Indoor airborne fungi as risk factors in IgE-mediated respiratory allergy

Abstract

The purpose of this epidemiological study was to assess respiratory allergy in relation to the presence of indoor airborne fungi. The relationship between IgE-mediated respiratory allergy (skin test positivity) and the presence of fungi (CFU/m3) in the indoor environments of 104 subjects was assessed in a cross-sectional study by controlling for extraneous variables (age, gender, predisposition, asthma, rhinitis, skin positivity to ragweed and mite, and smoking). The qualitative and quantitative measurements of airborne seasonal fungi (Alternaria spp. andCladosporium spp.) and non-seasonal airborne fungi (Penicillium spp. andAspergillus spp.) were taken in the subjects’ indoor environments twice in a 2-year period by volumetric methods (Burkard Personal Sampler). There was a significant association between skin test positivity to seasonal fungi and to ragweed (Adj. OR=3.42, CI=1.76–6.66). There was no association between skin test positivity to seasonal fungi and asthma (Adj. OR=0.52, CI=0.28–0.98), but a significant association was found between skin test positivity to seasonal fungi and rhinitis (Adj. OR=5, CI=2.03–12.32). In a logistic regression analysis (maximum likelihood estimates—model A), no statistical association was found indoors between skin prick test positivity to seasonal fungi (Alternaria and/orCladosporium) and airborneAlternaria and/orCladosporium concentrations (Adj. OR=1.18, CI=0.66–2.07). There was a significant association between skin prick test positivity to seasonal fungi and to non-seasonal fungi (Adj. OR=12.81, CI=1.67–98.34). There was no association between asthma and airbornePenicillium concentrations (Adj. OR=1.86, CI=0.47–7.33) nor between rhinitis and airbornePenicillium concentrations (Adj. OR=0.18, CI=0.03–1.19). In another logistic regression analysis (maximum likelihood estimates — model B) using non-seasonal fungi (Aspergillus andPenicillium), no statistical association was found indoors between skin prick test positivity to non-seasonal fungi and airbornePenicillium concentrations (Adj. OR=0.33, CI=0.07–1.69). These findings suggest an association between rhinitis and seasonal fungi. In the rhinitis stratum, subjects who had skin test positivity to ragweed had a higher risk of being sensitive to seasonal airborne fungal allergens. Subjects with non-seasonal fungal allergy had a high relative risk if they were also allergic to seasonal fungi. There was no association between asthma and airborne fungi, as the epidemiological study (cross-sectional design), by definition, does not allow an etiological evaluation of chronic disease. This would require a longitudinal study, i.e. the measurement of repeated exposure as an independent variable (allergen) and repeated measurement as a function of the disease as outcome in humans as a dependent variable.