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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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Research works printed but not linked: 9

  1. Sly, 1984, Ann Allergy, 53, 20
  2. Sly, 1986, Ann Allergy, 56, 207
  3. Markham, 1986, J Allergy Clin Immunol, 77, 161
  4. Rubinstein, 1984, Ann Allergy, 53, 311
  5. Sears, 1985, N Z Med J, 98, 271
  6. Solomon WR, Mathews KP. Aerobiology and inhalant allergens. In: Middleton E Jr, Reed CE, Ellis EF, Adkinson NF Jr, Yunginger JW, eds.Allergy: principles and practice. 3rd ed. Vol. 1. St. Louis: C.V. Mosby,1988:312-72.
  7. Richerson, 1986, Iowa Med, 76, 212
  8. Richerson HB, Metzger WJ, Hunninghake GW. Experimental models of bronchial asthma in man and the rabbit. In: Kay AB, ed. Asthma: clinical pharmacology and therapeutic progress. Oxford, England: Blackwell Scientific, 1986:23-32.
  9. Piccolo, 1988, Ann Allergy, 60, 107

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Metadata

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
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
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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