Fungal levels in the home and allergic rhinitis by 5 years of age

Paul C. Stark,1 Juan C. Celedón,2 Ginger L. Chew,3 Louise M. Ryan,4 Harriet A. Burge,5 Michael L. Muilenberg,5 and Diane R. Gold2

1Biostatistics Research Center, Institute for Clinical Research and Health Policy Studies, Department of Medicine, Tufts-New England Medical Center, Boston, Massachusetts, USA; 2Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital and the Harvard Medical School, Boston, Massachusetts, USA; 3Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA; 4Department of Biostatistics, and 5Department of Environmental Health, Harvard University School of Public Health, Boston, Massachusetts, USA


Studies have repeatedly demonstrated that sensitization to fungi, such as Alternaria, is strongly associated with allergic rhinitis and asthma in children. However, the role of exposure to fungi in the development of childhood allergic rhinitis is poorly understood. In a prospective birth cohort of 405 children of asthmatic/allergic parents from metropolitan Boston, Massachusetts, we examined in-home high fungal concentrations (> 90th percentile) measured once within the first 3 months of life as predictors of doctor-diagnosed allergic rhinitis in the first 5 years of life. In multivariate Cox regression analyses, predictors of allergic rhinitis included high levels of dust-borne Aspergillus [hazard ratio (HR) = 3.27; 95% confidence interval (CI), 1.50-7.14], Aureobasidium (HR = 3.04; 95% CI, 1.33-6.93), and yeasts (HR = 2.67; 95% CI, 1.26-5.66). The factors controlled for in these analyses included water damage or mild or mildew in the building during the first year of the child’s life, any lower respiratory tract infection in the first year, male sex, African-American race, fall date of birth, and maternal IgE to Alternaria > 0.35 U/mL. Dust-borne Alternaria and nonsporulating and total fungi were also predictors of allergic rhinitis in models excluding other fungi but adjusting for all of the potential confounders listed above. High measured fungal concentrations and reports of water damage, mold, or mildew in homes may predispose children with a family history of asthma or allergy to the development of allergic rhinitis. Key words: allergic rhinitis, fungi, mold, respiratory health effects, water damage. Environ Health Perspect 113:1405-1409 (2005).  doi:10.1289/ehp.7844 available via [Online 20 May 2005]

Address correspondence to P.C. Stark, Biostatistics Research Center, Institute for Clinical Research and Health Policy Studies, Tufts-New England Medical Center, 750 Washington St., Tufts-NEMC #63, Boston, MA 02111 USA. Telephone: (617) 636-5457. Fax: (617) 636-5560. E-mail:

We thank the participating families for their enthusiastic participation. We also thank C. Rogers and D. Sredl for their efforts.

This study was supported by National Institutes of Health grant AI/EHS35786. P.C.S. was supported by the Yamaguchi Endowment.

The authors declare they have no competing financial interests.

Received 10 December 2004; accepted 19 May 2005.