Discussion
Approximately 80,000 fungal species have been identified, and
>1 million may exist.6 Respiratory and
skin symptoms caused by exposure to these environmental allergens are
not uncommon in the atopic population,4 with rates of
sensitization in allergy patients ranging from 5% to
20%.6 Case reports suggest that previous
sensitization may lead to life-threatening anaphylactic reactions
through direct ingestion of molds.4,7
In previous case reports, the most common molds identified as food
contaminants were Penicillium, Fusarium, Mucor, Aspergillus,
Alternaria, and Cladosporium. 2–5,8 The molds
encountered in food spoilage are strictly aerobes.9Oxygen must enter the packaging during manufacturing or afterwards by
compromise of the seal, after which high water and carbohydrate content
and low light create an environment ripe for mold growth,
.9
Our two patients with allergic symptoms after drinking juices and
positive skin tests for mold were tested for only five of the most
common mold types in our area: Alternaria alternata, Bipoaris
sorokiniana, Hormodendrum cladospor, Aspergillus mix, andPenicillium mix. The third patient did not test positive for
these molds, but could theoretically be allergic to a different mold
species present in her beverage. Although the fourth patient could not
be tested for mold, he experienced an allergic reaction following
consumption of a packaged juice, and later tested negative to the
ingredient which might have explained his reaction. Together, these
results are concerning for mold contamination in packaged,
preservative-free juices. In response to this risk, Capri Sun changed
their juice packaging in 2014 to include clear bottoms, so consumers can
detect the presence of molds. 10
Our four patients did not experience true anaphylaxis, but previously
published case reports describe patients with previous sensitization to
allergens who have experienced anaphylaxis after ingesting food with
hidden contaminants. Many health implications associated with ingesting
mold cause concern for the safety of children who drink packaged,
preservative-free juices. Further studies are needed.
Veronica Kwiatkowski, MD1, Jeanne M. Lomas,
DO2
1 Department of Pediatrics, University of Rochester
Medical Center, 601 Elmwood Avenue, Rochester, NY 14642
2 Department of Allergy and Immunology, University of
Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642