title: Wheeze in infancy: protection associated with yeasts in house dust contrasts with increased risk associated with yeasts in indoor air and other fungal taxa.
abstract: BACKGROUND
  While fungal exposures are assumed to provoke wheeze through irritant or allergenic mechanisms, little is known about the differential effects of indoor and outdoor fungi on early-life wheeze.
  
  
  METHODS
  In a Boston prospective birth cohort of 499 at-risk infants, culturable fungi in bedroom air and dust and outdoor air were measured at the age of 2-3 months. Wheeze was determined using bimonthly telephone questionnaires. Odds ratios were estimated for an interquartile increase in fungal natural log-transformed concentrations, adjusting for predictors of wheeze and potential confounders.
  
  
  RESULTS
  Increased odds of 'any wheeze' (≥1 vs 0 episodes) by age one were positively associated with indoor dust Alternaria [odds ratio (OR) = 1.83; 95% confidence interval (CI), 1.07-3.14], Penicillium [OR = 1.18; (0.98-1.43)], and Cladosporium [OR = 1.47; (1.16-1.85)]; indoor air Penicillium [OR = 1.26; (0.92-1.74)]; and outdoor air Cladosporium [OR = 1.68; (1.04-2.72)]. In contrast, indoor dust yeasts were protective [OR = 0.78; (0.66-0.93)]. 'Frequent wheeze' (≥2 vs <2 episodes) by age one was borderline associated with dust yeasts [OR = 0.86; (0.70-1.04)] and indoor air yeasts [OR = 1.53; (0.93-2.53)]. Alternaria concentration was associated with any wheeze for children with maternal mold sensitization [OR = 9.16; (1.37-61.22)], but not for those without maternal mold sensitization [OR = 1.32; (0.79-2.20)].
  
  
  CONCLUSIONS
  While wheeze rates were higher with exposures to fungal taxa considered to be irritant or allergenic in sensitive subjects, yeasts in the home had a strong protective association with wheeze in infancy. Molecular microbiologic studies may elucidate specific components of innate microbiologic stimulants that lead to contrasting effects on wheeze development.
authors.affiliation: Harvard School of Public Health, Boston, MA, USA.
authors.forename: B
authors.initials: B
authors.lastname: Behbod
authors.forename: J E
authors.initials: JE
authors.lastname: Sordillo
authors.forename: E B
authors.initials: EB
authors.lastname: Hoffman
authors.forename: S
authors.initials: S
authors.lastname: Datta
authors.forename: M L
authors.initials: ML
authors.lastname: Muilenberg
authors.forename: J A
authors.initials: JA
authors.lastname: Scott
authors.forename: G L
authors.initials: GL
authors.lastname: Chew
authors.forename: T A E
authors.initials: TA
authors.lastname: Platts-Mills
authors.forename: J
authors.initials: J
authors.lastname: Schwartz
authors.forename: H
authors.initials: H
authors.lastname: Burge
authors.forename: D R
authors.initials: DR
authors.lastname: Gold
mesh_terms: D016902:Air Pollution, Indoor / Q000009:adverse effects*; D000528:Alternaria / Q000276:immunology; D000818:Animals; D000946:Antigens, Fungal / Q000008:administration & dosage / Q000276:immunology*; D001230:Aspergillus / Q000276:immunology; D020048:Blattellidae / Q000276:immunology; D002963:Cladosporium / Q000276:immunology; D004391:Dust / Q000276:immunology*; D005260:Female; D006801:Humans; D007223:Infant; D010407:Penicillium / Q000276:immunology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012130:Respiratory Hypersensitivity / Q000175:diagnosis / Q000276:immunology / Q000382:microbiology; D012135:Respiratory Sounds / Q000175:diagnosis / Q000276:immunology*; D018570:Risk Assessment
chemical_list: D000946:Antigens, Fungal; D004391:Dust
keywords: asthma; fungi; housing; wheeze; yeast