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Diagnosis of mold allergy

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Conclusion

The problems of elucidating the role of mold spores in allergy are related to both an absence of detailed information about allergen exposure, and lack of standardized allergen extracts. Provided qualitatively and quantitatively optimal extracts are available, the IgE-diagnostic tests are of equal value in diagnosing mold sensitization, as with other aeroallergens. In the opinion of the author, the specific diagnosis represents the combination of demonstrated IgE reactivity (using diagnostic tests) and clinical symptoms related to exposure to the causative allergen. In order to diagnose organ-specific disease, an unequivocally positive challenge in the relevant shock organ is essential. The rational approach to diagnosing mold allergy is, based on the clinical history, to use skin test as the primary screening test. SPT has the highest sensitivity (few false negative reactions) and, compared to ICT, few irrelevant positive reactions, and should consequently be used to screen for IgE sensitization in the diagnostic workup. Because of the lower sensitivity, RAST is not optimal as the initial test, but as a result of high specificity (few false positive reactions) it is optimal as a confirmatory test for the presence of specific IgE. The clinical relevance of the IgE sensitization should be confirmed by reevaluating the history to ensure that the patients do in fact have symptoms caused by the allergen (Table 2). Challenge tests are normally indicated only if the diagnosis of allergen sensitization implies therapeutic interventions, such as allergen-specific immunotherapy.

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  1. Laboratory of Clinical Allergology, State University Hospital, Copenhagen, Denmark

    Hans-JØrgen Malling

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Malling, HJ. Diagnosis of mold allergy. Clinical Reviews In Allergy 10, 213–236 (1992). https://doi.org/10.1007/BF02802289

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