Alternaria alternata

Latin name: Alternaria alternata/Alternaria tenuis

Source material: Spores and mycelium
Family: Pleosporaceae
Common names: Alternaria
Mold
A mold, which may result in allergy symptoms in sensitised individuals.

Allergen Exposure
A. alternata, growing commonly on vegetation, is a member of the imperfect fungi and is one of the most
important among the allergenic fungi. Brown segmented mycelia give rise to simple or solitary
conidiophores, which may produce solitary apical spores, or a string of spores. 
Alternaria is one of the main allergens affecting children. In temperate climates, airborne Alternaria spores
are detectable from May to November, with peaks in late summer and autumn. Dispersion of Alternaria
spores occurs during dry periods. These feature higher wind velocity and lower relative humidity, which
result in peak dispersion during sunny afternoon periods.

Environment
A. alternata occurs on many plants and other substrates, including foodstuffs and textiles. Favourite habitats
are soils, corn silage, rotten wood, compost, bird nests, and various forest plants. Black spots on tomatoes
may be caused by A. Alternata. It is frequently found on water condensed on window frames. It is one of the
most common mold spores found in dwelling dust in both North America and Europe. But Alternaria is
predominantly an outdoor allergen favouring damp spots, and most indoor concentrations may derive from
outdoor primary sources.
 
Allergens:
 Alt a 1, a major allergen, a heat-stable protein
 
 Alt a 2, a major allergen, an aldehyde dehydrogenase
 
 Alt a 3, a heat shock protein
 
 Alt a 4 - disulfidizomeraza
 
  Alt a 5, an enolase (formerly Alt a 11)
 
 Alt a 6, an acid ribosomal protein P2
 
 Alt a 7 a YCP4 Protein
 
 Alt a 8 – manitol dehidrogenaza
 
 Alt a 9
 
 Alt a 10, an aldehyde dehydrogenase
 
 
 Alt a 12, an acid ribosomal protein P1
 
 Alt a 7
 
 Alt a 12 - NTF2, a nuclear transport factor 2 protein

 Alt a 13 – glutation-S-transferaza
 
 rAlt a 1
 
 rAlt a 2
 
 rAlt a 5
 
 rAlt a 7

Alt a 1 is the major Alternaria allergen causing sensitisation in asthmatics. 

Alt a 2 appears to be a major allergen,
Alt a 3 is recognised by approx. 5% of allergic subjects (14).
 
Alt a 5, an enolase, is recognised by approximately 20% to 50% of Alternaria-sensitised individuals (15, 44).
Alt a 6 bound IgE from the sera of 7% of Alternaria-sensitive individuals (33).
 
Alt a 7 bound IgE in 7% of Alternaria-sensitive individuals ( 
Alt a 10 bound IgE in 2% of Alternaria-sensitised individuals (46).
 

Potential Cross-Reactivity
Enolase is a common allergen found in many species of mold, and has been shown to exhibit high cross-
reactivity to other fungal enolases (39).
Extensive cross-reactivity has been reported to occur between the enolases of C. herbarum, A. alternata, S.
cerevisiae, C. albicans and A. fumigatus (15).
The Latex allergen Hev b 9 is an enolase and has been shown to be cross-reactive with enolases from
Cladosporium herbarum and Alternaria alternata (42, 55).
 
The nuclear transport factor 2 (NTF2) allergen from A. alternata has sequence homology with allergens from
Cladosporium herbarum and Aspergillus fumigatus (49).
 

Clinical Experience
IgE-mediated reactions
Sensitivity to Alternaria, a potent allergen, has been increasingly recognised as a risk factor for the
development, persistence, and exacerbation of asthma. 
Alternaria-sensitised patients may also be at risk for allergic rhinitis. Most severe cases of rhinitis may be
attributable to Alternaria sensitivity. Researchers concluded that the anomalous immune and inflammatory
responses to ubiquitous fungi may explain the chronic nature of airway inflammation in chronic rhinosinusitis
 Fungal components may upon skin contact cause eczema or trigger inflammatory skin eruptions in a
subgroup of patients with atopic eczema. Infrequently, hypersensitivity pneumonitis has also been attributed
to this organism.
 
 
Occupational allergy
Alternaria sensitisation may occur in occupational settings, including gardens, bakeries, forests and farms.
Alternaria is associated with baker's asthma and wood pulp worker's lung.
Air contamination inside greenhouses is mainly related to molds, and is facilitated by the high indoor
temperature and humidity. Cladosporium, Penicillium, Aspergillus, and Alternaria and a wide range of flower
pollens can sensitise greenhouse workers and cause occupational asthma.
 
Other reactions
Pulmonary fungal infections and localised skin infections, in particular in patients receiving long-term
glucocorticoid therapy, and especially in immune-compromised patients, may also be encountered (106).
 

Aspergillus fumigatus
Latin name: Aspergillus fumigatus
Source material: Spores and mycelium

Allergen Exposure
Aspergillus fumigatus is an opportunistic fungus causing allergic and invasive aspergillosis in humans and
animals. It is unusual compared to other allergen sources in that it is both a primary and an opportunistic
pathogen, as well as an important major allergen. Its conidia production is prolific, so humans are continually
inhaling its ubiquitous spores. The result is that exposure of the respiratory tract is almost constant. However,
inhalation rarely causes adverse effects, as the conidia are usually eliminated efficiently by the innate immune
system. But increasing use of immunosuppressive therapy has resulted in increasingly frequent conditions
involving infection by A fumigatus.

Environment
A. fumigatus is isolated from human habitats and vegetable compost heaps. It is found in soils, leaf and plant
litter, decaying vegetables and roots, bird droppings, tobacco, and stored sweet potatoes. In comparison with
other aeroallergens, the concentration of spores in the air may be low, though there may be high localised.

Allergen Description
The following allergens have been identified to date:

 Asp f 1, also known as ribotoxin and mitogillin.

 Asp f 2, a fibrinogen-binding protein.
 Asp f 3, also known as PMP, a peroxisomal protein.
 Asp f 4
 Asp f 5, also known as MEP, a metalloprotease.
 Asp f 6, also known as Mn-SOD, a manganese superoxide dismutase
  Asp f 7.
 Asp f 8, also known as ribosomal protein P2.
 Asp f 9, a glycosyl hydrolase.
 Asp f 10, also known as PEP, an aspartic protease.
 Asp f 11, also known as cyclophilin, a cyclophilin or rotamase.
 Asp f 12, also known as heat shock protein P90.
 Asp f 13, also known as oryzin, an alkaline serine protease.
 Asp f 15, a serine protease.
 Asp f 16.
 Asp f 17.
 Asp f 18, also known as cerevisin, a vacuolar serine protease.
 Asp f 22, also known as enolase, a glycolytic enzyme.
 Asp f 23, a ribosomal protein L3.
 Asp f 27, also known as cyclophilin, a cyclophilin.
 Asp f 28, a thioredoxin.
 Asp f 29, a thioredoxin.
 Asp f 34, a 19.4 kDa protein, also known as PhiA.

Asp f 1
Asp f 1 is a major allergen and is produced by the mycelia of A. fumigatus. Germination of spores and growth
of the fungus appear to be essential for the production of this allergen. More than 80% of patients with
allergic bronchopulmonary aspergillosis (ABPA) are sensitised to this allergen. It is also raised in patients
with cystic fibrosis with the complication of ABPA. It is not present in spores, and can be used as a specific
marker for the detection of germination of this fungus.

Asp f 2
Asp f 2 is also a major allergen, with sensitisation to this allergen occurring in more than 90% of A.
fumigatus-sensitised individuals. (22) In patients with ABPA, 96% had IgE antibodies directed against Asp f
2, whereas none of the normal control subjects, or the subjects with allergic asthma who had positive results
on the skin-prick test, had a reaction.

Asp f 3
sensitisation to rAsp f 3 was found in 84% of asthmatics sensitised to this fungus. 

Asp f 4
rAsp f 4 and rAsp f 6 can be considered specific markers for ABPA, and in particular, for early diagnosis of
the disease; a clear distinction between allergic sensitisation to A. fumigatus and ABPA is essential for
therapy to prevent deterioration of pulmonary function in subjects with ABPA.

Asp f 6
Similarly, Asp f 6 has been shown to be recognised by IgE from ABPA patients but not from A. fumigatus-
sensitised individuals, which result can be used to differentiate between these two groups of allergic patients.
A. fumigatus colonises its environment by the formation of hyphae. Hyphae are found in the lungs of ABPA
patients, but not in patients suffering from atopic asthma. Asp f 6 is specifically expressed in hyphae, which
might explain why an IgE response to Asp f 6 is specific for ABPA patients.

Asp f 12
Asp f 12 belongs to the heat shock protein 90 (Hsp 90) family. Recombinant Asp f 12 has been shown to react
with serum IgE and IgG antibodies from patients with ABPA. (47) Hsps are considered to be important for
stress response during inflammation. (6)

Asp f 16
Seventy percent of the patients with ABPA were shown to have high levels of serum IgE antibodies to Asp f
16, whereas patients with allergic asthma, Aspergillus skin test-positive asthmatics without clinical evidence
of ABPA, and normal controls failed to show Asp f 16-specific IgE binding by ELISA. (44)
Asp f 18
may be considered a major allergen of A. fumigatus. (52)

Asp f 34
Asp f 34 appears to be a fungal cell-wall component, and shows sequence homology to phiA, an essential
protein for the formation of conidia in the genus Aspergillus. About 94% of ABPA and 46% of A. fumigatus-
sensitised individuals tested were shown to have Asp f 34-specific serum IgE

The ABPA patients had significantly increased IgE reactivity to Asp f 2, Asp f 3, Asp f 4, Asp f 6, and Asp f
16 compared with the Asperigillus ST+ and ST- non-ABPA CF patients.

Asp f 4 and Asp f 6 represented specific markers for ABPA and allowed a sensitive, fully-specific diagnosis
of the disease, and that the data suggested distinct IgE responses to colonisation of the bronchial tree in CF
patients with ABPA or A. fumigatus allergy. (46)

Potential Cross-Reactivity
Mala f 2 and Mala f 3, from Malassezia furfur, a common allergen in atopic dermatitis, have sequence
homology with two peroxisomal membrane proteins of Candida boidinii and Asp f 3. (84, 85)

Mala s 11 from Malassezia furfur has a high degree of amino acid sequence homology to manganese
superoxide dismutase (MnSOD) from Homo sapiens (50%) and A. fumigatus (Asp f 6) (56%).

Pen ch 13, an alkaline serine protease allergen from P. chrysogenum, is cross-reactive with Pen c 13 of
Penicillium citrinum and Asp f 13, suggesting that atopic patients sensitised primarily by either of these
prevalent fungal species may develop allergic symptoms by exposure to other environmental fungi, due to
cross-reacting IgE antibodies against this protease.

Asp f 18, a major allergen of Aspergillus-sensitised individuals, a vacuolar serine proteinase, shows IgE
cross-reactivity with P. notatum and P. oxalicum. (58) 

Extensive cross-reactivity has been reported to occur between the enolases of Cladosporium herbarum,
Alternaria alternata, Saccharomyces cerevisiae, Candida albicans and A. fumigatus. (88)

Clinical Experience
IgE-mediated reactions
Aspergillus fumigatus is one of the most prevalent airborne fungal pathogens, and the etiological agent in
80% of Aspergillus-related diseases. Inhalation of conidia and mycelium of A. fumigatus can lead to benign
colonisation of the lung by several diseases, the severity of which depends on the host's immune response: as
a result of the complexity in the antigenic structure of A. fumigatus, the varying immune responses of
different hosts lead to a wide spectrum of clinical conditions such as hypersensitivity, pneumonitis, allergic
rhinitis, IgE-mediated asthma, allergic bronchopulmonary aspergillosis (ABPA), aspergilloma, and invasive
aspergillosis in immune-compromised patients and in individuals with cystic fibrosis.

Other species that have been associated with aspergillosis include A.flavus, A. nidulans, A. niger, A. terreus,
A. oryzae and A.ochraceous. (6)

About 15-20% of allergic asthmatics suffer from Aspergillus-induced allergies.

A. fumigatus has also been implicated as an important causative agent in allergic fungal sinusitis. (9) Other
diseases, such as extrinsic allergic alveolitis (hypersensitivity pneumonitis) and Farmer's Lung, have been
reported to be linked to this mould.
Importantly, ABPA, allergic Aspergillus sinusitis, and aspergilloma can occur simultaneously in the same
patient. (117)

Individuals working in laboratories (in particular, medical research laboratories) may also be exposed to this
mould

Patients with bird fancier’s disease, although primarily sensitised to avian sera and avian droppings, may be
significantly and more frequently sensitised to other allergens such as A. fumigatus. (121)

Recombinant allergens
The allergenic proteins are derived from 2 function categories: secreted and cytoplasmic proteins. Secreted
allergens are recognised by serum IgE antibodies of A. fumigatus-sensitised individuals with or without
ABPA, whereas nonsecreted allergens are exclusively recognised by serum IgE antibodies of ABPA patients
(4). The use of recombinant allergens therefore may be of great value in assessing individuals affected by this
mould.

Aspergillus niger
Latin name: Aspergillus niger
Source material: Spores and mycelium
Aspergillus niger is not as prevalent in the air as e.g. A fumigatus, but the fungus may be present in several
occupational situations.

Allergen Exposure
Aspergillus niger (A. niger), known as the black mold, is often found in damp places. Like other Aspergillus
species, it can resist the human lung's defences. It is not as prevalent in the air as e.g. A. fumigatus, but the
fungus may be present in several occupational situations, see below (1).

Clinical Experience
Inhalation of enzyme dust, such as cellulases from A. niger, is a commonly reported cause of occupational
asthma.
The enzyme ß-xylosidase derived from A. niger and present in baking additives (5), has been identified as a
causative allergen in Baker's asthma.
Byssinosis is an acute respiratory disease among workers exposed to dusts generated during the processing of
cotton. One cotton dust component is A. niger, and it is considered an important allergy trigger in byssinosis
pathogenesis (3). A. niger may also cause other types of allergy, allergic alveolitis and invasive aspergillosis.
Although Aspergillus fumigatus is by far the most common cause of allergic bronchopulmonary aspergillosis
(ABPA) A. niger can also lead to an identical disease (7). There are also reports describing the involvement of
A. niger in endocarditis after open-heart surgery (4) and in cystic fibrosis (8).
 

Aureobasidium pullulans
Latin name: Aureobasidium pullulans
Source material: Spores and mycelium
Aureobasidium is known as a primary invader of all kinds of leaves.

Allergen Exposure
A. pullulans appears in the surface layers of soils, and has also been recorded on wheat seeds, barley, oats,
tomato and pecans. It is often found in kitchens and bathrooms and can damage interior painted surfaces.
 
Aureobasidium is known as a primary invader of all kinds of leaves. During the summer, the spores are
deposited on the leaf surface without attacking the cells. In autumn, when the leaves reach senescence,
Aureobasidium begins decomposition. A. pullulans appears in the surface layers of soils, and has also been
recorded on wheat seeds, barley, oats, tomato and pecans. It is often found in kitchens and bathrooms and can
damage interior painted surfaces.
 

Botrytis cinerea
Latin name: Botrytis cinerea
Source material: Spores and mycelium
Botrytis cinerea is called the grey mold, as it covers the decayed tissues with conidiophores.

Allergen Exposure
B. cinerea is found regularly in the soil, though its proportion of the total fungus population is not high. It can
be parasitic on a wide range of plants, causing blight or rot of leaves, flowers and fruits. It is called the grey
mold, as it covers the decayed tissues with conidiophores, e.g. grey mold of cabbage or lettuce, tomato. It is
especially seen in connection with soft fruits, e.g. strawberries and grapes.

Candida albicans
Latin name: Candida albicans
Source material: Disrupted cells
Yeast
Candida-specific IgE antibodies have been demonstrated in asthma and rhinitis (1).

Allergen Exposure
C. albicans is common in soil, organic debris and in humans where it occurs as a saprophyte in the
nasopharynx and feces.

Clinical Experience
The role of C. albicans as a cause of allergy has been much disputed. It may cause clinically significant
infections, such as thrush in infants, skin infections in diabetic patients and sepsis in immuno-compromised
patients.
 
Cladosporium herbarum
Latin name: Cladosporium herbarum (obsolete name Hormodendrum)
Mold
A mold, which may result in allergy symptoms in sensitized individuals. Cladosporium is the most frequently
encountered mold in the air (1).

Allergen Exposure
Spores of Cladosporium spp. probably occur more abundantly worldwide than any other spore type and are
the dominant airborne spores in many areas, especially in temperate climates. Although C. cladosporioides
may be the most prevalent airborne species, C. herbarum frequently dominates indoor and outdoor air and is a
major source of fungal inhalant allergens.

It occurs abundantly on fading or dead leaves of herbaceous and woody plants, as a secondary invader on
necrotic leaf spots, and has frequently been isolated from air, foodstuffs, paints, textiles, humans and
numerous other substrates.

The most common in temperate and arctic climates is C. herbarum, accounting for the largest number of
spores recovered in outdoor sampling.

Cladosporium will grow indoors in damp situations and high counts may indicate moisture problems. (8)
Ideal growth temperatures are 18 to 28 degrees C, but growth may occur down to -6 degrees C, contributing
even to spoilage in refrigerated foodstuffs.

The following allergens have been identified to date:

 Cla h 1,
 Cla h 2,
 Cla h 3, an aldehyde dehydrogenase.
 Cla h 5, an acid ribosomal protein P2.
 Cla h 6, an enolase.
 Cla h 7, a YCP4 protein.
 Cla h 8, a mannitol dehydrogenase – alergen major
 Cla h 9, a vacuolar serine protease.
 Cla h 10, an aldehyde dehydrogenase.
 Cla h 12, an acid ribosomal protein P1.

Potential Cross-Reactivity
Extensive cross-reactivity between the different individual species of the genus may be expected. (1)

Cross-reactivity is seen between Alternaria and Cladosporium as a result of homologous allergens (Alt a 10
and Cla h 3), aldehyde dehydrogenase (Alt a 6 and Cla h 4), acidic ribosomal protein P2 (Alt a 7 and Cla h 5),
Saccharomyces cerevisiae protein (YCP4); and Alt a 11 and Cla h 6 (enolase, a major allergen). (7, 16, 40)

Extensive cross-reactivity has been reported to occur between the enolases of C. herbarum, A. alternata, S.
cerevisiae, C. albicans and A. fumigatus. 

Clinical Experience
IgE-mediated reactions
In the allergic population, sensitisation to moulds may vary from 5 to 30%. (45, 46) The wide range of
allergenic proteins in C. herbarum may result in sensitisation and subsequent expression of a range of
immune-related diseases. Cladosporium sensitisation is particularly associated with severe or life-threatening
asthma.

Other reactions

A case of allergic broncho-pulmonary cladosporiosis has been reported in a child. (63)

hypersensitivity pneumonitis (HP)

Curvularia lunata
Latin name: Curvularia lunata
Source material: Spores and mycelium
There appears to be extensive cross-reactivity between Stemphylium and Curvularia and Alternata (3).

Allergen Exposure
Curvularia is a facultative pathogen and may cause leaf spots and seedling blight. It is also seen on castor
beans, cotton, rice, barley, wheat, and corn.

Potential Cross-Reactivity
There appears to be extensive cross-reactivity between Stemphylium and Curvularia and Alternata (3).

Clinical Experience
Curvularia is a mold which is associated with allergy in the literature and frequently reported in mold spore
counts. Chapman & Williams (1) reported 7.3% of the atopic patients being hypersensitive to Curvularia.
Allergic bronchopulmonary disease caused by Curvularia has been reported (2).
 

Mucor racemosus
Latin name: Mucor racemosus
Source material: Spores and mycelium
M. racemosus was one of the first soil fungi ever to have been discovered and was isolated as early as 1886.

Allergen Exposure
The species is primarily a soil fungus but has been found elsewhere such as in horse manure, plant remains,
grains, vegetables and nuts. It is often seen on soft fruit, fruit juice and marmalade. Mucor is also the
dominating mold found in floor dust in houses and is considered an indoor mold.

Penicillium chrysogenum
Latin name: Penicillium chrysogenum/P.notatum
Source material: Spores and mycelium
Mold
A mold, which may result in allergy symptoms in sensitised individuals.

Allergen Exposure
Geographical distribution
Penicillium is the blue-green mold found on stale bread, fruits and nuts, and used for production of green and
blue mold cheese.
 
.Penicillium molds prefer damp and dark places, but can occur elsewhere. Penicillium dominates in the soils
of temperate climates, from which spores are easily released into the atmosphere. The molds are widespread
in soil, decaying vegetation and compost, particularly in temperate-zone forests, grasslands and cultivated
land.
 
Allergens 
 Pen ch 13, previously known as Pen n 13 and also known as oryzin, an alkaline serine protease
 Pen ch 18, previously known as Pen n 18 and also known as cerevisin, a vacuolar serine protease
 Pen ch 20, a 68 kDa protein, an N-acetyl glucosaminidase.

Potential Cross-Reactivity
An extensive cross-reactivity among the different individual species of the genus could be expected but has
not been completely evaluated. Importantly, hypersensitivity to Penicillium mold bears no relationship with
hypersensitivity to the antibiotic Penicillin.
 

Clinical Experience
IgE-mediated reactions
Penicillium has long been recognised as one of the molds most often producing positive skin test reactions in
allergic individuals (25-28). Inhalation of Penicillium spores in quantities comparable with those encountered
by natural exposure can induce both immediate and late asthma in sensitive persons (28). Sensitivity to
Penicillium bears no relationship to sensitivity to the antibiotic Penicillin.
  
Sick building syndrome (SBS) was first described in 1982. Although no single cause is likely to be found, the
presence of certain molds is becoming increasingly associated with this phenomenon. Symptoms most
commonly are fatigue, runny nose, itchy eyes, sore throat, and headaches.
Penicillium spp. are commonly considered as contaminants but may cause infections, including pneumonia,
particularly in immunocompromised hosts. In addition to their infectious potential, some Penicillium spp. are
known to produce mycotoxins

Rhizopus nigricans
Latin name: Rhizopus nigricans
Source material: Spores and mycelium
The risk for occupational exposure is most likely to occur among food handlers during the storage, transfer
and marketing of strawberries, peaches, cherries, corn and peanuts (1).

Allergen Exposure
Rhizopus is closely related to Mucor and inhabits the same ecological niches. R. nigricans is one of the most
common members of the Mucorates and has a worldwide distribution, although most commonly occurring in
warmer areas. It has frequently been reported from dry habitats. The spores are dispersed in hot, dry weather.
 
It is frequently isolated from both forest and cultivated soils. It occurs in children's sandboxes. Typical
microhabitats include fresh or decaying litter such as pine needles and leaves. Other known substrates are
sweet potato, cold-stored strawberries, stewed fruits, and the nests, feathers and droppings of wild birds.
 
Rhizopus is often included in the list of molds which are thought to have clinical relevancy for skin testing
mold-sensitive patients. The risk for occupational exposure is most likely to occur among food handlers
during the storage, transfer and marketing of strawberries, peaches, cherries, corn and peanuts

Tilletia tritici/Ustilago
Latin name: Tilletia tritici / Ustilago nuda/tritici/maydis
Source material: Spores
Family: Ustilaginaceae
Common names: Ustilago, Corn smut fungus
Fungi
A fungus, which may result in allergy symptoms in sensitised individuals. It is a major clinical problem to
identify the extent to which a mold-sensitive patient´s symptoms can be attributed to IgE-mediated allergy.

Allergen Exposure
Geographical distribution
Ustilago is a member of the basidomycetes, which number over 20,000 species and are physically the largest
and morphologically most complex fungi. They include Mushrooms, puffballs, bracket fungi, rusts, and
smuts. Most of this group are microfungi, and many are important allergen sources. Basidiospores occur in
the air in high concentration in many parts of the world, and positive skin tests, RAST, and bronchial
reactivity to their extracts have been detected in hypersensitive subjects (1-2).
 
Ustilago maydis, also known as the Corn smut fungus, replaces the normal kernels of the cobs with large
distorted tumours.
Unlike other basidiomycete fungi, such as Mushrooms, this fungus does not have a fruiting body. The large
black sac which contains the teliospores drops to the ground, and the spores are spread by the wind. In the
spring the spores germinate to form basidia, which produce the basidiospores the are the actual infective agent
of the corn. Ustilago maydis is dimorphic, with a unicellular, nonpathogenic form, and a dikaryotic,
filamentous, pathogenic form that requires the plant for its growth.
 

Clinical Experience
IgE-mediated reactions
Ustilago has been reported to induce symptoms of rhinitis, asthma and endemic regional asthma in sensitised
individuals (9-12), but its association with human disease is unclear, and very few studies have evaluated its
relevance in respiratory allergy.
 
As Ustilago is predominantly found in crops, in particular Corn, occupational exposure would be the main
source of exposure and therefore sensitisation. Occupations involved would be farming, animal husbandry,
baking, longshoreman’s work, and milling.
 
Other reactions
The basidiospores of these fungi are found in the atmosphere and transported by wind, and reach the
maxillary sinuses through the nasal route. Many cause signs and symptoms of chronic sinusitis (18). For
example, a central venous catheter infection due to Ustilago species was reported (19).

Trichophyton rubrum
Latin name: Trichophyton spp.
Source material: Spores and mycelium
Family: Arthrodermataceae
Common names: Trichophyton

Allergen Exposure
Geographical distribution
Trichophyton fungi inhabit the soil, humans and animals, different species preferring different environments.
Trichophyton (along with Epidermophyton and Microsporum) is a dermatophyte fungus; it has the ability to
utilise keratin as a nutrient source. For this it uses a unique enzyme, keratinase; acid proteinases, elastase, and
other proteinases are also major virulence factors of the fungi of this genus (1). These organisms can result in
dermatophytosis (tinea or ringworm) of the scalp, and glabrous skin and nails. Dermatophytosis is unique in
that no living tissue is invaded; keratinised stratum corneum is simply colonised, and the presence of the
fungus and its metabolic products usually induces an allergic and inflammatory eczematous response in the
host.
 
Allergens
Trichophyton proteins are members of diverse enzyme families; this fact supports our understanding of a dual
role for these proteins in fungal pathogenesis and allergic disease (6).
 
A number of allergens has been characterised.

Trichophyton tonsurans:

 Tri t 1- a major allergen, an exo 1,3-beta-glucanase

 Tri t 4 (previously known as Protein IV)

Trichophyton rubrum:
 Tri r 2, a serine protease, a subtilase homologue
 Tri r 4

Clinical Experience
IgE-mediated reactions
Fungal infections of the skin, nails or hair are extremely common and often caused by dermatophyte fungi of
the genus Trichophyton. Trichophyton spp. classically induce delayed-type, or cell-mediated, hypersensitivity
but a unique feature of Trichophyton allergens is the ability of the same antigen to elicit immediate-type
hypersensitivity reactions as well . The possible role of Trichophyton spp. in IgE-mediated urticaria, asthma,
and rhinitis has been debated for decades, but only within the last couple of decades has a definitive link
between sensitisation to Trichophyton and allergy been established.
  
Trichophyton rubrum has been implicated as a potential trigger in flares of atopic dermatitis. Similarly to
patients with uncontrolled asthma who improve following antifungal treatment, a patient with atopic
dermatitis, a history of multiple flares and concurrent acute tinea pedis and onychomycosis, was relieved,
through the use of systemic antifungals during each flare, of symptoms of atopic dermatitis and acute
infection with T. rubrum. 
Occupations at particular high risk for sensitisation to Trichophyton are those of podiatrists, manicurists and
chiropodists. Trichophyton rubrum is the most common fungal cause of nail dystrophy.