Substance Info: (and synonyms)|
Cladosporium herbarum (Hormodendrum) Background Info:
Fungi related to allergies are commonly found in dwelling environments. The predominant fungi Cladosporium, Penicillium, Aspergillus, Alternaria, Wallemia and Rhodotorula live mainly in indoor air, house dust (HD), futons, clothes and contaminated building materials.
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Epidemiologic studies in the United States and Europe have associated mold sensitivity, particularly to Alternaria alternata and Cladosporium herbarum, with the development, persistence, and severity of asthma. In addition, sensitivity to Aspergillus fumigatus has been associated with severe persistent asthma in adults. Allergic bronchopulmonary aspergillosis (ABPA) is caused by A fumigatus and is characterized by exacerbations of asthma, recurrent transient chest radiographic infiltrates, coughing up thick mucus plugs, peripheral and pulmonary eosinophilia, and increased total serum IgE and fungus-specific IgE levels, especially during exacerbation. The airways appear to be chronically or intermittently colonized by A fumigatus in patients with ABPA. ABPA is the most common form of allergic bronchopulmonary mycosis (ABPM); other fungi, including Candida, Penicillium, and Curvularia species, are implicated. The characteristics of ABPM include severe asthma, eosinophilia, markedly increased total IgE and specific IgE levels, bronchiectasis, and mold colonization of the airways. The term severe asthma associated with fungal sensitization (SAFS) has been coined to illustrate the high rate of fungal sensitivity in patients with persistent severe asthma and improvement with antifungal treatment. The immunopathology of ABPA, ABPM, and SAFS is incompletely understood.
Knutsen AP, Bush RK, Demain JG, Denning DW, Dixit A, Fairs A, Greenberger PA, Kariuki B, Kita H, Kurup VP, Moss RB, Niven RM, Pashley CH, Slavin RG, Vijay HM, Wardlaw AJ. Fungi and allergic lower respiratory tract diseases. J Allergy Clin Immunol 2012 Feb;129(2):280-291
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Two hypersensitivity pneumonitis (HP) cases which developed in an office area and in a home in Japan: a 47-year-old woman with acute-onset HP and a 72-year-old woman with chronic HP followed up as idiopathic pulmonary fibrosis following isolation of Cladosporium cladosporioides and Cladosporium herbarum, respectively. (Chiba 2009 ref.24948 7)
Chiba S, Okada S, Suzuki Y, Watanuki Z, Mitsuishi Y, Igusa R, Sekii T, Uchiyama B. Cladosporium species-related hypersensitivity pneumonitis in household environments. Intern Med 2009;48(5):363-7.
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This study was performed to delineate the prevalence of, and evaluate possible risk factors for, adverse reactions to SPT in a prospective study of 5,908 patients aged =18 yr. The adverse reactions were classified into two groups: (1) Generalized allergic reactions (GAR), (2) Vasovagal reactions (VVR). Adverse reactions were observed in 14 out of 5,908 children examined with SPT. Seven of the adverse reactions were GARs and required medication, yielding a 0.12% risk for GAR.
Generalized allergic reactions
1. Boy, 5 m, eczema. Tested with 4 allergens, positive for cows milk and egg. After 10 min developed generalized urticaria, severe pruritus, swelling of the arm where the tests were performed, and excessive crying.
2. Boy, 6 m, eczema. Test with cows milk. After 10 min, generalized erythema, severe pruritus, itchy, red conjunctivae, vomiting.
3. Girl, 6 m, eczema. SPT with 5 allergens. Positive to egg, milk, wheat, rye, dog. Generalized urticaria, severe pruritus and reddening of eczema over the whole body.
4. Girl, 8 m, occasional urticaria when exposed to a casein hydrolysate formula on the skin, drop test negative. SPT with two allergens, both positive (Nutramigen and Profylac). After 10-15 min urticaria and pruritus.
5. Boy, 5.5 y, eczema, allergy to cows milk and egg. SPT to four allergens, positive to egg white and dog. After 10 min, sore throat, hoarseness, becomes pale, starts to cough and goes into cold sweat.
6. Boy, 10.5 y, with asthma and urticaria occasionally. SPT with 4 allergens, positive to almond and peanut. Complains of nasal congestion after 10 min.
7. Boy, 11 y, eczema, rhinitis, asthma. SPT with 9 allergens, positive tests to 7 (dog, cat, horse, birch, timothy, Cladosporium and Aspergillus). Nasal congestion and red, itchy and watery eyes.
(Norrman 2009 ref.23010 7)
Norrman G, Falth-Magnusson K. Adverse reactions to skin prick testing in children - Prevalence and possible risk factors. Pediatr Allergy Immunol 2009 Feb 4;
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In this Australian study, participants whose Cladosporium fungal exposure doubled had 52% greater odds of having had an attack of asthma in the last 12 months. A doubling of fungal exposure was also associated with 53% greater odds of developing atopy. A doubling of Fel d 1 floor levels was associated with 73% increased odds of doctor-diagnosed asthma. A doubling of Der p 1 levels in bed dust was associated with a 64% greater odds of persistent bronchial hyper-reactivity. (Matheson 2005 ref.12059 7)
Matheson MC, Abramson MJ, Dharmage SC, Forbes AB, Raven JM, Thien FC, Walters EH. Changes in indoor allergen and fungal levels predict changes in asthma activity among young adults. Clin Exp Allergy 2005 Jul;35(7):907-13.
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In this New York study, analysis showed that the presence of hypersensitivity to either A. tenuis or C. herbarum had a significant independent association with asthma after adjustment for cat/dust mite hypersensitivity and after adjustment for other clinical factors. (Lin 2003 ref.24956 8)
Lin RY, Williams KD. Hypersensitivity to molds in New York City in adults who have asthma. Allergy Asthma Proc 2003 Jan-Feb;24(1):13-8.
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In an Italian study, skin prick tests were applied to a cohort of 4962 respiratory subjects, aged 3-80 years. Fungal extracts from Alternaria, Aspergillus, Candida, Cladosporium, Penicillium, Saccharomyces, and Trichophyton were used, along with extracts from pollens, mites, and animal dander. Nineteen percent of the allergic population reacted to at least one fungal extract by means of the skin test. Alternaria and Candida accounted for the largest number of positive tests, and along with Trichophyton they were the main sensitizers in the subset of patients with an isolated sensitization. (Mari 2003 ref.10913 4)
Mari A, Schneider P, Wally V, Breitenbach M, Simon-Nobbe B. Sensitization to fungi: epidemiology, comparative skin tests, and IgE reactivity of fungal extracts. Clin Exp Allergy 2003;33(10):1429-38
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In 553 asthmatics in Kuwait, sensitisation to common aeroallergens as measured by serum specific IgE was: pollens (87.1%), house dust (76.1%), and molds (30.3%). The three most prevalent sensitizing pollens were from Chenopodium (S. kali) (70.7%), Bermuda grass (62.9%), and Prosopis (62.7%), all of which are horticultural plants imported for the purpose of "greening" the desert.
Frequency of sensitization to individual allergens among confirmed extrinsic asthmatics:
Allergens All patients (n=482)
Chenopodium weed 70.7
Bermuda grass 62.9
Prosopis tree 62.7
Cajeput tree 53.5
D. pteronyssinus 46.5
D. microceras 44.8
Eucalyptus tree 42.9
Date palm 39.6
D. farinae 38.6
Cat dander 30.9
(Ezeamuzie 2000 ref.4940 5)
Ezeamuzie CI, Thomson MS, Al-Ali S, Dowaisan A, Khan M, Hijazi Z. Asthma in the desert: spectrum of the sensitizing aeroallergens. Allergy 2000;55(2):157-62
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In 100 Thai individuals who were diagnosed with allergic rhinitis by history and clinical presentation who underwent a prick skin test with 30 aeroallergens:TREES: acacia 19%, mango 16%, coconut 12%. GRASSES: bermuda 17%, johnson 21%, timothy 16%, bahia 16% orchard 18%. WEEDS: pigweed 16%, kochia 14%. MOLDS: alternaria 11%, cladosporium 11%, aspergillus 12%, penicillium 16%, helminthosporium 16%, botrytis 15%, rhodotorula 20%, fusarium 26%, curvularia 26%, smut mix 11%, rust 9%. EPIDERMALS: cat 29%, dog 28%, feathers 37%. INDOOR ALLERGENS: house dust 72%, D. pteronyssinus 76%, D. farinae 79%, American cockroach 60%, German cockroach 41%, kapok 30%. Eighty-five percent of patients sensitive to house dust mites were positive to both D. pteronyssinus and D. farinae. (Pumhirun 1997 ref.2256 8)
Pumhirun P, Towiwat P, Mahakit P. Aeroallergen sensitivity of Thai patients with allergic rhinitis. Asian Pac J Allergy Immunol 1997;15(4):183-5
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A 6-year-old child was seen who, for the last 3 years, had had several febrile episodes of cough, dyspnea, green-brown sputum production, and wheezing. Chest xray had shown pulmonary infiltrates on
several occasions. Skin prick tests were positive to Cladosporium herbarum. Total IgE level was 1771 ng/ml. Specific IgE was positive to Cladosporium herbarum (14.8 kU/L), Alternaria tenuis (0.7 kU/L), and Aspergillus fumigatus (0.57 kU/L). Specific IgE to other fungi were
negative (<0.35 kU/L). Specific IgG were positive to Cladosporium herbarum, Alternaria tenuis, and Aspergillus fumigatus. Precipitating antibodies measured by immune electrodiffussion in agar plaque were
found positive only against Cladosporium herbarum. A diagnosis of acute phase of ABPM (allergic bronchopulmonary cladosporiosis) was established (stage 1). Cladosporium herbarum was considered to be the causative agent. (Moreno-Ancillo 1996 ref.24947 5)
Moreno-Ancillo A, Díaz-Pena JM, Ferrer A, Martín-Muñoz F, Martín-Barroso JA, Martin-Esteban M, Ojeda JA. Allergic bronchopulmonary cladosporiosis in a child. J Allergy Clin Immunol 1996 Feb;97(2):714-5.
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Of 981 children on the Isle of Wight, followed for atopy at age 4 years, and skin-prick tested with a battery of allergens, 61 (6%) reacted positively to Alternaria alternata and Cladosporium herbarum. (Tariq 1996 ref.2647 3)
Tariq SM, Matthews SM, Stevens M, Hakim EA Sensitization to Alternaria and Cladosporium by the age of 4 years. Clin Exp Allergy 1996;26(7):794-8
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Elevated mean concentrations for the group of fungi including Cladosporium, Epicoccum, Aureobasidium, and yeast spp. were found to be associated (P = 0.03) with allergy symptoms reported on a health questionnaire. (Su 1992 ref.13275 0)
Su JH, Rotnitzky A, Burge HA, Spengler JD. Examination of fungi in domestic interiors by using factor analysis: correlations and associations with home factors. Appl Environ Microbiol 1992;58:181-186
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Cladosporium is one of the moulds most widely studied and most often producing positive skin test reactions in allergic individuals. In a study of 1300 asthmatic children from Finland, 7.1% had positive (3+) SPT reactions to Cladosporium, which was the most common mould allergen causing symptoms in that study. (Foucard 1984 ref.1225 4)
Foucard T, Dreborg S. Eds. Mould Allergy Workshop. Pharmacia Diagnostics AB. Uppsala. Sweden 1984;c1984
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290 asthmatic patients with positive skin tests for mould allergens were analyzed retrospectively. Tests with Alternaria alternata, Aureobasidium pullulans, Penicillium notatum, Fusarium culmorum, Aspergilus fumigatus and Cladosporium herbarum showed the highest correlation with clinical allergy. (Kersten 1980 ref.11485 7)
Kersten W, Hoek GT. Mould allergy (author's transl). [German] Wien Med Wochenschr 1980;130(8):275-82
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In a study evaluating the incidence, abundance and species diversity of fungi in chronic wounds, a total of 915 chronic wounds was evaluated in a retrospective study. 208 (23%) were positive for fungal species. The most abundant fungi were yeasts in the genus Candida; however, Curvularia, Malessezia, Aureobasidium, Cladosporium, Ulocladium, Engodontium and Trichtophyton were also found to be prevalent components of these polymicrobial infections. (Dowd 2011 ref.25754 7)
Dowd SE, Delton Hanson J, Rees E, Wolcott RD, Zischau AM, Sun Y, White J, Smith DM, Kennedy J, Jones CE. Survey of fungi and yeast in polymicrobial infections in chronic wounds. J Wound Care 2011 Jan;20(1):40-7.
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Two cases of chromomycosis due to Fonsecaea pedrosoi and Cladosporium herbarum, observed in two women from the Tlemcen region in France. Due to the wart-like or nodular lesions, these case were mistaken for other skin diseases with similar manifestations, particularly verrucous tuberculosis and cutaneous leishmaniasis. The histology revealed fumagoid bodies leading to the identification of the causative agents. Chromomycosis is rare in Algeria although 3 cases have been observed in our area since 1989. (Boudghène-Stambouli 1994 ref.24962 2)
Boudghène-Stambouli O, Mérad-Boudia A. Chromomycosis: 2 cases. [French] Ann Dermatol Venereol 1994;121(1):37-9.
[ 1 ]
Recent studies suggest that besides the long-known farmer's lung antigen sources Saccharopolyspora rectivirgula (Micropolyspora faeni), Thermoactinomyces vulgaris, and Aspergillus fumigatus, additionally the mold Absidia (Lichtheimia) corymbifera as well as the bacteria Erwinia herbicola (Pantoea agglomerans) and Streptomyces albus may cause farmer's lung in Germany. In this study the sera of 64 farmers with a suspicion of farmer's lung were examined for the following further antigens: Wallemia sebi, Cladosporium herbarum, Aspergillus versicolor, and Eurotium amstelodami. Our results indicate that these molds are not frequent causes of farmer's lung in Germany (Sennekamp 2012 ref.28653 0)
Sennekamp J, Joest M, Sander I, Engelhart S, Raulf-Heimsoth M. Farmer's lung antigens in Germany. [German] Pneumologie 2012 May;66(5):297-301
[ 2 ]
Five consecutive cases of Hypersensitivity Pneumonitis in subjects working in a salami factory was observed. The workers had to clean the white mould growing on salami surface using a manual wire brush. Three patients had an acute clinical presentation with fever, dyspnoea, dry cough, oxygen desaturation, and presented at the emergency department with suspected diagnosis of community acquired pneumonia. The mean latency for developing respiratory symptoms was 11.6 days. Pulmonary function test demonstrated a reduction in diffusing capacity in all 5 patients. Skin prick test was positive for Penicillium spp in 3 cases and for Cladosporium and Aspergillus spp in 2 others. Specific IgG antibodies against Penicillium spp were positive in 3 subjects; 2 were positive for Aspergillus Fumigatus. Four subjects had a complete radiological and clinical resolution after changing work. (Marvisi 2012 ref.28094 9)
Marvisi M, Balzarini L, Mancini C, Mouzakiti P. A new type of Hypersensitivity Pneumonitis: salami brusher's disease. Monaldi Arch Chest Dis 2012 Mar;77(1):35-37
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Asthma in a patient, which was difficult to diagnosis from an etiological viewpoint. Routine diagnostic tests were unhelpful in determining the causal allergens, although the clinical history suggested that allergens were confined to a restricted environment. Aerobiological sampling using a battery-powered portable device allowed identification of the responsible allergen, Alternaria in one case and thuja pollen in the other. Once environmental care had been performed, the patients' symptoms rapidly improved and antiasthma therapy could be stepped down or discontinued. This study suggests that, in selected cases of difficult diagnosis the presence of proximity allergens is suspected, aerobiological sampling with a portable device should be considered. (Monso 2004 ref.11189 7)
Monso E. Occupational asthma in greenhouse workers. Curr Opin Pulm Med 2004;10(2):147-50.