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Am. J. Respir. Crit. Care Med., Volume 164, Number 3, August 2001, 455-459

Clinical Importance of Alternaria Exposure in Children

SARA H. DOWNS, TERESA Z. MITAKAKIS, GUY B. MARKS, N. GEORGE CAR, ELENA G. BELOUSOVA, JÖRG D. LEÜPPI, WEI XUAN, SUE R. DOWNIE, AURELIO TOBIAS, and JENNIFER K. PEAT

Institute of Respiratory Medicine and School of Biological Sciences, University of Sydney, Sydney, Australia; School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, Australia; Clinical Epidemiology Unit, New Children's Hospital, Westmead, NSW, Australia; and Department of Clinical Epidemiology and Public Health, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain

The fungus Alternaria is known to be allergenic and is one of the most common fungi worldwide. We investigated the extent to which exposure to Alternaria increases the severity of asthma. We undertook a prospective cohort study in Australia of 399 school children who had positive skin tests to one or more aeroallergens. Airway responsiveness to histamine, wheeze, and bronchodilator use in 1 mo was measured five times between 1997 and 1999. Airway hyperresponsiveness was defined as PD20FEV1 = 3.9 µmol histamine. Airborne concentrations of Alternaria spores were measured throughout the study, and mean daily concentrations over 1 mo ranged from 2.2 to 307.7 spores/m3 of ambient air. Using generalized estimating equations, we found that airway responsiveness, wheeze, and bronchodilator use increased significantly in association with increased spore concentrations and that the increase in airway responsiveness was greater in children sensitized to Alternarxia than in other children (p = 0.01). The odds ratio for airway hyperresponsiveness in children sensitized to Alternaria was 1.26 (95% CI, 1.14 to 1.39) after an increase in mean exposure of 100 spore/m3/d over 1 mo. These results suggest that Alternaria allergens contribute to severe asthma in regions where exposure to the fungus is high.

Keywords: Alternaria; airway responsiveness; asthma; fungi; children




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