Abstract
Fungal spores and conidia are the major components of total airspora in the tropical Asia environment, and their sensitization patterns are often associated with allergic diseases such as asthma, allergic rhinitis (AR), and atopic dermatitis. Hence, we recruited a cross-sectional cohort of 9223 Singapore/Malaysia Chinese adults and assessed their sensitization against Curvularia lunata allergen using the skin prick test approach. A subset of this cohort (n = 254) was also screened for specific Immunoglobulin E (sIgE) titers against a panel of 11 fungal allergens. We found significant association of Curvularia lunata sensitization with the risk of asthma (OR = 1.66, 95% CI: 1.17–2.33; p = 0.00391) and AR (OR = 1.69, 95% CI: 1.18–2.41; p = 0.00396). Among asthmatic patients (n = 1680), Curvularia lunata sensitization also increased frequencies of wheezing symptoms (OR = 1.81, 95% CI: 1.05–2.96; p = 0.0239), general practitioner/specialist visits (OR = 2.37, 95% CI: 1.13–4.61; p = 0.0157), and other asthma-related exacerbation events (OR = 2.14, 95% CI: 1.04–4.10; p = 0.0289). In our serum cohort, sensitization to Aspergillus spp. was the most common fungal sensitization, with 23.6% (n = 60) had a class 3 and above sensitization (positive sensitization; sIgE titers of > 3.5 kU/L) against this allergen. Increasing sIgE titer against Aspergillus spp. was also correlated with increased AR risk and AR-related symptoms. In conclusion, our findings emphasize an important role of fungal sensitization in the manifestations of asthma and AR in the Southeast Asian Chinese population.
Highlights
The worldwide prevalence of allergic diseases, including asthma, allergic rhinitis (AR), and atopic dermatitis (AD), has increased over the past decades [1,2,3]
A positive skin prick test (SPT) reaction to the Curvularia lunata allergen was significantly associated with an increased susceptibility to asthma and AR, but not AD (Table 1)
Curvularia lunata sensitization was significantly associated with the presence of some recent asthma symptoms or exacerbation events, which included wheezing, general practitioner/specialist visits, and any asthma-related exacerbation event (Table 1)
Summary
The worldwide prevalence of allergic diseases, including asthma, allergic rhinitis (AR), and atopic dermatitis (AD), has increased over the past decades [1,2,3]. AR has been considered as a post-industrial revolution epidemic due to increase in urbanization air pollution [5]. The ongoing fourth industrial revolution will continue to exacerbate allergic diseases due to air pollution and climate change [6]. In the tropical urban environment of Singapore, multiple fungal species including Cladosporium spp., Didymosphaeria spp., Curvularia spp., Drechslera spp., and Pithomyces spp. were the most dominant fungal spore type in the total outdoor airspora and their spores densities were affected by temperature and relative humidity [7]. We report the association of airborne fungal sensitization with allergic disease susceptibility and severity in a Southeast Asian Chinese population. Using a cross-sectional cohort of 9923 Singapore/ Malaysia Chinese adults, we assessed their Curvularia lunata sensitization profile using skin prick test (SPT) and compared across their asthma-, AR-, or ADrelated phenotypes. Using a subset of serum samples, we evaluated specific Immunoglobulin E (specific IgE or sIgE) titers against multiple fungal allergens presented in the tropical Asia environment and associated them with AR-related phenotypes
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