Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, the University of Melbourne, Melbourne, Australia.
School of Public Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia.
J Allergy Clin Immunol. 2017 Apr;139(4):1140-1147.e4. doi: 10.1016/j.jaci.2016.06.046. Epub 2016 Aug 12.
Childhood asthma is a significant public health problem and severe exacerbations can result in diminished quality of life and hospitalization.
We sought to examine the contribution of outdoor fungi to childhood and adolescent asthma hospitalizations.
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.
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.
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.
儿童哮喘是一个严重的公共卫生问题，严重恶化可导致生活质量下降和住院治疗。
我们旨在研究室外真菌对儿童和青少年哮喘住院的影响。
墨尔本空气花粉儿童和青少年研究是一项针对 644 名（年龄 2-17 岁）因哮喘住院的儿童和青少年的病例交叉研究。墨尔本空气花粉儿童和青少年研究收集了人类鼻病毒感染、对Alternaria 和 Cladosporium 的致敏以及环境中真菌孢子、花粉和空气污染物的每日浓度的个体数据。使用条件逻辑回归模型评估了与孢子计数增加的关联，同时控制了潜在的混杂因素并测试了相互作用。
暴露于Alternaria（调整后的优势比[aOR]，1.07；95%置信区间[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）和总孢子（aOR，1.05；95% CI，1.01-1.09）与儿童哮喘住院独立于人类鼻病毒感染显著相关。在 Alternaria、Leptosphaeria、Cladosporium、Sporormiella、Coprinus 和 Drechslera 中，存在高达 3 天的明显滞后效应。这些关联中的一些在对 Cladosporium 致敏的参与者中显著更大。
暴露于几种室外真菌孢子类群，包括以前研究中未报道的一些，与儿童和青少年哮喘住院的风险相关，尤其是在对 Cladosporium 致敏的个体中。我们需要进一步的研究来检查导致哮喘恶化的交叉反应。在患有哮喘的儿童中鉴定出对多种真菌过敏原的致敏性，可以支持设计和实施更有效的策略来预防哮喘恶化。
