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