How Do Triggers Inform Therapy?

If you have asthma, it’s important to know what triggers an attack. When your doctor knows your triggers, they can give you more effective treatment. In fact, if the plan is to use allergen immunotherapy, it’s essential that they know exactly what you’re allergic to.

You might already have heard of allergen immunotherapy, which is also known as desensitisation or hypo-sensitisation. It helps with environmental allergies: dust, pollen, fungal spores, animal dander and even insect bites. It involves exposure to increasingly large amounts of the allergen, and it can be very effective against asthma and allergic rhinitis, which is often called hay fever.

What’s Important During Diagnosis?

Fungal spores are highly associated with several severe forms of asthma. If you have asthma and you don’t yet know why, you should definitely ask your doctor to do a skin prick test for fungal spore allergies (or ‘mould allergies’) as well as for pollen, dust mite and animal dander allergies. In particular, the fungi Aspergillus, Alternaria, and Cladosporium should be included. There’s also evidence for including Penicillium in the tests.

There are of course more steps in diagnosing a fungal airway allergy. For example, a detailed patient history is essential and follow-up blood tests for serological analyses of recombinant allergens can be very useful. But including these three fungi in skin prick tests is a great starting point.

If your doctor would like to know more about the research supporting testing for fungal spores, you can send them the link to the above-mentioned research paper. It concludes that fungi are relevant allergens for asthma and explains why the four named fungi are important. It also states that it’s not a good idea to use just one fungus as a representative (or proxy) for fungal allergies in general.

What Should You Know about Fungal Spores?

When you know what you’re allergic to, you should get an appropriate treatment, such as immunotherapy, but it’s also good to know how to avoid contact with the allergen. Fungal spores are present everywhere. It might sound like they’re impossible to get away from, but you can certainly minimise your risk of inhaling large quantities of them.

• Aspergillus is mainly found in soil and dust. When you disturb these, especially during garden work, construction, renovation or demolition, you might cause the fungus to release large quantities of spores. If you’re allergic to Aspergillus, consider wearing a mask if you’re doing such work and keep your home environment low on dust.
• Alternaria is a plant pathogen, so your main chance of encountering it in high quantities is in the garden or on agricultural properties. Again, wearing a mask is advisable if you’ve tested positive for an allergy.
• Cladosporium is very common indoors and outdoors. If you see greenish, brown or black mould, that’s probably Cladosporium. You’ll most likely see it in bathrooms, attics or cellars — anywhere with a moderate to high moisture level. It’s important to have good ventilation that keeps humidity down in your house, especially in those spaces. A humidity of 50–55% is considered healthy for humans. Also, wear a mask if you’re going to be working in the attic or cellar for a longer period.
• Penicillium is very important in the natural environment. You’ve probably seen it on mouldy bread or cake. It can also grow on fruit and vegetables or even on wood surfaces and carpets. Again, good ventilation and the appropriate humidity are important, but you should also make sure spoiling food is thrown out as soon as possible if you have an allergy.

Stay Safe!

Hopefully this has helped you get a better sense of what to do if you have asthma. If you don’t know what you’re allergic to, get tested! And if you do, make sure you take the appropriate treatment and precautions.