Cited by 694Asthma and respiratory diseasesOccupational exposure and asthmaAllergic Rhinitis and Sensitization

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Exposure to an Aeroallergen as a Possible Precipitating Factor in Respiratory Arrest in Young Patients with Asthma

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O'Hollaren, Mark T., Yunginger, John W., Offord, Kenneth P., Somers, Michael J., O'Connell, Edward J., Ballard, David J., Sachs, Martin I.·1991·New England Journal of Medicine

DOI 10.1056/nejm199102073240602

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Abstract

BACKGROUND: Exposure to airborne spores of the common mold Alternaria alternata has been implicated in asthma attacks. Such exposure is particularly frequent in the Midwest during the summer and fall months. To determine the role of A. alternata in triggering severe asthma attacks, we investigated the cases of 11 patients with asthma who had sudden respiratory arrest and determined the frequency of sensitivity to this allergen in these patients. METHODS: The 11 patients (age range, 11 to 25 years) with initial episodes of respiratory arrest, which was fatal in 2 patients, were identified in the course of their care in our pediatric and adult clinical allergy practice and by a retrospective review of all Mayo Clinic records of patients with severe asthma cared for between 1980 and 1989. Skin-test reactivity to A. alternata and levels of IgE antibody against this mold in the 11 patients were compared with those in 99 matched controls with asthma who had no history of respiratory arrest. RESULTS: All the patients came from the upper Midwest, and the episodes of respiratory arrest occurred in the summer or early fall. Ten of the 11 patients with asthma who had respiratory arrest (91 percent) had positive skin-puncture tests for sensitivity to alternaria, as compared with 31 percent of the controls (P less than 0.001), and the serum levels of IgE antibodies to alternaria were elevated in all 9 patients tested. Among the covariates we examined (age, sex, and distance from the Mayo Clinic), only age was a significant confounder. After adjustment for age, alternaria skin-test reactivity was found to be associated with an increase of approximately 200-fold in the risk of respiratory arrest (adjusted odds ratio, 189.5; 95 percent confidence interval, 6.5 to 5535.8). CONCLUSIONS: Exposure to the aeroallergen A. alternata is a risk factor for respiratory arrest in children and young adults with asthma.

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Authors: O'Hollaren, M. T., Yunginger, J. W., Offord, K. P., Somers, M. J., O'Connell, E. J., Ballard, D. J., & Sachs, M. I.
Affiliations: Mayo Clinic (US)
ORCID: Somers, Michael J.
Ballard, David J.
Venue: New England Journal of Medicine
Publisher: Massachusetts Medical Society
Published: 1991-02-07
Volume: 324
Issue: 6
Pages: 359-363
ISSN: 0028-4793 (ISSN-L)
1533-4406
DOI: 10.1056/nejm199102073240602
OpenAlex: W2332088998
Cited by: 694
References: 38
Citations by year: 2026: 7 · 2025: 8 · 2024: 10 · 2023: 18 · 2022: 11 · 2021: 9 · 2020: 15 · 2019: 14 · 2018: 19 · 2017: 14 · 2016: 19 · 2015: 19 · 2014: 14 · 2013: 20 · 2012: 20
FWCI: 14.39
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: New England Journal of Medicine (publishedVersion)
PubMed (publishedVersion)
Funders: Mayo Foundation for Medical Education and Research
Topics: Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Asthma and respiratory diseases
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Occupational exposure and asthma
Health Sciences › Medicine › Immunology and Allergy › Allergic Rhinitis and Sensitization
Keywords: asthma, respiratory arrest, Alternaria alternata, mold spores, aeroallergen exposure, allergen sensitivity, IgE antibodies, skin test reactivity, asthma exacerbations, young patients, risk factors
MeSH terms: Adolescent, Adult, Allergens, Alternaria, Antibodies, Fungal, Asthma, Child, Environmental Exposure, Female, Humans, Immunoglobulin E, Male, Respiratory Insufficiency, Risk Factors, Seasons, Skin Tests, Spores, Fungal

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Exposure to an Aeroallergen as a Possible Precipitating Factor in Respiratory Arrest in Young Patients with Asthma

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