WESTPORT, Apr 07 (Reuters) - High levels of fungal airspora appear to be associated with increases in asthma exacerbations in children in Singapore, report researchers in the February issue of Respiratory Medicine.
Dr. F. T. Chew of the National University of Singapore, and colleagues, note that asthma is a cause of increasing childhood morbidity in that nation and is second only to injuries in generating pediatric hospital admissions.
In order to determine whether environment factors might play a part, the researchers analyzed data from 1990-1996 covering pediatric asthma emergency room treatment and hospital admissions. Emergency room visits peaked in January-February, May and August of each year. Hospital admissions showed "...similar trends and seasonal variations."
"The only striking seasonal changes in weather," in Singapore, say the researchers, are "...wind speed and direction and rainfall." These changes did not correlate with asthma admissions, nor did a number of other possible triggers.
However, peaks in fungal airspora were "...significantly associated with the peaks for asthma." This, in combination with local air pollution, forest fires, and volcanic activity, the investigators conclude "...may be involved, possibly in a synergistic manner."
Respir Med 1998;92:345-350.
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Molds that produce potent toxins have been found in the homes of infants diagnosed with acute pulmonary hemorrhage, according to Dr. Ruth Etzel, chairperson of the American Academy of Pediatrics' Committee on Environmental Health.
Etzel presented her findings Monday at the Academy's spring session being held in Atlanta, Georgia, coinciding with the release of a policy statement from the Academy, entitled "Toxic Effects Of Indoor Mold."
In the Academy statement, experts note that some mold toxins "are readily absorbed by the intestinal lining, airways, and skin."
"In general, the presence of these molds indicates a long-standing water problem," they write.
More than 100 cases of infant pulmonary hemorrhage have been diagnosed in the US in the past four years. Ten cases were reported in a 2-year period (January 1993 through December 1994) in the metropolitan Cleveland area. According to Etzel, five of these infants had a recurrence of pulmonary hemorrhage after they were discharged to their homes. In an interview, Etzel told Reuters that her committee investigated these rare diseases among infants because "such a geographic and temporal cluster often leads to new understanding of disease."
Etzel's group completed a case-control study comparing the 10 infants diagnosed with acute pulmonary hemorrhage with 30 age-matched control infants from the same geographic area in Cleveland. The infants with pulmonary hemorrhage lived in homes showing a higher quantity of molds, including the toxigenic fungus Stachybotrys atra. Etzel stated the 10 infants with pulmonary bleeding were "16 times more likely to live in homes with severe water damage than the 30 control infants."
Etzel concludes that severe water damage and mold growth can be a problem for infants with rapidly growing lungs because, "mold spores become airborne, lodge in the lungs, and expose infants to very potent toxins." Etzel told Reuters this is a new risk factor that parents and pediatricians should be aware of. "It is important to clean up water damage," from plumbing leaks, roof leaks, or floods, "within 24 hours of occurrence to prevent spores from growing," Etzel said.
The Academy report recommends cleaning walls and flood-damage items with diluted chlorine bleach (four parts water to one part bleach) to prevent mold growth, and discarding moldy items.
The report also says that infants with a history of pulmonary hemorrhage should be kept away from environments where people smoke.
Etzel also recommends that, "pediatricians should inquire about water damage in the home," whenever they treat infants with pulmonary hemorrhage.
In the policy statement, published in the April issue of Pediatrics, the American Academy of Pediatrics recommends that, "Until more is known about the etiology of idiopathic pulmonary hemorrhage, prudence dictates that pediatricians try to ensure that infants under 1 year of age are not exposed to chronically moldy, water-damaged environments."
Etzel's committee reiterates the Academy's guidelines which state, "pediatricians should report cases of idiopathic pulmonary hemorrhage... to state health departments," noting that a reporting form for such cases is available from the Centers for Disease Control and Prevention.
SOURCE: Pediatrics (1998;101:712-714)
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