FUNGUS AMONG US? THE ASSOCIATION BETWEEN FUNGAL DERMATOPHYTES AND ALLERGIC HYPERSENSITIVITY REACTIONS

Abstract

<h3>Introduction</h3> The dermatophyte <i>Trichophyton rubrum t</i>ypically infects human skin, hair, and nails and causes common cutaneous manifestations such as athlete's foot and fungal nail infections. However, it has been proposed that sensitization, characterized by high levels of circulating IgE, to this allergen is a risk factor for future development of severe asthma. We surveyed the current literature to find clinical associations. <h3>Methods</h3> A systematic review was conducted using PubMed, Embase, and Web of Science using the search terms "<i>Trichophyton rubrum</i> AND rhinosinusitis OR asthma OR rhinitis OR conjunctivitis OR allergic fungal sinusitis OR allergic bronchopulmonary aspergillosis". Only studies with clinical data were used. <h3>Results</h3> Four studies met inclusion criteria with 356 total patients. They consisted of a case report presenting bronchial asthma and dystrophic toenails whose KOH scrapings isolated <i>Trichophyton rubrum</i> (n=1)<i>,</i> a case series of patients with positive skin-prick- tests and bronchial reactivity to <i>Trichophyton</i> with moderately severe asthma (n=11), a cohort which completed allergen sensitization for <i>Trichophyton</i> with high positivity rates associated with moderate asthma (n=258), and a case series investigating the role of inhaling <i>Trichophyton</i> and its association with asthma (n=86). In these studies, patients treated with systemic steroids (n=12) showed minimal change in pulmonary function tests. After treatment with both oral and topical antifungals (n=12), patients reported a resolution of asthma symptoms leading to a concurrent cessation of allergy medications. <h3>Conclusions</h3> This systematic review identified rare but important association of hypersensitivity to <i>Trichophyton rubrum</i> and the development of severe asthma. Treatment with antifungal agents was more effective than allergy medications.