Rachel Tham1, Don Vicendese2, Shyamali C Dharmage1, Rob J Hyndman3, Ed Newbigin4, Emma Lewis4, Molly O'Sullivan5, Adrian J Lowe6, Philip Taylor7, Philip Bardin8, Mimi L K Tang9, Michael J Abramson10, Bircan Erbas11. 1. Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, the University of Melbourne, Melbourne, Australia. 2. School of Public Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia. 3. Department of Econometrics & Business Statistics, Monash University, Clayton, Australia. 4. School of Biosciences, the University of Melbourne, Melbourne, Australia. 5. Allergy & Immune Disorders, Murdoch Children's Research Institute, the Royal Children's Hospital, Melbourne, Australia. 6. Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, the University of Melbourne, Melbourne, Australia; Allergy & Immune Disorders, Murdoch Children's Research Institute, the Royal Children's Hospital, Melbourne, Australia. 7. School of Life and Environmental Sciences, Deakin University, Geelong, Australia. 8. Monash Lung & Sleep, Monash Medical Centre and University and Hudson Institute, Melbourne, Australia. 9. Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, the University of Melbourne, Melbourne, Australia; Allergy & Immune Disorders, Murdoch Children's Research Institute, the Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, the University of Melbourne, Melbourne, Australia. 10. Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia. 11. School of Public Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia. Electronic address: b.erbas@latrobe.edu.au.
Abstract
BACKGROUND: Childhood asthma is a significant public health problem and severe exacerbations can result in diminished quality of life and hospitalization. OBJECTIVE: We sought to examine the contribution of outdoor fungi to childhood and adolescent asthma hospitalizations. METHODS: The Melbourne Air Pollen Children and Adolescent study is a case-crossover study of 644 children and adolescents (aged 2-17 years) hospitalized for asthma. The Melbourne Air Pollen Children and Adolescent study collected individual data on human rhinovirus infection and sensitization to Alternaria and Cladosporium and daily counts of ambient concentrations of fungal spores, pollen, and air pollutants. Conditional logistic regression models were used to assess associations with increases in spore counts while controlling for potential confounding and testing interactions. RESULTS: Exposure to Alternaria (adjusted odds ratio [aOR], 1.07; 95% CI, 1.03-1.11), Leptosphaeria (aOR, 1.05; 95% CI, 1.02-1.07), Coprinus (aOR, 1.04; 95% CI, 1.01-1.07), Drechslera (aOR, 1.03; 95% CI, 1.00-1.05), and total spores (aOR, 1.05; 95% CI, 1.01-1.09) was significantly associated with child asthma hospitalizations independent of human rhinovirus infection. There were significant lagged effects up to 3 days with Alternaria, Leptosphaeria, Cladosporium, Sporormiella, Coprinus, and Drechslera. Some of these associations were significantly greater in participants with Cladosporium sensitization. CONCLUSIONS: Exposures to several outdoor fungal spore taxa, including some not reported in previous research, are associated with the risk of child and adolescent asthma hospitalization, particularly in individuals sensitized to Cladosporium. We need further studies to examine cross-reactivity causing asthma exacerbations. Identifying sensitization to multiple fungal allergens in children with asthma could support the design and implementation of more effective strategies to prevent asthma exacerbations.
BACKGROUND: Childhood asthma is a significant public health problem and severe exacerbations can result in diminished quality of life and hospitalization. OBJECTIVE: We sought to examine the contribution of outdoor fungi to childhood and adolescent asthma hospitalizations. METHODS: The Melbourne Air Pollen Children and Adolescent study is a case-crossover study of 644 children and adolescents (aged 2-17 years) hospitalized for asthma. The Melbourne Air Pollen Children and Adolescent study collected individual data on human rhinovirus infection and sensitization to Alternaria and Cladosporium and daily counts of ambient concentrations of fungal spores, pollen, and air pollutants. Conditional logistic regression models were used to assess associations with increases in spore counts while controlling for potential confounding and testing interactions. RESULTS: Exposure to Alternaria (adjusted odds ratio [aOR], 1.07; 95% CI, 1.03-1.11), Leptosphaeria (aOR, 1.05; 95% CI, 1.02-1.07), Coprinus (aOR, 1.04; 95% CI, 1.01-1.07), Drechslera (aOR, 1.03; 95% CI, 1.00-1.05), and total spores (aOR, 1.05; 95% CI, 1.01-1.09) was significantly associated with childasthma hospitalizations independent of human rhinovirus infection. There were significant lagged effects up to 3 days with Alternaria, Leptosphaeria, Cladosporium, Sporormiella, Coprinus, and Drechslera. Some of these associations were significantly greater in participants with Cladosporium sensitization. CONCLUSIONS: Exposures to several outdoor fungal spore taxa, including some not reported in previous research, are associated with the risk of child and adolescent asthma hospitalization, particularly in individuals sensitized to Cladosporium. We need further studies to examine cross-reactivity causing asthma exacerbations. Identifying sensitization to multiple fungal allergens in children with asthma could support the design and implementation of more effective strategies to prevent asthma exacerbations.
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