title: Variable risk of atopic disease due to indoor fungal exposure in NHANES 2005-2006.
abstract: BACKGROUND
  Exposure to damp indoor environments is associated with increased risk of eczema, allergy and asthma. The role of dampness-related exposures and risk of allergic diseases are yet to be fully explored in the US population.
  
  
  OBJECTIVE
  We assess whether exposure to fungi, house dust mites and endotoxin increases the risk of eczema, allergy and asthma in children and adults participating in NHANES 2005-2006.
  
  
  METHODS
  A total of 8412 participants (2849 were children aged between 6 and 17 years) were recruited in the 2005-2006 survey. We used multiple logistic regression to investigate whether mildew/musty odour and increased concentrations of Alternaria alternata allergen, Aspergillus fumigatus antigens, house dust mite and endotoxin antigens increase the risk of eczema, allergy and asthma. We stratified models by total IgE < 170 and ≥ 170 KU/L to assess allergic and non-allergic asthma outcomes. Exposure to multiple biological agents and risk of reporting eczema, allergy and asthma were also investigated.
  
  
  RESULTS
  Reporting of a mildew/musty odour was associated with increased risk of childhood asthma (OR 1.60; 95% CI 1.17-2.19), and adult eczema, allergy and asthma (OR 1.92; 95% CI 1.39-2.63, OR 1.59 95% CI 1.26-2.02 and OR 1.61 95% CI 1.00-2.57, respectively). Risk of asthma was associated with total IgE ≥ 170 KU/L in children (OR 1.81; 95% CI 1.01-3.25) and total IgE < 170 KU/L in adults (OR 1.91; 95% CI 1.07-3.42). Children and adults exposed to more than eight biological agents present in the home were at reduced risk of eczema (OR 0.17; 95% CI 0.04-0.77) and asthma (OR 0.49; 95% CI 0.25-0.97), respectively.
  
  
  CONCLUSIONS
  Exposure to a mildew/musty odour, as a proxy for exposure to fungus, was implicated in an increased risk of atopic diseases. Sensitisation may play a different role in children and adults, and exposure to multiple allergens may reduce the risk of atopic disease.
authors.affiliation: European Centre for Environment and Human Health, University of Exeter Medical School, Truro, UK.
authors.forename: R A
authors.initials: RA
authors.lastname: Sharpe
authors.affiliation: Biosciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK.
authors.forename: C R
authors.initials: CR
authors.lastname: Thornton
authors.affiliation: European Centre for Environment and Human Health, University of Exeter Medical School, Truro, UK.
authors.forename: J
authors.initials: J
authors.lastname: Tyrrell
authors.affiliation: University of Exeter Medical School, Exeter, UK.
authors.forename: V
authors.initials: V
authors.lastname: Nikolaou
authors.affiliation: European Centre for Environment and Human Health, University of Exeter Medical School, Truro, UK.|Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia.|Department of Clinical Pharmacology, Sydney Medical School, University of Sydney, Sydney, N.S.W., Australia.
authors.forename: N J
authors.initials: NJ
authors.lastname: Osborne
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016902:Air Pollution, Indoor / Q000009:adverse effects*; D000485:Allergens / Q000633:toxicity*; D000528:Alternaria; D001232:Aspergillus fumigatus; D001249:Asthma / Q000453:epidemiology* / Q000209:etiology; D002648:Child; D004485:Eczema / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014481:United States
chemical_list: D000485:Allergens
keywords: allergy; asthma; atopy; damp; eczema; fungi; microbiome; odour