TABLE VI.B-4.
Evidence for the effects of fungal allergens exposure (in utero and early childhood exposure) on the development of allergic rhinitis
| Study | Year | LOE | Study design | Study groups | Type of exposure | Conclusiona |
|---|---|---|---|---|---|---|
| Early exposure to fungal allergens as a risk factor for AR | ||||||
| Thacher et al.559 | 2016 | 2b | Birth cohort | 3798 adolescents (16 years old) from BAMSE study; 785 with AR | Visible mold at 2 months | Risk factor for AR (OR 1.3; 95% CI, 1.04–1.6) |
| Stark et al.555 | 2005 | 2b | Birth cohort | 405 children of asthmatic/allergic parents from metropolitan Boston, Massachusetts (younger than 5 years old) | Exposure to high levels of dust-borne Aspergillus at 0–3 months | Risk factor for doctor-diagnosed AR at 0–5 years (HR 3.3; 95% CI, 1.5–7.1) |
| Exposure to high levels of dust-borne Aureobasidium at 0–3 months | Risk factor for doctor-diagnosed AR at 0–5 years (HR 3.0; 95% CI, 1.3–6.9) | |||||
| Exposure to high levels of dust-borne yeasts at 0–3 months | Risk factor for doctor-diagnosed AR at 0–5 years (HR 2.7; 95% CI, 1.3–5.7) | |||||
| Deng et al.557 | 2016 | 3b | Cross-sectional | 2598 children (3–6 years old) attending kindergarten | Prenatal (whole pregnancy) or postnatal (from birth to current) exposure to indoor mold/dampness | Risk factors for rhinitis-like current symptoms: prenatal (OR 1.5; 95% CI, 1.2–1.9); postnatal (OR 2.1; 95% CI, 1.6–2.8) |
| Lin et al.558 | 2016 | 3b | Cross-sectional | 4246 children (3–8 years old) from 18 day cares | Visible indoor mold (weekly/sometimes vs never) at 0–2 years | Risk factor for new onset of rhinitis symptoms (OR 1.3; 95% CI, 1.01–1.6). Exposure was a significant risk factor for the remission of rhinitis (OR 0.6; 95% CI, 0.3–0.9) |
| Lam et al.553 | 2014 | 3b | Cross-sectional | 508 preschool children (4–6 years old) | Exposure to moisture/mold <1 year | Risk factor for rhinoconjunctivitis (OR 2.1; 95% CI, 1.2–3.8) |
| Kim et al.551 | 2012 | 3b | Cross-sectional | 4554 schoolchildren (mean age 9.50 years old, SD 1.73) | Mold exposure in house during infancy | Risk factor for current AR (OR 1.8; 95% CI, 1.4–2.4) |
| Lombardi et al.538 | 2010 | 3b | Cross-sectional | 20,016 children (median age 7 years old) from SIDRIA-2 Study | Mold exposure at 0–1 year | Risk factor for current rhinoconjunctivitis (unadjusted OR 1.4; 95% CI, 1.2–1.6) |
| Ibargoyen-Roteta et al.527 | 2007 | 3b | Cross-sectional | 3360 schoolchildren (5–8 years old) | Having mold on walls at 0–1 year | Risk factor for allergic rhinoconjunctivitis (OR 2.5; 95% CI, 1.5-4.0) |
| Kuyucu et al.556 | 2006 | 3b | Cross-sectional | 2774 children (9–11 years old) | Dampness/mold at 1 year | Risk factor for AR (OR 1.7; 95% CI, 1.3–2.3) |
| Bornehag et al.560 | 2005 | 3b | Cross-sectional | 10,851 children (1–6 years old) | Visible mold or damp spots in the child’s or parent’s bedroom at 1–6 years | Risk factor for rhinitis (OR 2.7; 95% CI, 1.4–5.4) |
| Early exposure to fungal allergens is not associated with AR | ||||||
| Biagini et al.465 | 2006 | 2b | Cross-sectional | 585 infants (1 year) born to families with at least 1 parent with positive SPT | High mold exposure (mold in 1 room (≥0.2 m2 or a combined area of visible mold and water damage on the same surface ≥0.2 m2) during early infancy (average 7.5 months) | No association with AR (OR 1.2; 95% CI, 0.6–2.5) |
| Low mold exposure (mold in one room (<0.2 m2 or a combined area of visible mold and water damage on the same surface <0.2 m2) during early infancy (average 7.5 months) | No association with AR (OR 3.2; 95% CI, 0.7–14.8) | |||||
| Deng et al.557 | 2016 | 3b | Cross-sectional | 2598 children (3–6 years old) attending kindergarten | Prenatal (during the whole pregnancy) or postnatal (from birth to the current) exposure to indoor mold or dampness | No association with AR: prenatal (OR 0.7; 95% CI, 0.4–1.1), postnasal (OR 1.0; 95% CI, 0.6–1.7) |
| Yang et al.542 | 2014 | 3b | Cross-sectional | 7389 schoolchildren (mean age 13.9 years, SD 0.9) | Mold exposure during infancy | No association with AR (OR 0.99; 95% CI, 0.8–1.3) |
a
ORs are adjusted unless otherwise specified.
AR = allergic rhinitis; BAMSE = Barn/Child Allergy Milieu Stockholm Epidemiology; CI = confidence interval; HR = hazard ratio; LOE = level of evidence; OR = odds ratio; SD = standard deviation; SIDRIA-2 = Studi Italiani sui Disturbi Respiratori del l’Infanzia el Ambiente; SPT = skin prick test.