Does Specific Fungal Allergen Really Matter?

389 Exposure and sensitization to allergens can promote development and exacerbation of allergic disease. Various indoor aller-gens, including dust mites, animal dander, and mold have been reported to associate with allergic disease. Fungal spores and particles are widely distributed in outdoor and indoor environments and exposure to fungi has been shown to induce allergic disease and exacerbate symptoms in individuals sensitized to fungi. 1 However, it is still unclear whether the total fungal spore count or specific species is more relevant to allergic responses. It should be investigated that the contribution of fungi to allergic disease is species-specific, with specific fungal species leading to allergic disease exacerbations. Many studies examining the relationships between fungal exposure and allergic disease have focused on the total fungal spore count instead of specific fungal species as an indicator of exposure. 2,3 In an elementary school with indoor mold count ranging 6,000 to 50,000 spores/m 3 , 85% of the students and teachers reported significant allergy symptoms. 2 The author concluded that the elevations of the total spore count can have clinical implications, and a building is considered unhealthy at a total spore count of >1,000 spores/m 3. 2 Another observational study which is conducted in a large urban population demonstrated a positive correlation between daily concentrations of fungal spores and the frequency of visits to the emergency department. 4 Therefore, changes in total fungal spore concentrations appear to be associated with an increase in allergy ex-acerbations. A more recent study 5 on fungal spores in 173 asthmatic homes and 85 non-asthmatic homes reported that the total fungal spore and specific fungal species were higher in asthmatic homes than in non-asthmatic homes. However, that study did not confirm that the differences in the total fungal spore count or the distribution of specific fungi can cause asthma symptoms. In contrast, case-control studies conducted with patients with asthma 6 or allergic rhinitis 7 showed no significant differences in the total spore count between cases and controls. The authors of these studies documented a potential relationship between genus-species and allergic diseases because some allergenic fungi were significantly higher in the allergy patients' homes, suggesting the type of mold is more important than the total spore count. In a large study of Taiwanese schoolchildren, there was no significant correlation between asthma and the total fungal spore in classrooms; however, Aspergillus/Penicillium and basidiospores spp. significantly correlated with current asthma. 8 …