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Ann Allergy Asthma Immunol. 2019 Mar 20. pii: S1081-1206(19)30190-5. doi: 10.1016/j.anai.2019.03.011. [Epub ahead of print]

Association between fungal spore exposure in inner-city schools and asthma morbidity.

Author information

1
Boston Children's Hospital, Division of Allergy and Immunology, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
2
Channing Laboratory, Brigham and Women's Hospital, Boston, Massachusetts.
3
Division of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts.
4
Harvard Medical School, Boston, Massachusetts; Boston Children's Hospital, Division of Respiratory Diseases, Boston, Massachusetts.
5
Harvard Medical School, Boston, Massachusetts; Massachusetts General Hospital, Division of Pediatric Allergy and Immunology, Boston, Massachusetts.
6
Harvard Medical School, Boston, Massachusetts; Massachusetts General Hospital, Division of Pulmonary and Critical Care, Boston, Massachusetts.
7
Brigham and Women's Hospital, Boston, Massachusetts.
8
Brigham and Women's Hospital, Boston, Massachusetts; Boston Children's Hospital, Clinical Research Center Boston, Massachusetts.
9
Harvard Medical School, Boston, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts.
10
Boston Children's Hospital, Division of Allergy and Immunology, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts. Electronic address: wanda.phipatanakul@childrens.harvard.edu.

Abstract

BACKGROUND:

Home fungus exposures may be associated with development or worsening of asthma. Little is known about the effects of school/classroom fungus exposures on asthma morbidity in students.

OBJECTIVE:

To evaluate the association of school-based fungus exposures on asthma symptoms in both fungus-sensitized and nonsensitized students with asthma.

METHODS:

In this prospective study, 280 children with asthma from 37 inner-city schools were phenotypically characterized at baseline and followed-up for 1 year. Fungal spores were collected by using a Burkard air sampler twice during the school year. Clinical outcomes were evaluated throughout the school year and linked to classroom-specific airborne spore sampling. The primary outcome was days with asthma symptoms per 2-week period.

RESULTS:

Fungal spores were present in all classroom samples. The geometric mean of the total fungi was 316.9 spores/m3 and ranged from 15.0 to 59,345.7 spores/m3. There was variability in total fungus quantity between schools and classrooms within the same school. Mitospores were the most commonly detected fungal grouping. Investigation of the individual mitospores revealed that exposure to Alternaria was significantly associated with asthma symptom days in students sensitized to Alternaria (OR = 3.61, CI = 1.34-9.76, P = .01), but not in children not sensitized to Alternaria (OR = 1.04, CI = 0.72-1.49, P = .85). Students sensitized to Alternaria and exposed to high levels (≥75th percentile exposure) had 3.2 more symptom days per 2-week period as compared with students sensitized but exposed to lower levels.

CONCLUSION:

Children with asthma who are sensitized to Alternaria and exposed to this fungus in their classroom may have significantly more days with asthma symptoms than those who were sensitized and not exposed.

CLINICAL TRIAL REGISTRATION:

Clinicaltrials.govNCT01756391.

PMID:
30904580
DOI:
10.1016/j.anai.2019.03.011

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