The Association Between Superficial Fungal Infection And Allergic Diseases Of Skin

BackgroundThe fungi are widely distributed in our nature, it can be pathogenic in various ways, including infection, teratogenic, toxic, carcinogenic, or induce allergic reactions. Fungi as the one of the most common and one of the most important inhaled allergens, it can induce a variety of allergic diseases such as bronchial asthma, allergic rhinitis, allergic bronchopulmonary aspergillosis (ABPA). chronic urticaria,etc. By present, many studies on Aspergillus, Penicillium have been done in allergic diseases, but little research as to Dermatophytes. Several cases about the association between Dermatophytes infection and allergic diseases such as urticaria, asthma have reported recently, which suggests that dermatophytes infection may play an important etiology role of part allergic diseases.Through performing skin prick tests (SPTs) of fungal allergens and unfungal allergens among allergic diseases, we investigated the sensitivity and cross-reaction of dermatophytes extracts, and also through performing anti-fungal therapies on part refractory CU or CE patients, we observed therapic effection, so as to define the etiology role of dermatophytes in allergic diseases. This study is divided into three parts.Part I The study of fungal allergens and unfungal allergens sensitivity in chronic urticaria or chronic eczema with/without superfical mycosis ObjectiveThe purposes of this study were to investigate the possible role of aeroallergens in CU or CE patients with/without superfical mycosis, and to compare positivity rates between Trichophyton allergen and fungal culture of dermatophytes in order to evaluate the etiology factors of superfical mycosis in CU or CE.MethodsOne thousand and fifty-four CU or CE patients were recruited over an eleven-month period from the department of dermatology at Jinling Hospital, China. CU and CE were diagnosed by history and physical examination. The subjects were divided into two groups classified by direct microscopic examination:group1, CU or CE with superficial mycosis; group2, CU or CE without superficial mycosis. Skin prick tests(SPT) with standardized extracts of9fungal allergens and9unfungal allergens were performed in all subjects. The group1patients were also subjected to fungal culture.ResultsA total number of1054cases of CU or chronic eczema (451female and603male) were studied.516were classified into the group1and538were classified into the group2. The skin test positivity rates to Trichophyton, Penicillium notatum, Curvularia lunata and Aspergillus fumigatus allergens of group1was higher than group2in both CU and chronic eczema patients(P<0.05). There were no significant differences between the two groups in terms of other fungal allergens and unfungal allergens (P>0.05). Fungal culture revealed T. rubrum (56.15%), T. mentagrophytes (10.73%), Epidermophyton floccosum(4.42%), Candida spp.(12.93%) are the common fungus in317cases from group1. The positivity rate was no significant difference between Trichophyton allergen and fungal culture of dermatophytes (P>0.05).Part Ⅱ Dermatophyte and Candida albicans allergens sensitivity and cross-reaction in patients of chronic urticariaObjectivePrepared the extracts of Trichophyton rubrum, Trichophyton mentagrophytes, Epidermophyton floccosum and Candida albicans. Through performe these four fungal extracts in CU, onychomycosis patients, to evaluate the factors determining Trichophyton sensitivity and the dermatophytes infection in the etiology of the role of chronic urticaria, also to observe whether there is cross-reaction between these four fungal extracts.Methods174subjects (95male and79female), with average age of35.7±13.5years were participated in this experiment. According to history, symptom, and fungal microscopy, subjects were divided into the following four groups:1) experimental group:CU with onychomycosis (n=53);2) control groupl:onychomycosis without allergic diseases (n=45);3) control group2:CU without fungal infections (n=42);4) control group4:healthy control (n=34). All subjects were performed skin prick tests with the four fungal extracts. The experimental group and control group1were also subjected to microscopic evaluation and fungal culture for fungal infection.ResultsThe skin prick tests positive rates to Trichophyton rubrum, Epidermophyton floccosum, Trichophyton mentagrophytes extracts of experimental group were significantly higher than those in control groupl,2,3(P<0.05); control group1higher than that in control group2and3(P>0.05).There is no significant difference between group2and group3. The SPTs positive rares to Candida albicans extract were no significant difference between four groups(P>0.05). In experimental group, SPTs positive rates to Trichophyton rubrum, Epidermophyton floccosum, Trichophyton mentagrophytes extracts were no significant difference (P>0.05), but three dermatophytes extracts were all higher than Candida albicans extracts (P<0.05).Part III The observation of anti-fungal therapy in patients of refractory chronic urticaria or chronic eczema with dermatophytosisObjectiveThrough performing anti-fungal therapies on part refractory CU or CE patients with dermatophytosis, we observed therapic effection, so as to define the etiology role of dermatophytes in allergic diseases.MethodsAccording to four scoring method to record the severity of part refractory CU and CE patients in Part Ⅰ and Part Ⅱ. performed anti-fungal and anti-histamine treatment on patients for three months, evaluated the treatment effect based on the therapeutic index, and telephone follow-up to statistics recurrence rate.ResultsThe group include16patients, six patients of onychomycosis with the treatment of oral itraconazole and anti-histamine, one patient of onychomycosis with the treatment of oral terbinafine and anti-histamine, nine patients of topical tinea pedis with antifungal and anti-histamine treatment. The results showed that the recovery in2cases cured and3cases excellence,9cases improved,2cases ineffective, among16patients, The anti-fungal treatment effectivity is87.5%. After the end of the treatment14patients were followed up for3months,4patients recur, the recurrence rate was28.6%. The security of Trichophyton rubrum, Trichophyton mentagrophytes, Epidermophyton floccosum and Candida albicans extract we have prepared is well,so can be generalization applicated in clinical allergy detection.ConclusionsAccording to the data, the patients with CU or CE whose Trichophyton allergen present immediate hypersensitivity(IH) always have dermatophytes infection. The presence of fungal infection seems to be an important determinant in hypersensitivity to Trichophyton. There are obvious cross-reactions among Trichophyton mentagrophytes, Trichophyton rubrum, Epidermophyton floccosum extracts, but on cross-reaction between these three dermatophytes and Candida albicans extracts. Through performing anti-fungal therapies on part refractory CU or CE patients with dermatophytosis, There were conspicuous improved of allergic symptoms. We proposed that the dermatophytes infection play an important etiology role in allergic dieases.