Dustborne Alternaria alternata antigens in US homes: results from the National Survey of Lead and Allergens in Housing.

BACKGROUND Alternaria alternata is one of the most common fungi associated with allergic disease. However, Alternaria exposure in indoor environments is not well characterized. OBJECTIVE The primary goals of this study were to examine the prevalence of Alternaria exposure and identify independent predictors of Alternaria antigen concentrations in US homes. METHODS Data for this cross-sectional study were obtained from the National Survey of Lead and Allergens in Housing. A nationally representative sample of 831 housing units in 75 different locations throughout the United States completed the survey. Information on housing and household characteristics was obtained by questionnaire and environmental assessments. Concentrations of A alternata antigens in dust collected from various indoor sites were assessed with a polyclonal anti-Alternaria antibody assay. RESULTS Alternaria antigens were detected in most (95% to 99%) of the dust samples. The geometric mean concentration, reflecting the average Alternaria concentration in homes, was 4.88 microg/g (SEM, 0.13 microg/g). In the multivariable linear regression analysis, the age of the housing unit, geographic region, urbanization, poverty, family race, observed mold and moisture problems, use of de-humidifier, and presence of cats and dogs were independent predictors of Alternaria antigen concentrations. Less frequent cleaning and smoking indoors also contributed to higher Alternaria antigen levels in homes. CONCLUSION Exposure to A alternata antigens in US homes is common. Antigen levels in homes are influenced not only by regional factors but also by residential characteristics. Preventing mold and moisture problems, avoiding smoking indoors, and regular household cleaning may help reduce exposure to Alternaria antigens indoors.

[1]  R. Burnett,et al.  It's about time: A comparison of Canadian and American time–activity patterns† , 2002, Journal of Exposure Analysis and Environmental Epidemiology.

[2]  J. Corden,et al.  The long-term trends and seasonal variation of the aeroallergen Alternaria in Derby, UK , 2001 .

[3]  F. Martinez,et al.  Alternaria as a major allergen for asthma in children raised in a desert environment. , 1997, American journal of respiratory and critical care medicine.

[4]  R. Bush,et al.  Alternaria-induced asthma. , 2004, The Journal of allergy and clinical immunology.

[5]  B. Brunekreef,et al.  Fungal extracellular polysaccharides in house dust as a marker for exposure to fungi: relations with culturable fungi, reported home dampness, and respiratory symptoms. , 1999, The Journal of allergy and clinical immunology.

[6]  J Bousquet,et al.  Is sensitization to Alternaria alternata a risk factor for severe asthma? A population-based study. , 1999, The Journal of allergy and clinical immunology.

[7]  D. Guest,et al.  Incidence ofCladosporium, alternaria and total fungal spores in the atmosphere of melbourne (Australia) over three years , 1997 .

[8]  B. Shelton,et al.  Profiles of Airborne Fungi in Buildings and Outdoor Environments in the United States , 2002, Applied and Environmental Microbiology.

[9]  G. O'Connor,et al.  Airborne fungi in the homes of children with asthma in low-income urban communities: The Inner-City Asthma Study. , 2004, The Journal of allergy and clinical immunology.

[10]  G. Marks,et al.  Personal exposure to allergenic pollen and mould spores in inland New South Wales, Australia , 2000, Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology.

[11]  J. Leech,et al.  Environmental Tobacco Smoke Exposure Patterns: A Subanalysis of the Canadian Human Time-Activity Pattern Survey , 1999, Canadian journal of public health = Revue canadienne de sante publique.

[12]  Takanori Takahashi.  Airborne Fungal Colony-Forming Units in Outdoor and Indoor Environments in Yokohama, Japan , 2004, Mycopathologia.

[13]  S. Gravesen.  Bioaerosols, fungi and mycotoxins: Health effects, assessment, prevention and control , 1999 .

[14]  B. Green,et al.  Allergen detection from 11 fungal species before and after germination. , 2003, The Journal of allergy and clinical immunology.

[15]  Disease Prevention.  Clearing the Air: Asthma and Indoor Air Exposures , 2000 .

[16]  D. Howard,et al.  Fungi pathogenic for humans and animals , 1983 .

[17]  M. Sneller,et al.  Frequency of airborne Alternaria spores in Tucson, Arizona over a 20-year period. , 1981, Annals of allergy.

[18]  K. Offord,et al.  Exposure to an aeroallergen as a possible precipitating factor in respiratory arrest in young patients with asthma. , 1991, The New England journal of medicine.

[19]  G. S. Hoog,et al.  On the potentially pathogenic dematiaceous hyphomycetes. , 1983 .

[20]  B. Leaderer,et al.  Comparisons of seasonal fungal prevalence in indoor and outdoor air and in house dusts of dwellings in one Northeast American county1 , 1999, Journal of Exposure Analysis and Environmental Epidemiology.

[21]  L. Vailes,et al.  Quantitation of the major fungal allergens, Alt a 1 and Asp f 1, in commercial allergenic products. , 2001, The Journal of allergy and clinical immunology.

[22]  B. Thomma.  Alternaria spp.: from general saprophyte to specific parasite. , 2003, Molecular plant pathology.

[23]  P. Gergen,et al.  Relationship of indoor allergen exposure to skin test sensitivity in inner-city children with asthma. , 1998, The Journal of allergy and clinical immunology.

[24]  J. Portnoy,et al.  Affinity purification of a major Alternaria allergen using a monoclonal antibody. , 1990, Annals of allergy.

[25]  T. Platts-Mills,et al.  Association of sensitization to Alternaria allergens with asthma among school-age children. , 1998, The Journal of allergy and clinical immunology.

[26]  T. Mitakakis,et al.  Spore germination increases allergen release from Alternaria. , 2001, The Journal of allergy and clinical immunology.

[27]  P. Koutrakis,et al.  The effect of outdoor fungal spore concentrations on daily asthma severity. , 1997, Environmental health perspectives.

[28]  Thien,et al.  Prevalence and residential determinants of fungi within homes in Melbourne, Australia , 1999, Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology.

[29]  J. Portnoy,et al.  Allergenic materials in the house dust of allergy clinic patients. , 2001, Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology.

[30]  A. Wilson,et al.  Role of Alternaria and Penicillium spores in the pathogenesis of asthma. , 1985, The Journal of allergy and clinical immunology.

[31]  J. Portnoy,et al.  Comparison of outdoor allergenic particles and allergen levels. , 2000, Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology.

[32]  G. Marks,et al.  Clinical importance of Alternaria exposure in children. , 2001, American journal of respiratory and critical care medicine.

[33]  H. Burge,et al.  Dustborne and airborne fungal propagules represent a different spectrum of fungi with differing relations to home characteristics , 2003, Allergy.

[34]  P. Vojta,et al.  First National Survey of Lead and Allergens in Housing: survey design and methods for the allergen and endotoxin components. , 2002, Environmental health perspectives.

[35]  D. Sterling,et al.  Pollen and fungal spores indoor and outdoor of mobile homes. , 1998, Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology.

[36]  Bénédicte Leynaert,et al.  Sensitisation to airborne moulds and severity of asthma: cross sectional study from European Community respiratory health survey , 2002, BMJ : British Medical Journal.

[37]  M. Wickman,et al.  Indoor viable dust-bound microfungi in relation to residential characteristics, living habits, and symptoms in atopic and control children. , 1992, The Journal of allergy and clinical immunology.

[38]  G. Marks,et al.  Natural exposure to Alternaria spores induces allergic rhinitis symptoms in sensitized children , 2003, Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology.

[39]  J. Portnoy,et al.  Selection of representative Alternaria strain groups on the basis of morphology, enzyme profile, and allergen content. , 1993, The Journal of allergy and clinical immunology.

[40]  E. Ripe.  MOULD ALLERGY , 1962, Acta allergologica.

[41]  P. Rayment,et al.  Indoor airborne fungal spores, house dampness and associations with environmental factors and respiratory health in children , 1998, Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology.

[42]  Molecular cloning of a major Alternaria alternata allergen, rAlt a 2. , 1999, The Journal of allergy and clinical immunology.