ALTERNARIA ALTERNATA AS THE MAJOR FUNGAL ALLERGEN: MOLECULAR ANALYSIS OF FUNGAL SENSITIZATION PATTERNS

Yana Reznik, Olga Dzekan, Victoria Rodinkova, Serhii Yuriev


DOI: http://dx.doi.org/10.30970/sbi.2001.870

Abstract


Background. Among the agents causing respiratory and skin pathologies, fungal allergens play a significant role. The epidemiological situation regarding fungal sensitization in Ukraine, specifically in the Vinnytsia region, remains insufficiently studied. Conversely, its characteristics, defined at both the individual and population levels, may contribute to understanding patterns relevant to prevention of fungal allergy. The aim of our study was to evaluate the prevalence and analyze the sensitivity profiles to fungal allergens among residents of the Vinnytsia region.
Materials and Methods. We analyzed sensitization profiles to 13 fungal allergens in 2,623 residents of the Vinnytsia region using the ALEX multicomponent test. We considered sIgE levels for major molecules and extracts of Alternaria, Aspergillus, Cladosporium, Malassezia, Penicillium, and Saccharomyces (sensitivity threshold ≥ 0.31 kU/L). We examined the overall prevalence and isolated sensitization cases. Statistical analysis utilized non-parametric methods (Mann–Whitney U-test, χ² with Yates’ correction, p < 0.05) in Statistica 8.0 and MS Excel.
Results. The overall prevalence of sensitization to fungal allergens was 9.57 %, and it was 1.85 times more common in children. The leading allergen was Alternaria alternata (Alt a 1), with sensitivity observed in 70.12 % of patients sensitized to fungal components. Among children, 82.93 % were sensitized to Alt a 1 alone. The mediansIgE value for Alt a 1 in children (25.64 kU/L) was significantly higher than in adults (7.87 kU/L) and was the highest among sIgE levels for all fungal components. Aspergillus fumigatus allergens (Asp f 1, Asp f 6) did not show isolated sensitization, which is consistent with their classification as secondary sensitizing agent, although their sIgE levels were substantial. Adults showed more frequent sensitization to Asp f 1 and Asp f 6, while sensitivity to Alt a 1 and Mala s 6 was more prominent in children.
Conclusions. The obtained data confirm a high prevalence of fungal sensitization in the Vinnytsia region, particularly hypersensitivity to Alt a 1 among children. The identified age-related and immunological features of allergen sensitivity could contribute to the diagnosis and development of effective, personalized allergen-specific immunotherapy programs.


Keywords


allergic diseases, fungal sensitization, multicomponent molecular allergy diagnostics, molecular sensitization profiles, Alternaria alternata, Malassezia sympodialis, polysensitization

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Abel-Fernández, E., Martínez, M. J., Galán, T., & Pineda, F. (2023). Going over fungal allergy: Alternaria alternata and its allergens. Journal of Fungi, 9(5), 582. doi:10.3390/jof9050582
CrossrefPubMedPMCGoogle Scholar

Alska, E., Doligalska, A., Napiórkowska-Baran, K., Dolina, M., Osińska, K., Pilichowicz, A., Wojtkiewicz, A., Kaczor, J. J., Szymczak, B., & Bartuzi, Z. (2025). Global burden of allergies: mechanisms of development, challenges in diagnosis, and treatment. Life, 15(6), 878. doi:10.3390/life15060878
CrossrefPubMedPMCGoogle Scholar

Altrichter, S., Schumacher, P., Alraboni, O., Wang, Y., Hiragun, M., Hide, M., & Maurer, M. (2020). Sensitization against skin resident fungi is associated with atopy in cholinergic urticaria patients. Clinical and Translational Allergy, 10(1), 18. doi:10.1186/s13601-020-00324-z
CrossrefPubMedPMCGoogle Scholar

Anderegg, W. R. L., Abatzoglou, J. T., Anderegg, L. D. L., Bielory, L., Kinney, P. L., & Ziska, L. (2021). Anthropogenic climate change is worsening North American pollen seasons. Proceedings of the National Academy of Sciences, 118(7), e2013284118. doi:10.1073/pnas.2013284118
CrossrefPubMedPMCGoogle Scholar

Anees-Hill, S., Douglas, P., Pashley, C. H., Hansell, A., & Marczylo, E. L. (2022). A systematic review of outdoor airborne fungal spore seasonality across Europe and the implications for health. Science of The Total Environment, 818, 151716. doi:10.1016/j.scitotenv.2021.151716
CrossrefPubMedPMCGoogle Scholar

Arshad, S., Kurukulaaratchy, R., Holloway, J., Carra, S., Ewart, S., Karmaus, W., Vijayanand, P., Seumois, G., & Zhang, H. (2024). The association of alternaria sensitization with asthma and allergic rhinitis in the Isle of Wight cohort from early childhood to adulthood. Journal of Allergy and Clinical Immunology, 153(2), AB361. doi:10.1016/j.jaci.2023.11.856
CrossrefGoogle Scholar

Asano, K., Hebisawa, A., Ishiguro, T., Takayanagi, N., Nakamura, Y., Suzuki, J., Okada, N., Tanaka, J., Fukutomi, Y., Ueki, S., Fukunaga, K., Konno, S., Matsuse, H., Kamei, K., Taniguchi, M., Shimoda, T., & Oguma, T. (2021). New clinical diagnostic criteria for allergic bronchopulmonary aspergillosis/mycosis and its validation. Journal of Allergy and Clinical Immunology, 147(4), 1261-1268.e5. doi:10.1016/j.jaci.2020.08.029
CrossrefPubMedGoogle Scholar

Belda, I., Ruiz, J., Santos, A., Van Wyk, N., & Pretorius, I. S. (2019). Saccharomyces cerevisiae. Trends in Genetics, 35(12), 956-957. doi:10.1016/j.tig.2019.08.009
CrossrefPubMedGoogle Scholar

Bohomolov, A. Ye., & Zaikov, S. V. (2020). Analiz diahnostychnykh parametriv imunoblotynhu dlia vyznachennia sensybilizatsii do pylkovykh alerheniv u patsiientiv z respiratornymy zakhvoriuvanniamy [Analysis of immunoblotting diagnostic parameters for determination of sensibilization to pollen allergens in patients with respiratory diseases]. Infectious Diseases - Infektsiyni Khvoroby, 1, 32-36. doi:10.11603/1681-2727.2020.1.11096 (In Ukrainian)
CrossrefGoogle Scholar

Bush, A. (2020). Kids, difficult asthma and fungus. Journal of Fungi, 6(2), 55. doi:10.3390/jof6020055
CrossrefPubMedPMCGoogle Scholar

Cacheiro-Llaguno, C., Mösges, R., Calzada, D., González-de la Fuente, S., Quintero, E., & Carnés, J. (2024). Polysensitisation is associated with more severe symptoms: the reality of patients with allergy. Clinical & Experimental Allergy, 54(8), 607-620. doi:10.1111/cea.14486
CrossrefPubMedGoogle Scholar

Celakovská, J., Josef, B., Ettler, K., Vaneckova, J., Ettlerova, K., & Jan, K. (2018). Sensitization to fungi in atopic dermatitis patients 14 year and older - association with other atopic diseases and parameters. Indian Journal of Dermatology, 63(5), 391. doi:10.4103/ijd.ijd_493_17
CrossrefPubMedPMCGoogle Scholar

Celakovska, J., Vankova, R., Bukac, J., Cermakova, E., Andrys, C., & Krejsek, J. (2021). Atopic dermatitis and sensitisation to molecular components of Alternaria, Cladosporium, Penicillium, Aspergillus, and Malassezia - results of allergy explorer ALEX 2. Journal of Fungi, 7(3), 183. doi:10.3390/jof7030183
CrossrefPubMedPMCGoogle Scholar

Cervantes, R., Pena, P., Riesenberger, B., Rodriguez, M., Henderson, D., Gonçalves, S., Newire, E., Pogner, C., Salonen, H., Almeida Silva, M., Ferguson, R. M. W., Haverinen-Shaughnessy, U., & Viegas, C. (2025). Critical insights on fungal contamination in schools: a comprehensive review of assessment methods. Frontiers in Public Health, 13, 1557506. doi:10.3389/fpubh.2025.1557506
CrossrefPubMedPMCGoogle Scholar

Chen, H., Zhang, X., Zhu, L., An, N., Jiang, Q., Yang, Y., Ma, D., Yang, L., & Zhu, R. (2022). Clinical and immunological characteristics of Aspergillus fumigatus-sensitized asthma and allergic bronchopulmonary aspergillosis. Frontiers in Immunology, 13, 939127. doi:10.3389/fimmu.2022.939127
CrossrefPubMedPMCGoogle Scholar

De Linares, C., Navarro, D., Puigdemunt, R., & Belmonte, J. (2023). Aspergillus conidia and allergens in outdoor environment: a health hazard? Journal of Fungi, 9(6), 624. doi:10.3390/jof9060624
CrossrefPubMedPMCGoogle Scholar

Dramburg, S., Hilger, C., Santos, A. F., de Las Vecillas, L., Aalberse, R. C., Acevedo, N., ... & Hoffmann-Sommergruber, K. (2023). EAACI molecular allergology user's guide 2.0. Pediatric Allergy and Immunology, 34(S28), e13854. doi:10.1111/pai.13854
CrossrefPubMedGoogle Scholar

Fang, H., Li, J., Ren, L., & Liu, E. (2023). Age-related differences in IgE between childhood and adulthood allergic asthma: analysis of NHANES 2005-2006. World Allergy Organization Journal, 16(12), 100842. doi: 10.1016/j.waojou.2023.100842
CrossrefPubMedPMCGoogle Scholar

Fernández-Soto, R., Navarrete-Rodríguez, E. M., Del-Rio-Navarro, B. E., Sienra-Monge, J. J. L., Meneses-Sánchez, N. A., & Saucedo-Ramírez, O. J. (2018). Fungal allergy: pattern of sensitization over the past 11 years. Allergologia et Immunopathologia, 46(6), 557-564. doi:10.1016/j.aller.2018.01.005
CrossrefPubMedGoogle Scholar

Forkel, S., Beutner, C., Schröder, S. S., Bader, O., Gupta, S., Fuchs, T., Schön, M. P., Geier, J., & Buhl, T. (2021). Sensitization against fungi in patients with airway allergies over 20 years in Germany. International Archives of Allergy and Immunology, 182(6), 515-523. doi:10.1159/000512230
CrossrefPubMedPMCGoogle Scholar

Frisk, C. A., Brobakk, T. E., & Ramfjord, H. (2024). Allergenic pollen seasons and regional pollen calendars for Norway. Aerobiologia, 40(2), 145-159. doi:10.1007/s10453-023-09806-6
CrossrefGoogle Scholar

Goh, K. J., Yii, A., Lapperre, T., Chan, A., Chew, F., Chotirmall, S., & Koh, M. (2017). Sensitization to Aspergillus species is associated with frequent exacerbations in severe asthma. Journal of Asthma and Allergy, 10, 131-140. doi:10.2147/jaa.s130459
CrossrefPubMedPMCGoogle Scholar

Gueçamburu, M., Dupont, A., Djidonou, B., Thibaut de Ménonville, C., Barakat, L., Laborier, F., Le Brun, M., Dupin, C., Neukirch, C., & Taillé, C. (2025). Monosensitization vs polysensitization in severe asthma: implications for disease severity. Journal of Asthma and Allergy, 18, 683-694. doi:10.2147/jaa.s502442
CrossrefPubMedPMCGoogle Scholar

Hernandez-Ramirez, G., Barber, D., Tome-Amat, J., Garrido-Arandia, M., & Diaz-Perales, A. (2021). Alternaria as an inducer of allergic sensitization. Journal of Fungi, 7(10), 838. doi:10.3390/jof7100838
CrossrefPubMedPMCGoogle Scholar

Hughes, K. M., Price, D., Torriero, A. A. J., Symonds, M. R. E., & Suphioglu, C. (2022). Impact of fungal spores on asthma prevalence and hospitalization. International Journal of Molecular Sciences, 23(8), 4313. doi:10.3390/ijms23084313
CrossrefPubMedPMCGoogle Scholar

Izmailovich, M., Semenova, Y., Abdushukurova, G., Mukhamejanova, A., Dyussupova, A., Faizova, R., Gazaliyeva, M., Akhvlediani, L., Glushkova, N., Kalmakhanov, S., & Bjørklund, G. (2023). Molecular aspects of allergen-specific immunotherapy in patients with seasonal allergic rhinitis. Cells, 12(3), 383. doi:10.3390/cells12030383
CrossrefPubMedPMCGoogle Scholar

Kader, H. A., Azeem, M., Jwayed, S. A., Al-Shehhi, A., Tabassum, A., Ayoub, M. A., Hetta, H. F., Waheed, Y., Iratni, R., Al-Dhaheri, A., & Muhammad, K. (2021). Current insights into immunology and novel therapeutics of atopic dermatitis. Cells, 10(6), 1392. doi:10.3390/cells10061392
CrossrefPubMedPMCGoogle Scholar

Kasprzyk, I., Rodinkova, V., Šaulienė, I., Ritenberga, O., Grinn-Gofron, A., Nowak, M., Sulborska, A., Kaczmarek, J., Weryszko-Chmielewska, E., Bilous, E., & Jedryczka, M. (2015). Air pollution by allergenic spores of the genus Alternaria in the air of central and eastern Europe. Environmental Science and Pollution Research, 22(12), 9260-9274. doi:10.1007/s11356-014-4070-6
CrossrefPubMedPMCGoogle Scholar

Klain, A., Giovannini, M., Arasi, S., Barni, S., Castagnoli, R., Caminiti, L., Gelsomino, M., Liotti, L., Mastrorilli, C., Mori, F., Pecoraro, L., Saretta, F., Miraglia del Giudice, M., & Novembre, E. (2025). Alternaria allergy and asthma in children. Medicina, 61(9), 1639. doi:10.3390/medicina61091639
CrossrefPubMedPMCGoogle Scholar

Kwong, K., Robinson, M., Sullivan, A., Letovsky, S., Liu, A. H., & Valcour, A. (2023). Fungal allergen sensitization: prevalence, risk factors, and geographic variation in the United States. Journal of Allergy and Clinical Immunology, 152(6), 1658-1668. doi:10.1016/j.jaci.2023.09.010
CrossrefPubMedGoogle Scholar

Latgé, J. P., & Chamilos, G. (2019). Aspergillus fumigatus and aspergillosis in 2019. Clinical Microbiology Reviews, 33(1), e00140-18. doi:10.1128/cmr.00140-18
CrossrefPubMedPMCGoogle Scholar

López Couso, V. P., Tortajada-Girbés, M., Rodriguez Gil, D., Martínez Quesada, J., & Palacios Pelaez, R. (2021). Fungi sensitization in Spain: importance of the Alternaria alternata species and its major allergen Alt a 1 in the allergenicity. Journal of Fungi, 7(8), 631. doi:10.3390/jof7080631
CrossrefPubMedPMCGoogle Scholar

Lukaszewicz, R., Mahay, G., Boyer, O. & Martinet, J. (2022). Medical algorithm: Aspergillus fumigatus components in the diagnosis of allergic bronchopulmonary aspergillosis. Allergy, 77(1), 327-330. doi:10.1111/all.15001
CrossrefPubMedGoogle Scholar

Michel, M., Sereme, Y., Mankouri, F., Gouitaa, M., Gautier, C., Mège, J.-L., Cassagne, C., Ranque, S., Reynaud-Gaubert, M., & Vitte, J. (2022). Basophil activation test with Aspergillus molecules: the case for ABPA. Frontiers in Allergy, 3, 898731. doi:10.3389/falgy.2022.898731
CrossrefPubMedPMCGoogle Scholar

Mistry, H., Ajsivinac Soberanis, H. M., Kyyaly, M. A., Azim, A., Barber, C., Knight, D., Newell, C., Haitchi, H. M., Wilkinson, T., Howarth, P., Seumois, G., Vijayanand, P., Arshad, S. H., & Kurukulaaratchy, R. J. (2021). The clinical implications of Aspergillus fumigatus sensitization in difficult-to-treat asthma patients. The Journal of Allergy and Clinical Immunology: In Practice, 9(12), 4254-4267.e10. doi:10.1016/j.jaip.2021.08.038
CrossrefPubMedGoogle Scholar

Nageen, Y., Wang, X., & Pecoraro, L. (2023). Seasonal variation of airborne fungal diversity and community structure in urban outdoor environments in Tianjin, China. Frontiers in Microbiology, 13, 1043224. doi:10.3389/fmicb.2022.1043224
CrossrefPubMedPMCGoogle Scholar

Nowicka, D., & Nawrot, U. (2019). Contribution of Malassezia spp. to the development of atopic dermatitis. Mycoses, 62(7), 588-596. doi:10.1111/myc.12913
CrossrefPubMedGoogle Scholar

Parapouli, M., Vasileiadis, A., Afendra, A. S., & Hatziloukas, E. (2020). Saccharomyces cerevisiae and its industrial applications. AIMS Microbiology, 6(1), 1-31. doi:10.3934/microbiol.2020001
CrossrefPubMedPMCGoogle Scholar

Paredes Idiaquez, A., Calderón-Llosa, O., Feliciano, M., & Sánchez-Reyes, E. (2025). Analysis of airborne fungal spores in Lima, Perú (2021-2024): seven clinically important spore types. Atmosphere, 16(9), 1069. doi:10.3390/atmos16091069
CrossrefGoogle Scholar

Patchett, B. J., Nriagu, B. N., Mavraj, G., Patel, R. R., MacLellan, C., Thakur, T., & Schulman, E. S. (2023). Allergic polysensitization clusters: newly recognized severity marker in urban asthmatic adults. International Archives of Allergy and Immunology, 184(3), 261-272. doi:10.1159/000526706
CrossrefPubMedGoogle Scholar

Rapeport, W. G., Ito, K. & Denning, D. W. (2020). The role of antifungals in the management of patients with severe asthma. Clinical and Translational Allergy, 10, 46. doi:10.1186/s13601-020-00353-8
CrossrefPubMedPMCGoogle Scholar

Rhee, C.-S., Wee, J. H., Ahn, J.-C., Lee, W. H., Tan, K. L., Ahn, S., Lee, J. H., Lee, C.-H., Cho, Y.-S., Park, K. H., Lee, K. H., Kim, K.-S., Lee, A., & Kim, J.-W. (2014). Prevalence, risk factors and comorbidities of allergic rhinitis in South Korea: the fifth Korea national health and nutrition examination survey. American Journal of Rhinology & Allergy, 28(2), e107-e114. doi:10.2500/ajra.2014.28.4040
CrossrefPubMedGoogle Scholar

Rodinkova, V., Yuriev, S., Mokin, V., Kryvopustova, M., Shmundiak, D., Bortnyk, M., Kryzhanovskyi, Y., & Kurchenko, A. (2024). Bayesian analysis suggests independent development of sensitization to different fungal allergens. World Allergy Organization Journal, 17(5), 100908. doi:10.1016/j.waojou.2024.100908
CrossrefPubMedPMCGoogle Scholar

Rodríguez, D., Tabar, A. I., Castillo, M., Martínez-Gomariz, M., Dobski, I. C., & Palacios, R. (2021). Changes in the sensitization pattern to Alternaria alternata allergens in patients treated with Alt a 1 immunotherapy. Journal of Fungi, 7(11), 974. doi:10.3390/jof7110974
CrossrefPubMedPMCGoogle Scholar

Sánchez, P., Vélez-del-Burgo, A., Suñén, E., Martínez, J., & Postigo, I. (2022). Fungal allergen and mold allergy diagnosis: role and relevance of Alternaria alternata Alt a 1 protein family. Journal of Fungi, 8(3), 277. doi:10.3390/jof8030277
CrossrefPubMedPMCGoogle Scholar

Sio, Y. Y., Pang, S. L., Say, Y.-H., Teh, K. F., Wong, Y. R., Shah, S. M. R., Reginald, K., & Chew, F. T. (2021). Sensitization to airborne fungal allergens associates with asthma and allergic rhinitis presentation and severity in the Singaporean/Malaysian population. Mycopathologia, 186(5), 583-588. doi:10.1007/s11046-021-00532-6
CrossrefPubMedPMCGoogle Scholar

Sztandera-Tymoczek, M., & Szuster-Ciesielska, A. (2023). Fungal aeroallergens - the impact of climate change. Journal of Fungi, 9(5), 544. doi:10.3390/jof9050544
CrossrefPubMedPMCGoogle Scholar

Storz, L., Schmid, B., Bosshard, P. P., Schmid-Grendelmeier, P., Brüggen, M. C., & Lang, C. (2024). Decreased skin colonization with Malassezia spp. and increased skin colonization with Candida spp. in patients with severe atopic dermatitis. Frontiers in Medicine, 11, 1353784. doi:10.3389/fmed.2024.1353784
CrossrefPubMedPMCGoogle Scholar

Tiew, P. Y., Narayana, J. K., Quek, M. S. L., Ang, Y. Y., Ko, F. W. S., Poh, M. E., Jaggi, T. K., Xu, H., Thng, K. X., Koh, M. S., Tee, A., Hui, D. S. C., Abisheganaden, J. A., Tsaneva-Atanasova, K., Chew, F. T., & Chotirmall, S. H. (2023). Sensitisation to recombinant Aspergillus fumigatus allergens and clinical outcomes in COPD. European Respiratory Journal, 61(1), 2200507. doi:10.1183/13993003.00507-2022
CrossrefPubMedPMCGoogle Scholar

Torres-Borrego, J., Suárez-Pérez, J., Aliaga-Mazas, Y., Martínez-Cañavate Burgos, A., & Nevot-Falcó, S. (2025). Allergy to Alternaria alternata: comprehensive review from the origin to the therapeutic approach. Allergologia et Immunopathologia, 53(5), 179-188. doi:10.15586/aei.v53i5.1454
CrossrefPubMedGoogle Scholar

Wardlaw, A. J., Rick, E.-M., Pur Ozyigit, L., Scadding, A., Gaillard, E. A., & Pashley, C. H. (2021). New perspectives in the diagnosis and management of allergic fungal airway disease. Journal of Asthma and Allergy, 14, 557-573. doi:10.2147/jaa.s251709
CrossrefPubMedPMCGoogle Scholar

Wójcik-Kanach, M., & Kasprzyk, I. (2025). Fungal spore calendar for the warm temperate climate zone. What else besides Cladosporium spores? Fungal Biology, 129(6), 101641. doi:10.1016/j.funbio.2025.101641
CrossrefPubMedGoogle Scholar

Wu, R., Song, Y., Head, J. R., Katz, D. S. W., Peay, K. G., Shedden, K., & Zhu, K. (2025). Fungal spore seasons advanced across the US over two decades of climate change. GeoHealth, 9(7), e2024gh001323. doi:10.1029/2024gh001323
CrossrefPubMedPMCGoogle Scholar

Xing, H., Wang, J., Sun, Y., & Wang, H. (2022). Recent advances in the allergic cross-reactivity between fungi and foods. Journal of Immunology Research, 2022(1), 7583400. doi:10.1155/2022/7583400
CrossrefPubMedPMCGoogle Scholar

Zhang, Y., & Steiner, A. L. (2022). Projected climate-driven changes in pollen emission season length and magnitude over the continental United States. Nature Communications, 13(1), 1234. doi:10.1038/s41467-022-28764-0
CrossrefPubMedPMCGoogle Scholar

Zhang, Y., Gao, Y., Liang, Y., Dong, Y., Yang, X., & Qiu, D. (2019). Verticillium dahliae PevD1, an Alt a 1-like protein, targets cotton PR5-like protein and promotes fungal infection. Journal of Experimental Botany, 70(2), 613-626. doi:10.1093/jxb/ery351
CrossrefPubMedPMCGoogle Scholar

Zheng, J., Jin, Y. J., Wang, C. H., Feng, C., Lai, X. Y., Hua, S. Q., & Tai, J. H. (2025). Global, regional, and national epidemiology of allergic diseases in children from 1990 to 2021: findings from the global burden of disease study 2021. BMC pulmonary medicine, 25(1), 54. doi:10.1186/s12890-025-03518-y
CrossrefPubMedPMCGoogle Scholar

Ziska, L. H. (2021). Climate, carbon dioxide, and plant-based aero-allergens: a deeper botanical perspective. Frontiers in Allergy, 2, 714724. doi:10.3389/falgy.2021.714724
CrossrefPubMedPMCGoogle Scholar


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