针对霉菌过敏的过敏原特异性免疫疗法

Q3 Medicine
Randolf Brehler, Uta Rabe
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引用次数: 0

摘要

霉菌在我们的环境中无处不在,被人们视为最重要的室内污染物问题[1]。目前,AWMF 于 2023 年更新了霉菌指南[1],旨在消除或疏导人们的恐惧心理,为做出合理的诊断和治疗决定提供帮助。然而,与使用花粉和室内尘螨的有效 AIT 相比,在决定使用霉菌提取物的 AIT 时,必须在利益和风险之间进行更多权衡。交替孢霉的孢子在室外空气中的浓度很高。由于交替孢霉具有很高的致敏性,而且孢子的体积很小,因此对交替孢霉过敏的人往往会引发支气管哮喘,尤其是儿童。有几项研究测试了用 Alternaria 提取物进行 AIT 的有效性;但对于其他霉菌,尤其是来自室内环境的霉菌,其有效性和适用性非常有限。在鉴别诊断方面,必须牢记的是,霉菌不仅会引起常见的过敏反应,还可能导致过敏性支气管肺霉菌病/曲霉菌病(ABPA)、曲霉菌性支气管炎、外源性过敏性肺泡炎(EAA)、侵袭性曲霉菌病、霉菌病和鼻炎。特别是在工作场所,极高浓度的霉菌也会导致中毒效应("有机粉尘中毒综合症");霉菌还可导致粘膜刺激、气味影响和情绪失调[1]。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Allergen-specific immunotherapy for mold allergies

Molds are ubiquitous in our environment and are considered by the population to be the most important indoor pollutant problem [1]. The current 2023 update to the AWMF mold guideline [1] is intended to allay or channel fears and provide assistance for a sensible diagnosis and treatment decision.

The detection of an IgE-mediated allergy implies for allergists Allergen immunotherapy (AIT) as an established treatment option. However, compared to the well-validated AIT with pollen and house dust mites, the decision to use AIT with mold extracts must be weighed more heavily between the benefits and risks.

Spores of Alternaria alternata are found in high concentrations in the outdoor air. Due to the high allergenic potential and the small size of the spores, an Alternaria allergy often leads to bronchial asthma, especially in children. The effectiveness of AIT with Alternaria extracts has been tested in several studies; for other molds, especially those from the indoor environment, the efficacy and applicability is very limited.

In terms of differential diagnosis, it must be borne in mind that molds can not only cause common allergic reactions but can also be responsible for allergic bronchopulmonary mycoses/aspergillosis (ABPA), Aspergillus bronchitis, exogenous allergic alveolitis (EAA), invasive aspergillosis, mycoses and rhinosinusitis. Very high concentrations, which can occur particularly in workplaces, can also result in toxic effects (“organic dust toxic syndrome”); molds are also held responsible for mucous membrane irritation, odor effects and mood disorders [1].

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来源期刊
Allergo Journal International
Allergo Journal International Medicine-Immunology and Allergy
CiteScore
4.60
自引率
0.00%
发文量
31
期刊介绍: Allergo Journal International is the official Journal of the German Society for Applied Allergology (AeDA) and the Austrian Society for Allergology and Immunology (ÖGAI). The journal is a forum for the communication and exchange of ideas concerning the various aspects of allergy (including related fields such as clinical immunology and environmental medicine) and promotes German allergy research in an international context. The aim of Allergo Journal International is to provide state of the art information for all medical and scientific disciplines that deal with allergic, immunological and environmental diseases. Allergo Journal International publishes original articles, reviews, short communications, case reports, and letters to the editor. The articles cover topics such as allergic, immunological and environmental diseases, the latest developments in diagnosis and therapy as well as current research work concerning antigens and allergens and aspects related to occupational and environmental medicine. In addition, it publishes clinical guidelines and position papers approved by expert panels of the German, Austrian and Swiss Allergy Societies. All submissions are reviewed in single-blind fashion by at least two reviewers. Originally, the journal started as a German journal called Allergo Journal back in 1992. Throughout the years, English articles amounted to a considerable portion in Allergo Journal. This was one of the reasons to extract the scientific content and publish it in a separate journal. Hence, Allergo Journal International was born and now is the international continuation of the original German journal. Nowadays, all original content is published in Allergo Journal International first. Later, selected manuscripts will be translated and published in German and included in Allergo Journal.
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