Asthma and allergy development: contrasting influences of yeasts and other fungal exposures
Asthma and allergy development: contrasting influences of yeasts and other fungal exposures
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DOI：
10.1111/cea.12401
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发表时间：
2015-01-01
影响因子：
6.1
通讯作者：
Gold, D. R.
中科院分区：
文献类型：
--
作者：
Behbod, B.;Sordillo, J. E.;Gold, D. R.
背景：儿童发育阶段易受环境影响，易患儿童慢性疾病。很少有出生队列研究详细测量了婴儿卧室中的真菌多样性数据，限制了测量这些复杂暴露与哮喘或过敏发展之间长期关联的潜力。目的评价婴儿家中真菌水平与13岁时反复测量喘息、哮喘和鼻炎的发展以及12岁时致敏的关系。方法在“家庭过敏原与哮喘流行病学”前瞻性出生队列研究中，我们招募了408名有变应性疾病或哮喘家族史的儿童。当孩子2-3个月大时，我们测量了卧室空气和灰尘以及室外空气中的可培养真菌。主要结局包括从出生到13岁通过问卷调查确定症状/疾病发病。我们估计了风险比，对于喘息和致敏，对数转化真菌浓度四分位数间增加的优势比，调整了其他结果预测因子和潜在混杂因素。结果卧室地板灰尘中酵母菌含量的升高与以下因素有关：1)任何年龄段的喘息次数减少；Ii)真菌致敏；13岁前哮喘发展(风险比=0.86；95%置信区间（CI），[0.75 ~ 0.98])。室外空气传播的枝孢子菌和粉尘传播的曲霉预示着鼻炎的增加。12岁时真菌致敏的风险，对环境交替菌和曲霉的反应，在母亲有真菌致敏史的儿童中升高。结论和临床意义尽管真菌具有刺激性和致敏性，但生命早期暴露于粉尘酵母或其成分可能对有这些结果风险的儿童的过敏和哮喘有保护作用。确定与免疫保护作用相关的真菌成分可能对哮喘具有治疗意义。
BackgroundInfancy is a developmental stage with heightened susceptibility to environmental influences on the risk of chronic childhood disease. Few birth cohort studies have detailed measures of fungal diversity data in infants' bedrooms, limiting the potential to measure long-term associations of these complex exposures with development of asthma or allergy.ObjectiveWe evaluated the relation of home fungal levels in infancy to repeated measures of wheeze and development of asthma and rhinitis by age 13, and sensitization by age 12years.MethodsIn the Epidemiology of Home Allergens and Asthma prospective birth cohort study, we recruited 408 children with family history of allergic disease or asthma. When children were aged 2-3months, we measured culturable fungi in bedroom air and dust, and in outdoor air. Main outcomes included ascertainment of symptoms/disease onset by questionnaire from birth through age 13. We estimated hazard ratios and, for wheeze and sensitization, odds ratios for an interquartile increase in log-transformed fungal concentrations, adjusting for other outcome predictors and potential confounders.ResultsElevated levels of yeasts in bedroom floor dust were associated with reduced: i) wheeze at any age; ii) fungal sensitization; and iii) asthma development by age 13 (hazard ratio (HR)=0.86; 95% confidence interval (CI), [0.75 to 0.98]). Outdoor airborne Cladosporium and dustborne Aspergillus predicted increased rhinitis. Risk of fungal sensitization by age 12, in response to environmental Alternaria and Aspergillus, was elevated in children with a maternal history of fungal sensitization.Conclusions and Clinical RelevanceDespite the irritant and allergenic properties of fungi, early-life elevated dust yeast exposures or their components may be protective against allergy and asthma in children at risk for these outcomes. Ascertainment of fungal components associated with immunoprotective effects may have therapeutic relevance for asthma.