Clinical use of immunoassays in assessing exposure to fungi and potential health effects related to fungal exposure.
OBJECTIVE
To review and summarize current evidence regarding the proper role of immunoassays in clinical assessments of exposure to fungi and health effects related to fungal exposure.


METHODS
We reviewed relevant scientific investigations and previously published reviews concerning this topic.


METHODS
The authors' clinical, laboratory, and public health experiences were used to evaluate relevant data for scientific merit.


RESULTS
Testing to determine the presence of IgE to specific fungi may be a useful component of a complete clinical evaluation in the diagnosis of illnesses that can be caused by immediate hypersensitivity such as allergic rhinitis and asthma. Detection of IgG to specific fungi has been used as a marker of exposure to agents that may cause illnesses such as hypersensitivity pneumonitis. However, the ubiquitous nature of many fungi and the lack of specificity of fungal antigens limit the usefulness of these types of tests in the evaluation of potential building-related illness and fungal exposure. Specific serologic tests (such as tests for cryptococcal antigen, coccidioidal antibody, and Histoplasma antigen) have been shown to be useful in the diagnosis of some fungal infections, but these are the exception not the rule.


CONCLUSIONS
There is currently not enough scientific evidence to support the routine clinical use of immunoassays as a primary means of assessing environmental fungal exposure or health effects related to fungal exposure. Health care providers who care for persons expressing concerns about the relationship of symptoms to potential exposure to fungi are advised to use immunoassay results with care and only as an adjunct to a comprehensive approach to patient care.
Trout
Douglas B
DB
Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio 45226-1998, USA. dtrout@cdc.gov
Seltzer
James M
JM
Page
Elena H
EH
Biagini
Raymond E
RE
Schmechel
Detlef
D
Lewis
Daniel M
DM
Boudreau
A Yvonne
AY
D000818:Animals; D000908:Antibodies, Fungal / Q000276:immunology; D000946:Antigens, Fungal / Q000276:immunology; D002675:Child, Preschool; D004781:Environmental Exposure; D004783:Environmental Microbiology; D005658:Fungi / Q000276:immunology*; D006801:Humans; D006969:Hypersensitivity, Immediate; D007118:Immunoassay; D008297:Male; D009181:Mycoses / Q000276:immunology
D000908:Antibodies, Fungal; D000946:Antigens, Fungal