Gleeson Patrick K, Morales Knashawn H, Kerlin Meeta Prasad, Fadugba Olajumoke O, Apter Andrea J, Christie Jason D, Himes Blanca E
Section of Allergy and Immunology, Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Ann Allergy Asthma Immunol. 2025 Feb;134(2):190-197.e10. doi: 10.1016/j.anai.2024.08.959. Epub 2024 Sep 12.
Allergic sensitization to mold is a risk factor for poor asthma outcomes, but whether it accounts for disparities in asthma outcomes according to race or socioeconomic status is not well-studied.
To identify factors associated with allergic sensitization to molds and evaluate associations of sensitization to molds with asthma exacerbations after stratifying by race.
We conducted a retrospective cohort study of adults with asthma who had an outpatient visit to a large health system between January 1, 2017 and June 30, 2023 and received aeroallergen testing to Aspergillus fumigatus, Penicillium, Alternaria, and Cladosporium. We used logistic regression models to evaluate factors associated with mold sensitization and the effect of mold sensitization on asthma exacerbations in the 12 months before testing, overall and then stratified by race.
A total of 2732 patients met the inclusion criteria. Sensitization to each mold was negatively associated with being a woman (odds ratios [ORs] ≤ 0.59, P ≤ .001 in 5 models) and positively associated with the Black race (ORs ≥ 2.16 vs White, P < .0005 in 5 models). In the full cohort, sensitization to molds was not associated with asthma exacerbations (ORs = 0.95-1.40, P ≥ .003 in 5 models and all above the corrected P value threshold). Among 1032 Black patients, sensitization to A fumigatus, but not to other molds, was associated with increased odds of asthma exacerbations (OR = 2.04, P < .0005).
Being a man and Black race were associated with allergic sensitization to molds. Sensitization to A fumigatus was associated with asthma exacerbations among Black patients but not the overall cohort, suggesting that A fumigatus allergy is a source of disparities in asthma outcomes according to race.
对霉菌的过敏致敏是哮喘预后不良的一个危险因素，但它是否导致了哮喘预后因种族或社会经济地位而异，尚未得到充分研究。
确定与对霉菌过敏致敏相关的因素，并在按种族分层后评估霉菌致敏与哮喘加重之间的关联。
我们对2017年1月1日至2023年6月30日期间在一个大型医疗系统门诊就诊并接受烟曲霉、青霉、链格孢和枝孢菌气传变应原检测的成年哮喘患者进行了一项回顾性队列研究。我们使用逻辑回归模型评估与霉菌致敏相关的因素，以及在检测前12个月内霉菌致敏对哮喘加重的影响，先对总体情况进行评估，然后按种族分层评估。
共有2732名患者符合纳入标准。对每种霉菌的致敏与女性性别呈负相关（在5个模型中，比值比[ORs]≤ 0.59，P≤ 0.001），与黑人种族呈正相关（在5个模型中，与白人相比，ORs≥ 2.16，P< 0.0005）。在整个队列中，霉菌致敏与哮喘加重无关（在5个模型中，ORs = 0.95 - 1.40，P≥ 0.003，且均高于校正后的P值阈值）。在1032名黑人患者中，对烟曲霉的致敏而非对其他霉菌的致敏与哮喘加重几率增加相关（OR = 2.04，P< 0.0005）。
男性和黑人种族与对霉菌的过敏致敏相关。对烟曲霉的致敏与黑人患者而非整个队列的哮喘加重相关，这表明烟曲霉过敏是哮喘预后因种族而异的一个原因。
