title: Fungal levels in the home and allergic rhinitis by 5 years of age.
abstract: Studies have repeatedly demonstrated that sensitization to fungi, such as Alternaria, is strongly associated with allergic rhinitis and asthma in children. However, the role of exposure to fungi in the development of childhood allergic rhinitis is poorly understood. In a prospective birth cohort of 405 children of asthmatic/allergic parents from metropolitan Boston, Massachusetts, we examined in-home high fungal concentrations (> 90th percentile) measured once within the first 3 months of life as predictors of doctor-diagnosed allergic rhinitis in the first 5 years of life. In multivariate Cox regression analyses, predictors of allergic rhinitis included high levels of dust-borne Aspergillus [hazard ratio (HR) = 3.27; 95% confidence interval (CI), 1.50-7.14], Aureobasidium (HR = 3.04; 95% CI, 1.33-6.93), and yeasts (HR = 2.67; 95% CI, 1.26-5.66). The factors controlled for in these analyses included water damage or mild or mildew in the building during the first year of the child's life, any lower respiratory tract infection in the first year, male sex, African-American race, fall date of birth, and maternal IgE to Alternaria > 0.35 U/mL. Dust-borne Alternaria and nonsporulating and total fungi were also predictors of allergic rhinitis in models excluding other fungi but adjusting for all of the potential confounders listed above. High measured fungal concentrations and reports of water damage, mold, or mildew in homes may predispose children with a family history of asthma or allergy to the development of allergic rhinitis.
authors.affiliation: Biostatistics Research Center, Institute for Clinical Research and Health Policy Studies, Department of Medicine, Tufts-New England Medical Center, Boston, Massachusetts, USA. pstark@tufts-nemc.org
authors.forename: Paul C
authors.initials: PC
authors.lastname: Stark
authors.forename: Juan C
authors.initials: JC
authors.lastname: Celedón
authors.forename: Ginger L
authors.initials: GL
authors.lastname: Chew
authors.forename: Louise M
authors.initials: LM
authors.lastname: Ryan
authors.forename: Harriet A
authors.initials: HA
authors.lastname: Burge
authors.forename: Michael L
authors.initials: ML
authors.lastname: Muilenberg
authors.forename: Diane R
authors.initials: DR
authors.lastname: Gold
mesh_terms: D001900:Boston / Q000453:epidemiology; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005658:Fungi / Q000145:classification / Q000472:pathogenicity*; D006801:Humans; D008297:Male; D012221:Rhinitis, Allergic, Perennial / Q000453:epidemiology* / Q000382:microbiology