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TOPLINE:

Sensitization to Alternaria often developed during adolescence, and persistent sensitization was associated with an increased risk for asthma and rhinitis. Testing for recombinant Alt a 1 (rAlt a 1), the major Alternaria allergen, better predicted asthma risk in younger participants, whereas skin and blood tests showed similar results by adulthood.

METHODOLOGY:

• Researchers analyzed data from a UK-based birth cohort to map the patterns of developing sensitization to Alternaria and their relationship to asthma and rhinitis.
• Participants underwent skin prick testing at ages 4, 10, 18, and 26 and blood testing for serum-specific immunoglobulin E (IgE, to whole Alternaria extract and to rAlt a 1) at ages 10, 18, and 26.
• Any Alternaria was defined as a positive result on any test. Based on results at ages 10, 18, and 26, participants were grouped into three trajectories: never (negative at all ages), any/nonpersistent (positive at one or two ages), or persistent (positive at all three ages).
• The main outcomes, assessed using standard questionnaires and clinical review, were the occurrence of asthma at age 26; allergic rhinitis at age 26; persistent asthma across ages 10, 18, and 26; and persistent rhinitis at the same timepoints.

TAKEAWAY:

• Among 434 participants with complete Alternaria sensitization data, 84.1% were never sensitized to Alternaria, 11.1% had nonpersistent sensitization, and 4.8% had persistent sensitization between ages 10 and 26.
• Persistent asthma occurred in 6.6% of participants in the never-sensitized group and in 23.8% in the persistently sensitized group. Persistent rhinitis occurred in 10.4% and 38.1% of participants in the respective groups.
• Persistent Alternaria sensitization was associated with a 3.59-fold higher risk for persistent asthma and a 3.65-fold higher risk for persistent rhinitis than no sensitization. Nonpersistent sensitization was also linked to elevated risks for both conditions (P < .05 for all).
• In younger participants, rAlt a 1 test findings showed a stronger association with the risk for asthma than whole‑extract IgE test findings. By 26 years, agreement between skin prick tests and blood assays increased with age and became near-perfect.

IN PRACTICE:

"These life-course data refine the clinical relevance of Alternaria within a population cohort and identify adolescence as a key window for targeted risk communication and prevention," the authors of the study wrote.

SOURCE:

S. Hasan Arshad, with The David Hide Asthma & Allergy Research Centre in Newport, Wales, was the corresponding author of the study, which was published online on May 18, 2026, in Allergy.

LIMITATIONS:

The study lost participants over time and had missing Alternaria test data at different ages. The analyzed group had fewer men and more patients with rhinitis than the original cohort, limiting generalizability. The analysis lacked environmental measures of mold or spore levels.

DISCLOSURES:

The authors did not report any specific funding for the study. The assessments of the source cohort received support from the US National Institutes of Health, Asthma UK, and The David Hide Asthma & Allergy Research Centre. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.