A LONGITUDINAL birth cohort study has shown that persistent sensitisation to Alternaria is strongly associated with ongoing asthma and rhinitis from childhood into adulthood, with researchers also identifying rAlt a 1 as a potentially superior marker for asthma risk detection in younger individuals.
Study Explores Long-Term Allergy Risk
The study analysed participants from the Isle of Wight birth cohort to investigate how Alternaria sensitisation develops over time and how it relates to respiratory allergic disease across the life course.
Alternaria is a common environmental mould linked to allergic respiratory conditions, but uncertainty has remained regarding its long-term sensitisation patterns and the most clinically useful diagnostic tests.
Researchers assessed participants at 4, 10, 18, and 26 years of age. Sensitisation was measured using skin prick testing (SPT) at all time points, alongside serum IgE testing to whole Alternaria extract and recombinant Alt a 1 (rAlt a 1) at ages 10, 18, and 26 years. Participants were classified into sensitisation trajectories of “Never”, “Any positive”, or “Persistent”.
Among 434 participants with complete data, most individuals (84.1%) were never sensitised to Alternaria, while 11.1% showed intermittent sensitisation and 4.8% demonstrated persistent sensitisation over time.
Alternaria Associated with Persistent Rhinitis
The investigators found strong graded associations between Alternaria sensitisation trajectories and respiratory disease outcomes. Persistent sensitisation was associated with the highest risks of persistent asthma and rhinitis, with particularly strong associations observed for rhinitis (trend p<0.001).
Importantly, rAlt a 1 appeared to discriminate asthma risk more effectively than whole-extract IgE testing during childhood and adolescence. However, by 26 years of age, differences between the diagnostic assays became less pronounced, suggesting they may be largely interchangeable in adulthood.
Agreement between sensitisation assays also strengthened with age, becoming substantial by late adolescence and near-perfect in adulthood.
The authors concluded that Alternaria sensitisation appears to consolidate from late adolescence onwards and that persistent sensitisation may serve as a marker for long-term allergic respiratory disease. The findings also support the potential value of rAlt a 1 testing for identifying asthma risk earlier in life.
Reference
Leily M et al. Natural history of Alternaria sensitisation and association with asthma and rhinitis from childhood to adulthood. Allergy. 2026;DOI: 10.1111/all.70394.
Feature image: Olya on Adobe Stock
