Supplementary Material for: Sensitization against Fungi in Patients with Airway Allergies over 20 Years in Germany

Background: Fungal spores are ubiquitous allergens. Severe forms of asthma are particularly highly associated with fungal sensitization. National and international asthma guidelines recommend the implementation of allergen immunotherapy if indicated. Thus, detection and treatment of relevant allergies are key components of primary care of these patients. Objectives: The aims of the study were (i) to investigate trends in the prevalence of sensitization to twelve fungi in central Germany over the last 20 years and (ii) to dissect specific sensitization patterns among the 3 most important fungi: Aspergillus, Alternaria, and Cladosporium. Methods: This single-center study evaluated skin prick test (SPT) results of 3,358 patients with suspected airway allergies over a period of 20 years (1998–2017). Results: While 19.2% of all study patients had positive test results to at least 1 of the 3 fungi (Alternaria, Aspergillus, or Cladosporium) in the first study decade, this rate increased to 22.5% in the second decade. Slight increases in sensitization rates to almost all fungi were observed over the 20-year period. In the last decade, polysensitization to Alternaria, Aspergillus, and Cladosporium increased significantly. Sensitization to fungi is age-dependent and peaks in the age-group of 21–40 years during the second decade. Conclusion: Fungi are relevant allergens for perennial and seasonal allergy symptoms. We currently recommend including Aspergillus, Alternaria, and Cladosporium in the standard series of SPTs for airway allergies.

背景：真菌孢子是广泛存在的变应原。重症哮喘与真菌致敏的相关性尤为显著。国内外哮喘诊疗指南均建议，在有指征时实施变应原特异性免疫治疗。因此，对相关过敏反应的检测与治疗，是此类患者初级医疗照护的关键环节。
研究目标：本研究旨在达成两项核心目标：其一，探究近20年来德国中部地区12种真菌致敏率的变化趋势；其二，剖析3种最主要致病真菌——曲霉菌（Aspergillus）、链格孢菌（Alternaria）以及枝孢菌（Cladosporium）的特异性致敏模式。
研究方法：本项单中心研究对1998年至2017年这20年间，共计3358例疑似气道过敏患者的皮肤点刺试验（Skin Prick Test, SPT）结果进行了回顾性分析。
研究结果：在研究的第一个十年，共有19.2%的受试患者对3种目标真菌（链格孢菌、曲霉菌或枝孢菌）中至少一种呈现皮试阳性结果，而在第二个十年，该比例升至22.5%。在20年的研究周期内，几乎所有真菌的致敏率均呈现小幅上升趋势。在研究的最后十年，对上述三种真菌的多重致敏现象显著增加。真菌致敏存在明确的年龄依赖性，在研究的第二个十年周期中，致敏率在21~40岁年龄组达到峰值。
研究结论：真菌是引发常年性及季节性过敏症状的重要变应原。目前我们建议，在针对气道过敏的皮肤点刺试验标准检测组合中，应纳入曲霉菌、链格孢菌及枝孢菌这三类真菌。