Relationship between the results of skin, conjunctival and bronchial tests and RAST with Candida albicans in patients with asthma

Sensitization to fungal allergens: Resolved and unresolved issues

Exposure and sensitization to fungal allergens can promote the development and worsening of allergic diseases. Although numerous species of fungi have been associated with allergic diseases in the literature, the significance of fungi from the genera Alternaria, Cladosporium, Penicillium, Aspergillus, and Malassezia has been well documented. However, it should be emphasized that the contribution of different fungal allergens to allergic diseases is not identical, but species-specific. Alternaria and Cladosporium species are considered to be important outdoor allergens, and sensitization and exposure to species of these genera is related to the development of asthma and rhinitis, as well as epidemics of asthma exacerbation, including life-threatening asthma exacerbation. In contrast, xerophilic species of Penicillium and Aspergillus, excluding Aspergillus fumigatus, are implicated in allergic diseases as indoor allergens. A. fumigatus has a high capacity to colonize the bronchial tract of asthmatic patients, causing severe persistent asthma and low lung function, and sometimes leading to allergic bronchopulmonary aspergillosis. Malassezia are common commensals of healthy skin, although they are also associated with atopic dermatitis, especially on the head and neck, but not with respiratory allergies. Despite its importance in the management of allergic diseases, precise recognition of species-specific IgE sensitization to fungal allergens is often challenging because the majority of fungal extracts exhibit broad cross-reactivity with taxonomically unrelated fungi. Recent progress in gene technology has contributed to the identification of specific and cross-reactive allergen components from different fungal sources. However, data demonstrating the clinical relevance of IgE reactivity to these allergen components are still insufficient.

Evaluation of Candida albicans allergens reactive with specific IgE in asthma and atopic eczema patients

Candida albicans (C. albicans) produces important allergenic components which can induce allergic reactions in sensitised patients. The purpose of this study was to extract the C. albicans antigens for evaluating the specific anti-Candida IgE in sera of atopic eczema (AE) and asthmatic patients (AS). 95 AE, 85 AS, and 70 non-atopic cases were selected with sequential trials. Candida albicans antigens were prepared and then skin prick test (SPT), ELISA and IgE-immunoblotting tests were performed for all patients. Positive SPT reactions were obtained on 52.6% of AE and 54.1% of AS patients and 4.3% of healthy controls (P < 0.05). Using ELISA, specific anti-C. albicans IgE antibody was detected in 32.6% and 41.2% of patients with AE and AS, respectively. No specific IgE antibody was detected in healthy controls (P < 0.05). In SDS-PAGE, protein bands with molecular weights between 13 and 135 kDa were detected, and some of them reacted with specific IgE in immunoblotting. In AE patients, the most important allergenic components were 25, 34, and 57 kDa protein bands, whereas in AS, 22, 25, and 34 kDa protein bands were observed as major allergens. Candida albicans produces different allergenic components that can induce allergic reactions and may be pathogenetically important in patients with AE and AS.

Characterization of a novel Candida albicans 29 kDa IgE-binding protein--purification, cDNA isolation and heterologous expression of Cand a 3

BACKGROUND

Candida albicans has been implicated in human allergic disorders. However, many of its immunoglobulin E (IgE)-reacting components have not yet been identified. The purpose of the present study is to characterize a novel 29 kDa IgE-binding protein from C. albicans.

METHODS

The 29 kDa protein was partially purified and its tryptic digests subjected to mass spectrometric analysis. The cDNA encoding this protein was isolated and heterologously expressed in Escherichia coli. Monoclonal antibodies (MoAbs) were raised against the 29 kDa protein purified from C. abicans extracts.

RESULTS

We isolated a 29 kDa IgE-reacting component from C. albicans. The protein was digested on-gel with trypsin and the masses of the resulting fragments were determined in a MALDI-TOF mass spectrometer. The data were searched against protein sequences deduced from the C. albicans genome. An open reading frame that possibly encodes the 29 kDa IgE-reacting component was identified. The cDNA corresponding to the open reading frame was isolated. It encodes a 236 residues protein that has 62% sequence identity to that of a hypothetical protein (YDR533c) from Saccharomyces cerevisiae. Conserved domain search suggests that the encoded protein belongs to the ThiJ/PfpI family. The cDNA isolated was inserted into a pQE-30 vector for protein expression in Escherichia coli. The recombinant protein can react with IgE antibodies in sera from asthmatic patients and two MoAbs that were generated against the purified native 29 kDa protein from C. albicans.

CONCLUSIONS

We identified and cloned a novel 29 kDa IgE-reacting component (Cand a 3) from C. albicans. The recombinant proteins produced from this clone and the MoAbs prepared may be useful in the standardization of diagnostic extracts. They are also instrumental in elucidating the role of C. albicans in clinical allergy.

Cross-reacting IgE and IgG antibodies to Pityrosporum ovale mannan and other yeasts in atopic dermatitis

Atopic dermatitis (AD) patients often demonstrate positive skin prick test results and serum IgE antibodies to a range of different yeasts. This has been thought to be due to cross-reactivity. In this study, the cross-reactivity of IgE and IgG antibodies between mannan and crude antigens of Pityrosporum ovale, Candida albicans, and Saccharomyces cerevisiae and crude antigens of Cryptococcus albidus and Rhodotorula rubra was examined by RAST and ELISA inhibition with two serum pools of AD patients. We found cross-reacting IgE and IgG antibodies. In the IgE response, the main cross-reacting pattern was the mannan region, although inhibition could be achieved also with crude antigens of C. albicans, S. cerevisiae, and, to some extent, C. albidus. P. ovale was the most potent inhibitor of IgE-binding components, and against it the highest IgE antibody levels were detected in AD serum pools. In contrast, C. albicans was found to be the most important inducer of IgG antibodies, since the IgG level against P. ovale mannan in both AD serum pools was very low. Cross-reacting antibodies were also seen in ELISA inhibition with both crude and mannan antigens, but since the IgG antibody level of P. ovale mannan in AD serum pools was low, further studies are needed to confirm the IgG results.

Recurrent vaginal candidiasis and allergic rhinitis: a common association

BACKGROUND

In a recent series of studies, it has been shown that hypersensitivity is an important factor in recurrent vaginal candidiasis and several referring gynecologists have been asking for our support in the evaluation of women with regard to the possibility of local vaginal hypersensitivity. This study was instituted because, since the first anamnesis, a high incidence of perennial allergic rhinitis, as well as family allergies have been observed in these patients.

OBJECTIVE

To study the association between recurrent vaginal candidiasis and perennial allergic rhinitis, and to explore the allergic characteristics of the patients and of the disease.

METHODS

For 28 months, we have prospectively studied 95 patients with recurrent vaginal candidiasis referred by gynecologists to a private allergy practice. All of them were unresponsive to all other modalities of therapy, and had no diabetes or immunodeficiency diseases. As a control group, we studied 100 women, who came to the allergy office for other reasons, and had no recurrent vaginal candidiasis. All of these 195 women were submitted to a standard allergy medical history, a complete physical examination, and immediate skin tests with a standard battery of inhalant allergens and Candida albicans. The incidence of allergic diseases in the two groups was compared.

RESULTS

Sixty-four patients with recurrent vaginal candidiasis also had allergic rhinitis (71%), while in the control group the incidence of this pathology was 42%. The difference was considered statistically significant, according to the software Epi info (P < .0001). The study (1) did not show an association between recurrent vaginal candidiasis and asthma and (2) indicated that patients with recurrent vaginal candidiasis have a high incidence of skin tests positive to inhalant allergens (50%), to Candida albicans (55%), and a high incidence of family history of allergies (73%). In control women, the incidence of skin test positive to inhalant allergens was 72% and to Candida albicans, 10%. There was a family history of allergies in 61% of women.

CONCLUSIONS

The data demonstrate that recurrent vaginal candidiasis is statistically associated with perennial allergic rhinitis and that many of these women with recurrent vaginal candidiasis tend to be atopic.

In-house reference (IHR) preparation of Candida albicans allergen extract. A standardized extraction procedure

A standardized, controlled procedure for preparation of an in-house reference (IHR) preparation of an allergen extract of Candida albicans is described. The procedure, based on previous studies of allergens of C. albicans, is designed to yield a maximum of allergens in optimum extraction conditions and to provide a reference preparation for further extract production. The SDS-PAGE, IgE-immunoblotting, and crossed radioimmunoelectrophoresis (CRIE) analyses showed that the procedure is reproducible with acceptable batch-to-batch variation. The variation in the content of the most important allergens, namely, proteins with molecular weights of 46, 29, and 27 kDa in the pooled final batches, is acceptable (coeff. of variation < 15%), although in the intermediate batches of different strains, the coefficient of variation may occasionally exceed 20%. A comparison with other C. albicans allergen preparations used in our previous studies is also presented. The resulting extract can be used as a reference in further extract production and also in experimental in vitro and in vivo studies.

Allergenicity of acid protease secreted by Candida albicans

We have previously reported the cases of Candida albicans (C. alb) acid protease (CAAP)-induced atopic asthma. In this study, the allergenicity of the released enzyme CAAP was examined among asthmatic patients with positive immediate skin response to crude C. alb antigen. Among 49 patients with positive skin response to crude C. alb, anti-crude C. alb IgE antibodies were detected in 40 and anti-CAAP IgE antibodies were detected in 18. Moreover, anticrude C. alb IgE antibodies were detected in all of the patients in whom anti-CAAP IgE antibodies were detected. No correlations between IgG antibodies to both antigens or between IgE and IgG antibodies to CAAP were observed. CAAP induced significant T-cell proliferation in 20/28 patients showing positive T-cell proliferation response to crude C. alb antigen. Most of the patients showing positive conjunctival response to crude C. alb antigen also showed positive response to CAAP. Most of the patients showing high levels of serum IgE antibody and positive histamine-release response of peripheral blood leukocytes to CAAP showed positive conjunctival response. The results indicate that CAAP is an important allergen in C. alb-related mucosal allergy.

Foot and ear disease--the dermatophytid reaction in otology

Chronic otitis external (COE) is occasionally refractory to treatment and may persist for years. In such cases, a dermatophytid (id) reaction from a fungal infection in a remote location should be suspected. Immunotherapy with dermatophyte (Trichophyton, Oidiomycetes, and Epidermophyton [T.O.E.]) extracts and dust mite, based on serial endpoint titration skin test results, as well as a yeast elimination diet, is the treatment of choice. Fourteen cases of id reaction are described. The primary fungal source was not always obvious, but immunotherapy and diet led to complete resolution of the COE in 8 cases (21.4%). Some case reports illustrate presentation, treatment, and outcome.

Fungal allergens

Airborne fungal spores occur widely and often in far greater concentrations than pollen grains. Immunoglobulin E-specific antigens (allergens) on airborne fungal spores induce type I hypersensitivity (allergic) respiratory reactions in sensitized atopic subjects, causing rhinitis and/or asthma. The prevalence of respiratory allergy to fungi is imprecisely known but is estimated at 20 to 30% of atopic (allergy-predisposed) individuals or up to 6% of the general population. Diagnosis and immunotherapy of allergy to fungi require well-characterized or standardized extracts that contain the relevant allergen(s) of the appropriate fungus. Production of standardized extracts is difficult since fungal extracts are complex mixtures and a variety of fungi are allergenic. Thus, the currently available extracts are largely nonstandardized, even uncharacterized, crude extracts. Recent significant progress in isolating and characterizing relevant fungal allergens is summarized in the present review. Particularly, some allergens from the genera Alternaria, Aspergillus, and Cladosporium are now thoroughly characterized, and allergens from several other genera, including some basidiomycetes, have also been purified. The availability of these extracts will facilitate definitive studies of fungal allergy prevalence and immunotherapy efficacy as well as enhance both the diagnosis and therapy of fungal allergy.

Atopic asthma caused by Candida albicans acid protease: case reports

Two cases of atopic asthma caused by acid protease produced by Candida albicans are reported. Both patients had high levels of serum IgE antibodies against the acid protease and showed positive conjunctival and immediate bronchial responses when challenged with the protease. Significant histamine release was detected in both patients when their peripheral leukocytes were challenged with the protease antigen. These findings clearly showed that C. albicans acid protease is the causative allergen of atopic asthma.

Allergens of Pityrosporum ovale and Candida albicans. I. Cross-reactivity of IgE-binding components

In atopic dermatitis (AD), a high prevalence has been reported of type I reactions and specific IgE to extracts of the commensal lipophilic skin yeast Pityrosporum ovale. In the present study, a highly significant correlation (r = 0.77) was found between levels of anti-P. ovale IgE and of IgE reacting with extracts of Candida albicans, both measured by a sensitive ELISA method. In a series of 128 AD sera, 34 sera reacted positively with both yeast extracts, 38 reacted with P. ovale but not with C. albicans, and only one of the 56 anti-P. ovale-negative sera showed a very weak reaction with C. albicans. The correlation was due to a marked cross-reactivity, as shown by inhibition ELISA. Fluid-phase preincubation of double-positive sera with either of the two yeast extracts resulted in a dose-dependent, and at high concentrations complete, inhibition of the IgE reactions with both coated P. ovale and C. albicans allergens. Mutual inhibition of IgE-binding could also be achieved with pools of glycoproteins and/or polysaccharides isolated from the crude extracts by Con A affinity chromatography. P. ovale allergens were, however, more potent fluid-phase inhibitors than the corresponding C. albicans components. The apparently higher avidity for P. ovale allergens suggests that these antiyeast IgE antibodies in AD result from sensitization to P. ovale and cross-react with C. albicans.

The 40-kilodalton allergen of Candida albicans is an alcohol dehydrogenase: molecular cloning and immunological analysis using monoclonal antibodies

To characterize the 40-kilodalton (kD) major allergen of Candida albicans (C. albicans), six monoclonal antibodies (MoAbs) against this allergen were generated. In SDS-polyacrylamide gel electrophoresis and immunoblot analysis, these MoAbs showed four different reaction patterns to antigens of six different Candida species. With the exception of one MoAb, other MoAbs were resistant to periodate treatment indicating non-carbohydrate epitopes were probably being recognized by these MoAbs. These MoAbs were used in the molecular cloning and immunological analysis of the gene coding for the 40-kD allergen. Nucleotide sequence determination of the two lambda gt11 cDNA clones obtained showed that the 40-kD allergen is an alcohol dehydrogenase (ADH) which shares a 70% amino acid sequence homology with the ADH isozyme I of Saccharomyces cerevisiae. This finding was confirmed by positive immunological response of the lysates of the clones obtained and a preparation of ADH of Saccharomyces cerevisiae to various MoAbs and to IgE antibodies in sera of allergic patients.

Use of the extended Phadebas RAST panel in the diagnosis of mould allergy in asthmatic children

The clinical significance of mould allergens in Phadebas RAST panel was investigated in 121 asthmatic children. They were selected from a total population of 1649 patients. The patients were distributed into four groups, based on the combination of positive or negative skin prick tests (SPT) together with symptoms suggestive or not of mould sensitivity. Mould-specific IgE antibodies were investigated using the original RAST panel (Alternaria, Aspergillus, Candida, Cladosporium, Mucor and Penicillium) and a set of 10 additional mould-allergen discs (Aureobasidium, Botrytis, Curvularia, Epicoccum, Fusarium, Helminthosporium, Phoma, Rhizopus, Stemphylium and Trichoderma). The set of additional RAST discs revealed patients with mould-reaginic antibodies not found with the original RAST panel. This occurred in four of 49 (8.2%) RAST positive (class greater than or equal to 2) patients. The allergens most frequently positive were Cladosporium (in 28% of the patients), Candida (28%) and Helminthosporium (26%). A remarkable degree of simultaneous reactivity to almost all moulds tested was observed. Patients with multiple (greater than or equal to 7) mould sensitization were effectively pinpointed using any duplicate combination of Aureobasidium, Botrytis, Candida, Cladosporium, Helminthosporium, Penicillium and Stemphylium.

Assessment of airborne fungal spores in different industrial working environments and their importance as health hazards to workers

A survey to assess the occurrence of airborne fungal spores in three different industries, dairies, carpentries and greenhouses, was carried out. The results revealed considerable fungal pollution in the environments of the industries sampled. Noteworthy was the occurrence of fungal genera frequently implicated in allergic and non-allergic diseases, or well known for the production of mycotoxins in foods or characterized by a marked degradative activity on different substrata. Penicillium, Candida, Mucor and Geotrichum were the most common genera identified in the dairies; Penicillium, Cladosporium, yeasts, Trichoderma and Rhizopus occurred more frequently in the carpentries; Cladosporium, Alternaria, Penicillium and Stemphilium were prevailing in the greenhouse.The results of our survey support the idea that, due to their high incidence and variety, fungal spores may represent a potential health hazard in working environments, where their concentration can be affected by many operations and handling.

Immediate hypersensitivity to Parthenium hysterophorus. II. Clinical studies on the prevalence of Parthenium rhinitis

The airborne pollen of the South American weed, Parthenium hysterophorus (American feverfew), accidentally introduced into India was found to be responsible for severe allergic rhinitis. A random clinical survey conducted on 2035 residents of Bangalore city with the aid of questionnaires and skin tests revealed that 7.1% of the study population was suffering from allergic rhinitis due to exposure to Parthenium pollen. Skin-prick tests performed on 1294 clinic patients suffering from nasobronchial allergy during the past 4 years have also shown that 42.5% were sensitive to Parthenium pollen. IgE and IgG antibodies specific for Parthenium pollen allergens were demonstrable in the sera of Parthenium-sensitive rhinitis patients. The specificity of these antibodies to Parthenium allergens was established by ELISA. A 7- to 11-fold higher stimulation was observed when lymphocytes from two Parthenium-sensitive rhinitis patients were treated in vitro with Parthenium pollen extract. To our knowledge, nowhere in the world has such a high incidence of allergic rhinitis due to a single pollen ever been reported.

A randomized, double-blind trial of nystatin therapy for the candidiasis hypersensitivity syndrome

BACKGROUND

Candida albicans infection has been proposed to cause a chronic hypersensitivity syndrome characterized by fatigue, premenstrual tension, gastrointestinal symptoms, and depression. Long-term antifungal therapy has been advocated as treatment for the syndrome, which is most often diagnosed in women with persistent or recurrent candida vaginitis.

METHODS

To determine the efficacy of nystatin therapy for presumed candidiasis hypersensitivity syndrome, we conducted a 32-week randomized, double-blind, cross-over study using four different combinations of nystatin or placebo given orally or vaginally in 42 premenopausal women who met present criteria for the syndrome and had a history of candida vaginitis. The outcomes studied were the changes from base line in scores for vaginal, systemic, and overall symptoms and in the results of standardized psychological tests.

RESULTS

The three active-treatment regimens (oral and vaginal nystatin, oral nystatin and vaginal placebo, and oral placebo and vaginal nystatin) and the all-placebo regimen significantly reduced both vaginal and systemic symptoms (P less than 0.001), but nystatin did not reduce the systemic symptoms significantly more than placebo. On average, the scores for systemic symptoms improved 25 percent with the three active-treatment regimens and 23 percent with the all-placebo regimen, a difference of only 2 percent (95 percent confidence interval, -3 to 7 percent). As expected, the three active-treatment regimens were more effective than placebo in relieving vaginal symptoms (P less than 0.001). All four regimens reduced psychological symptoms and global indexes of distress; there were no significant differences among the treatment regimens.

CONCLUSIONS

In women with presumed candidiasis hypersensitivity syndrome, nystatin does not reduce systemic or psychological symptoms significantly more than placebo. Consequently, the empirical recommendation of long-term nystatin therapy for such women appears to be unwarranted.

IgE-, IgA- and IgG-antibody responses to carbohydrate and protein antigens of Candida albicans in asthmatic children

Analysis of IgE, IgA and IgG antibodies directed against Candida albicans antigens in 28 asthmatic children was performed with immunoblotting after SDS-PAGE. Analysis with the purified cytoplasmic protein fraction revealed a major protein allergen with an MW of 46 kD. In addition to the major allergen, 15 other antigenic bands with molecular weights between 16 and 135 kD bound IgE. Ten of 13 anti-C. albicans IgE-positive children had IgE towards the 46 kD major allergen. None of the subjects in the study group or in the non-atopic controls had IgA or IgG antibodies towards this protein. Analysis of the crude surface extract showed that mannan, a carbohydrate, was an intermediate allergen contrary to being the major antigen in IgA and IgG antibody responses.

Immunoblotting analysis of concanavalin A-isolated allergens of Candida albicans

The carbohydrate-containing fraction of Candida albicans was isolated from the crude extract with ConA Sepharose affinity chromatography and studied by IgE-immunoblotting with individual and pooled sera from C. albicans-allergic subjects. In the ConA-bound fraction there was a diffuse IgE binding in the high molecular weight area which also gave a carbohydrate stain (PAS). A distinct band corresponding to a molecular weight of 70 kD bound specific IgE antibodies. This glycoprotein, presumably a mannoprotein, gave a weak carbohydrate staining and a strong protein staining. Further biochemical studies are needed to reveal the exact nature of the epitopes in the ConA-bound mannose-containing fraction of C. albicans.

Distribution of watersoluble antigens and allergens of Candida albicans in blastospore cell extract fractions

Watersoluble antigens of Candida albicans were sequentially extracted from intact and disrupted yeast cells grown on protein-free agar, and analysed on immunoblots after SDS-PAGE. Washing of the cells in saline before proper extraction resulted in loss of 47.2% of the total carbohydrate and 1.5% of the total protein. The protein fraction contained 14 antigenic bands when analysed with hyperimmune rabbit antisera. Four of these bound IgE when probed with a RAST-positive serum pool and beta-galactosidase-labelled anti-IgE. Extraction of the disrupted cells resulted in 15% of the total carbohydrate and 94% of the total protein. The cytoplasmic protein fraction showed 69 antigenic bands, 13 of which bound IgE. The carbohydrate fraction contained mannan, which was found in the washing solutions and in the surface extract as well as in the cytoplasmic extract. Allergens found in washing solutions were also present in cytoplasmic fraction. This study suggests that the rapid release of allergens from saprophytic C. albicans cells on mucous membranes of the body may cause continuous exposure and result in sensitization.

Fungal air-borne spores as health risk factors among workers in alimentary industries

A survey to evaluate the occurrence of air-borne fungal spores in two different food industries, dairies and bakeries, was conducted. Our data revealed considerable fungal pollution in the environments of both industries, as well as some differences in the distribution of the genera of fungi recovered. Noteworthy was the frequent finding of numerous fungi frequently responsible for allergic rhinitis, asthma and other diseases, or well-known for their production of mycotoxins in foods or characterized by their degradative activity against various substances. Aspergillus, Candida, Fusarium, Geotrichum, Mucor and Penicillium were the most common genera identified in dairies while Alternaria, Aspergillus, Botrytis, Candida, Cladosporium, Penicillium and Saccharomyces occurred more frequently in bakeries. The survey showed that fungi can play a significant role in allergic and non-allergic diseases in modern working environments.

Allergenic components of Candida albicans identified by immunoblot analysis

Allergenic components of Candida albicans fractionated by SDS-polyacrylamide gel electrophoresis (PAGE) and transferred to nitrocellulose membranes were identified using sera from 30 asthmatic patients who showed positive skin test and RAST (radio-allergosorbent test) to C. albicans. The IgE-binding yeast components in the complex antigen preparation were then detected by reaction with enzyme-labelled anti-human IgE antibodies. They were confirmed by Coomassie blue R-250 staining of the membrane to visualize all protein bands after reaction with the enzyme substrate. The IgE-binding patterns of the sera tested were heterogeneous, displaying a total of 16 identifiable components with molecular weights ranging from 20 to 94 kD. A 40 kD component showed the highest IgE-binding frequency, being recognized by 23 (77%) of the 30 sera examined. The other 15 allergenic components identified were recognized by less than 25% of the sera tested. Only two of the 30 serum samples contained IgE antibodies reactive with seven to eight allergenic components. Ten of the 30 sera reacted with only one allergenic component, and the remaining serum samples recognized two to five of the 16 identified allergens. Results described in this study are applicable to allergen standardization work and provide a basis for further study on the role of C. albicans in clinical allergy.

Relationship of immediate and delayed hypersensitivity to nasopharyngeal and intestinal growth of Candida albicans in allergic subjects

The growth of C. albicans yeast in the nasopharynx and in the anus as well as allergy symptoms were followed up for 8 months in 67 patients with bronchial asthma, allergic rhinitis and/or atopic eczema. 38 of the patients were skin prick test positive and 29 negative to C. albicans allergen extract. 32 of the patients had positive and 19 negative delayed skin reactions. The nasal, bronchial and skin symptoms of the yeast-sensitive allergic patients were not associated with the nasopharyngeal nor anal occurrence of C. albicans or other yeasts. The use of nasal or inhaled steroids had no effect on the occurrence of Candida in the nasopharynx. It was observed that immediate skin sensitivity had a positive correlation and the delayed sensitivity a negative correlation with the occurrence of C. albicans growth in nasopharynx and anus. These findings are in agreement with the concept that impaired cell-mediated immunity to C. albicans may lead to increased IgE response. This may explain the increased liability towards C. albicans nasopharyngeal and gastrointestinal "saprophytic" growth.

Serum IgE, skin and radioallergosorbent tests for house dust and mites in asthmatic children

Thirty asthmatic children were given an intradermal skin test, total IgE measurements and the radioallergosorbent test (RAST) against house dust and house dust mites (Dermatophagoides pteronyssinus and Dermatophagoides farinae). Results of the intradermal skin test and RAST were highly positive with overall agreement in 95.6%. The correlation coefficient between the total IgE and the RAST to house dust was 0.35 (p less than 0.05). There was no significant difference between the total IgE and the RAST to D. pteronyssinus and D. farinae (p greater than 0.05). The highly significant correlation coefficient between house dust and house dust mites (D. farinae, p less than 0.0001; D. pteronyssinus, p less than 0.00001) was determined by RAST. House dust has been found to be the most important allergen in children in Taiwan. The role of mites as a possible allergen in house dust also showed a highly significant correlation in our study.

Diagnosis and immunotherapy of mould allergy. III. Diagnosis of Cladosporium allergy by means of symptom score, bronchial provocation test, skin prick test, RAST, CRIE and histamine release

Thirty-three adult asthmatic patients suspected of mould allergy were investigated by in vivo and in vitro tests in order to establish a specific diagnosis of asthma caused by the mould species Cladosporium. The patients were evaluated by daily symptom scores in the peak Cladosporium season, bronchial provocation test (BPT), skin prick test (SPT), RAST, histamine release from basophil granulocytes (HIST), and crossed radioimmunoelectrophoresis (CRIE), and the results were scored as negative (score 0), equivocal (score 1) or positive (score 2). Based on daily symptom scores and the result of BPT the patients were classified as being manifest allergic (asthma) to Cladosporium (positive allergy), inconclusive or negative. Positive allergy was defined as asthma symptoms oscillating with the spore concentration and a BPT score 2 (positive at allergen concentration less than 10,000 BU). Negative allergy was defined as no asthma symptoms and a negative BPT (score 0) and inconclusive in the case of symptoms and BPT sum of score 1-3. According to the classification a final diagnosis (positive or negative) could be established in 85% of the patients. "False positive" tests were found: for BPT in 27%, SPT 18%, RAST 0%, HIST 18%, and CRIE 0%. The corresponding figures for "false negative" were: BPT 0%, SPT 0%, RAST 27%, HIST 18%, and CRIE 23%. The relative risk of being allergic in spite of a negative test result was 0% for BPT and SPT, and 25-30% with RAST, HIST, and CRIE. In the case of positive test the risk was 90-100%. Excluding BPT, SPT was found to be the optimal single test to predict/rule out clinical allergy. A stepwise combination of positive SPT and positive RAST was found exclusively in patients clinically evaluated as positive, and does not call for an additional BPT. Using a potent allergenic extract a negative SPT excluded clinically important allergy. The primary conclusion of the study, however, is that the final diagnosis of Cladosporium asthma could not be based on a positive BPT alone (due to "false positive"), but only on a combination of clinical symptoms during the spore season and a positive BPT.