Sensitization to Saprophytic Fungi in a Case of Eczema

Abstract

In a communication now in press we have described a case of asthma due to a saprophytic fungus. This patient's attacks occurred in damp houses or other places where molds and similar fungi flourish. On testing his skin for its reaction to extracts of fungi isolated from places where he had had severe attacks, we found a consistently positive reaction to a species of Altenaria (mali?). His serum also gave a positive Kustner-Prausnitz reaction to Altenaria in the skin of 3 out of 4 individuals. Inhalation of a spray of extract of this fungus produced characteristic paroxysms of asthma. Other saprophytes produced milder reactions. We concluded that his spontaneous attacks were caused by the spores of these fungi which abound in the air.

This patient also has a chronic eczema involving the hands and feet and to a lesser extent the forearms and legs. The lesions begin as groups of minute papules and vesicles on red patches of skin. The areas slowly enlarge and become infiltrated and desquamating. Their appearance resembles that of the eczematous lesions which frequently follow dermatophytosis of the feet—lesions which Jadassohn and Peck have recently shown to be due to sensitization to trichophyta. In our case cultures from the lesions have never yielded pathogenic fungi, though a common saprophyte, Aspergillus nidulans, has been repeatedly isolated from a lesion on the leg.

Some years ago Hilgermann and Niethe reported that certain patients with eczema were sensitized to saprophytic fungi which grew on their lesions. In this patient we could obtain immediate intradermal reactions to extracts of the altenaria which produced asthma, of the aspergillus which we obtained from his skin, and of a number of other fungi obtained from house dust.