Cladosporium Allergy Shots: Highest Spore Count, Lowest Evidence
Cladosporium herbarum allergy shots are supported by only one small early trial (Dreborg 1986, 16 children) and are not recommended by AAAAI/ACAAI or EAACI consensus — despite Cladosporium being the most abundant fungal genus in outdoor air worldwide with counts reaching 50,000 spores/m³.
About Curex’s SCIT program
Curex’s at-home allergy shots (SCIT) are coming soon and focus on the most common environmental allergens:
- • Pollens — tree, grass, weed & ragweed
- • Pet dander — cat & dog
- • Dust mites
- • Molds — Alternaria & mold mix
Cladosporiumis covered here for general education and may not be part of Curex’s current treatment set. Join the waitlist and our care team will help confirm your options.
Cladosporium Allergy Immunotherapy: How It Works
Allergy immunotherapy is the only long-term treatment that re-trains the immune system to stop overreacting to cladosporium — rather than just masking symptoms with antihistamines or steroids. By gradually exposing the body to controlled doses of cladosporium allergen, immunotherapy shifts the underlying allergic response and produces relief that often outlasts treatment by 7–10 years.
There are two evidence-based forms of cladosporium immunotherapy used today, both built on the same desensitization principle but delivered very differently.
of sustained relief after a complete immunotherapy course — the only allergy treatment with proven long-term effect after stopping.
Allergy Shots (SCIT)
Weekly injections of cladosporium extract in a clinic, escalating over 3–6 months until a maintenance dose is reached. Continued monthly for 3–5 years. Longest clinical track record for cladosporium allergy.
- Strongest evidence base for severe and polysensitized patients
- Covered by most insurance plans
- Requires 50–100+ in-person clinic visits across the full course
- Or at home with no clinic visits— Curex’s Virtual Shot Room model delivers the same SCIT program with live video supervision by trained Curex clinical staff for the first injection from each new vial or concentration and restarts after gaps or reactions.
Allergy Drops / Tablets (SLIT)
Daily drops or dissolvable tablets containing cladosporium extract, held under the tongue at home. Same desensitization principle, delivered without injections. WHO-recognized as an effective form of allergy immunotherapy since 2001.
- Taken at home — no weekly clinic trips, no needles
- Lower systemic reaction rate than allergy shots
- Curex offers prescription cladosporium immunotherapy drops with allergist oversight
The rest of this page goes deep on allergen-specific immunotherapy with shots — protocol, efficacy data, side effects, and cost. If you’d rather skip the clinic and treat cladosporium allergy with at-home drops, see how Curex sublingual immunotherapy compares below.
What is Cladosporium?
The biology, taxonomy, and clinical fingerprint of Cladosporium — the foundation of how SCIT targets it.
Cladosporium herbarum colonies — olive-green to dark brown. Psychrophilic growth down to −6°C; counts 15,000–50,000 spores/m³ at summer peak.
- Scientific name
- Cladosporium herbarum / Cladosporium cladosporioides
- Family
- DavidiellaceaeCapnodiales, Dothideomycetes, Ascomycota
- Type
- Outdoor and indoor dematiaceous mold — primarily seasonal
- Native to
- Cosmopolitan; found on plant surfaces, soil, and indoor environments worldwide
- Allergen proteins
- Cla h 8 (major) — 29.5 kDa NADP-mannitol dehydrogenase; 57% IgE recognition (Simon-Nobbe 2008)Cla h 6 — enolase, pan-fungal cross-reactive with Alt a 6 and other fungal enolasesCla h 9 — serine protease; cross-reacts with Asp f 18 and Pen ch 18
- Particle size
- 3–5 µm aerodynamic diameter (range 3–35 µm) — highly respirable, alveolar penetration possible
- Avoidance difficulty
- Very difficult
How Cladosporium Allergy Presents
Symptoms by body system — useful for distinguishing Cladosporium sensitivity from overlapping allergies and infections.
Respiratory
- Allergic rhinitis — sneezing, congestion, and watery discharge peaking in summer
- Asthma exacerbation triggered by outdoor spore counts above 3,000 spores/m³
- Chronic cough correlating with high summer outdoor mold counts
- Thunderstorm-related wheeze in patients co-sensitized to both Cladosporium and Alternaria
Ocular
- Allergic conjunctivitis — itching, redness, and tearing during summer mold peaks
- Bilateral chemosis on high-count afternoons outdoors
- Periorbital puffiness after extended outdoor exposure
Dermal
- Eczema flares in atopic-dermatitis patients correlating with Cladosporium season
- Contact urticaria from direct contact with decaying plant matter
- Skin prick test reactions — wheal-flare with non-standardized extract
Systemic
- Co-sensitization with Alternaria dramatically amplifies thunderstorm-asthma risk (OR 63.97 vs 9.31 for Alternaria alone, Pulimood 2007)
- Fatigue and cognitive fog during sustained high-count summer periods
- Hypersensitivity pneumonitis reported from heavy Cladosporium-laden indoor environments
When a patient comes in with a positive Cladosporium IgE in a panel full of other mold positives, my first question is: is this real sensitization or pan-fungal enolase cross-reactivity? Cla h 8 is the only commercially available Cladosporium component, and it helps answer that. If Alternaria is also positive, I typically treat with Alternaria SCIT — it covers the shared enolase pathway — and avoid adding Cladosporium extract to the vial, where the evidence is thin and the systemic-reaction rate is higher.
When & Where Cladosporium Peaks
Allergen intensity by month and by state. Useful for timing SCIT start dates and travel planning.
12-Month Intensity
Peak: June through August outdoors; counts can reach 15,000–50,000 spores/m³ in temperate regions· ~5 months of outdoor significance (May–September); growth continues at refrigerator temperatures (−6°C to −10°C)
US Exposure Map
12 high-intensity statesExposure intensity by state (text version)
- ME:
- Low
- VT:
- Low
- NH:
- Low
- WA:
- High
- MT:
- Moderate
- ND:
- Low
- MN:
- High
- WI:
- High
- MI:
- High
- NY:
- High
- MA:
- High
- OR:
- High
- ID:
- Moderate
- WY:
- Moderate
- SD:
- Low
- IA:
- Moderate
- IL:
- Low
- IN:
- Low
- OH:
- High
- PA:
- High
- NJ:
- High
- CT:
- High
- RI:
- Low
- CA:
- High
- NV:
- Moderate
- UT:
- Moderate
- CO:
- Moderate
- NE:
- Low
- MO:
- Moderate
- KY:
- Moderate
- WV:
- Low
- VA:
- Moderate
- MD:
- Low
- DE:
- Low
- AZ:
- Low
- NM:
- Low
- KS:
- Low
- AR:
- Low
- TN:
- Moderate
- NC:
- Moderate
- SC:
- Low
- OK:
- Low
- LA:
- Low
- MS:
- Moderate
- AL:
- Moderate
- GA:
- Moderate
- TX:
- Low
- FL:
- Low
- AK:
- Low
- HI:
- Low
What Cladosporium Cross-Reacts With
Patients sensitized to one allergen often react to others sharing similar proteins. This map shows the documented molecular overlaps.
Cladosporium cross-reactivity is dominated by two pan-fungal allergen families — enolase (Cla h 6) and serine protease (Cla h 9) — that are shared with Alternaria, Aspergillus, and Penicillium, complicating interpretation of multi-mold IgE panels.
Cla h 8 / Alt a 8 mannitol dehydrogenase at 85.7% identity; Cla h 6 / Alt a 6 enolase cross-reactive (79–94% identity)
Both Dothideomycetes; shared melanized cell-wall epitopes; both colonize indoor moist surfaces
Pan-fungal enolase cross-reactivity (Cla h 6 / Asp f 22); Cla h 9 serine protease overlaps with Asp f 18
Cla h 9 / Pen ch 18 serine protease cross-reactivity; both colonize water-damaged indoor environments
Shared IgE-binding bands documented in atopic-fungal panels; both outdoor seasonal molds
Is SCIT Right for Your Cladosporium Allergy?
Answer five questions to understand whether Cladosporium SCIT is worth discussing with a specialist or whether another approach fits better.
How severe are your mold-season symptoms (summer)?
The Cladosporium SCIT Protocol
Cladosporium SCIT, when considered by a specialist, uses a non-standardized mold-only extract administered separately from all pollen extracts — a conservative buildup is mandatory given the elevated systemic-reaction rate documented in surveillance data.
International consensus recommends a slower buildup for Cladosporium than for pollen allergens due to higher systemic-reaction rates documented in mold-mix safety reviews. Rush or cluster schedules are not advisable. Each injection requires a 30-minute observation period — with Curex's at-home protocol you self-observe with a prescribed epinephrine auto-injector on hand, and the first injection from each new vial or concentration is Virtual Shot Room–supervised by the care team. The non-standardized nature of US extracts means Alt a 1-equivalent protein content is unknown — dose titration is based entirely on the manufacturer's weight-volume specification.
Maintenance dosing is reached after successful build-up. Mold-only vials are kept separate from any pollen vials (protease degradation rule). The limited trial evidence (Dreborg 1986, 16 children) does not define an optimal maintenance dose for Cladosporium. Your allergist will individualize the dose based on tolerability and symptom response.
Given the absence of long-term RCT data, the durability of Cladosporium SCIT response is unknown. Decisions about stopping are individualized. If Alternaria SCIT was run in parallel and is the documented primary driver of improvement, Cladosporium extract may be discontinued first.
Extract Concentration Ladder
You progress through each vial during build-up. Concentration increases ~10x per step.
What the Research Shows for Cladosporium SCIT
Cladosporium SCIT has essentially no modern RCT evidence — only one early controlled trial exists, and it is too small to support a clinical recommendation.
- Symptom score reduction in only published controlled trial40%Dreborg S et al., 1986, DBPC SCIT trial in children, N=16 — significant per protocol but small n and high systemic-reaction rate
- Thunderstorm asthma OR reduction with Alternaria SCIT (cross-coverage estimate)35%Pulimood TB et al., JACI 2007 — co-sensitization Alternaria + Cladosporium drives OR 63.97; Alternaria SCIT addresses shared enolase/mannitol-dehydrogenase pathway
No modern DBPC-RCT supports Cladosporium SCIT. The AAAAI/ACAAI Practice Parameter (Cox 2011) and EAACI position papers do not recommend Cladosporium SCIT as first-line; mold-mix extracts containing Cladosporium account for a disproportionate share of systemic reactions in US surveillance data. Environmental control and optimized pharmacotherapy remain the primary evidence-based interventions.
Ready to skip the surprise bills?
At-home allergy shots (SCIT) are designed by board-certified allergists. See the listed SCIT plan rate in our pricing record and request a quote for eligibility, initiation and total care costs.
- MD-ledBoard-certified allergists
- QuoteTotal care estimate
- 50K+Patients treated
- HSA/FSAEligible
Cladosporium SCIT Side Effects
Cladosporium SCIT carries a higher systemic-reaction rate than pollen-based SCIT — a key safety consideration when weighing the thin efficacy evidence.
Local reactions
4 documented| Reaction | Rate | Severity |
|---|---|---|
Injection-site swelling and erythema Mold extracts cause larger local reactions than pollen extracts on average | Rate 30–60% | Mild |
Large local reaction (>5 cm induration) More common with Cladosporium than with Alternaria; requires dose adjustment | Rate 15–25% | Moderate |
Injection-site pruritus | Rate 25–45% | Mild |
Delayed local swelling | Rate 10–20% | Mild |
Systemic reactions
4 documented| Reaction | Rate | Severity |
|---|---|---|
Rhinitis or mild asthma flare Higher rate than pollen-SCIT; warrants careful dose escalation | Rate 1–3% of injections | Mild |
Generalized urticaria Mold-mix extracts including Cladosporium are overrepresented in systemic-reaction surveillance data | Rate 0.2–0.8% of injections | Moderate |
Bronchospasm requiring bronchodilator | Rate 0.1–0.3% of injections | Moderate |
Anaphylaxis 30-minute self-observation and a prescribed epinephrine auto-injector on hand are mandatory for every at-home dose, with the first injection from each new vial or concentration Virtual Shot Room–supervised | Rate <0.01% of injections | Severe |
Cladosporium is consistently associated with higher systemic-reaction rates in SCIT safety surveillance compared to pollen allergens — a meaningful counterweight to its thin efficacy data. The risk-benefit ratio is less favorable than for Alternaria SCIT or for well-standardized pollen immunotherapy.
SCIT vs Alternatives for Cladosporium
For Cladosporium-sensitive patients, the evidence actually tilts toward environmental control and optimized medications rather than SCIT — unlike most other inhalant allergens where immunotherapy is a strong first-line option.
| Criterion | SCIT | SLIT Drops | AvoidanceBest | Medications |
|---|---|---|---|---|
| Effectiveness | Very limited — 1 small trial (Dreborg 1986) | No high-quality trial data for Cladosporium | Meaningful — reducing peak exposure below 3,000 spores/m³ clinical threshold | Good symptom control for mild-to-moderate disease |
| 5-yr cost | $3,500–$15,000 total | Custom compounded drops (off-label, no Cladosporium RCT) | Low — HEPA, monitoring apps | $500–$2,000/year |
| Duration | 3–5 years maintenance | 3–5 years typical | Ongoing — lifestyle modification | Every season indefinitely |
| Convenience | Weekly then monthly clinic visits | Daily at-home drops | Moderate burden | Daily pills and sprays |
| Safety | Higher systemic-reaction rate than pollen SCIT | Low systemic risk | No injection risk | Generally safe |
| Lasting effect | Unknown — no long-term follow-up | Unknown | Sustained with continued control | No disease modification |
SCIT
SLIT Drops
AvoidanceBest
Medications
Given the thin evidence for Cladosporium SCIT, environmental control (HEPA filtration, limiting outdoor exposure above 3,000 spores/m³) and optimized antihistamines and nasal steroids are the best-evidenced interventions. If immunotherapy is pursued, Curex delivers it as weekly at-home self-injections with pricing confirmed in a current program quote, with allergist oversight via telehealth, a prescribed epinephrine auto-injector confirmed on hand, and Virtual Shot Room–supervised dosing for the first injection from each new vial or concentration — though high-quality Cladosporium-specific immunotherapy data are also lacking.
What Cladosporium SCIT Actually Costs
Cladosporium SCIT may require additional prior-authorization documentation given that consensus guidelines do not list it as a recommended first-line treatment; your allergist may need to provide a detailed letter of medical necessity. Coverage policies vary by insurer — confirm before beginning a course. Curex at-home IgE testing identifies specific cladosporium sensitization before allergist consultations, eliminating the need for an initial skin-test visit.
Cost range varies by deductible, co-insurance, and clinic.
Verify these codes with your insurer to confirm coverage.
See the listed Environmental Allergy Shots Plan rate, commercial terms dated 2026-10-12; consultations are included without copay. Confirm availability, eligibility, other included services, testing, any in-person care, insurance responsibility and billing cadence in your written quote before enrolling.
Join the waitlistStop guessing about your cladosporium allergy. Get a plan.
Take Curex’s 3-minute allergy quiz. A board-certified allergist will review your symptoms and recommend the right immunotherapy path for you — shots or drops.
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Cladosporium SCIT — Frequently Asked
Quick answers to the questions patients ask most before starting treatment.
Cladosporium is the most frequently occurring fungal genus in outdoor air worldwide, with counts reaching 15,000–50,000 spores/m³ in summer — far higher than any pollen. However, allergenic potency per spore is much lower than Alternaria. The clinical-significance threshold for Cladosporium symptoms is approximately 3,000 spores/m³, compared to only 100 spores/m³ for Alternaria. This means Alternaria triggers reactions at far lower concentrations. The combination of both sensitizations dramatically increases risk — Pulimood 2007 found that co-sensitization to Alternaria and Cladosporium raised thunderstorm asthma odds ratio to 63.97, compared to 9.31 for Alternaria alone. Abundance in air does not equal severity of individual allergic response.
No — AAAAI/ACAAI Practice Parameter (Cox 2011) and EAACI position papers do not recommend Cladosporium SCIT as standard first-line treatment. The evidence base consists of one early controlled trial by Dreborg (1986) with only 16 children. Additionally, mold-mix extracts containing Cladosporium are associated with higher systemic-reaction rates than pollen-based extracts in US surveillance data. This risk-benefit profile — thin efficacy evidence combined with elevated safety concerns — is why consensus guidelines do not endorse routine Cladosporium SCIT. A board-certified allergist may still consider it in selected highly symptomatic patients after thorough discussion of the evidence gaps.
Cla h 8 is the major Cladosporium allergen — a 29.5 kDa NADP-mannitol dehydrogenase recognized by 57% of sensitized patients and the only recombinant Cladosporium allergen commercially available for component-resolved diagnostics. Testing with rCla h 8 helps distinguish genuine primary Cladosporium sensitization from cross-reactivity via the pan-fungal enolase pathway (Cla h 6), which is shared with Alternaria, Aspergillus, and Penicillium. A patient with high total Cladosporium IgE but negative rCla h 8 may actually be primarily sensitized to another mold. SPT-to-sIgE concordance for Cladosporium can be as low as 30%, making component testing valuable before committing to a long SCIT course.
For most patients co-sensitized to both molds, Alternaria SCIT is the better-evidenced and safer choice. Alternaria has multiple DBPC-RCTs and is supported by international consensus; Cladosporium has essentially one small trial and elevated systemic-reaction risk. Alternaria SCIT also incidentally addresses the shared enolase (Alt a 6 / Cla h 6) and mannitol dehydrogenase (Alt a 8 / Cla h 8) cross-reactive pathways between the two genera — meaning treating Alternaria may also reduce sensitivity to the shared Cladosporium allergen proteins. Your allergist will use component testing (rAlt a 1, rCla h 8) to confirm which mold is the dominant driver and tailor the treatment accordingly.
Cladosporium spore counts peak from June through August in temperate Northern Hemisphere climates, with highest levels in warm, humid afternoon air. Counts regularly exceed the 3,000 spores/m³ clinical-significance threshold during this window. Practical avoidance strategies include checking local mold-count apps before outdoor activity, staying indoors during windy afternoons when counts are reported high, keeping windows closed during peak season, using HEPA air purifiers indoors (capturing greater than 99.97% of spores at 3+ µm), and maintaining indoor humidity below 50%. Morning hours typically have lower Cladosporium counts than afternoon. Cladosporium is psychrophilic and can grow at near-freezing temperatures, making it active in early spring before other outdoor molds appear.
Yes — Cladosporium is one of the top three most common indoor airborne fungi, though it thrives outdoors at much higher counts. Indoors, it colonizes refrigerators (growth at −6 to −10°C), windowsills, grout, and any surface with humidity above 86–88% relative humidity. It is xerophilic — tolerating lower water activity (0.86–0.88) than most indoor molds — which means it can grow on surfaces that other molds cannot colonize. Addressing moisture infiltration, maintaining indoor humidity below 50%, and using HEPA filtration reduce indoor Cladosporium concentrations. Unlike Stachybotrys or Penicillium, which require more severe moisture damage to establish, Cladosporium can colonize ordinary bathroom surfaces and window condensation.
The only published controlled trial for Cladosporium SCIT (Dreborg 1986) was conducted in 16 children, so the limited evidence actually comes from a pediatric population. In clinical practice, most pediatric allergists follow the same caution as for adults — Alternaria SCIT is preferred when co-sensitization is present, and Cladosporium SCIT is approached with conservative buildup and extended observation due to higher systemic-reaction rates. For overall injection safety context, a large safety study of self-administered allergen immunotherapy (Schaffer et al., 2015) found a systemic reaction rate of just 0.16% per patient across 23,614 patients giving 2,021,600 injections, with no fatalities — lower than the 3%–14% typically seen with office-based shots. A board-certified pediatric allergist will consider the child's symptom burden, component-testing results, and family capacity for weekly clinic visits before recommending Cladosporium SCIT. Sublingual immunotherapy drops may be considered as a lower-risk alternative for children unable to tolerate injections, though no high-quality Cladosporium SLIT-drop trial exists.
Cladosporium shares pan-fungal cross-reactive proteins — particularly the serine protease (Cla h 9) that overlaps with Asp f 18 (Aspergillus) and Pen ch 18 (Penicillium) — but this cross-reactivity at the molecular level does not necessarily translate into meaningful clinical cross-desensitization. No trial has tested whether Cladosporium SCIT reduces reactivity to Aspergillus or Penicillium. For patients with significant Aspergillus disease (especially ABPA), SCIT is not first-line regardless — the priority is ABPA workup and treatment with corticosteroids, itraconazole, or biologics. For Penicillium, no controlled SCIT trial exists either. The practical answer is that cross-coverage from Cladosporium SCIT onto other molds should not be assumed without trial evidence.
This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider with questions about a medical condition. Content reviewed by board-certified allergists at Curex.
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