Botrytis cinerea
Summary
Botrytis cinerea is a ubiquitous, necrotrophic, phytopathic fungus. It poses a significant economic burden worldwide through spoilage of various crops pre-and post-harvest. B. cinerea has a low prevalence in both outdoor and indoor environments, despite there being a high prevalence of sensitization. B. cinerea causes allergic rhinitis in children and adults, asthma in children and hypersensitivity pneumonitis in the horticultural and viticultural settings. There is currently no recognized B. cinerea allergen.
Epidemiology
Worldwide distribution
B. cinerea is found globally, with geographically dependent spore seasons. It has a low prevalence in ambient air both indoors and outdoors, with a calculated median of around 1.1% across different environments. However, this was reported to be higher in the Netherlands, at between 2.7–17%.
Sensitization to B. cinerea antigen among patients with clinical hypersensitivity is estimated to range from 1.3% to 52%, with a calculated median of 18.1%, as determined by skin prick or radioallergosorbent test. Similarly, the reported prevalence of sensitivity to B. cinerea in a cohort of patients with severe asthma was 18%, although this was always with co-sensitization with at least one other fungal allergen.
Furthermore, it has been demonstrated that B. cinerea is the most prevalent allergen in mold-sensitized patients in the USA and the second most prevalent allergen amongst patients in Denmark and Sweden.
The prevalence of sensitization to B. cinerea in the occupational setting has also been evaluated. A study of greenhouse workers in the Netherlands found 4% of chrysanthemum workers and 13.8% bell pepper workers.
Route Of Exposure
Main
Airborne exposure has been reported globally.
Secondary
Exposure by the oral route has been proposed with ingestion of fruit and vegetables with surface B. cinerea, which can persist after washing. Additionally, a role for B. cinerea allergens in the pathogenesis of wine hypersensitivity has been proposed. However, there is no documented evidence of this.
Clinical Relevance
B. cinerea has been associated with allergic rhinitis and asthma. SAFS is a hypersensitivity syndrome characterized by allergic sensitization to fungi and the resulting modulating effect on asthma, with chronic fungal bronchitis resulting in mucosal damage and airway remodeling. There is overlap with allergic bronchopulmonary aspergillosis (ABPA), however, a significant difference is that ABPA is rarely diagnosed in children with asthma. Central to the diagnosis of SAFS is the demonstration of sensitization (skin prick test wheal ≥3mm or Specific IgE ≥0.4) to at least one of seven fungal species, one of which is B. cinerea. Hypersensitivity pneumonitis has been reported in a case study of two vinery workers (Wine-grower’s lung) in Austria.
References
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