatus

7. Major pathogenic species of Aspergillus

8. Allergenic fungi

9. The number of fungal spores in the atmosphere underlies seasonal and regional variations. Climatic factors such as temperature, rainfall, relative humidity, wind speed, and atmospheric pressure.

10. What Times of the Year Does Mold Allergy Occur? In colder climates , molds can be found in the outdoor air: - Starting in late winter and - peaking in late summer to early fall months In warmer climates , mold spores may be found throughout the year , highest levels in late summer to early fall months. While indoor molds can occur year-round and are dependent on moisture levels in the home, indoor mold levels are higher when outdoor mold levels are higher .

11. EAACI POSITION PAPEROpen Access Fungal exposome, human health, and unmet needs: A 2022 update with special focus on allergy Joana Vitte ,  Moïse Michel ,  Andrei Malinovschi ,  Marco Caminati ,  Adeyinka Odebode ,  Isabella Annesi-Maesano ,  Davide Paolo Caimmi ,  Carole Cassagne  … See all authors  First published: 17 August 2022 https://doi.org/10.1111/all.15483 Citations:  7

12. https://childstudy.ca/fungi-in-babies-gut-influences-allergies/

13. MAJOR FUNGAL-RELATED HYPERSENSITIVITY DISEASES   Upper airways : Allergic fungal rhinosinusitis (AFRS) Lower airways Bronchial Asthma Allergic bronchopulmonary mycosis (ABPM) Hypersensitivity pneumonitis (HSP) Skin Atopic dermatites Cholinergic urticaria

14. CT scan demonstrating left allergic fungal sinusitis in the frontal (red), ethmoid-maxillary (green) and sphenoid (yellow) sinuses https://sinushealth.com/conditions/fungal-sinusitis/

15. Close up view of allergic mucin and polyps in both sides of the nose.

16. Aspergillus Fumigatus

17. Invasive fungal sinusitis. The surgical photograph of the face shows a purple discoloration of the skin, which is dead tissue causes by disease. Similar findings are indicated by the blue arrows in the sinonasal cavity.

18. https://www.researchgate.net/figure/Fig-3-Mechanism-of-action-of-corticosteroids-Corticosteroids-diffuse-across-the-cell_fig1_258631989

19. Candida Albicans

20. Candida Albicans: Yeast and Fungus In and On the Human Body https://www.sciencesourceimages.com/science-images-blog/2023/3/31/candida-albicans-yeast-and-fungus-in-and-on-the-human-body

21. STUDIES ON THE POSSIBLE ROLE OF CHRONIC INTESTINAL CANDIDIASIS SYNDROME IN GENESIS OF INTRACTABLE ALLERGIC DISEASES

22. Diagnosis of fungal allergy Full history taking Clinical examination Skin prick test Radiological investigations Serological tests : SSIgE , IgG CBC and Differential : eosinophil count Fungal culture and identification. Molecular identification.

23. Treatment of fungal hypersensitivity : AIM Down-regulate host allergic response Lower fungal burden 1-Environmental control 2-Antifungal treatment 1-Pharmacological treatment 2-Specific immunotherapy Aim

24. What Measures Can Be Used to Decrease Indoor Mold Levels? keeping doors and windows closed and using air conditioning equipped with allergen-grade air filters Control indoor moisture with the use of dehumidifiers Fix water leaks in bathrooms, kitchens, and basements Ensure adequate ventilation of moist areas Clean (or replace) contaminated surfaces with diluted a chlorine bleach solution , while using proper protective gear (mask and goggles) Utilize HEPA- filters on vacuums or as a stand-alone air filter Limit indoor houseplants , and ensure those that are present are free of mold on leaves and in potting soil Which Molds Are Known to Cause Allergies ? Updated February 05, 2018

25. Dehumidifiers

26. RHIZOPUS ALLERGY IN ASTHMATIC PATIENTS: DIAGNOSIS AND IMMUNOTHERAPEUTIC TRIAL. Z.A. Ashour , Y.M. Shetaia, M.Y. Atiha and H.M. Sanad . - Egyptian Journal of Biomedical Sciences vol. 19, (327-338), November, 2005 - National Conference on Immunology and Allergy for Non Immunologist: 26-27 June, 2007 Dar El- Diafa - Annual Ain Shams International Medical Congress 10-13 March 2008 Cairo-Egypt

27. SPECIFIC FUNGAL IMMUNOTHERAPY IN PATIENTS WITH ALLERGIC SINUSITIS El- Tarabishi MN, MD, Sabri SM, MD, Fawaz Samia A, MD, Gouda Amr S MD, Ashour Zeinab A , MD, Dessouky Osama Y, MD, Salman Manal I, MD, Atiha Mohamed Y, MD, Sanad Hesham M, MD . The Egyptian Journal of Otolaryngology and allied sciences, Vol. 7(2): 65-79, June 2006 The Annual Congress of the Egyptian Society of allergy and immunology 27th Nov , 2008 Nile Hilton Hotel, Cairo, Egypt (Oral presentation)

28. Journal of Immunology Research Volume 2022, Article ID 7583400, 10 pages https://doi.org/10.1155/2022/7583400 Review Article Recent Advances in the Allergic Cross-Reactivity between Fungi and Foods Haiyan Xing, 1,2 Jianyong Wang, 3 Yuemei Sun, 1 and Hongtian Wang 2 1 Department of Allergy, The A ffi liated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong 264000, China 2 Department of Allergy, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China 3 Department of Pediatric, The A ffi liated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong 264000, China

29. Mechanism of Sensitization to Fungal Allergens In recent years , with the progress of molecular biology , genetics, and bioinformatics , specific immunoglobulin E ( sIgE ) levels in individuals sensitized to fungi appear to closely match their phylogenetic relationships which provide an opportunity to systematically look at allergic cross reactivity among fungi .

30. Fungal spores and/or hyphae may cause allergic reactions after entering the human body through various ways, such as inhalation, ingestion, contact, and injection

31. Fungal allergens , including proteases, protease activity receptor, glucans and membrane receptor, chitosanase, glycosidase, ribosome, mycotoxin, and volatile organic substances, can mainly cause type I, II, III, and IV allergic reactions . Fungus-related foods, such as edible mushrooms, mycoprotein, and fungi-fermented foods,  can cause fungus food allergy syndrome (FFAS) by allergic cross-reactivity with airborne fungi .

32. Allergen components of Alternaria have homologues in the other three relevant mold genera in allergy: Cladosporium , Penicillium , and Aspergillus . No specific major allergen components have been identified for Cladosporium allergies, while most registered allergens are cross-reactive minor allergens. For example, Cladosporium allergen Cla h8 has 75% sequence similarity with Alternaria allergen Alt a8.

33. Figure 3: Schematic diagram of FFAS after ingestion of fungus-related foods .

34. Diagnosis and Treatment of FFAS The association between primary IgE sensitization with respiratory symptoms to fungi allergens and food allergy due to cross-reactive allergen components is important to assess in allergy practice. It is now generally accepted that correct diagnosis of FFAS should be evaluated within the framework of a patient’s clinical history though there is oftentimes more challenging and difficulties.

35. Atopic patients with a history of inhalation fungal allergy trigger allergic reactions during or just following ingestion of fungus related food, which apparently were not sensitized in the past. Clinical suspicion of the FFAS is based on prick or intradermal skin tests in vivo diagnosis, determination of fungi allergen-specific IgE antibodies in vitro diagnosis. double- blind, placebo-controlled food challenge (DBPCFC), as known as the food provocative test, remains the gold standard in diagnosis of food allergy in FFAS .

36. Treatment of FFAS Allergen avoidance and emergency treatment to allergic reactions. Antihistamines blocking specific H1 receptors could be effective in the case of itching and urticarial . Adrenaline should be administered early in cases of anaphylaxis due to accidental ingestion of the culprit food, which is crucial to prevent the fatal outcome of anaphylactic reactions. Allergen immunotherapy (AIT) is currently the cornerstone of IgE -mediated allergy treatment, which has been used for over a century .Food allergen-specific therapies have not been applied in FFAS.

37. Fungal Aeroallergen Sensitization Patterns among Airway-Allergic Patients in Zagazig , Egypt Ghada A. Mokhtar 1,† , Manar G. Gebriel 1,† , Noha M. Hammad 1, * ,† , Sylvia W. Roman 2 , Osama Attia 3 ,Ahmed Behiry 4 , Nagwan A. Ismail 5 , Mohamed Salah Abd El Azeem El Sayed 6 , Ahmed Nagy Hadhoud 6 ,Yosra A. Osama 7 , Ahmed A. Ali 8 and Heba M. Kadry 1,† J. Fungi 2023 , 9, 185. https://doi.org/10.3390/jof9020185

38. Results. As determined by a skin prick test, 58% of the patients studied were allergic to mixed molds . Alternaria alternata was the predominant fungal aeroallergen among the studied patients (72.2%), which was followed by Aspergillus fumigatus (53.45%), Penicillium notatum (52.6%), Candida albicans(34.5%), and Aspergillus niger (25%). Conclusion: Mixed mold sensitization ranked fourth among the most frequent aeroallergens in airway-allergic patients, and Alternaria alternata was the most frequently encountered fungal aeroallergen in the Zagazig locality.

39. MOLD/YEAST FREE DIET INFORMATION YEAST FORMING : The following substances contain yeast or yeast‐like substances because of their nature or the nature of their manufacture or preparation (including brewer’s and distiller’s yeast and malt): A. Vinegars (pear, grape and distilled): These may be used as such or are used in these foods: catsup, mayonnaise, French dressing, salad dressing, barbeque sauce, tomato sauce, sauerkraut, horseradish, pickles, olives, condiments and spices (pepper, cinnamon), mince pie, Gerber’s oatmeal, and barley cereal. B. Fermented beverages : whiskey, wine, brandy, gin, rum, vodka, beer, root beer. C. Fruit juices : citrus fruit (and others), either canned or frozen. Only home squeezed are yeast free!

40. YEAST DERIVATIVES : The following contain substances that are derived from yeast or yeast‐like substances: A. Vitamins B. Flour MALT PRODUCTS : Cereals, candy, and milk drinks that have been malted and some fermented beverages; also some bakery products. MOLD FOODS : Mushrooms, truffles, morels.

41. MOLD CONTAINING FOODS : A. Cheeses (of all kinds), including cottage cheese, buttermilk, cream cheese, sour cream and sour cream butter. B. Foods which acquire mold growths during the preparation of processing or after exposure to air, even when refrigerated, such as ham, bacon, butter, preserves, jams, jellies, syrups, molasses, canned fruit and vegetables, and breads.

42.   Summary The vast and largely uncharted field of the fungal exposome calls for a multidisciplinary approach including environmental science, allergology, immunology, mycology, pulmonary medicine, epidemiology, and biostatistics.

43. the unmet needs in the domain of fungal exposome health effects and personalized medicine should be addressed with three concurrent front lines: Identification of further pathophysiologically relevant species and molecules   Innovative biomarker assays allowing the personalized profiling of immune responses to fungal species and molecules. Advanced statistical analyses and epidemiological interpretation able to predict the health effects of ongoing fungal exposure and climate-related changes in the fungal exposome .