Differential effects of outdoor versus indoor fungal spores on asthma morbidity in inner-city children

doi:10.1016/j.jaci.2009.10.036

Journal of Allergy and Clinical Immunology

Volume 125, Issue 3, March 2010, Pages 593-599

https://doi.org/10.1016/j.jaci.2009.10.036 Get rights and content

Background

Although sensitization to fungal allergens is prevalent in inner-city children with asthma, the relationship between fungal exposure and morbidity is poorly understood.

Objective

We examined relationships between fungal sensitization, exposure, and asthma morbidity in inner-city children.

Methods

Participants were 5 to 11 years old and enrolled in the Inner-City Asthma Study. This report includes the subset of children with at least 1 positive skin test (PST) response to a fungal allergen extract; for these children, indoor and outdoor airborne culturable fungi levels were measured at baseline and throughout the 2-year study. Asthma morbidity measures were collected prospectively. The primary outcome was symptom days per 2 weeks.

Results

At baseline, children with a PST response to a fungal allergen extract had significantly more symptom days compared with those without a PST response to any fungal allergen extract (6.3 vs 5.7 days per 2 weeks, P = .04). During the study, increases in total fungal exposure and indoor Penicillium species exposure were associated with increases in symptom days and asthma-related unscheduled visits. Indoor exposures to total fungi and to Penicillium species were associated with significant increases in unscheduled visits, even after controlling for outdoor fungal levels. Adverse effects associated with exposure to a specific fungus were stronger among children with PST responses to that fungal allergen extract compared with those seen in children with negative skin test responses.

Conclusion

Outdoor fungal exposure is primarily associated with increased asthma symptoms and increased risk of exacerbations in this population.

Section snippets

Methods

The ICAS was a multicenter, randomized controlled trial of environmental intervention to reduce asthma morbidity in which 937 inner-city children aged 5 to 11 years with moderate-to-severe asthma were enrolled. This analysis includes all ICAS participants with a positive skin test (PST) response to at least 1 fungal allergen extract (n = 469). All caregivers provided written informed consent. Details regarding recruitment methods, eligibility criteria, and baseline clinical information for

Results

Nine hundred thirty-six children completed the original ICAS intervention study. Fifty percent (n = 469) of children had a PST response to at least 1 fungal allergen extract.1, 21 These children are included in the present study. Alternaria species sensitization was most prevalent (36%).²⁴ Sensitization to Aspergillus, Cladosporium, and Penicillium species was found in 27%, 18%, and 13% of children, respectively.²⁴ Indoor and outdoor air sampling were performed in 469 households. Of 4690

Discussion

This report presents the respiratory health effects of airborne fungi in a sample of atopic inner-city children with moderate-to-severe asthma. Children sensitized to fungal allergens had increased asthma impairment, as defined by the NHLBI asthma guidelines,²² reflected by more symptom days compared with those seen in children with NST responses to fungal allergen extracts. These associations did not change after adjusting for degree of atopy (ie, number of PST responses to indoor allergens).

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: Supported by National Institutes of Health grants AI/ES-39769, AI/ES-39900, AI/ES-39902, AI/ES-39789, AI/ES-39901, AI/ES-39761, AI/ES-39785, and AI/ES-39776 from the National Institute of Allergy and Infectious Diseases and the National Institutes of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, and by grant M01 RR00533 from the National Center for Research Resources, National Institutes of Health, Department of Health and Human Services.

: Disclosure of potential conflict of interest: J. A. Pongracic receives research support from the National Institute of Allergy and Infectious Diseases and the Food Allergy Project. G. T. O'Connor is a consultant for Sepracor, Inc, and Pulmatrix, Inc. M. L. Muilenberg receives research support from the National Institutes of Health. B. Vaughn is employed by Rho, Inc. D. R. Gold receives grant support from the National Institutes of Health and the US Environmental Protection Agency. W. J. Morgan is a consultant for the Cystic Fibrosis Foundation and Genentech, Inc, and receives grant support from the National Institutes of Health. R. S. Gruchalla is a consultant for GlaxoSmithKline, receives research support from Novartis, and is on the Board of Directors for ABAI. H. E. Mitchell is employed by Rho, Inc, and receives research support from the National Institute of Allergy and Infectious Diseases and the National Institutes of Environmental Health Sciences. The rest of the authors have declared that they have no conflict of interest.

View full text

Asthma and lower airway diseaseDifferential effects of outdoor versus indoor fungal spores on asthma morbidity in inner-city children

Background

Objective

Methods

Results

Conclusion

Section snippets

Methods

Results

Discussion

J Allergy Clin Immunol

J Allergy Clin Immunol

J Pediatr

J Allergy Clin Immunol

J Pediatr

J Allergy Clin Immunol

J Allergy Clin Immunol

New Mexico. J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

Ann Allergy Asthma Immunol

Home and allergic characteristics of children with asthma in seven U.S. urban communities and design of an environmental intervention: the Inner-City Asthma Study

Environ Health Perspect

Damp indoor spaces and health

Environmental allergens and asthma morbidity in low-income children

J Asthma

Examination of fungi in domestic interiors by using factor analysis: correlations and associations with home factors

Appl Environ Microbiol

Damp housing, mould growth, and symptomatic health state

BMJ

Respiratory symptoms in damp homes. A pilot study

Allergy

Quantification of airborne moulds in the homes of children with and without wheeze

Thorax

Asthma and lower airway disease
Differential effects of outdoor versus indoor fungal spores on asthma morbidity in inner-city children