title: Quantity and diversity of environmental microbial exposure and development of asthma: a birth cohort study.
abstract: BACKGROUND
  Early-life exposure to environmental microbial agents may be associated with the development of allergies. The aim of the study was to identify better ways to characterize microbial exposure as a predictor of respiratory symptoms and allergies.
  
  
  METHODS
  A birth cohort of 410 children was followed up until 6 years of age. Bacterial endotoxin, 3-hydroxy fatty acids, N-acetyl-muramic acid, fungal extracellular polysaccharides (EPS) from Penicillium and Aspergillus spp., β-D-glucan, ergosterol, and bacterial or fungal quantitative polymerase chain reactions (qPCRs) were analyzed from dust samples collected at 2 months of age. Asthma, wheezing, cough, and atopic dermatitis were assessed using repeated questionnaires. Specific IgEs were determined at the age of 1 and 6 years.
  
  
  RESULTS
  Only few associations were found between single microbial markers and the studied outcomes. In contrast, a score for the total quantity of microbial exposure, that is, sum of indicators for fungi (ergosterol), Gram-positive (muramic acid) bacteria, and Gram-negative (endotoxin) bacteria, was significantly (inverted-U shape) associated with asthma incidence (P < 0.001): the highest risk was found at medium levels (adjusted odds ratio (aOR) 2.24, 95% confidence interval (95% CI) 0.87-5.75 for 3rd quintile) and the lowest risk at the highest level (aOR 0.34, 95% CI 0.09-1.36 for 5th quintile). The microbial diversity score, that is, sum of detected qPCRs, was inversely associated with risk of wheezing and was significantly (inverted-U shape) associated with sensitization to inhalant allergens.
  
  
  CONCLUSIONS
  Score for quantity of microbial exposure predicted asthma better than single microbial markers independently of microbial diversity and amount of dust. Better indicators of total quantity and diversity of microbial exposure are needed in studies on the development of asthma.
authors.affiliation: Department of Environmental Health, National Institute for Health and Welfare, Kuopio, Finland.
authors.forename: A M
authors.initials: AM
authors.lastname: Karvonen
authors.forename: A
authors.initials: A
authors.lastname: Hyvärinen
authors.forename: H
authors.initials: H
authors.lastname: Rintala
authors.forename: M
authors.initials: M
authors.lastname: Korppi
authors.forename: M
authors.initials: M
authors.lastname: Täubel
authors.forename: G
authors.initials: G
authors.lastname: Doekes
authors.forename: U
authors.initials: U
authors.lastname: Gehring
authors.forename: H
authors.initials: H
authors.lastname: Renz
authors.forename: P I
authors.initials: PI
authors.lastname: Pfefferle
authors.forename: J
authors.initials: J
authors.lastname: Genuneit
authors.forename: L
authors.initials: L
authors.lastname: Keski-Nisula
authors.forename: S
authors.initials: S
authors.lastname: Remes
authors.forename: J
authors.initials: J
authors.lastname: Lampi
authors.forename: E
authors.initials: E
authors.lastname: von Mutius
authors.forename: J
authors.initials: J
authors.lastname: Pekkanen
mesh_terms: D000485:Allergens / Q000276:immunology; D001249:Asthma / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004391:Dust; D004781:Environmental Exposure; D004783:Environmental Microbiology; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D016017:Odds Ratio; D011159:Population Surveillance; D011795:Surveys and Questionnaires
chemical_list: D000485:Allergens; D004391:Dust
keywords: asthma; atopy; children; microbial exposure; respiratory tract disease