Aggiornamento
Problemi respiratori e allergici legati a umidità e muffe ambientali
Respiratori and allergic health effects of dampness and mould exposure
Luciano Anfossi
Azienda Ospedaliero-Universitaria “Città della Salute e della Scienza”, Torino - Ospedale Infantile “Regina Margherita”, Torino
Novembre 2017 - pagg. 563 -569
Abstract
Scientific evidences showed indoor dampness to be associated consistently with increased
asthma development, cough, bronchitis, allergic rhinitis and upper respiratory
tract symptoms. Sufficient evidence exists for associating the presence of mould in damp
buildings with respiratory exacerbations. Associations were found in allergic and nonallergic
individuals, but causal links remain unclear. The 4 genera most commonly associated
with the development of allergy are Alternaria, Cladosporium, Penicillium, and Aspergillus.
Fungi can actively germinate and colonise the respiratory tract and are
sources of allergic proteins. Due to the poor quality of natural fungal allergen extracts,
diagnosis of fungal allergy is hampered. Exposure and sensitization to fungal allergens
can promote the development and worsening of allergic rhinitis. A patient with allergic
fungal rhinosinusitis will present with a history of sinus disease strongly recalcitrant to
traditional medical and even surgical therapy. There is current evidence to demonstrate
a close association between fungal sensitisation and asthma severity. Allergic bronchopulmonary
aspergillosis usually causes increased severity of asthma, transient infiltrates
in the lungs, sputum production, elevated total IgE, immediate hypersensitivity to
Aspergillus, and eosinophilia.
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Bibliografia
1. Saijo Y, Nakagi Y, Ito T, Sugioka Y, Endo H,
Yoshida T. Dampness, food habits and sick
building syndrome symptoms in elementary
school pupils. Environ Health Prev Med 2010;
15(5):276-84.
2. Weinmayr G, Gehring U, Genuneit J, et al.
Dampness and mould in relation to respiratory
and allergic symptoms in children: results from
Phase Two of the International Study of Asthma
and Allergies in Childhood (ISAAC Phase
Two). Clin Exp Allergy 2013;43(7):762-74.
3. Park JH, Cox-Ganser JM. Mold exposure
and respiratory health in damp indoor environments.
Front Biosci (Elite Ed) 2011;3:757-71.
4. Simoni M, Lombardi E, Berti G, et al.
Mould/dampness exposure at home in associated
with respiratory disorders in Italian children
and adolescent: the SIDRIA-2 Study. Occup
Environ Med 2005;62(9):616-22.
5. Mendell MJ, Mirer AG, Cheung K, Tong M,
Douwes J. Respiratory and allergic health effects
of dampness, mold and dampness-related
agents: a review of the epidemiologic evidence.
Environ Health Perspect 2011;119(6):
748-56.
6. Fisk WJ, Lei-Gomez Q, Mendell MJ. Metaanalyses
of the association of respiratory health
effects with dampness and mold in homes. Indoor
air 2007;17(4):284-96.
7. Iossifova YY, Reponen T, Ryan PH, et al.
Mold exposure during infancy as a predicato of
potential asthma development. Ann Allergy
Asthma Immunol 2009;102(2):131-7.
8. Fisk WJ, Eliseeva EA, Mendell MJ. Association
of residential dampness and mold with respiratory
tract infections an bronchitis: a metaanalysis.
Environ Health 2010;9:72.
9. Mendell MJ, Mirer AG, Cheung K, Tong M,
Douwes J. Respiratory and allergic health effects
of dampness, mold, and dampness-related
agents: a review of the epidemiologic evidence.
Environ Health Perspect 2011;119(6):
748-56.
10. Sharpe RA, Thornton CR, Tyrrell J, Nikolaou
V, Osborne NJ. Variable risk of atopic disease
due to indoor fungal exposure in NHANES
2005-2006. Clin Exp Allergy 2015;45(10):
1566-78.
11. Polizzi V, Delmulle B, Adams A, et al. JEM
Spotlight: Fungi, mycotoxins and microbial volatile
organic compounds in mouldy interiors
from water-damaged buildings. J Environ Monit
2009;11(10):1849-58.
12. Borràs-Santos A, Jacobs JH, Täubel M, et
al. Dampness and mould in schools and respiratory
symptoms in children: the HITEA study.
Occup Environ Med 2013;70(10):681-7.
13. Jones R, Recer GM, Hwang SA, Lin S. Association
between indoor mold and asthma
among children in Buffalo, New York. Indoor
Air 2011;21(2):156-64.
14. Knutsen AP, Bush RK, Demain, et al. Fungi
and allergic lower respiratory tract diseases. J
Allergy Clin Immunol 2012;129(2): 280-91.
15. WHO (World Health Organization)
Europe. WHO Guidelines for indoor air quality:
dampness and mould. Geneva: World Health
Organization, 2009.
16. Täubel M, Sulyok M, Vishwanath V, et al.
Co-occurrence of toxic bacterial and fungal secondary
metabolites in moisture-damaged indoor
environments. Indoor Air 2011;21(5):368-
75.
17. Savilahti R, Uitti, J, Laippala, P, Husman T,
Roto P. Respiratory morbidity among children
following remediation of a water-damaged
school. Arch Environ Health 2000;55: 405-410.
18. Kercsmar CM, Dearborn D, Schluchter M,
et al. Reduction in asthma morbidity in
children as a result of home remediation aimed
at moisture sources. Environ Health Perspect
2006;114(10):1574-80.
19. Denning DW, Pashley, Hartl D, et al. Fungal
allergy in asthma-state of art and research
needs. Clin Transl Allergy 2014;4:14.
20. Bush RK, Portnoy JM, Saxon A, Terr AI,
Wood RA. The medical effects of mold exposure.
J Allergy Clin Immunol 2006;117(2): 326-33.
21. Castanhinha S, Sherburn R, Walker S, et al.
Pediatric severe asthma with fungal sensitization
in mediated by steroid-resistant IL-33. J Allergy
Clin Immunol 2015;136(2):312-22.e7.
22. Bossley CJ, Fleming L, Gupta A, et al. Pediatric
severe asthma is characterized by eosinophilia
and remodeling without T(H)2 cytokines.
J Allergy Clin Immunol 2012;129(4):974-
82.e13.
23. Vicencio AG, Santiago MT, Tsirilakis K, et
al. Fungal sensitization in childhood persistent
asthma is associated with disease severity. Pediatr
Pulmonol 2014;49(1):8-14.
24. Smith JA, Kauffman CA. Pulmonary fungal
infections. Respirology 2012;17(6):913-26.
25. Kilic M, Ufuk Altintas D, Yilmaz M, et al.
The effect of meteorological factors and Alternaria
spore concentrations on children sensitised
to Alternaria. Allergol Immunopathol (Madr)
2010;38(3):122-8.
26. de Ana SG, Torres-Rodríguez JM, Ramírez
EA, García SM, Belmonte-Soler J. Seasonal distribution
of Alternaria, Aspergillus, Cladosporium
and Penicillium species isolated in
homes of fungal allergic patients. J Investig Allergol
Clin Immunol 2006;16(6):357-63.
27. Crameri R, Weichel M, Flückiger S, Glaser
AG, Rhyner C. Fungal allergies: a yet unsolved
problem. Chem Immunol Allergy 2006;91:121-
33.
28. Heinzerling L, Frew AJ, Bindslev-Jensen, et
al. Standard skin prick testing and sensitization
to inhalant allergens across Europe. A survey
from the GALEN network. Allergy 2005;60(10):
1287-300.
29. Burbach GJ, Heinzerling LM, Edenharter
G, et al. GA(2)Len skin test study II: clinical relevance
of inhalant allergen sensitization in Europe.
Allergy 2009;64(10):1507-15.
30. de Benedictis FM, Franceschini F, Hill D,
et al.; EPAAC Study Group. The allergic sensitization
in infants with atopic eczema from different
countries. Allergy 2009;64(2):295-303.
31. Arbes SJ Jr, Gergen PJ, Elliott L, Zeldin DC.
Prevalences of positive skin test responses to
10 common allergens in the US population: results
from the third National Health and Nutrition
Examination Survey. J Allergy Clin Immunol
2005;116(2):377-83.
32. Cantani A, Ciaschi V. Epidemiology of Alternaria
alternata allergy: a prospective study
in 6840 Italian asthmatic children. Eur Rev
Med Pharmacol Sci 2004;8(6):289-94.
33. Twaroch TE, Curin M, Valenta R, Swoboda
I. Mold allergens in respiratory allergy: from
structure to therapy. Allergy Asthma Immunol
Res 2015;7(3):205-20.
34. Vailes L, Sridhara S, Cromwell O, Weber B,
Breitenbach M, Chapman M. Quantitation of
the major fungal allergens, Alt a 1 and Asp f 1,
in commercial allergenic products. J Allergy
Clin Immunol 2001;107(4):641-6.
35. Kolodzieiczyk K, Bozek A. Clinical distinctness
of allergic rhinitis in patients with allergy
to molds. Biomed Res Int 2016;2016: 3171594.
36. Bousquet J, Khaltaev N, Cruz AA, et al.;
World Health Organization; GA(2)LEN; Aller-
Gen. Allergic rhinitis and its impact on asthma
(ARIA) 2008. Allergy 2008;63 Suppl 86:8-160.
37. Sharpe RA, Bearman N, Thornton CR,
Husk K, Osborne NJ. Indoor fungal diversity
and asthma: a meta-analysis and systematic review
of risk factors. J Allergy Clin Immunol
2015;135(1):110-22.
38. Hamilos DL. Chronic rhinosinusitis: epidemiology
and medical management. J Allergy
Clin Immunol 2011;128(4):693-707.
39. O’Driscoll BR, Hipkinson LC, Denning DW.
Mold sensitization is common amongst patients
with severe asthma requiring multiple hospital
asdmissions. BMC Pulm Med 2005;5: 4.
40. Agarwal R. Severe asthma with fungal sensitization.
Curr Allergy Asthma Rep 2011;11:
403-13.
41. Zureik M, Neukirch C, Leynaert B, Liard R,
Bousquet J, Neukirch F; European Community
Respiratory Health Survey. Sensitisation to airborne
moulds and severity of asthma: cross
sectional study from European Community respiratory
health survey. BMJ 2002;325(7361):
411-4.
42. Vicencio AG, Santiago MT, Tsirilakis K, et
al. Fungal sensitization in childhood persistent
asthma is associated with disease severity. Pediatr
Pulmonol 2014;49(1):8-14.
43. Blatter J, Forno E, Brehm J, et al. Fungal
exposure, atopy, and asthma exacerbations in
Puerto Rican children. Ann Am Thorac Soc
2014;11(6):925-32.
44. Inal A, Karakoc GB, Altintas DU, et al. Effects
of indoor mold concentrations on daily
symptoms severity of children with asthma
and/or rhinitis monosensitized to molds. J
Asthma 2007;44(7):543-6.
45. Torres-Rodríguez JM, Pulido-Marrero Z,
Vera-García Y. Respiratory allergy to fungi in
Barcelona, Spain: clinical aspects, diagnosis
and specific treatment in a General Allergy
Unit. Allergol Immunopathol (Madr) 2012;40
(5):295-300.
46. Nasser SM, Pulimood TB. Allergens and
thunderstorm asthma. Curr Allergy Asthma
Rep 2009;9(5):384-90.
47. D’Amato G, Vitale C, D’Amato M, et al.
Thunderstorm-related asthma: what happens
an why. Clin Exp Allergy 2016;46(3):390-6.
48. Fairs A, Agbetile J, Hargadon B, et al. IgE
sensitization to Aspergillus fumigatus is associated
with reduced lung function in asthma.
Am J Respir Crit Care Med 2010;182(11):1362-
8.
49. Rivera A, Van Epps HL, Hohl TM, Rizzuto
G, Pamer EG. Allergic bronchopulmonary
aspergillosis’ diagnosis remain a challenge. Infect
Immun 2005;73(11):7170-9.
50. Wang JL, Patterson R, Mintzer R, Roberts
M, Rosenberg M. Allergic bronchopulmonary
aspergillosis in pediatric practice. J Pediatr
1979;94(3):376-81.
51. Singh M, Das S, Chauhan A, et al. The diagnostic
criteria for allergic bronchopulmonary
aspergillosis in children with poorly controlled
asthma need to be re-evaluated. Acta Paediatr
2015;104(5):e206-9.
52. Knutsen AP, Slavin RG. Allergic bronchopulmonary
aspergillosis in asthma and cystic
fibrosis. Clin Dev Immunol 2011;2011: 843763.
53. Antunes J, Fernandes A, Borrego LM, Leiria-
Pinto P, Cavaco J. Cystic fibrosis, atopy,
asthma and ABPA. Allergol Immunopathol
(Madr) 2010;38(5):278-84.
54. Selman M, Lacasse Y, Pardo A, Cormier Y.
Hypersensitivity pneumonitis caused by fungi.
Proc Am Thorac Soc 2010;7(3):229-36.
55. Vece TJ, Fan LL. Interstitial lung disease
in children older than 2 years. Pediatr Allergy
Immunol Pulmonol 2010;23(1):33-41.
Corrispondenza: lucianoanfossi@hotmail.it