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Candida albicans (monilia albicans)

In addition to mites and pollen, fungi are considered to be major sources of allergens in allergic disorders such as bronchial asthma [1]; however, the relationship between the allergenicities  of fungi and the pathophysiology of allergic disorders is unclear in comparison to mites. Candida albicans (C. alb) is a yeast-like fungus found in the human oral cavity, gastrointestinal tract, and vaginal mucosa as part of the normal flora. It has been reported the significance of an acid protease(AP) as a major allergn in mucosal atopic reactions. C. alb exists in the host mucosa and secretes enzymes, such as  AP and a phospholipase, which degrade secretory IgA and  IgG-these immunoglobulins attack C.alb as part of the host’s immune defense system. The production of IgE antibodies against these enzymes leads to atopic reactions. Mannan (Mn) [4], a component of cell-wall polysaccharides, is known to be a fungal antigen; in particular, in terms of the serotyping of C. alb. It has been observed common andigenicity between Mn A and Mn B in the human IgE and IgG antibody production system, and the cross allergenicity observed among some fungi was considered to be the result of the common antigenicity of Mn isoforms. Candida mannans are immunogenically potent antigens to which the host's immune system reacts regularly. The human host is not immunologically naïve towards Candida albicans [3].
The role of C. alb as a cause of allergy has been much disputed in the past. Positive skin reactions  are frequently obtained in patients without clinical evidence of Candida infection or allergic disease. m5 is the symbol of Candida albicans in RAST. Patients with chronic spontaneous urticaria (CU) frequently exhibit increased levels of total IgE (tIgE). According to Staubach P, et al (2008) almost all IgE-anti-CA positive CU patients show high levels of tIgE. These data suggest that IgE-anti-CA expression contributes, at least in part, to increased tIgE levels in CU patients.
References

1. O'Driscoll BR, Powell G, Chew F, Niven RM, Miles JF, Vyas A, Denning DW. Comparison of skin prick tests with specific serum immunoglobulin E in the diagnosis of fungal sensitization in patients with severe asthma. Clin Exp Allergy.2009 Aug 18.

2. Staubach P, Vonend A, Burow G, Metz M, Magerl M, Maurer M. Patients with chronic urticaria exhibit increased rates of sensitisation to Candida albicans, but not to common moulds. Mycoses.2008 Sep 12.

3. Müller J, Melchinger W. The significance of Candida serology based on cell wall antigens. Mycoses.2004;47 Suppl 1:2-10.

4.  Akiyama K et al : Assay for detecting IgE and IgG antibodies against Candida albicans cell-wall mannan. Allergy.1998:53:173-179