Stark PC, Burge HA, Ryan LM, et al. Am J Respir Crit Care Med. 2003;168:232–237
Purpose of the Study.
Previous studies found a relationship between home dampness and lower respiratory tract symptoms among children. Is this relationship attributable to exposure to fungi, which thrive in damp conditions?
A birth cohort of 499 children with a history of asthma or allergy for at least 1 parent was studied.
During a home visit, when the child was 2 or 3 months of age, a technician determined household and socioeconomic characteristics and obtained air and dust samples. Every 2 months thereafter, a follow-up telephone questionnaire, regarding respiratory symptoms and illnesses experienced by the child, was administered to the child’s primary caregiver. In-home fungal concentrations were evaluated as predictors of lower respiratory tract illnesses (LRIs) (croup, pneumonia, bronchitis, and bronchiolitis) in the first 1 year of life.
In multivariate analyses, after controlling for gender, the presence of water damage or visible mold/mildew, being born in winter, breastfeeding, and being exposed to other children through siblings, the authors found a significantly increased relative risk (RR) of LRI with high levels (>90th percentile) of airborne Penicillium (RR: 1.73; 95% confidence interval [CI]: 1.23–2.43), dust-borne Cladosporium (RR: 1.52; 95% CI: 1.02–2.25), Zygomycetes (RR: 1.96; 95% CI: 1.35–2.83), or Alternaria (RR: 1.51; 95% CI: 1.00–2.28), or any fungus (RR: 1.86; 95% CI: 1.21–2.88).
Exposure to high fungal levels increased the risk of LRI in infancy. The actual mechanisms remain unknown. Sensitivity to inhaled allergens, including mold, as measured with skin testing or radioallergosorbent testing, is uncommon in infancy, and this association in infancy is likely to be nonallergic.
These are interesting and potentially useful findings, but more study is required. It should be noted that no increase in LRI was associated with high levels of exposure to a large number of other individual fungi evaluated. As the authors pointed out, “People are routinely exposed to >200 different species of fungi. Exposure occurs universally and is impossible to avoid completely. Often there are no adverse effects from these exposures.” It is hoped that solid scientific work such as this will not be misconstrued to bolster the mold hysteria prevalent in many parts of the country, resulting in expensive and unnecessary mold removal projects.