Clinical use of immunoassays in assessing exposure to fungi and potential health effects related to fungal exposure.

OBJECTIVE To review and summarize current evidence regarding the proper role of immunoassays in clinical assessments of exposure to fungi and health effects related to fungal exposure. DATA SOURCES We reviewed relevant scientific investigations and previously published reviews concerning this topic. STUDY SELECTION The authors' clinical, laboratory, and public health experiences were used to evaluate relevant data for scientific merit. RESULTS Testing to determine the presence of IgE to specific fungi may be a useful component of a complete clinical evaluation in the diagnosis of illnesses that can be caused by immediate hypersensitivity such as allergic rhinitis and asthma. Detection of IgG to specific fungi has been used as a marker of exposure to agents that may cause illnesses such as hypersensitivity pneumonitis. However, the ubiquitous nature of many fungi and the lack of specificity of fungal antigens limit the usefulness of these types of tests in the evaluation of potential building-related illness and fungal exposure. Specific serologic tests (such as tests for cryptococcal antigen, coccidioidal antibody, and Histoplasma antigen) have been shown to be useful in the diagnosis of some fungal infections, but these are the exception not the rule. CONCLUSIONS There is currently not enough scientific evidence to support the routine clinical use of immunoassays as a primary means of assessing environmental fungal exposure or health effects related to fungal exposure. Health care providers who care for persons expressing concerns about the relationship of symptoms to potential exposure to fungi are advised to use immunoassay results with care and only as an adjunct to a comprehensive approach to patient care.

[1]  J. Portnoy,et al.  IgE-reactive proteins from Stachybotrys chartarum. , 2002, Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology.

[2]  D. Lynch,et al.  Hypersensitivity pneumonitis: sensitivity of high-resolution CT in a population-based study. , 1992, AJR. American journal of roentgenology.

[3]  R. Patterson,et al.  Diphenylmethane diisocyanate hypersensitivity pneumonitis: a serologic evaluation. , 1989, Journal of occupational medicine. : official publication of the Industrial Medical Association.

[4]  D. Trout,et al.  The role of Stachybotrys mycotoxins in building-related illness. , 2001, AIHAJ : a journal for the science of occupational and environmental health and safety.

[5]  N. Arora,et al.  Antigenic and allergenic cross-reactivity of Epicoccum nigrum with other fungi. , 2002, Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology.

[6]  Y. Cormier,et al.  The diagnosis of hypersensitivity pneumonitis. , 1997, Chest.

[7]  D Trout,et al.  Bioaerosol lung damage in a worker with repeated exposure to fungi in a water-damaged building. , 2001, Environmental health perspectives.

[8]  P. Williams,et al.  A blinded, multi-center evaluation of two commercial in vitro tests for latex-specific IgE antibodies. , 2000, Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology.

[9]  P. Morey,et al.  Building-associated pulmonary disease from exposure to Stachybotrys chartarum and Aspergillus versicolor. , 1998, Journal of occupational and environmental medicine.

[10]  T. Meklin,et al.  Immunoglobulin G antibodies to moulds in school-children from moisture problem schools , 2002 .

[11]  G. Sarosi,et al.  Fungal Diseases of the Lung , 1993 .

[12]  A. Helbling,et al.  Allergy to basidiomycetes. , 2002, Chemical immunology.

[13]  S. Vesper,et al.  Initial Characterization of the Hemolysin Stachylysin from Stachybotrys chartarum , 2001, Infection and Immunity.

[14]  E. Bardana,et al.  Toxic mold: phantom risk vs science. , 2003, Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology.

[15]  D. Strong,et al.  Extrinsic allergic alveolitis after Aspergillus fumigatus inhalation. Evidence of a type IV immunologic pathogenesis. , 1976, The American journal of medicine.

[16]  S. Lehrer,et al.  Evidence for cross-reactive allergens among basidiomycetes: immunoprint-inhibition studies. , 1990, The Journal of allergy and clinical immunology.

[17]  A. Terr.  Stachybotrys: relevance to human disease. , 2001, Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology.

[18]  O. Niemelä,et al.  Serum IgG and IgE antibodies against mold-derived antigens in patients with symptoms of hypersensitivity. , 2001, Clinica chimica acta; international journal of clinical chemistry.

[19]  B. Wong,et al.  Current Status of Nonculture Methods for Diagnosis of Invasive Fungal Infections , 2002, Clinical Microbiology Reviews.

[20]  N Franklin Adkinson,et al.  23. Clinical laboratory assessment of IgE-dependent hypersensitivity. , 2003, The Journal of allergy and clinical immunology.

[21]  P. Morey,et al.  Health and immunologv study following exposure to toxigenic fungi (Stachybotrys chartarum) in a water-damaged office environment , 1996 .

[22]  C. McSharry,et al.  Relationships between avian exposure, humoral immune response, and pigeon breeders' disease among Scottish pigeon fanciers. , 1986, Thorax.

[23]  F. Fung,et al.  Stachybotrys, a mycotoxin-producing fungus of increasing toxicologic importance. , 1998, Journal of toxicology. Clinical toxicology.

[24]  L J Swenson,et al.  Health effects of mycotoxins in indoor air: a critical review. , 2000, Applied occupational and environmental hygiene.

[25]  M. Ghannoum,et al.  Indoor Mold, Toxigenic Fungi, and Stachybotrys chartarum: Infectious Disease Perspective , 2003, Clinical Microbiology Reviews.

[26]  E. Terho.  Diagnostic criteria for farmer's lung disease , 1986 .

[27]  Lee Goldman,et al.  Cecil Textbook of Medicine , 1985 .

[28]  S. Gutman.  The role of Food and Drug Administration regulation of in vitro diagnostic devices--applications to genetics testing. , 1999, Clinical chemistry.

[29]  B. Lushniak,et al.  Indirect assessment of 4,4'-diphenylmethane diisocyanate (MDI) exposure by evaluation of specific humoral immune responses to MDI conjugated to human serum albumin. , 1998, American journal of industrial medicine.

[30]  Moira Chan-Yeung,et al.  Asthma in the Workplace , 1993 .

[31]  S. Gravesen.  Bioaerosols, fungi and mycotoxins: Health effects, assessment, prevention and control , 1999 .

[32]  M. Tam,et al.  Production and characterization of monoclonal antibodies to serine proteinase allergens in Penicillium and Aspergillus species , 2000, Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology.

[33]  I. Bernstein,et al.  Guidelines for the clinical evaluation of hypersensitivity pneumonitis. Report of the Subcommittee on Hypersensitivity Pneumonitis. , 1989, The Journal of allergy and clinical immunology.

[34]  E. Krieg,et al.  Diagnostic performance of Food and Drug Administration-cleared serologic assays for natural rubber latex-specific IgE antibody. The Multi-Center Latex Skin Testing Study Task Force. , 1999, The Journal of allergy and clinical immunology.

[35]  R. Arellano,et al.  Prevalence of latex sensitization among hospital physicians occupationally exposed to latex gloves. , 1992, Anesthesiology.

[36]  R. Malkin,et al.  The relationship between symptoms and IgG and IgE antibodies in an office environment. , 1998, Environmental research.

[37]  H. Burge.  Fungi: toxic killers or unavoidable nuisances? , 2001, Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology.

[38]  C. Scully.  Oral infections in the immunocompromised patient , 1992, British Dental Journal.

[39]  J.David Miller,et al.  Fungi as contaminants in indoor air , 1992 .

[40]  M. Breitenbach,et al.  The allergens of Cladosporium herbarum and Alternaria alternata. , 2002, Chemical immunology.

[41]  S. Vesper,et al.  ELISA Measurement of Stachylysin™ in Serum to Quantify Human Exposures to the Indoor Mold Stachybotrys chartarum , 2003, Journal of occupational and environmental medicine.

[42]  E. Bruck,et al.  National Committee for Clinical Laboratory Standards. , 1980, Pediatrics.

[43]  N. Arora,et al.  Allergenic cross‐reactivity of Curvularia lunata with other airborne fungal species , 2002, Allergy.

[44]  C. McSharry,et al.  Takes your breath away – the immunology of allergic alveolitis , 2002, Clinical and experimental immunology.

[45]  R. Patterson,et al.  Immunopathogenesis of hypersensitivity pneumonitis , 1977 .

[46]  Disease Prevention.  Clearing the Air: Asthma and Indoor Air Exposures , 2000 .

[47]  A. Nevalainen,et al.  Mould‐specific immunoglobulin G antibodies in students from moisture‐ and mould‐damaged schools: A 3‐year follow‐up study , 2002, Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology.

[48]  S. Petrou,et al.  Pore-forming proteins and their application in biotechnology. , 2002, Current pharmaceutical biotechnology.

[49]  R. Hoffmann,et al.  Precipitating antibodies to farmer's lung antigens in a Wisconsin farming population. , 1981, The American review of respiratory disease.

[50]  R. Calderone.  Fungal Pathogenesis: Principles and Clinical Applications , 2001 .

[51]  Y. Lacasse,et al.  Keys to the Diagnosis of Hypersensitivity Pneumonitis: The Role of Serum Precipitins, Lung Biopsy, and High-Resolution Computed Tomography , 1996 .

[52]  E. Krieg,et al.  Receiver Operating Characteristics Analyses of Food and Drug Administration-Cleared Serological Assays for Natural Rubber Latex-Specific Immunoglobulin E Antibody , 2001, Clinical Diagnostic Laboratory Immunology.

[53]  B. Alexander.  Diagnosis of fungal infection: new technologies for the mycology laboratory. , 2002, Transplant infectious disease : an official journal of the Transplantation Society.

[54]  Su Dl.  Stachybotrys chartarum: current knowledge of its role in disease. , 2000 .

[55]  D. Schmechel,et al.  The production and characterization of monoclonal antibodies to the fungus Aspergillus versicolor. , 2005, Indoor air.

[56]  Lilah M. Besser,et al.  Specific, Sensitive, and Quantitative Enzyme-Linked Immunosorbent Assay for Human Immunoglobulin G Antibodies to Anthrax Toxin Protective Antigen , 2002, Emerging infectious diseases.

[57]  M. Ando,et al.  Prevention of summer-type hypersensitivity pneumonitis: effect of elimination of Trichosporon cutaneum from the patients' homes. , 1989, Archives of environmental health.

[58]  M. Dykewicz.  7. Rhinitis and sinusitis. , 2003, The Journal of allergy and clinical immunology.

[59]  Philip I Harber,et al.  Occupational and environmental respiratory disease , 1996 .