Original Articles: Asthma, Lower Airway Diseases
Mold exposure during infancy as a predictor of potential asthma development

https://doi.org/10.1016/S1081-1206(10)60243-8Get rights and content

Background

Exposure to mold has been associated with exacerbation of asthma symptoms in children.

Objective

To report how the presence of visible mold and exposure to (1–3)-β-D-glucan in infancy affects the risk of asthma at the age of 3 years as defined by an Asthma Predictive Index (API).

Methods

Visible mold was evaluated by means of home inspection. (1–3)-β-D-glucan levels were measured in settled dust. Children were considered to be at high risk for asthma at later ages if they reported recurrent wheezing at the age of 3 years and met at least 1 of 3 major or 2 of 3 minor API criteria.

Results

Children aged 3 years with high visible mold in the home during infancy were 7 times more likely to have a positive API than were those with no visible mold (adjusted odds ratio [aOR], 7.1; 95% confidence interval [CI], 2.2–12.6). In contrast, at low (1–3)-β-D-glucan levels (<22 μg/g), children were at increased risk of a positive API (aOR, 3.4; 95% CI, 0.5–23.5), whereas those with high (1–3)-β-D-glucan levels (>133 μg/g) were at decreased risk (aOR, 0.6; 95% CI, 0.2–1.6). Of the other covariates, mother's smoking was the strongest significant risk factor for the future development of asthma based on a positive API (aOR, 4.4; 95% CI, 1.7–11.6).

Conclusions

The presence of high visible mold and mother's smoking during infancy were the strongest risk factors for a positive API at the age of 3 years, suggesting an increased risk of asthma. High (1–3)-β-D-glucan exposure seems to have an opposite effect on API than does visible mold.

Section snippets

INTRODUCTION

Several studies1, 2 have shown that home dampness and visible mold are associated with the severity of respiratory symptoms, such as wheezing, coughing, and asthma, in children. The association between mold exposure and the development of asthma is less studied. Parental report of a moldy odor at home in the past year has been associated with the development of physician-diagnosed asthma in children aged 1 to 7 years.3 Similarly, parental reports of visible mold or moisture at home during the

Recruitment

Infants were identified from birth certificate records (October 1, 2001, through July 31, 2003) and were recruited into the Cincinnati Childhood Allergy and Air Pollution Study as described previously.13, 15, 17 This study was approved by the institutional review boards of the University of Cincinnati and Cincinnati Children's Hospital Medical Center. Informed consent was obtained from a parent of each participating child.

Exposure Evaluation

When infants reached an average age of 8 months, a detailed questionnaire

Exposure and Participant Characteristics

Of the 483 children in this study, 16% were black, 43% were male, and 32% had no siblings in the home (Table 1). Almost half of the children reporting high visible mold at home (7 of 16) had a positive API, and one-third (4 of 11) had atopic wheezing. Overall, one-fifth of those with any visible mold had a positive API and atopic wheezing (Table 1). One-third of children whose mothers smoked (18 of 58) and one-quarter of those who had lower respiratory tract symptoms (45 of 178) had a positive

DISCUSSION

We previously presented data on environmental exposures, including visible mold and (1–3)-β-D-glucan, and related sensitization and wheezing in this cohort at the age of 1 year. Herein we report the effect of these exposures in the same cohort at the age of 3 years. Furthermore, the main focus, and the uniqueness, of this study is that it is, to our knowledge, the first to explore the effect of visible mold and (1–3)-β-D-glucan exposure on the clinical API. We found that exposure to high

REFERENCES (43)

  • AA Litonjua et al.

    A longitudinal analysis of wheezing in young children: the independent effects of early life exposure to house dust endotoxin, allergens, and pets

    J Allergy Clin Immunol

    (2002)
  • Institute of Medicine

    Damp Indoor Spaces and Health

    (2004)
  • YL Lee et al.

    Indoor and outdoor environmental exposures, parental atopy, and physician-diagnosed asthma in Taiwanese schoolchildren

    Pediatrics

    (2003)
  • J Jaakkola et al.

    Home dampness and molds, parental atopy, and asthma in childhood: a six-year population-based cohort study

    Environ Health Perspect

    (2005)
  • B Rydjord et al.

    Mould-specific immunoglobulin antibodies quantified by flow cytometry reflect mould exposure in Norwegian children

    Clin Exp Allergy

    (2008)
  • A Hyvärinen et al.

    Characterizing microbial exposure with ergosterol, 3-hydroxy fatty acids, and viable microbes in house dust: determinants and association with childhood asthma

    Arch Environ Occup Health

    (2006)
  • J Pekkanen et al.

    Moisture damage and childhood asthma: a population-based incident case-control study

    Eur Respir J.

    (2007)
  • D Schram-Bijkerk et al.

    Bacterial and fungal agents in house dust and wheeze in children: the PARSIFAL study

    Clin Exp Allergy

    (2005)
  • U Gehring et al.

    Bacteria and mould components in house dust and children's allergic sensitisation

    Eur Respir J.

    (2007)
  • JH Park et al.

    House dust endotoxin and wheeze in the first year of life

    Am J Respir Crit Care Med.

    (2001)
  • F Martinez et al.

    Asthma and wheezing in the first six years of life

    N Engl J Med.

    (1995)
  • Cited by (81)

    • Household mold, pesticide use, and childhood asthma: A nationwide study in the U.S.

      2021, International Journal of Hygiene and Environmental Health
    • Author response

      2020, Annals of Allergy, Asthma and Immunology
    • Risk factors for wheezing in primary health care settings in the tropics

      2020, Annals of Allergy, Asthma and Immunology
      Citation Excerpt :

      Firstly, Villahermosa has a tropical climate: 24% of all our households reported the presence of mold. Mold exposure during infancy has been demonstrated to be a predictor of potential asthma development,15 partly because of allergic sensitization, but also because of volatile substances and other toxins that molds secrete.16,17 Similarly, a small study in Costa Rica concluded that lifetime childhood asthma prevalence was related to relative moldiness index values in floor dust, but not to dust mite allergen concentrations in bed dust (positive in 90% of all homes, but not different in homes with high vs low lifetime childhood asthma prevalence).18

    View all citing articles on Scopus

    Disclosures: Authors have nothing to disclose.

    Funding Sources: This study was supported by National Institute of Environmental Health Sciences grant ES11170 and by National Institute for Occupational Safety and Health Training Program of the University of Cincinnati Education and Research Center grant T42/CCT510420.

    View full text