Abstract | March 23, 2023

Sensitivity to Aureobasidium Pullulans and the Severity of Asthma with Environmental Risk Factors

Geetha Gowda, MS, BA

Scout M Treadwell, BA, Medical Student, 3rd Year, Tulane School of Medicine, New Orleans, LA; Maxwell Green, MS, Medical Student 3rd Year, Tulane School of Medicine, New Orleans, LA; Andrew McKernan, MD; John Carlson, MD, Pediatric Residency Program Director, Tulane School of Medicine, New Orleans, LA.

Learning Objectives

  1. Examine sensitizations to less common aeroallergens such as A. pullulans.
  2. Discuss A. pullulans association with the development and worsening of asthma in the setting of environmental risk factors.
  3. Recommend testing for A. pullulans when evaluating patients with severe asthma in conjunction with environmental risk factors.

Introduction: The fungi, Aureobasidium pullulans, has been reported as an aeroallergen and is commercially available as an extract when screening for sensitization to environmental allergens. Using these extracts it is possible to screen for sensitization to A. pullulans through skin prick testing or as part of a serum ImmunoCAP assay for serum-specific IgE. However, most allergists do not routinely screen for this sensitization. We undertook a systematic review of the literature to examine the evidence linking A. pullulans sensitization to human disease.

Methods: A systematic review was conducted using PubMed, Embase, and Web of Science using the search terms “Aureobasidium pullulans” AND rhinosinusitis OR asthma OR rhinitis OR conjunctivitis OR allergic fungal sinusitis OR allergic bronchopulmonary aspergillosis. Studies were included only if they used clinical data along with allergy testing. Results: Fifteen studies were included in this review. Two studies reported fungal sensitization to A. pullulans leading to greater severity of asthma specifically in asthmatic patients living in homes damaged by Hurricane Sandy [1,2]. Specifically, one study found that children living in Hurricane Sandy damaged homes had measurable IgE to common fungi with A. pullulans being one of the most prevalent (19%) [1]. Similarly, another study administered skin prick testing in asthmatic patients with common aeroallergens including A. pullulans [3]. Results indicated that sensitization to A. pullulans was significantly associated with increased asthma severity (p=0.006) [3]. Conclusions: The results of this systematic review demonstrate the correlation between hypersensitivity to A. pullulans and the severity of asthma. Although sensitization is uncommon, sensitization to A. pullulans should be considered as a causative agent when evaluating patients with severe asthma in conjunction with environmental risk factors.

 

References

  1. Divjan A, Acosta L, Sobek E, Soffer N, and Perzanowski M. Ige Antibodies to Fungi among Asthmatic Children Living in Homes Damaged by Hurricane Sandy in New York City. Journal of Allergy and Clinical Immunology 137, no. 2 (2016): AB180. doi: 10.1016/j.jaci.2015.12.723
  2. Iakovou A, and Lisker G. “A Case of Severe Asthma with Fungal Sensitization (Safs) Due to Aureobasidium Pullulans Following Hurricane Sandy.” In D32. Interesting Cases in Allergy and Immunology, A5644-A44.
  3. Niedoszytko M, Chełmińska M, Jassem E, Czestochowska E. Association between sensitization to Aureobasidium pullulans (Pullularia sp) and severity of asthma. Ann Allergy Asthma Immunol. 2007;98(2):153-156. doi:10.1016/S1081-1206(10)60688-6

 

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