title: Associations between outdoor fungal spores and childhood and adolescent asthma hospitalizations.
abstract: BACKGROUND
  Childhood asthma is a significant public health problem and severe exacerbations can result in diminished quality of life and hospitalization.
  
  
  OBJECTIVE
  We sought to examine the contribution of outdoor fungi to childhood and adolescent asthma hospitalizations.
  
  
  METHODS
  The Melbourne Air Pollen Children and Adolescent study is a case-crossover study of 644 children and adolescents (aged 2-17 years) hospitalized for asthma. The Melbourne Air Pollen Children and Adolescent study collected individual data on human rhinovirus infection and sensitization to Alternaria and Cladosporium and daily counts of ambient concentrations of fungal spores, pollen, and air pollutants. Conditional logistic regression models were used to assess associations with increases in spore counts while controlling for potential confounding and testing interactions.
  
  
  RESULTS
  Exposure to Alternaria (adjusted odds ratio [aOR], 1.07; 95% CI, 1.03-1.11), Leptosphaeria (aOR, 1.05; 95% CI, 1.02-1.07), Coprinus (aOR, 1.04; 95% CI, 1.01-1.07), Drechslera (aOR, 1.03; 95% CI, 1.00-1.05), and total spores (aOR, 1.05; 95% CI, 1.01-1.09) was significantly associated with child asthma hospitalizations independent of human rhinovirus infection. There were significant lagged effects up to 3 days with Alternaria, Leptosphaeria, Cladosporium, Sporormiella, Coprinus, and Drechslera. Some of these associations were significantly greater in participants with Cladosporium sensitization.
  
  
  CONCLUSIONS
  Exposures to several outdoor fungal spore taxa, including some not reported in previous research, are associated with the risk of child and adolescent asthma hospitalization, particularly in individuals sensitized to Cladosporium. We need further studies to examine cross-reactivity causing asthma exacerbations. Identifying sensitization to multiple fungal allergens in children with asthma could support the design and implementation of more effective strategies to prevent asthma exacerbations.
authors: Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, the University of Melbourne, Melbourne, Australia.
authors: Rachel
authors: R
authors: Tham
authors: School of Public Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia.
authors: Don
authors: D
authors: Vicendese
authors: Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, the University of Melbourne, Melbourne, Australia.
authors: Shyamali C
authors: SC
authors: Dharmage
authors: Department of Econometrics & Business Statistics, Monash University, Clayton, Australia.
authors: Rob J
authors: RJ
authors: Hyndman
authors: School of Biosciences, the University of Melbourne, Melbourne, Australia.
authors: Ed
authors: E
authors: Newbigin
authors: School of Biosciences, the University of Melbourne, Melbourne, Australia.
authors: Emma
authors: E
authors: Lewis
authors: Allergy & Immune Disorders, Murdoch Children's Research Institute, the Royal Children's Hospital, Melbourne, Australia.
authors: Molly
authors: M
authors: O'Sullivan
authors: Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, the University of Melbourne, Melbourne, Australia; Allergy & Immune Disorders, Murdoch Children's Research Institute, the Royal Children's Hospital, Melbourne, Australia.
authors: Adrian J
authors: AJ
authors: Lowe
authors: School of Life and Environmental Sciences, Deakin University, Geelong, Australia.
authors: Philip
authors: P
authors: Taylor
authors: Monash Lung & Sleep, Monash Medical Centre and University and Hudson Institute, Melbourne, Australia.
authors: Philip
authors: P
authors: Bardin
authors: Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, the University of Melbourne, Melbourne, Australia; Allergy & Immune Disorders, Murdoch Children's Research Institute, the Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, the University of Melbourne, Melbourne, Australia.
authors: Mimi L K
authors: ML
authors: Tang
authors: Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
authors: Michael J
authors: MJ
authors: Abramson
authors: School of Public Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia. Electronic address: b.erbas@latrobe.edu.au.
authors: Bircan
authors: B
authors: Erbas
mesh_terms: D000293:Adolescent; D000393:Air Pollutants / Q000009:adverse effects / Q000032:analysis / Q000276:immunology; D001249:Asthma / Q000276:immunology / Q000382:microbiology*; D001315:Australia; D002648:Child; D002675:Child, Preschool; D018592:Cross-Over Studies; D004781:Environmental Exposure / Q000009:adverse effects*; D005260:Female; D006760:Hospitalization; D006801:Humans; D006967:Hypersensitivity / Q000276:immunology / Q000382:microbiology; D008297:Male; D012882:Skin Tests; D013172:Spores, Fungal / Q000276:immunology*
chemical_list: D000393:Air Pollutants
keywords: Outdoor fungi; adolescent; asthma; case-crossover design; child; hospitalization