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[Respiratory sensitization to molds in children: myth or reality?]
G Guerrier1, E Billard, J Ghipponi
1Hôpital Debrousse, Lyon.
Abstract:
The authors have made a systematic study by PRICK-test and RAST, sometimes followed by a rhino-manometric provocation, of the frequency of sensitization to the two moulds Alternaria and Cladosporium in 200 "all comers" children in a paediatric consultation. The frequency was low, only 10% for those consulting in the groups of asthma, rhinitis, pollinosis, repeated respiratory infections and syndromes of obstructed expiration taken together, and 13% for allergic asthma only. This sensitivity is rarely isolated, but is most often accompanied, or complicated by, other pneumoallergens, such as dust, mites, pollens and sometimes cockroaches. It imposes certain particular clinical traits on asthma (summer asthma or recurring asthma) and in others appears to be strongly influenced by the habitat. The skin tests seem to be very weak and RAST insufficient to be sure of real sensitization. Diagnosis, always difficult, is probably best done by a provocation test (preferably rhino-manometry) and this jumps over the bundle of clinical and biological arguments, as well as being, at least in our country, the most useful mimic of atmospheric moulds. The authors insist on the importance of the interrogation which should be concerned with the chronological and environmental circumstances and all respiratory infections that are suspected of having an allergic factor.
Insights
Mold sensitization in children is uncommon, affecting 10-13% of those with respiratory issues. Diagnosis is best confirmed by provocation tests, not just skin or RAST tests.
Area of Science:
- Allergy and Immunology
- Pediatric Pulmonology
- Environmental Health
Context:
- Investigated sensitization to common molds (Alternaria, Cladosporium) in pediatric patients.
- Evaluated 200 children presenting at a pediatric consultation.
- Assessed frequency of mold sensitization in relation to various respiratory conditions.
Purpose:
- To determine the prevalence of sensitization to Alternaria and Cladosporium molds in children.
- To evaluate the diagnostic efficacy of skin prick tests (PRICK-test), radioallergosorbent tests (RAST), and rhino-manometric provocation.
- To understand the clinical presentation and associated factors of mold-induced respiratory allergies in children.
Summary:
- Systematic study using PRICK-test, RAST, and rhino-manometry in 200 children.
- Low sensitization frequency observed: 10% for general respiratory issues, 13% for allergic asthma.
- Mold sensitivity often co-occurs with other allergens (dust, mites, pollens) and influences asthma phenotype (e.g., summer asthma).
- Skin tests and RAST showed limitations; provocation tests, particularly rhino-manometry, are recommended for accurate diagnosis.
- Detailed patient history focusing on chronological, environmental factors, and respiratory infections is crucial.
Impact:
- Highlights the limited role of standard allergy tests (skin, RAST) for mold sensitization diagnosis in children.
- Emphasizes the diagnostic superiority of provocation tests, specifically rhino-manometry, for identifying mold allergies.
- Underscores the importance of comprehensive clinical evaluation, including detailed patient history and environmental assessment, for managing pediatric respiratory allergies.