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Iranian Journal of Pediatrics
Tehran University of Medical Sciences Press
ISSN: 1018-4406 EISSN: 2008-2150
Vol. 20, Num. 2, 2010, pp. 242-243

Iran Journal of Pediatrics, Vol. 20, No. 2, April-June, 2010, pp. 242-243

Letter To Editor

Skin test reactivity to fungal aeroallergens in asthmatic children in Southern Iran

1. Allergy  Research  Center, Shiraz  University of Medical Sciences, Shiraz, Iran 
2. Department of Pediatric Immunology and Allergy, Shiraz University of Medical Sciences, Shiraz, Iran

Correspondence Address: * Allergy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

Date of Submission: 26-Jun-2009

Date of Acceptance: 13-Dec-2009

Code Number: pe10037

Keywords: Asthma; Fungi; Skin prick test; Children; Iran

The development of asthma appears to involve interplay between host factors and environmental exposures. The most important environmental factors are viral respiratory infections and airborne allergens in consist of sensitization to fungal aeroallergens [1]. Exposure to fungal aeroallergens was reported to be a cause of asthma in many parts of the world.

There are few data on the prevalence of allergy to molds in Iran. This study was performed to determine the positive skin prick test to molds and their related risk factors in asthmatic children in Shiraz, southern Iran [Table - 1].

Skin prick test was done in two hundred and thirty asthmatic children with five types of common fungal aeroallergens (Aspergillus fumigates, Caldosporium herbarum, Penicillium, Alternaria and Rhizopus).

Out of 230 asthmatic children (175 boys, 55 girls) with mean age 6.34±3 years, 25 (10.9%) had positive skin test to molds. In other studies this rate was reported to be different between 2% to 80% [2].

Of 25 children with positive skin test to molds, the common fungal aeroallergen was Aspergillus followed by Cladosporium, Alternaria, Penicillium and Rhizopus. Amin R et al studied airborne fungal spores in Shiraz. The most important fungi, in order of numbers, had been Altenaria, Asp ergilus, hizopus and Penicillium [3]. With regard to results of skin prick test in our study, it seems that Alternia is the most common outdoor fungus, but Aspergillus could be the most important indoor fungus. Another study showed in asthmatic patients that main skin test reactivity to fungi was for Aspergillus but most frequent cultured fungus was Cladosporium [4].

Of 25 subjects with positive skin test to molds, 5 (20%) were females, 20 (80%) were residents of urban areas and 4 (56%) lived in homes older than ten years. There was no significant correlation between the prevalence of mold skin test positivity in males and females, rural and urban habitats and age of homes.

There was no difference in the frequency of positive skin test response to fungi in infants (<2 years of age) and older children in our study. This finding demonstrates that fungi allergy can start very early in life.

Fifty-nine (25.7%) fathers had college degrees of whom five (8.5%) children had positive skin test to molds. Thirty-nine (17%) mothers had college degrees and three (7.7%) of their children had positive skin test to molds. We found no significant relationship between parents' education level and results of the mold skin prick test. In other study, authors analyzed 57,000 children aged 6-12 yrs from 13 diverse countries. Multiple logistic regressions showed that low parental educational level was associated with an increased prevalence of wheeze and nocturnal dry cough [5]. There was no reason for our finding; only small sizes of parents with college degree were available.

One child lived in apartment and 24 (96%) in houses. There was significant differences in the frequency of positive skin test response to mold and living in apartment or house. Ginger et al examined home characteristics and level of indoor allergens in 499 homes of asthmatic children. Increased temperature in apartment could be related to warming of surface and resultant decreased micro environmental relative humidity [6]. We think that decreased entrance of fungal aeroallergens and low humidity in apartments are causes of these differences.

The site's weather of our study is hot and dry; there were no significant differences between positive skin test to mold with dampness of home in this study. Other studies have shown that home dampness increases indoor mold burden and is associated with increased allergic symptoms among young children [7].

The results of this study showed that sensitivity to fungal aeroallergens may occur in asthmatic children. A positive reaction may even be observed during infancy. It seems that type of home is a significant factor to increase the presence of molds in residential areas. It is reasonable to consider fungal aeroallergens in the routine battery of inhalant skin tests in this geographic location.


The authors would like to thank the Center for Development Clinical Studies of Nemazee Hospital for editorial assistance.


1.Expert Panel Report 3 (EPR3): Guidelines for the diagnosis and management of asthma. National Asthma Education and Prevention Program (NAEPP), summary updated 2007; Oct: 9-12.  Back to cited text no. 1    
2.Yazicioglu M, Asan A, Ones U, et al. Indoor airborne fungal spores and home characteristics in asthmatic children from Edirne region of Turkey. Allergologia et immunopathologia. 2004;32(4):197-203.  Back to cited text no. 2    
3.Amin R, Bockhari MH. Survey on atmospheric fungus spores in Shiraz, Iran. Ann Allergy. 1979: 22(4);246-7.  Back to cited text no. 3    
4.Martinet Ordaz VA, Rincon-Castaneda CB, Esquivei Lopez G, et al. Fungal Spores in the environment of the asthmatic patient in a semi­desert area of Mexico. Rev Allerg Mex. 2002; 49(1): 2-7.  Back to cited text no. 4    
5.Gehring U, Pattenden S, Slachtova H, et al. Parental education and children's respiratory and allergic symptoms in the pollution and the young study. Eur Respir J. 2006;27(1):95-107.  Back to cited text no. 5    
6.Ginger L, Chew HA, Burge DW, et al. Limitation of home characteristics questionnaire as a predictor of indoor allergen. Am J Respir Crit Care Med, 1998;157(5):1536-41.  Back to cited text no. 6    
7.Tham KW, Zuraimi MS, Koh D, et al. Association between home dampness and presence of molds with asthma and allergic symptoms among young children in the tropics. Pediatr Allergy Immunol. 2007;18(5) :418-24.  Back to cited text no. 7    

Copyright 2010 - Iran Journal of Pediatrics

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