TNF and autoimmune disease: Since most of our patients with MD were classified as MD type 1 and did not have a comorbid autoimmune disease, and we also excluded patients with response to inhalatory allergens in the prick test (including Penicillium and Aspergillus), the elevation of TNF-α observed in patients with MD after exposure of PBMC to Penicillium and Aspergillus cannot be explained by another autoimmune condition or previous sensitization to other allergens.