Immedeate and delayed-type reactivity to fungi and effects of antifungal drugs on atopic dermatitis]

OBJECTIVE: To investigate immediate and delayed-type reactivity for fungi in atopic dermatitis (AD) patients and the effect of antifungal therapy. METHODS: We examined immediate and delayed-type reactivity in AD patients for Candida albicans and Malassezia furfur by skin prick test (SPT), and estimated the effect of amphotericin B (AMPH) and itraconazole (ITCZ). RESULTS: Twenty eight of 40 patients showed positive immediate-type reaction and 10 of 27 patients did delayed-type reaction for Candida albicans. As for Malassezia furfur, positive immediate-type reaction was shown in 30 of 40 patients and positive delayed-type reaction did in 4 of 27 patients. The RAST score of specific IgE to Candida albicans was low in the patients with positive delayed-type skin reaction for Candida albicans, while the score was high in the patients with the negative delayed-type skin reaction. Both of AMPH and ITCZ were effective to the patients with positive immediate-type reaction for Candida albicans in SPT. The skin reaction for Malassezia furfur was stronger in the patients treated with ITCZ effectively than in the patients treated not effectively. In addition, ITCZ was effective in all patients except one, who showed positive reaction for Malassezia furfur accompanied with negative reaction for Candida albicans in SPT. CONCLUSION: Fungal allergy is one of the aggravation factors of AD, and SPT is useful to evaluate fungal allergy and to choose effective antifungal therapy.     

Cross-reacting IgE and IgG antibodies to Pityrosporum ovale mannan and other yeasts in atopic dermatitis.

Atopic dermatitis (AD) patients often demonstrate positive skin prick test results and serum IgE antibodies to a range of different yeasts. This has been thought to be due to cross-reactivity. In this study, the cross-reactivity of IgE and IgG antibodies between mannan and crude antigens of Pityrosporum ovale, Candida albicans, and Saccharomyces cerevisiae and crude antigens of Cryptococcus albidus and Rhodotorula rubra was examined by RAST and ELISA inhibition with two serum pools of AD patients. We found cross-reacting IgE and IgG antibodies. In the IgE response, the main cross-reacting pattern was the mannan region, although inhibition could be achieved also with crude antigens of C. albicans, S. cerevisiae, and, to some extent, C. albidus. P. ovale was the most potent inhibitor of IgE-binding components, and against it the highest IgE antibody levels were detected in AD serum pools. In contrast, C. albicans was found to be the most important inducer of IgG antibodies, since the IgG level against P. ovale mannan in both AD serum pools was very low. Cross-reacting antibodies were also seen in ELISA inhibition with both crude and mannan antigens, but since the IgG antibody level of P. ovale mannan in AD serum pools was low, further studies are needed to confirm the IgG results.     

Immediate hypersensitivity to Malassezia furfur and Candida albicans mannans in vivo and in vitro

BACKGROUND: Elevated and correlative Malassezia furfur (M. furfur) and Candida albicans (C. albicans) mannan-specific IgE have been demonstrated in atopic eczema dermatitis syndrome (AEDS) of the head, neck and shoulder (HNS) region of the skin. The significance of these antibodies in vivo has not been demonstrated. METHODS: Sixty-five AEDS patients with HNS distribution were included. Serum total IgE (S-IgE) and yeast antigen-specific (Cetavlon-purified mannan and whole extract antigens of M. furfur and C. albicans) IgE were measured and skin prick tests (SPT) were performed with the yeast antigens. RESULTS: Mannan-specific IgE and SPT were positive in 51 and 48% of patients with M. furfur and in 42 and 22% with C. albicans, respectively. Whole extract-specific IgE and SPT were positive in 85 and 95% of patients with M. furfur and in 91 and 57% with C. albicans, respectively. The highest correlation between specific IgE and SPT was seen with M. furfur mannan (r = 0.60; P < 0.0001). Both M. furfur mannan-specific IgE (r = 0.76; P < 0.0001) and SPT (r = 0.44; P = 0.0005) correlated with S-IgE. CONCLUSIONS: Mannan-induced immediate hypersensitivity in vivo was demonstrated in SPT. The significant correlation between M. furfur mannan-specific IgE and SPT suggests that mannan is an important allergen in yeast hypersensitive AEDS in vivo.     

Use of specific IgE in assessing the relevance of fungal and dust mite allergens to atopic dermatitis: a comparison with asthmatic and nonasthmatic control subjects

BACKGROUND: Although allergens have been implicated as aggravating factors in atopic dermatitis (AD), there is little epidemiologic data on the significance of specific IgE. OBJECTIVE: We sought to compare sensitization to dust mite and fungi between patients with AD and asthmatic and nonasthmatic control subjects. METHODS: Total IgE and specific IgE to Dermatophagoides pteronyssinus, Alternaria alternata, Aspergillus fumigatus, Candida albicans, Malassezia furfur, and Trichophyton rubrum were measured in 73 patients with moderate to severe AD. Total IgE and IgE specific for D pteronyssinus, A alternata, and M furfur were also measured in sera from 156 asthmatic and 212 nonasthmatic control subjects. RESULTS: Positive correlations were found between total IgE and IgE antibodies specific for each of the antigens. IgE specific for M furfur was observed more frequently in adults compared with children with AD (P <.01). AD sera had higher levels of total IgE and a higher prevalence of positive sera to D pteronyssinus (95% vs 42% and 17% for subjects with AD, asthmatic subjects, and nonasthmatic subjects, respectively), M furfur (53% vs 1% and 0.5%), and A alternata (49% vs 29% and 18%). Among the sera from subjects allergic to mites, the contribution of IgE specific for D pteronyssinus to the total IgE levels was similar regardless of the clinical status. CONCLUSIONS: Our results demonstrate that moderate-to-severe AD is strongly associated with sensitization to dust mite andM furfur (odds ratios, 45.6 and 132 vs pooled control sera). These results suggest that both environmental allergens and colonizing fungi contribute to the severity of disease, which is consistent with the view that mite avoidance and antifungal treatment can be beneficial in the treatment of these patients.     

Learning from fungus allergy in atopic dermatitis patients]

It has been recognized that there are considerable variations in their skin reactivity to environmental allergens as well as in immunoreactivities, even in AD patients with similar signs and symptoms. Some AD patients have high serum IgE antibody levels, while others show low levels. There are also differences in the kinds of triggering factors that are related to the development and maintenance of AD, e.g., allergic or non-allergic. Even among AD patients with high titers of serum IgE antibodies, the kinds and number of allergens involved in the exacerbation of AD are different and can change with time. The types of the underlying allergic reactions vary as well, i.e., some show immediate reactions, while others show delayed type hypersensitivity responses to environmental allergens. Thus, even AD patients diagnosed by the established criteria may have remarkably different backgrounds. When we looked over our published data, we noticed that there were differences in levels of IgE RAST and skin reactions between AD with atopic respiratory diseases (ARD) and pure AD without ARD. Levels of IgE RAST against airborne allergens, which come into the body mainly through the respiratory tract, were higher in AD with ARD, while those against allergens such as Candida albicans and Malassezia furfur, which can colonize on the skin, were higher in pure AD. In addition to these Th2-mediated immunological abnormalities, Th1-mediated DTH reaction and lymphocyte proliferation indices against airborne allergens were remarkably low in AD with ARD, whereas those against Candida albicans and Malassezia furfur were relatively preserved, although they were lower than those found in normal subjects. We understand from these findings that routes of allergen entry are important for the outcome of the resultant allergic reactions. This point of view is important answering questions such as how AD develops and how it can be prevented from the insults of each allergen.     

The role of fungal allergy in bronchial asthma]

Fungus is known to be one of the causative allergens inducing bronchial asthma as are housedustmites, pollen and pet dander. Outdoor airborne fungi such as Cladosporium, Alternaria, Penicillium and Aspergillus are important inducing IgE antibody formation. In addition to these common fungi, the indoor fungi Aspergillus restrictus, Neurospora and Eurotium are important allergenic fungi which have recently been identified. The yeast Candida albicans, is a common commensal of the human oral and vaginal mucosae and gastrointestinal tract and part of the normal flora, is known as one of the main allergens causing bronchial asthma. We examined the allergenicity of mannan (Mn) as a cell-wall constituent and acid protease (CAAP) as a secreted enzyme of C. albicans. We previously reported cases of atopic asthma caused by CAAP and stressed the role of CAAP as an important allergen in mucosal allergy to C. albicans 9). The levels of the antibodies to these antigens in the sera of asthmatic patients who showed positive immediate intradermal response to crude C. albicans (n=86) were measured. Anti-Mn IgE and IgG antibody levels were measured by liquid-phase assay (AlaSTAT). Anti-CAAP and anti-crude C. albicans IgE and IgG antibody levels were measured by RAST and AlaSTAT. Anti-Mn A and anti-Mn B IgE antibody titers were strongly correlated (r=0.87), while anti-Mn A and anti-CAAP IgE titers were not correlated. However, all of the anti-Mn A IgE positive sera and all of the anti-CAAP IgE positive sera were positive for IgE to crude-C. albicans. This indicates that both Mn and CAAP are C. albicans-related allergens. Titers of IgG antibodies to Mn A and crude C. albicans were highly correlated (r=0. 90). Results of inhibition assays performed using other fungal antigens as inhibitors showed that Mn is a cross reactive allergen among different fungi and that CAAP is a C. albicans specific allergen causing human mucosal allergic reaction.     

Comparison of skin prick tests with specific serum immunoglobulin E in the diagnosis of fungal sensitization in patients with severe asthma

Background It has been shown that patients with allergic bronchopulmonary aspergillosis (ABPA) and patients with severe asthma with fungal sensitization (SAFS) can benefit from antifungal therapy. It is not known whether allergy skin prick tests (SPT) or specific IgE tests are more sensitive in the identification of patients who are sensitized to fungi and who are therefore candidates for antifungal therapy.
Objectives To compare SPT and specific serum IgE tests for fungal sensitization in patients with severe asthma.
Methods We have undertaken SPT and specific serum IgE tests to six fungi ( Aspergillus fumigatus, Candida albicans, Penicillium notatum, Cladosporium herbarum, Alternaria alternata and Botrytis cineria ) and specific serum IgE test for Trichophyton in 121 patients with severe asthma (British Thoracic Society/SIGN steps 4 and 5).
Results Sixty-six percent of patients were sensitized to one or more fungi based on SPT and/or specific serum IgE results. Positivity to SPT and/or specific serum IgE was as follows: A. fumigatus 45%, C. albicans 36%, P. notatum 29%, C. herbarum 24%, A. alternata 22%, B. cineria 18%, Trichophyton 17% (specific serum IgE only). Concordance between the tests was 77% overall but only 14–56% for individual fungi. Twenty-nine (24%) patients were sensitized to a single fungus and seven (6%) were sensitized to all seven fungal species. Fifty percent of patients were sensitized to fungal and non-fungal extracts, 21% were sensitized only to non-fungal extracts, 16% were sensitized only to fungal extracts and 13% had no positive tests.
Conclusion This study is consistent with previous reports that fungal sensitization is common in patients with severe asthma. At present, it remains necessary to undertake both SPT and specific serum IgE testing to identify all cases of fungal sensitization. This may be important in the identification of patients with ABPA and SAFS who may benefit from antifungal therapy.     

Evaluation of IgE-sensitization to fungi in HIV-positive patients with eczematous skin reactions.

BACKGROUND: Human immunodeficiency virus infection is associated with declining immune function and polyclonal B-cell activation leading to elevated IgE-levels. In selected patient categories, increased total IgE may be associated with allergic diseases. Furthermore, a significant number of patients with low CD4+ cell numbers have various skin manifestations, eg, eczema and dermatophytosis. Patients with chronic fungal infections and a tendency to produce increased levels of specific IgE may become allergic and IgE-mediated mechanism may contribute to inflammatory reactions in the skin. OBJECTIVE: This study investigates IgE-sensitization of patients infected with human immunodeficiency virus to a panel of fungal extracts of Candida albicans, Fusarium moniliforme, Penicillium notatum, Pityrosporum ovale, and Trichophyton rubrum. METHODS: Fifteen HIV-positive patients with eczematous skin manifestations and five non-atopic healthy controls were evaluated by basophil histamine release and skin prick test with fungal extracts. The extracts were separated by sodium dodecylsulfate-polyacrylamide gel electrophoresis under reducing conditions and analyzed by IgE-immunoblotting with sera from the patients and controls. RESULTS: Thirteen of 15 patients (87%) released histamine to one or more of the fungi. Skin prick test was positive to one or more fungi in 7 (47%) patients. Patient sera revealed binding to a wide range of IgE-binding components present in the fungal extracts. The IgE response was most often directed against a 46-kD main protein in the Candida albicans extract. There was no correlation between total serum IgE, CD4+ cell counts, and frequency of IgE-sensitization to fungi. CONCLUSION: The human IgE response in HIV-infected patients appears to be polyspecific and may be directed against various fungi of which Candida albicans may be an important allergen. It is possible that the sensitization is due to frequent infections with Candida albicans in this patient population. No unspecific fungal reactions were noted among control patients. These results suggest that allergen-specific IgE-mediated mechanism may contribute to the pathogenesis of the eczematous skin reaction in HIV-infected patients.     

Skin prick test reactions to brewer's yeast (Saccharomyces cerevisiae) in adult atopic dermatitis patients

The sensitizing capacity of brewer's yeast ( Saccharomyces cerevisiae ) was studied with the skin prick test method in 449 subjects, including 226 atopic dermatitis (AD) patients, 50 patients with allergic rhinitis (AR) and/or asthma (A), and 173 nonatopic controls. A positive SPT reaction (≥++) was seen in 94% of patients with severe AD, in 76% with moderate AD, and in 25% with mild AD or no history of AD. Patients with AR and/or A and nonatopic controls displayed a positive reaction in only 8 and 2% of cases, respectively. There was also a parallel skin prick test reactivity with other yeasts including Pityrosporum ovale and Candida albicans , suggesting cross-reactivity. Parallel skin reactivity was observed also with molds and animal dander but not with pollen or house-dust mite. A significant correlation was also found between total serum IgE level and skin prick test (SPT) results with S. cerevisiae .     

Malassezia and atopic dermatitis]

Although many exacerbating factors for atopic dermatitis (AD) have been discussed, we are focusing on fungus antigen as a pathogenesis for this condition. About half of the patients were sensitized by Candida albicans and/or Malassezia furfur (MF) using IgE. Patients with severe eruption tended to have a higher concentration of specific IgE. IgE to purified antigens such as manganese superoxide dismutase (MnSOD), cyclophilin, and Malf2 from MF was also detected, while the pattern of positive IgE was varied among the patients so that the major allergen could not be determined. Skin testing gave a positive reaction to MF after 24 hours as well as an immediate type reaction; this delayed type reaction was AD specific since a small number of patients with bronchial asthma showed a positive response to MF. Peripheral mononuclear cells co-cultured with crude MF antigen in vitro produced IL-5 in some AD patients. This response was correlated with the severity of facial eruption, indicating that Th2 type response to MF might make these eruptions worse. MF was easily detected from various skin regions,but we were not able to explain why fewer colonies were obtained from a region with dermatitis than from a non-dermatitis region. From these results, we speculate there are patients who have IgE and Th2 cells which respond to MF. The exact mechanism, however, is still obscure as to how normal flora such as MF can react and exacerbate AD. Further investigations should be done to learn more about the relationship between AD and MF.     

Allergenicity of acid protease secreted by Candida albicans

We have previously reported the cases of Candida albicans (C. alb) acid protease (CAAP)-induced atopic asthma. In this study, the allergenicity of the released enzyme CAAP was examined among asthmatic patients with positive immediate skin response to crude C. alb antigen. Among 49 patients with positive skin response to crude C. alb , anti-crude C. alb IgE antibodies were detected in 40 and anti-CAAP IgE antibodies were detected in 18. Moreover, anticrude C. alb IgE antibodies were detected in all of the patients in whom anti-CAAP IgE antibodies were detected. No correlations between IgG antibodies to both antigens or between IgE and IgG antibodies to CAAP were observed. CAAP induced significant T-cell proliferation in 20/ 28 patients showing positive T-cell proliferation response to crude C. alb antigen. Most of the patients showing positive conjunctival response to crude C. alb antigen also snowed positive response to CAAP. Most of the patients showing high levels of serum IgE antibody and positive histamine-release response of peripheral blood leukocytes to CAAP showed positive conjunctival response. The results indicate that CAAP is an important allergen in C. alb-related mucosal allergy.     

Fournier's gangrene due to Candida glabrata.

Fournier's gangrene is a rare and serious event. Usual pathogens are bacteria of the skin and the digestive tract. Candida species are exceptionally involved, mostly Candida albicans. We report a patient with non-C. albicans Candida sp. Fournier's gangrene who survived with an appropriate antifungal therapy. Yeasts should be considered as emerging pathogens in pelvic infections due to the increase in long-term immunocompromised patients.     

Evidence for the presence of immunoglobulin E antibodies specific to the cell wall phosphomannoproteins of Candida albicans in patients with allergies.

To determine the major antigenic component of Candida albicans against immunoglobulin E (IgE) antibodies in the sera of patients with allergies who were positive for IgE antibodies to C. albicans crude antigen in a CAP system, phosphomannoproteins (CAMP/A or CAMP/B for serotype A or B strain, respectively) and their acid-stable portions (CAMP-S/A or CAMP-S/B) were isolated from beta-mercaptoethanol (2-ME) extracts of C. albicans cells of serotypes A and B, and IgE antibodies against these components were compared with those against protein complex and enolase (CAE) fractions isolated from C. albicans cells. The dot blot test, which was used to detect IgE antibodies to the C. albicans antigens, showed that IgE antibodies to the 2-ME extract and phosphomannoprotein fractions were present in the sera of 98.0% (2-ME extract), 96.8% (CAMP/A), 93.2% (CAMP-S/A), 97.2% (CAMP/B), and 81.5% (CAMP-S/B) of the patients, whereas IgE antibodies to the protein complex and CAE fractions were found in the sera of 73.6 and 48.8% of the patients, respectively. The extent of IgE binding to the 2-ME extract and phosphomannoproteins was well correlated with the fluorescence intensities estimated with the CAP system. Furthermore, the results obtained from the inhibition experiment with the CAP system indicated that the binding of IgE antibodies to Candida antigens is strongly inhibited by the phosphomannoprotein fraction and is an indication that the serum of the patients contained IgE antibodies specific to the cell wall phosphomannoproteins of C. albicans. Finally, an initial chemical analysis indicated that the epitopes for IgE antibodies on the phosphomannoproteins is a carbohydrate portion, since the ability of CAMP/A to inhibit the binding of IgE antibodies to the homologous CAMP/A was destroyed after oxidation by sodium periodate but not after digestion with proteinase K.     

Cladosporium herbarum and Pityrosporum ovale allergen extracts share cross-reacting glycoproteins

BACKGROUND: Patients sensitized to airborne fungi such as Alternaria alternata and Cladosporium herbarum often also show positive skin prick test results and specific serum IgE antibodies to a yeast, Pityrosporum ovale. We examined whether part of the IgE binding to these fungi is explained by cross-reacting mould and yeast allergens. METHODS: Serum samples from 36 patients with positive skin prick test to A. alternata or C. herbarum were analyzed for IgE antibodies to fungal extracts by ELISA and immunoblot analysis. Cross-reactivity between mould and yeast extracts was studied by ELISA and immunoblot inhibition assays. In further analysis, the mannan-containing glycoproteins were removed from the yeast extract by concanavalin A-Sepharose chromatography, and the IgE binding properties of the extracts were compared. RESULTS: Serum IgE reactivity to P. ovale was found in 40% of the mould-sensitized patients. The IgE antibody binding to A. alternata and C. herbarum moulds was partially inhibited by the yeast P. ovale in ELISA and immunoblot inhibition assays. When the glycoproteins were removed from the extract, cross-reactivity was markedly reduced. CONCLUSION: Part of the IgE binding to mould and yeast allergen extracts is due to cross-reacting glycoproteins. False-positive IgE and skin prick test results should be taken into account in the diagnosis of mould allergy.     

Systemic ketoconazole is an effective treatment of atopic dermatitis with IgE-mediated hypersensitivity to yeasts

BACKGROUND: IgE-mediated hypersensitivity to yeasts is often seen in atopic dermatitis (AD) patients, especially when dermatitis is located in the head, neck, and shoulder regions. Two studies have shown the efficacy of ketoconazole in the treatment of this type of AD, in contrast to results of topical treatment. The objective was to assess the clinical efficacy of antifungal treatment in AD in a randomized, double-blind, placebo-controlled study with oral ketoconazole and yeast-specific IgE levels and saprophytic yeast growth monitored simultaneously. METHODS: Eighty patients with AD and positive P. ovale and/or C. albicans RAST/skin prick test results were randomized to receive ketoconazole or placebo for 30 days. The yeast growth of skin and pharynx; P. ovale, C. albicans, andS. cerevisiae RAST; serum total IgE; and the severity of the eczema (SCORAD) were assessed at day 0 and thereafter at 1 and 3 months. RESULTS: A significant improvement was seen in the SCORAD scale in the ketoconazole group at the second visit in comparison to the first visit (P<0.0005; n=36), but not in the placebo group (n=39). Of the individual determinants of the SCORAD, itching (P<0.005), the extent of dermatitis (area percentage), excoriation, lichenification (P<0.01), erythema, papulation, and dryness (P<0.05) improved significantly in the ketoconazole group. In the placebo group, only the extent of dermatitis (area percentage) decreased significantly (P<0.05). In the ketoconazole group, the number of positive P. ovale cultures decreased from 60% to 31% (n=35) compared to the placebo group (64% to 56%; n=39). The clinical response was most significant in female patients with positive yeast cultures. CONCLUSION: Saprophytic yeasts may be a source of allergens in AD. Thus, patients with AD, yeast growth, and elevated IgE levels to yeasts should be offered antifungal treatment.     

Molecular and quantitative analyses of Malassezia microflora on the skin of atopic dermatitis patients and genotyping of M. globosa DNA]

To elucidate the role of Malassezia species in atopic dermatitis (AD) requires investigation of the Malassezia microflora on the skin of AD patients. Previously, M. furfur was considered the dominant species in the microflora, however, this microorganism has been reclassified into five species and reanalysis of the microflora based on the current Malassezia taxonomy is therefore needed. Malassezia is more difficult to isolate and culture than other pathogenic yeasts such as Candida and Cryptococcus, making it difficult to elucidate the microflora of AD patients accurately. We developed a PCR-based non-culture method that does not require the use of isolation or culture techniques. Of the members of the genus Malassezia, M. globosa colonized the skin of both AD patients and healthy subjects more frequently than other Malassezia species. In addition, we found polymorphisms in the intergenic spacer 1 region of the M. globosar RNA gene. The genotypes of the microorganisms obtained from AD patients were significantly different from those obtained from healthy subjects. We believe that a specific genotype of M. globosa is responsible for exacerbation of AD.     

Analysis of IgE reactivities of purified allergens from Candida albicans and Malassezia furfur among patients with atopic dermatitis]

We analyzed the reactivities of a series of purified allergens from Candida albicans (C. albicans) and Malassezia furfur (M. furfur) with IgE antibodies in sera from patients with atopic dermatitis. We compared the specific IgE antibody levels to manganese superoxide dismutase (Mn SOD), cyclophilin, enolase, secretory aspartic protease (SAP 2) and type A mannan from C. albicans and Mn SOD, cyclophilin and Mal f 2 from M. furfur in 21 sera from patients with atopic dermatitis and 20 sera from patients with asthma without atopic dermatitis. The prevalence of IgE antibodies and the mean IgE antibody levels to all of the allergens tested were higher among patients with atopic dermatitis than among those with asthma without atopic dermatitis. More than 50% of patients with atopic dermatitis were IgE antibody-positive to Mn SOD, cyclophilin and type A mannan from C. albicans, and Mn SOD and cyclophilin from M. furfur. The availability of these purified allergens will facilitate studies on the contribution of fungal allergens to the development of atopic dermatitis.     

Analysis of facial lesions on adult type atopic dermatitis with anti-fungus drug (terbinafine hydrochloride) -- analysis of serum anti-Malassezia IgE antibody titers and histamine release test]

Malassezia furfur has been described as an aggravating factor in facial lesions of atopic dermatitis, and oral antifungal agents have been reported to be effective against these lesions. We used terbinafine hydrochloride to treat 15 patients with adult-type atopic dermatitis and evaluated its efficacy by measuring the improvement in facial skin manifestations, serum IgE values, and serum anti-Malassezia IgE antibody titers. A histamine release test (HRT) for Malassezia. was also performed in 6 of the 15 patients. The facial skin manifestations improved in 8 (53.3%) of the 15 patients, and there were significant simultaneous decreases in their serum IgE values. The serum anti-Malassezia IgE antibody titer decreased significantly in all 15 patients. However, no significant correlation was observed between the HRT and the facial skin manifestations. We concluded that oral terbinafine hydrochloride is effective against the facial lesions of atopic dermatitis patients and this is possibly caused by decrease of Malassezia antigen in the facial lesions.     

Relationship of immediate and delayed hypersensitivity to nasopharyngeal and intestinal growth of Candida albicans in allergic subjects

The growth of C. albicans yeast in the nasopharynx and in the anus as well as allergy symptoms were followed up for 8 months in 67 patients with bronchial asthma, allergic rhinitis and/or atopic eczema. 38 of the patients were skin prick test positive and 29 negative to C. albicans allergen extract. 32 of the patients had positive and 19 negative delayed skin reactions. The nasal, bronchial and skin symptoms of the yeast-sensitive allergic patients were not associated with the nasopharyngeal nor anal occurrence of C. albicans or other yeasts. The use of nasal or inhaled steroids had no effect on the occurrence of Candida in the nasopharynx. It was observed that immediate skin sensitivity had a positive correlation and the delayed sensitivity a negative correlation with the occurrence of C. albicans growth in nasopharynx and anus. These findings are in agreement with the concept that impaired cell-mediated immunity to C. albicans may lead to increased IgE response. This may explain the increased liability towards C. albicans nasopharyngeal and gastrointestinal "saprophytic" growth.     

IgE and IgG antibodies to Malassezia spp. yeast extract in patients with atopic dermatitis

The presence of immunoglobulins to Malassezia spp. surface proteins in the sera from patients with atopic dermatitis and healthy subjects was studied. It was found that 28% of 25 examined patients with atopic dermatitis had IgE antibodies to Malassezia spp. surface protein preparation. All patients and 5 healthy subjects had IgG antibodies to this preparation. The presence and concentration of specific IgE antibodies in patients with atopic dermatitis correlated with reverse titers of IgG antibodies to this preparation (r=0.782). The medians of values reciprocal to IgG antibody titers in patients with atopic dermatitis with and without specific IgE antibodies to the preparation and in healthy subjects were 64, 1024, and 16, respectively. The preparation derived from Candida albicans (candidine) and previously derived preparation from Malassezia did not cross-react. According to immunoblotting data, the preparation contains allergens presented by proteins with molecular weights 15, 36, 52-56, and 78.4 kDa.