Fungal allergy as a risk factor for developing rosacea

The pathogenesis of rosacea is not fully understood. In this disease, the release of inflammatory molecules and overgrowth of skin-colonizing microorganisms, including fungal microbiota, are noted. The study of the frequency of occurrence and the nature of the spectrum of sensitization to fungal allergens in patients with rosacea is of particular interest and accounts for relevance of the study. Purpose of the study: to analyze the frequency of occurrence and the nature of the spectrum of sensitization to fungal allergens in patients with rosacea.

Materials and methods. The study included patients with rosacea aged 18 to 60 years (group 1, n = 31). All patients underwent a specific allergic examination: collected allergic history, skin prick testing using the following allergens: nutritional yeast, Candida albicans, Alternaria alternate, Aspergillus fumigatus, Cladosporium herbarum, Penicillium notatum (Allergopharma, Germany). Concentration of total immunoglobulin E (IgE) and eosinophilic cationic protein in blood serum was measured in indirect immunofluorescence analysis with Thermo Scientific Multiskan FC semi-automatic analyzer. Statistica 8.0 software package was used for statistical analysis.

Results. Analysis of the features of the spectrum of sensitization to fungal allergens in the group of patients with rosacea showed that the most significant allergens are Cladosporium herbarum (74.2% of patients) and Candida albicans (58.1%). Sensitization to nutritional yeast and Penicillium notatum was detected in almost half of the patients. The concentration of total immunoglobulin E in blood serum in the group of patients with rosacea was 79.4 IU/ml [23.4; 105.1], in the control group — 45.1 IU/ml [23.4; 144.0]. The concentration of eosinophilic cationic protein in blood serum in the group of patients with rosacea was significantly higher compared to the control group: 50.3 ng/ml [43.0; 62.0] and 7.9 ng/ml [4.6; 27.1], respectively. After skin prick testing with fungal allergens, patients with rosacea were prescribed an individual elimination diet with the exclusion of causally significant allergens for a period of 1 month. In 61.2% (n = 19) of cases in patients with rosacea, a positive elimination effect was noted: a significant decrease in the severity of erythema, papules and pustules in the face.

Conclusion. Thus, the study revealed a high incidence of fungal allergy and established the features of the spectrum of sensitization to fungal allergens in patients with rosacea. The most significant fungal allergens in rosacea are fungi of the genus Cladosporium herbarum, Candida albicans, Penicillium notatum as well as nutritional yeast.