Sensitisation to airborne moulds and severity of asthma: cross sectional study from European Community respiratory health survey.
OBJECTIVE
To assess whether the severity of asthma is associated with sensitisation to airborne moulds rather than to other seasonal or perennial allergens.


METHODS
Multicentre epidemiological survey in 30 centres.


METHODS
European Community respiratory health survey.


METHODS
1132 adults aged 20-44 years with current asthma and with skin prick test results.


METHODS
Severity of asthma according to score based on forced expiratory volume in one second, number of asthma attacks, hospital admissions for breathing problems, and use of corticosteroids in past 12 months.


RESULTS
The frequency of sensitisation to moulds (Alternaria alternata or Cladosporium herbarum, or both) increased significantly with increasing asthma severity (odds ratio 2.34 (95% confidence interval 1.56 to 3.52) for either for severe v mild asthma). This association existed in all of the study areas (gathered into regions), although there were differences in the frequency of sensitisation. There was no association between asthma severity and sensitisation to pollens or cats. Sensitisation to Dermatophagoides pteronyssinus was also positively associated with severity. In multivariable logistic regressions including sensitisation to moulds, pollens, D pteronyssinus, and cats simultaneously, the odds ratios for sensitisation to moulds were 1.48 (0.97 to 2.26) for moderate v mild asthma and 2.16 (1.37 to 3.35) for severe v mild asthma (P<0.001 for trend).


CONCLUSIONS
Sensitisation to moulds is a powerful risk factor for severe asthma in adults. This should be taken into account in primary prevention, management, and patients' education.
European Community Respiratory Health Survey, Unit 408 Epidémiologie, Faculté de Médecine Xavier Bichat, BP 416, 75870 Paris CEDEX 18, France. zureik@vjf.inserm.fr
Mahmoud
M
Zureik
Catherine
C
Neukirch
Bénédicte
B
Leynaert
Renata
R
Liard
Jean
J
Bousquet
Françoise
F
Neukirch
D000328:Adult; D000391:Air Microbiology; D000393:Air Pollutants / Q000009:adverse effects*; D000485:Allergens / Q000009:adverse effects*; D000528:Alternaria / Q000276:immunology; D000946:Antigens, Fungal / Q000009:adverse effects*; D001249:Asthma / Q000209:etiology* / Q000503:physiopathology; D002963:Cladosporium / Q000276:immunology; D003430:Cross-Sectional Studies; D004781:Environmental Exposure; D005260:Female; D005541:Forced Expiratory Volume; D005658:Fungi / Q000276:immunology*; D006306:Health Surveys; D006801:Humans; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D012307:Risk Factors; D012720:Severity of Illness Index; D012882:Skin Tests
D000393:Air Pollutants; D000485:Allergens; D000946:Antigens, Fungal