© Borgis - New Medicine 3/1999, s. 30-32
Jolanta Kuniar1, Lucyna Pośpiech1, Ewa Bogacka2, Marita Nittner-Marszalska2, Elżbieta Nikiel2
Mould allergies as the cause of allergic rhinitis and sinus inflammation in children
1 Otolaryngology Department and AM Clinic, Wrocław
Head: prof. Lucyna Pośpiech, M.D.
2 Internal Disease and Allergology Department and Clinic, Wrocław
Head: Prof. Józef Małolepszy, M.D. Specialist Allergology Consulting Unit for Children, Wrocław
158 children with Allergic Rhinitis were examined in relation to their mould allergies. Allergy anamnesis and laryngologic examinations were carried out with SPT for typical inhalation and 7 mould allergens. In this way, three groups emerged: I: 41 children with AR in whom, besides mites, pollens, and/or pet fur inhalation allergy, there were also mould allergies (positive SPT for moulds confirmed by anamnesis); II: 32 children with positive SPT for mould allergens but without the clinical features; III, control/check-up: 85 people with negative SPT for mould allergens. It is shown that the clinical course of AR in group I was essentially more severe, and infectious complications much more frequent than in the other two groups. In group I, 3 times more people suffered from bronchial asthma.
Mould allergy has not been examined as closely as allergies to mites and pollens. The published data suggests a more severe course of allergic disease if it coexists with mould allergy. In the last decade, different states of AR have been examined and various pictures of the disease described, depending on the kinds of mould allergens - those in the sinuses, or external ones. The diagnosis of AR variations is essential therapy and prognosis. This is why the authors decided to estimate the scale of the problem in atopic children from Lower Silesia.
Materials and methods
158 children from Lower Silesia, aged from 4 to 16 years the average age of both sexes being the same suffering from AR were examined. Diagnosis was made on the basis of allergy anamnesis, SPT and laryngologic examination. In suspicious cases, sinus RTG or even CT was made. All the children were tested with Allergopharma SPT with mite allergens (D. pteronyssimus, D. farinae), pet fur, and grass, tree, and weed pollens. The following mould allergens were tested: Alternalia alt., Cladosporinum herb., Aspergillus fum., Penicillium sp., Candida alb., Scorobolomycetes, Trichophyton sp. The children were divided into those with positive mould SPT and those with positive SPT to all other allergens. The children with positive mould SPT were further divided into those whose positive SPT correlated with exacerbation of the symptoms when exposed to moulds, or did not do so.
Two groups were created:
II - 41 children with positive mould SPT and anamnesis conformity;
II - 32 children without the conformity. The control group consisted of 85 children with AR and negative mould SPT. The groups were analysed in the course of AR and coexistence with other manifestations of allergy. In group I, the coexistence of allergy to moulds and to other inhalation allergens, and which mould most frequently allergises, was assessed. The results were calculated using the method of significant difference in percentage tests.
Analysis of the groups reveals a more severe course of disease in children allergic to moulds - 3 times more frequent coexistence of AR and BA, and 2 times less frequent AR alone in group I. Group I suffer from mild rhinitis significantly less often, but get moderate rhinitis and infections much more often than the control group and group II. The differences between the control group and group II were statistically insignificant. Our observations are congruent with/compatible with the publications of Katz, Kantothonasi, O´Hollarena, Ozanguc, and others. The data should change the allergists´ opinion of the role of moulds in allergies.
It seems that children allergic to moulds are more liable to get infections of the respiratory tracts, and nasal mucosa polyps. In 2 children with mould allergy, nasal mucosa polyps were detected, and in 2 other children, there was a supposition of AFS (CT image suggesting a mycetoma in the frontal sinus (1) and the maxillary sinus (1)). Because of the age of the boys (14 and 12), operative revision of the sinuses was postponed till they are 16. It is commonly thought that polyps seldom complicate AR, and thus the sinus changes are caused by frequent infections, not mould allergy. Still, this must be examined on a larger group of patients.
Mould allergy is commonly associated with pollinosis, agrees with most publications.
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1. D´Amato G. et al.: Mould induced respiratory allergy. Post graduate courses: Aerobiological and clinical aspects of allergenic moulds. EAACI 1997 Rhodes, June 1977. 2. Bogacka E.: Grzyby jako alergeny [In:] Zarys Mikologii Lekarskiej, Baran E., Volumed Wrocław, 1998. 3.Hodos N. et al.: Moulds in children: laboratory results. Abstracts.Workshop on Mould Allergy in Children. Herzliya, May,1998. p. 9. 4. Katz Y. et al.: Indoor survey of moulds and prevalence of mould atopy in Israel. Clin. Exper. Allergy, 1999, 29:186-192. 5.Ozanguc N. et al.: Allergen spectrum of allergic rhinitis and bronchial asthma in Turkey and relationship between the allergens and month of birth, blood groups, familial atopy history. Allergy Clin. Immunol. Inter. 1997, suppl. 4, poster 495.