Allergy to Alternaria alternata: Comprehensive review from the origin to the therapeutic approach

Alternaria alternata is an ubiquitous mold commonly found in both outdoor and indoor environments. It is a common airborne mold recognized as a significant aeroallergen linked to pediatric allergic rhinitis and asthma. Although sensitization rates in children vary regionally, evidence suggests that A. alternata allergy significantly impacts pediatric respiratory health and as its exposure worsens, respiratory outcomes in susceptible pediatric populations Alternaria. Children are especially vulnerable due to their developing immune and respiratory systems and greater exposure to environmental allergens. This narrative review aims to summarize current knowledge on A. alternata as an allergenic source in children, including its biology, allergenic components (especially Alt a 1), interactions with immune system, airway epithelium interacting with other allergens, and clinical relevance. We also discuss the allergen-specific immunotherapy strategies with standardized extracts that are effective and safe in pediatric patients. Understanding the role of Alternaria in allergic disease is essential for early and accurate diagnosis (including component-resolved methods), effective intervention, and improving long-term outcomes in affected children. Future research should focus on novel vaccine technologies and standardized pediatric-specific treatment protocols.