Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill, USA.
J Allergy Clin Immunol. 2010 Mar;125(3):593-9. doi: 10.1016/j.jaci.2009.10.036. Epub 2010 Feb 4.
Although sensitization to fungal allergens is prevalent in inner-city children with asthma, the relationship between fungal exposure and morbidity is poorly understood.
We examined relationships between fungal sensitization, exposure, and asthma morbidity in inner-city children.
Participants were 5 to 11 years old and enrolled in the Inner-City Asthma Study. This report includes the subset of children with at least 1 positive skin test (PST) response to a fungal allergen extract; for these children, indoor and outdoor airborne culturable fungi levels were measured at baseline and throughout the 2-year study. Asthma morbidity measures were collected prospectively. The primary outcome was symptom days per 2 weeks.
At baseline, children with a PST response to a fungal allergen extract had significantly more symptom days compared with those without a PST response to any fungal allergen extract (6.3 vs 5.7 days per 2 weeks, P = .04). During the study, increases in total fungal exposure and indoor Penicillium species exposure were associated with increases in symptom days and asthma-related unscheduled visits. Indoor exposures to total fungi and to Penicillium species were associated with significant increases in unscheduled visits, even after controlling for outdoor fungal levels. Adverse effects associated with exposure to a specific fungus were stronger among children with PST responses to that fungal allergen extract compared with those seen in children with negative skin test responses.
Outdoor fungal exposure is primarily associated with increased asthma symptoms and increased risk of exacerbations in this population.
尽管城市内哮喘儿童普遍对真菌过敏原敏感，但真菌暴露与发病率之间的关系尚不清楚。
我们研究了城市内儿童中真菌致敏、暴露与哮喘发病率之间的关系。
参与者年龄在 5 至 11 岁之间，参加了城市内哮喘研究。本报告包括至少对一种真菌过敏原提取物有 1 次阳性皮肤试验（PST）反应的儿童亚组；对于这些儿童，在基线和整个 2 年研究期间测量了室内和室外空气中可培养真菌的水平。前瞻性收集哮喘发病率的测量结果。主要结局是每 2 周的症状天数。
基线时，对真菌过敏原提取物有 PST 反应的儿童的症状天数明显多于对任何真菌过敏原提取物无 PST 反应的儿童（6.3 与 5.7 天/2 周，P =.04）。在研究期间，总真菌暴露和室内青霉属物种暴露的增加与症状天数和哮喘相关的非计划就诊次数的增加相关。即使在控制了室外真菌水平后，室内暴露于总真菌和青霉属物种也与非计划就诊次数的显著增加相关。与对特定真菌的暴露相关的不良反应在对该真菌过敏原提取物有 PST 反应的儿童中比在皮肤试验阴性的儿童中更为强烈。
在该人群中，室外真菌暴露主要与哮喘症状增加和恶化风险增加有关。
