Mould allergy has not been examined as closely as allergies to mites and pollens. The published data suggests a more severe course of allergic disease if it coexists with mould allergy. In the last decade, different states of AR have been examined and various pictures of the disease described, depending on the kinds of mould allergens - those in the sinuses, or external ones. The diagnosis of AR variations is essential therapy and prognosis. This is why the authors decided to estimate the scale of the problem in atopic children from Lower Silesia.

158 children from Lower Silesia, aged from 4 to 16 years the average age of both sexes being the same suffering from AR were examined. Diagnosis was made on the basis of allergy anamnesis, SPT and laryngologic examination. In suspicious cases, sinus RTG or even CT was made. All the children were tested with Allergopharma SPT with mite allergens (D. pteronyssimus, D. farinae), pet fur, and grass, tree, and weed pollens. The following mould allergens were tested: Alternalia alt., Cladosporinum herb., Aspergillus fum., Penicillium sp., Candida alb., Scorobolomycetes, Trichophyton sp. The children were divided into those with positive mould SPT and those with positive SPT to all other allergens. The children with positive mould SPT were further divided into those whose positive SPT correlated with exacerbation of the symptoms when exposed to moulds, or did not do so.

Two groups were created:

II - 41 children with positive mould SPT and anamnesis conformity;

II - 32 children without the conformity. The control group consisted of 85 children with AR and negative mould SPT. The groups were analysed in the course of AR and coexistence with other manifestations of allergy. In group I, the coexistence of allergy to moulds and to other inhalation allergens, and which mould most frequently allergises, was assessed. The results were calculated using the method of significant difference in percentage tests.

Analysis of the groups reveals a more severe course of disease in children allergic to moulds - 3 times more frequent coexistence of AR and BA, and 2 times less frequent AR alone in group I. Group I suffer from mild rhinitis significantly less often, but get moderate rhinitis and infections much more often than the control group and group II. The differences between the control group and group II were statistically insignificant. Our observations are congruent with/compatible with the publications of Katz, Kantothonasi, O´Hollarena, Ozanguc, and others. The data should change the allergists´ opinion of the role of moulds in allergies.

It seems that children allergic to moulds are more liable to get infections of the respiratory tracts, and nasal mucosa polyps. In 2 children with mould allergy, nasal mucosa polyps were detected, and in 2 other children, there was a supposition of AFS (CT image suggesting a mycetoma in the frontal sinus (1) and the maxillary sinus (1)). Because of the age of the boys (14 and 12), operative revision of the sinuses was postponed till they are 16. It is commonly thought that polyps seldom complicate AR, and thus the sinus changes are caused by frequent infections, not mould allergy. Still, this must be examined on a larger group of patients.

Mould allergy is commonly associated with pollinosis, agrees with most publications.

Analysis of the most common mould allergens indicates Alternaria, confirmed by positive SPT in 32 children, including 3 for whom it was the only allergen. According to our observations, this mould gives the strongest skin reaction in SPT, and the persons with Alternaria allergy have symptoms similar to pollinosis. Similar opinion have been presented by Peat, Potter and D´Adamo, and Rapiejko, but the work of Katz and Guneser suggest a lack of atopy symptoms in the case of isolated mould allergy. The second mould in frequency of occurrence in the group of children allergic to moulds was Cladosporium (10 people), third Aspergillus, and two persons whose leading allergen was Aspergillus had severe AR. Data concerning the frequency of mould allergy occurrence in Baltic countries indicated a leading role for Cladosporium (D´Amato, Mailing, Ankryust), but in our group it was Alternaria.

1. Coexistence of mould allergy affects the clinical course of AR, intensifying and escalating the frequency of complications.

2. In cases of AR with mould allergy, the coexistence of BA is more frequent than the other examined groups.

3. Mould allergy most often complicates AR symptoms with pollen allergy.

4. The most allergizing species of moulds are Alternaria alternata.