TABLE 1.
Chronology of the link between dermatophytosis and allergic disease
| Study (date) (reference) | No. of patients | Allergic disease | Tinea infection | Evidence of specific sensitization | Treatment | Outcome measures | Importance |
|---|---|---|---|---|---|---|---|
| Wise and Sulzberger (1930) (120) | 1 | Perennial asthma and rhinitis | Skin of trunk; history of severe tinea of feet | Elicitation of itch, urticaria; sneeze, and dyspnea after intradermal injection of trichophytin | Local | Clinical response (decreased skin lesions) | First evidence of a causal link between fungal infection and and rhinitis or asthma |
| Weary and Guerrant (1967) (117) | 1 | Chronic urticaria | Skin and nails of feet | IH skin test to trichophytin; flare of urticarial lesions after skin testing | Griseofulvin | Clinical response | Resolution of urticaria after antifungal therapy; relapse after therapy discontinued |
| Platts-Mills et al. (1986) (92) | 1 | Asthmaa | Skin of feet and groin | IH skin test and serum IgE (RAST) to Trichophyton spp/ | Griseofulvin | Clinical response (PEF,c symptoms, steroid use) | First report of “intrinsic” asthma and antifungal therapy |
| Platts-Mills et al. (1987) (91) | 73 | Urticaria, angioedema, asthma or rhinitis | History of skin infection and clinical signs of infection | IH skin tests to Trichophyton spp. 8/27 with urticaria/angioedema, 15/39 with asthma, 2/7 with rhinitis; IgE to Trichophyton spp. (RAST) in 87% of subjects with IH | None | NAd | High prevalence of serum IgE to Trichophyton antigens in patients with IH skin tests and allergic disease |
| Gumowski et al. (1987) (42) | 135 | Asthma or rhinitis with IH skin tests to fungal antigens | NDd | Immediate response to bronchial challenge with C. albicans, Trichophyton, or Epidermophyton (81 patients) | Desensitization (2 yr) | Clinical response and lung function (bronchial challenge) | Evidence of specific sensitization to fungal antigens within the respiratory tract; effect of immunotherapy on bronchial reactivity to Trichophyton |
| Ward et al. (1989) (115) | 10 | Asthma | Skin, toenails, groin | IH skin tests to Trichophyton spp.; serum IgE to T. tonsurans (RAST); immediate response to bronchial challenge with T. tonsurans; positive nasal challenge | None | NAd | Specific reactivity to T. tonsurans in the upper and lower respiratory tract |
| Kivity et al. (1992) (68) | 8 | Perennial rhinitisa | Skin or toenails | IH skin test, serum IgE (RAST), and positive nasal challenge to Trichophyton | Griseofulvin (4 patients) | Clinical response (nasal symptoms) | Effect of antifungal therapy on rhinitis |
| Wilson et al. (1993) (119) | 1 | Atopic dermatitis | Toenails | IH skin test to Trichophyton spp. & Tri t 1; serum IgE to T. tonsurans (RAST); serum IgE & IgG to Tri t 1 (RIA)b | Griseofulvin | Clinical response (skin lesions) | Effect of antifungal therapy on eczema |
| Ward et al. (1999) (116) | 11 | Severe or moderately severe asthma | Toenails (all patients) ± skin | IH skin test to Trichophyton spp.; serum IgE to T. tonsurans (RAST); serum IgE and IgG4 to Tri r 2 or Tri t 4 (RIA); positive bronchial challenge to Trichophyton spp. | Fluconazole | Clinical response (PEF, symptoms, steroid use, bronchial sensitivity) | Placebo-controlled trial of fluconazole |
| Klein et al. (1999) (71) | 1 | Atopic dermatitis: multiple flares with concurrent acute tinea pedis | Skin and nails of feet; positive culture for T. rubrum | IH skin test to Trichophyton spp. | Ketoconazole | Clinical response (skin lesions) | Repeated resolution of atopic dermatitis with clearance of fungal infection |
| Hurlimann and Fah (2001) (58) | 2 | Perennial rhinitis and asthma; chronic dermatitis | Skin and nails of feet; positive culture for T. rubrum | Severe dyspnea after skin prick test with T. rubrum; IH skin test to T. rubrum | Terbinafine | Clinical response (nasal symptoms or skin lesions) | Recurrence of nasal symptoms or skin lesions when treatment discontinued |
a
Patients exclusively sensitized to Trichophyton.
b
RIA, antigen binding radioimmunoprecipitation assay.
c
PEF, peak expiratory flow rate.
d
ND, not documented; NA, not applicable.