title: Clinical importance of Alternaria exposure in children.
abstract: 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 PD(20)FEV(1) = 3.9 micromol 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/m(3) 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 Alternaria 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/m(3)/d over 1 mo. These results suggest that Alternaria allergens contribute to severe asthma in regions where exposure to the fungus is high.
authors.affiliation: Institute of Respiratory Medicine and School of Biological Sciences, University of Sydney, Sydney, Australia. shd@mail.med.usyd.edu.au
authors.forename: S H
authors.initials: SH
authors.lastname: Downs
authors.forename: T Z
authors.initials: TZ
authors.lastname: Mitakakis
authors.forename: G B
authors.initials: GB
authors.lastname: Marks
authors.forename: N G
authors.initials: NG
authors.lastname: Car
authors.forename: E G
authors.initials: EG
authors.lastname: Belousova
authors.forename: J D
authors.initials: JD
authors.lastname: Leüppi
authors.forename: W
authors.initials: W
authors.lastname: Xuan
authors.forename: S R
authors.initials: SR
authors.lastname: Downie
authors.forename: A
authors.initials: A
authors.lastname: Tobias
authors.forename: J K
authors.initials: JK
authors.lastname: Peat
mesh_terms: D000485:Allergens / Q000276:immunology; D000528:Alternaria / Q000276:immunology*; D001249:Asthma / Q000209:etiology / Q000382:microbiology*; D002648:Child; D015331:Cohort Studies; D004781:Environmental Exposure; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D006967:Hypersensitivity; D008297:Male; D012720:Severity of Illness Index; D013170:Spores
chemical_list: D000485:Allergens