Department of Environmental Health, Harvard University School of Public Health; Biostatistics Research Center, Division of Clinical Care Research, Department of Medicine, Tufts-New England Medical Center; Department of Biostatistics, Harvard University School of Public Health; and Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and the Harvard Medical School, Boston, Massachusetts
Correspondence: Correspondence and requests for reprints should be addressed to Diane R. Gold, M.D., M.P.H., Channing Laboratory, 181 Longwood Avenue, Boston, MA 02115.
The association between home dampness and lower respiratorysymptoms in children has been well documented. Whether fungalexposures contribute to this association is uncertain. In aprospective birth cohort of 499 children of parents with asthma/allergies,we examined in-home fungal concentrations as predictors of lowerrespiratory illnesses (LRI) (croup, pneumonia, bronchitis, andbronchiolitis) in the first year. In multivariate analyses,we found a significant increased relative risk (RR) betweenLRI and high levels (more than the 90th percentile) of airborne
Penicillium (RR = 1.73, 95% confidence interval [CI], 1.23,2.43), dust-borne
Cladosporium (RR = 1.52; CI, 1.02, 2.25),
Zygomycetes (RR = 1.96; CI, 1.35, 2.83), and
Alternaria (RR= 1.51; CI, 1.00, 2.28), after controlling for sex, presenceof water damage or visible mold/mildew, born in winter, breastfeeding,and being exposed to other children through siblings. In a multivariateanalysis, the RR of LRI was elevated in households with anyfungal level at more than the 90th percentile (RR = 1.86; CI,1.21, 2.88). Exposure to high fungal levels increased the riskof LRI in infancy, even for infants with nonwheezing LRI. Actualmechanisms remain unknown, but fungi and their components (glucans,mycotoxins, and proteins) may increase the risk of LRI by actingas irritants or through increasing susceptibility to infection.
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