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Children's Health
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Fungal Levels in the Home and Allergic Rhinitis by 5 Years of Age Paul C. Stark,1 Juan C. Celedón,2 Ginger L.
Chew,3 Louise M. Ryan,4 Harriet A. Burge,5 Michael
L. Muilenberg,5 and Diane R. Gold2 1Biostatistics Research Center, Institute for Clinical Research
and Health Policy Studies, Department of Medicine, Tufts-New England Medical
Center, Boston, Massachusetts, USA; 2Channing Laboratory, Department
of Medicine, Brigham and Women’s Hospital and the Harvard Medical School,
Boston, Massachusetts, USA; 3Department of Environmental Health
Sciences, Mailman School of Public Health, Columbia University, New York, New
York, USA; 4Department of Biostatistics, and 5Department
of Environmental Health, Harvard University School of Public Health, Boston,
Massachusetts, USA Abstract Studies have repeatedly demonstrated that sensitization to fungi, such as Alternaria, is strongly associated with allergic rhinitis and asthma in children. However, the role of exposure to fungi in the development of childhood allergic rhinitis is poorly understood. In a prospective birth cohort of 405 children of asthmatic/allergic parents from metropolitan Boston, Massachusetts, we examined in-home high fungal concentrations (> 90th percentile) measured once within the first 3 months of life as predictors of doctor-diagnosed allergic rhinitis in the first 5 years of life. In multivariate Cox regression analyses, predictors of allergic rhinitis included high levels of dust-borne Aspergillus [hazard ratio (HR) = 3.27 ; 95% confidence interval (CI) , 1.50-7.14], Aureobasidium (HR = 3.04 ; 95% CI, 1.33-6.93) , and yeasts (HR = 2.67 ; 95% CI, 1.26-5.66) . The factors controlled for in these analyses included water damage or mild or mildew in the building during the first year of the child’s life, any lower respiratory tract infection in the first year, male sex, African-American race, fall date of birth, and maternal IgE to Alternaria > 0.35 U/mL. Dust-borne Alternaria and nonsporulating and total fungi were also predictors of allergic rhinitis in models excluding other fungi but adjusting for all of the potential confounders listed above. High measured fungal concentrations and reports of water damage, mold, or mildew in homes may predispose children with a family history of asthma or allergy to the development of allergic rhinitis. Key words: allergic rhinitis, fungi, mold, respiratory health effects, water damage. Environ Health Perspect 113:1405-1409 (2005) . doi:10.1289/ehp.7844 available via http://dx.doi.org/ [Online 20 May 2005] Address correspondence to P.C. Stark, Biostatistics Research Center, Institute for Clinical Research and Health Policy Studies, Tufts-New England Medical Center, 750 Washington St., Tufts-NEMC #63, Boston, MA 02111 USA. Telephone: (617) 636-5457. Fax: (617) 636-5560. E-mail: pstark@tufts-nemc.org We thank the participating families for their enthusiastic participation. We also thank C. Rogers and D. Sredl for their efforts. This study was supported by National Institutes of Health grant AI/EHS35786. P.C.S. was supported by the Yamaguchi Endowment. The authors declare they have no competing financial interests. Received 10 December 2004 ; accepted 19 May 2005. |
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[References Listed in PubMed] References
Andersen AA. 1958. New sampler for the collection, sizing and enumeration of viable airborne particles. J Bacteriol 76:471-484.
Arshad SH, Tariq SM, Matthews S, Hakim E. 2001. Sensitization to common allergens and its association with allergic disorders at age 4 years: a whole population birth cohort study. Pediatrics 108:E33-E37.
Beijer L, Thorn J, Rylander R. 2002. Effects after inhalation of (1 → 3)-β-D-glucan and relation to mould exposure in the home. Mediators Inflamm 11(3):149-153.
Camhi SL, Morgan WJ, Pernisco N, Quan SF. 2000. Factors affecting sleep disturbances in children and adolescents. Sleep Med 1(2):117-123.
Celedon JC, Litonjua AA, Weiss ST, Gold DR. 1999. Day care attendance in the first year of life and illnesses of the upper and lower respiratory tract in children with a familial history of atopy. Pediatrics 104(3 pt 1):495-500.
Chew GL, Burge HA, Dockery DW, Muilenberg ML, Weiss ST, Gold DR. 1998. Limitations of a home characteristics questionnaire as a predictor of indoor allergen levels. Am J Respir Crit Care Med 157:1536-1541.
Chew GL, Douwes J, Doekes G, Higgins KM, Spithoven J, van Strien R, et al. 2001. Fungal extracellular polysaccharides, and β(1 → 3) glucans, and culturable fungi in repeated sampling of house dust. Indoor Air 11(3):171-178.
Clark NM, Brown RW, Parker E, Robbins TG, Remick DG, Philbert MA, et al. 1999. Childhood asthma. Environ Health Perspect 107(suppl 3):421-429.
Corbo GM, Forastiere F, Agabiti N, Pistelli R, Dell’Orco V, Perucci CA, et al. 2001. Snoring in 9- to 15-year old children: risk factors and clinical relevance. Pediatrics 108(5):1149-1154.
Daisey JM, Angell WJ, Apte MG. 2003. Indoor air quality, ventilation and health symptoms in schools: an analysis of existing information. Indoor Air 13:53-64.
Devos SA, Van der Valk PG. 2000. The relevance of skin prick testing for Pityrosporum ovale in patients with head and neck dermititis. Allergy 55(11):1056-1058.
Dotterud LR, Vorland LH, Falk ES. 1996. Mould allergy in school children in relation to airborne fungi and residential characteristics in homes and schools in northern Norway. Indoor Air 6:71-76.
Downs SH, Mitakakis TZ, Marks GB, Car NG, Belousova EG, Leuppi JD, et al. 2001. Clinical importance of Alternaria exposure in children. Am J Respir Crit Care Med 164(3):455-459.
Ellis MB. 1971. Dematiaceous Hyphomycetes. Kew, Surry, UK:Commonwealth Mycological Institute.
Gent JF, Ren P, Belanger K, Triche E, Bracken MB, Holford TR, et al. 2002. Levels of household mold associated with respiratory symptoms in the first year of life in a cohort at risk for asthma. Environ Health Perspect 110:A781-A786.
Gold DR, Burge HA, Carey V, Milton DK, Platts-Mills T, Weiss ST. 1999. Predictors of repeated wheeze in the first year of life. Am J Respir Crit Care Med 160:227-236.
Greinert U, Lepp U, Becker W. 2000. Bird keeper’s lung without bird keeping. Eur J Med Res 5(3):124.
Halonen M, Stern DA, Wright AL, Taussig LM, Martinez FD. 1997. Alternaria as a major allergen for asthma in children raised in a desert environment. Am J Respir Crit Care Med 155:1356-1361.
Hastie TJ, Tibshirani RJ. 1990. Generalized Additive Models. London:Chapman and Hall.
International Study of Asthma and Allergies in Childhood (ISAAC) Steering Committee. 1998. Worldwide variation in prevalence of symptoms of asthma allergic rhinoconjunctivitis, and atopic eczema: ISAAC. Lancet 351:1225-1232.
Jarvis JQ, Morey PR. 2001. Allergic respiratory disease and fungal remediation in a building in a subtropical climate. Appl Occup Environ Hyg 16(3):380-388.
Johnston RB. ed. 2000. Clearing the Air: Asthma and Indoor Air Exposures. Washington, DC:National Academy Press.
Kapsali T, Horowitz E, Diemer F, Togias A. 1997. Rhinitis is ubiquitous in allergic asthmatics. J Allergy Clin Immunol 99:S138.
Kilpelainen M, Terho EO, Helenius H, Koskenvuo M. 2001. Home dampness, current allergic diseases, and respiratory infections among young adults. Thorax 56:462-467.
Litonjua AA, Carey VJ, Burge HA, Weiss ST, Gold DR. 1998. Parental history and the risk of childhood asthma. Does mother confer more risk than father? Am J Respir Crit Care Med 158(1):176-181.
Macher J. ed. 2000. Bioaerosols: Assessment and Control. Cincinnati, OH:American Conference of Government Industrial Hygienists Bioaerosols Committee.
Nittner-Marszalska M, Wojcicka-Kustrzeba I, Bogacka E, Patkowski J, Dobek R. 2001. Skin prick test response to enzyme enolase of the baker’s yeast (Saccharomyces cerevisiae) in diagnosis of respiratory allergy. Med Sci Monit 7(1):121-124.
Nolles G, Hoekstra MO, Schouten JP, Gerritsen J, Kauffman HF. 2001. Prevalence of immunoglobulin E for fungi in atopic children. Clin Exp Allergy 31:1564-1570.
Park JH, Gold DR, Spiegelman DL, Burge HA, Milton DK. 2001. House dust endotoxin and wheeze in the first year of life. Am J Respir Crit Care Med 163:322-328.
Phipatanakul W, Celedon JC, Raby BA, Litonjua AA, Milton DK, Sredl D, et al. 2004. Endotoxin exposure and eczema in the first year of life. Pediatrics 114:13-18.
Scharf MB, Cohen AP. 1998. Diagnostic and treatment implications of nasal obstruction in snoring and obstructive sleep apnea. Ann Allergy Asthma Immunol 81(4):279-287.
Scheel CM, Rosing WC, Farone AL. 2001. Possible sources of sick building syndrome in a Tennessee middle school. Arch Environ Health 56(5):413-417.
Skoner DP. 2001. Allergic rhinitis: definition, epidemiology, pathophysiology, detection, and diagnosis. J Allergy Clin Immunol 108:S2-S8. [CrossRef].
Stark PC, Burge HA, Ryan LM, Milton DK, Gold DR. 2003. Fungal levels in the home and lower respiratory tract illnesses in the first year of life. Am J Respir Crit Care Med 168:232-237.
Tengvall Linder M, Johansson C, Scheynius A, Wahlgren C. 2000. Positive atopy patch test reactions to Pityrosporum orbiculare in atopic dermatitis patients. Clin Exp Allergy 30(1):122-131.
Tibshirani R. 1997. The Lasso method for variable selection in the Cox model. Statist Med 16:385-395. [CrossRef].
Verhoeff AP, van Reenen-Hoekstra ES, Samson RA, Brunekreef B, van Wijnen JH. 1994. Fungal propagules in house dust. I. Comparison of analytic methods and their value as estimators of potential exposure. Allergy 49(7):533-539.
von Arx JA. 1970. The Genera of Fungi Sporulating in Pure Culture. Lehre, Germany:Verlag von J Cramer.
Last Updated: April 25, 2006
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