Clinical Importance of Alternaria Exposure in Children
Open accessAbstract
The fungus Alternaria is known to be allergenic and is one of the most common fungi worldwide. We investigated the extent to which exposure to Alternaria increases the severity of asthma. We undertook a prospective cohort study in Australia of 399 school children who had positive skin tests to one or more aeroallergens. Airway responsiveness to histamine, wheeze, and bronchodilator use in 1 mo was measured five times between 1997 and 1999. Airway hyperresponsiveness was defined as PD20FEV1 = 3.9 μ mol histamine. Airborne concentrations of Alternaria spores were measured throughout the study, and mean daily concentrations over 1 mo ranged from 2.2 to 307.7 spores/m3 of ambient air. Using generalized estimating equations, we found that airway responsiveness, wheeze, and bronchodilator use increased significantly in association with increased spore concentrations and that the increase in airway responsiveness was greater in children sensitized to Alternarxia than in other children (p = 0.01). The odds ratio for airway hyperresponsiveness in children sensitized to Alternaria was 1.26 (95% CI, 1.14 to 1.39) after an increase in mean exposure of 100 spore/m3/d over 1 mo. These results suggest that Alternaria allergens contribute to severe asthma in regions where exposure to the fungus is high.
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There is substantial evidence that indoor allergens generated by house dust mite, mold and cat are triggers for both childhood and adult asthma, especially in those sensitized.
“There is substantial evidence to suggest that indoor allergens generated by house dust mite, mold and cat are triggers for both childhood and adult asthma, especially in those sensitized (100–102).”
From Epidemiology of Asthma in Children and Adults (2019) · cites this paper as [102]
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Andersson, M., Downs, S. H., Mitakakis, T. Z., Leuppi, J. D., & Marks, G. B. (2003) · Pediatric Allergy and Immunology · doi:10.1034/j.1399-3038.2003.00031.x · Cited by 70 · see citing works
“Questionnaires were distributed to children at the schools (10).”
BackgroundMethodInfluentialSelf-citationAsthma in the Inner City and the Indoor Environment
Matsui, E. C., Hansel, N. N., McCormack, M. C., Rusher, R., Breysse, P. N., & Diette, G. B. (2008) · Immunology and Allergy Clinics of North America · doi:10.1016/j.iac.2008.03.004 · Cited by 66 · see citing works
“Cockroach allergen has also been directly linked to poorer asthma outcomes in inner-city children with asthma, including asthma-related health care use [4,8].”
BackgroundControversies surrounding the categorization of fungal sinusitis
Chakrabarti, A., Das, A., & Panda, N. K. (2008) · Medical Mycology · doi:10.1080/13693780802213357 · Cited by 66 · see citing works
Exposure, sensitization, and mechanisms of fungus-induced asthma
Kauffman, H. F., & der Heide, S. V. (2003) · Current Allergy and Asthma Reports · doi:10.1007/s11882-003-0080-z · Cited by 66 · see citing works
Seasonal variation of fungal spore populations in the atmosphere of Zarqa area, Jordan
Abu‐Dieyeh, M. H., Barham, R., Abu‐Elteen, K., Al-Rashidi, R., & Shaheen, I. (2010) · Aerobiologia · doi:10.1007/s10453-010-9162-2 · Cited by 66 · see citing works
“Alternaria is known to be allergenic and is one of the most common fungi worldwide that contribute to severe asthma (Downs et al. 2001); specifically, Alternaria alternata allergens have long been considered to cause significant respiratory allergies and serious cases of respiratory arrest…”
BackgroundAhluwalia, S. K., & Matsui, E. C. (2018) · The Journal of Allergy and Clinical Immunology: In Practice · doi:10.1016/j.jaip.2017.10.009 · Cited by 62 · see citing works
CHILD HEALTH AND THE ENVIRONMENT
Wigle, D. T. (1989) · The Lancet · doi:10.1016/s0140-6736(89)91481-5 · Cited by 62 · see citing works
Japanese species of Alternaria and their species boundaries based on host range
Nishikawa, J., & Nakashima, C. (2020) · Fungal Systematics and Evolution · doi:10.3114/fuse.2020.05.13 · Cited by 62 · see citing works
“They are often allergenic, and can cause mycoses in humans and insects (Rossmann et al. 1996, Christias et al. 2001, Downs et al. 2001), but most species are plant pathogenic (Yu 2001).”
Air pollution by allergenic spores of the genus Alternaria in the air of central and eastern Europe
Kasprzyk, I., Rodinkova, V., Šaulienė, I., Ritenberga, O., Grinn‐Gofroń, A., Nowak, M., Sulborska, A., Kaczmarek, J., Weryszko‐Chmielewska, E., Bilous, E., et al. (2015) · Environmental Science and Pollution Research · doi:10.1007/s11356-014-4070-6 · Cited by 59 · see citing works
“In sensitive patients, severe inhaled allergy symptoms are usually recorded at 300 Alternaria spores m, both in central Europe and elsewhere (Gravesen 1979; Black et al. 2000; Downs et al. 2001; Rapiejko et al. 2004) Conidia ofAlternariawere feature prominently in the longduration fungal air spora of many European cou…”
BackgroundAlternaria sensitization and allergic rhinitis with or without asthma in the French Six Cities study
Randriamanantany, Z. A., Annesi‐Maesano, I., Moreau, D., Rahérison, C., Charpin, D., Kopferschmitt, C., Lavaud, F., Taytard, A., Frederic de, B. L. A. Y., & Caillaud, D. M. (2009) · Allergy · doi:10.1111/j.1398-9995.2009.02210.x · Cited by 58 · see citing works
“Exposure or sensitization to these fungal propagules (especially to Alternaria) has been recognized to be a risk factor for asthma (7), including severe asthma (8) and sometimes respiratory arrest in asthma (9).”
BackgroundIt's blowing in the wind: New insights into thunderstorm-related asthma
Marks, G. B., & Bush, R. K. (2007) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2007.07.012 · Cited by 58 · see citing works
Self-citationInnate Type 2 Response to Alternaria Extract Enhances Ryegrass-Induced Lung Inflammation
Kim, H.-K., Lund, S. J., Baum, R. E., Rosenthal, P., Khorram, N., & Doherty, T. A. (2013) · International Archives of Allergy and Immunology · doi:10.1159/000356341 · Cited by 56 · see citing works
Bioaerosol assessment in indoor and outdoor environments: a case study from India
Jabeen, R., Kizhisseri, M. I., Mayanaik, S. N., & Mohamed, M. M. (2023) · Scientific Reports · doi:10.1038/s41598-023-44315-z · Cited by 55 · see citing works
“Among the several Alternaria species, A. alternata is renowned as a ubiquitous and prevalent allergic fungus that causes IgE-mediated respiratory illnesses, notably asthma exacerbations 77 .”
BackgroundValladao, A. C., Frevert, C. W., Koch, L., Campbell, D., & Ziegler, S. F. (2016) · The Journal of Immunology · doi:10.4049/jimmunol.1600007 · Cited by 51 · see citing works
“alternata sensitization and an increased risk for severe and fatal asthma (2, 3).”
BackgroundEpidemiology and Medical Mycology of Fungal Rhinosinusitis
Chatterjee, S. S., & Chakrabarti, A. (2009) · Otorhinolaryngology Clinics - An International Journal · doi:10.5005/jp-journals-10003-1001 · Cited by 51 · see citing works
Schmitt, P., Duval, A., Camus, M., Lefrançais, E., Roga, S., Dedieu, C., Ortéga, N., Bellard, E., Mirey, E., Mouton‐Barbosa, E., et al. (2024) · The Journal of Experimental Medicine · doi:10.1084/jem.20231236 · Cited by 51 · see citing works
“The widely distributed fungus Alternaria alternata is one of the major aeroallergens associated with the development and persistence of allergic inflammation and asthma (Bush and Prochnau, 2004; Downs et al., 2001; Halonen et al., 1997; O ’ Hollaren et al., 1991; Pulimood et al., 2007).”
Community-Based Approaches to Controlling Childhood Asthma
Clark, N. M. (2012) · Annual Review of Public Health · doi:10.1146/annurev-publhealth-031811-124532 · Cited by 50 · see citing works
Analysis of culturable airborne fungi in outdoor environments in Tianjin, China
Nageen, Y., Asemoloye, M. D., Põlme, S., Wang, X., Xu, S., Ramteke, P. W., & Pecoraro, L. (2021) · BMC Microbiology · doi:10.1186/s12866-021-02205-2 · Cited by 53 · see citing works
An emission inventory of livestock-related bioaerosols for Lower Saxony, Germany
Seedorf, J. (2004) · Atmospheric Environment · doi:10.1016/j.atmosenv.2004.08.023 · Cited by 48 · see citing works
Al-Shaarani, A. A. Q. A., & Pecoraro, L. (2024) · Frontiers in Microbiology · doi:10.3389/fmicb.2024.1428415 · Cited by 50 · see citing works
Airborne Fungi and Actinomycetes Concentrations in the Air of Eskisehir City (Turkey)
Asan, A., İlhan, S., Şen, B., Erkara, İ. P., İşçen, C. F., Çabuk, A., Demirel, R., Türe, M., Ökten, S., & Tokur, S. (2004) · Indoor and Built Environment · doi:10.1177/1420326x04033843 · Cited by 47 · see citing works
Temporal dynamics of emergency department and hospital admissions of pediatric asthmatics
KIMES, D. S., Levine, E. R., Timmins, S., Weiss, S. R., Bollinger, M. E., & Blaisdell, C. J. (2003) · Environmental Research · doi:10.1016/s0013-9351(03)00046-x · Cited by 47 · see citing works
Ooi, E. H., Wormald, P., Carney, A. S., James, C. L., & Tan, L. W. (2007) · American Journal of Rhinology · doi:10.2500/ajr.2007.21.3025 · Cited by 47 · see citing works
Alternaria extract activates autophagy that induces IL-18 release from airway epithelial cells
Murai, H., Okazaki, S., Hayashi, H., Kawakita, A., Hosoki, K., Yasutomi, M., Sur, S., & Ohshima, Y. (2015) · Biochemical and Biophysical Research Communications · doi:10.1016/j.bbrc.2015.05.076 · Cited by 43 · see citing works
“A number of epidemiological studies have shown that t e fungus Alternaria alternata is the source of a common allergen that causes allergi c airway diseases, including bronchial asthma, and that sensitivity to this Alternaria alternata allergen is associated with asthma severity, bronchial hyperresponsiveness, and fat…”
Stern, D. A., Lohman, I. C., Wright, A. L., Taussig, L. M., Martínez, F. D., & Halonen, M. J. (2004) · Clinical & Experimental Allergy · doi:10.1111/j.1365-2222.2004.02088.x · Cited by 43 · see citing works
Kita, H. (2015) · Allergology International · doi:10.1016/j.alit.2015.04.004 · Cited by 42 · see citing works
Grinn‐Gofroń, A., & Strzelczak, A. (2008) · International Journal of Biometeorology · doi:10.1007/s00484-008-0182-3 · Cited by 41 · see citing works
“Some researchers have related the occurrence of respiratory allergy symptoms to the presence of Alternaria spores in the ambient air (Kauffman et al. 1995; Downs et al. 2001; Rapiejko et al. 2004).”
BackgroundIndoor Fungal Concentration in the Homes of Allergic/Asthmatic Children in Delhi, India
Sharma, R., Deval, R., Priyadarshi, V., Gaur, S. N., Singh, V. P., & Singh, A. B. (2011) · Allergy & Rhinology · doi:10.2500/ar.2011.2.0005 · Cited by 40 · see citing works
Pediatric Asthma: Natural History, Assessment, and Treatment
Herzog, R., & Cunningham–Rundles, S. (2011) · Mount Sinai Journal of Medicine A Journal of Translational and Personalized Medicine · doi:10.1002/msj.20285 · Cited by 41 · see citing works
Nageen, Y., Wang, X., & Pecoraro, L. (2023) · Frontiers in Microbiology · doi:10.3389/fmicb.2022.1043224 · Cited by 41 · see citing works
O’Grady, S. M., Patil, N., Melkamu, T., Maniak, P. J., Lancto, C. A., & Kita, H. (2013) · The Journal of Physiology · doi:10.1113/jphysiol.2013.254649 · Cited by 39 · see citing works
“…severe asthma; life-threatening respiratory distress has been associated with increased exposure to Alternaria aeroallergens (Black et al. 2000; Downs et al. 2001; Weber, 2001; Kauffman & van der Heide, 2003; Bush & Prochnau, 2004; Shi et al. 2008; Sipos et al. 2009; Smith, 2010; Hayes et al.…”
BackgroundAirborne allergenic fungal spores and meteorological factors in Greece: Forecasting possibilities
Damialis, A., & Gioulekas, D. G. (2006) · Grana · doi:10.1080/00173130600601005 · Cited by 38 · see citing works
“…above fungal spores types (O’Hollaren et al. 1991; Kauffman et al. 1995; Dales et al. 2000; Bush & Prochnau, 2004), particularly in sensitised children and young adults (O’Hollaren et al. 1991; Targonski et al. 1995; Dales et al. 2000; Downs et al. 2001; Verini et al. 2001; Bush & Prochnau, 2004).”
BackgroundInfluentialGrimsley, L. F., Chulada, P. C., Kennedy, S., White, L. E., Wildfire, J. J., Cohn, R. D., Mitchell, H., Thornton, E., El-Dahr, J. M., Mvula, M. M., et al. (2012) · Environmental Health Perspectives · doi:10.1289/ehp.1104840 · Cited by 37 · see citing works
“Alternaria is a common fungus, and at high exposure levels, it has been associated with the onset of childhood asthma and with severe asthma reactions in sensitive individuals (Bush and Prochnau 2004; Downs et al. 2001; Lemanske 2002; Salo et al. 2005).”
BackgroundKilic, M., Altıntaş, D. U., Yilmaz, M., Kendirli, S. G., Karakoç, G. B., Taşkın, E., Çeter, T., & Pınar, N. M. (2010) · Allergologia et Immunopathologia · doi:10.1016/j.aller.2009.09.006 · Cited by 37 · see citing works
“Some epidemiologic studies suggested that sensitisation to Alternaria is associated with asthma, particularly with severe asthma and life-threatening exacerbations.(6,26) Huang et al.”
BackgroundLu, Y., Wang, X., Almeida, L. C. S. D. S., & Pecoraro, L. (2022) · Journal of Fungi · doi:10.3390/jof8050431 · Cited by 35 · see citing works
Role of Proteases in Lung Disease: A Brief Overview
Chakraborti, S., Sarkar, J., Pramanik, P. K., & Chakraborti, T. (2017) · Springer eBooks · doi:10.1007/978-981-10-3162-5_16 · Cited by 33 · see citing works
“The fungus Alternaria alternate has been observed to cause asthma under certain circumstances [157, 158].”
BackgroundHarmful and protective roles of group V phospholipase A2: Current perspectives and future directions
Samuchiwal, S. K., & Balestrieri, B. (2018) · Biochimica et Biophysica Acta (BBA) - Molecular and Cell Biology of Lipids · doi:10.1016/j.bbalip.2018.10.001 · Cited by 33 · see citing works
“Exposure to Alternaria spores induces development of asthma and asthma exacerbations [53, 54].”
BackgroundAlternaria toxins in South African sunflower seeds: cooperative study
Hickert, S., Hermes, L., Marques, L. M. M., Focke, C., Cramer, B., Lopes, N. P., Flett, B. C., & Humpf, H. (2017) · Mycotoxin Research · doi:10.1007/s12550-017-0290-1 · Cited by 32 · see citing works
“Furthermore, indoor building materials are commonly infested with Alternaria species (Nielsen et al. 1999) which is of concern as the spores can cause allergic reactions and are associated with severe asthma (Downs et al. 2001).”
Characterization and pro‐inflammatory potential of indoor mold particles
Holme, J. A., Øya, E., Afanou, A. K., Øvrevik, J., & Eduard, W. (2020) · Indoor Air · doi:10.1111/ina.12656 · Cited by 34 · see citing works
“alternata sensitization and an increased risk of severe and fatal asthma (237, 238).”
BackgroundMold‐sensitivity in children with moderate‐severe asthma is associated with HLA‐DR and HLA‐DQ
Knutsen, A. P., Vijay, H. M., Kumar, V. V., Kariuki, B., Santiago, L. A., Graff, R. J., Wofford, J. D., & Shah, M. R. (2010) · Allergy · doi:10.1111/j.1398-9995.2010.02382.x · Cited by 32 · see citing works
“HLA-DRB1*13 was significantly increased in 46% of African-American mold-sensitive moderate-severe asthmat- Asp f3 0 200 400 600 800 1000 1200 1400 1600 1800 2000 IL-4 IL-5 IL-10 IL-13 IFN-g IL-4 IL-5 IL-10 IL-13 IFN-gIL-4 IL-5 IL-10 IL-13 IFN-g IL-4 IL-5 IL-10 IL-13 IFN-g C yt o ki n e (p g /m l) Moderate-severe (29)…”
BackgroundInfluentialKids, Difficult Asthma and Fungus
Bush, A. (2020) · Journal of Fungi · doi:10.3390/jof6020055 · Cited by 33 · see citing works
Aerobiology of Outdoor Allergens
Esch, R. E., & Bush, R. K. (2009) · Elsevier eBooks · doi:10.1016/b978-0-323-05659-5.00032-2 · Cited by 31 · see citing works
Green, B. J., Schmechel, D., Sercombe, J. K., & Tovey, E. R. (2005) · Journal of Immunological Methods · doi:10.1016/j.jim.2005.10.001 · Cited by 31 · see citing works
“Personal exposure to airborne fungi is recognized to be a risk factor for seasonal rhinitis (Li and Kendrick, 1995), asthma (Downs et al., 2001) and even death (O’Hollaren et al.”
BackgroundSpecific IgE against Alternaria alternata in atopic dermatitis and asthma patients.
Hedayati, M. T., Arabzadehmoghadam, A., & Hajheydari, Z. (2009) · PubMed · Cited by 30 · see citing works
Qualité de l’air à l’intérieur des écoles
Cartieaux, E., Rzepka, M. A., & Cuny, D. (2011) · Archives de Pédiatrie · doi:10.1016/j.arcped.2011.04.020 · Cited by 30 · see citing works
Mold and Alternaria skin test reactivity and asthma in children in Connecticut
Lyons, T. W., Wakefield, D. B., & Cloutier, M. M. (2011) · Annals of Allergy Asthma & Immunology · doi:10.1016/j.anai.2010.12.009 · Cited by 30 · see citing works
Shabankarehfard, E., Ostovar, A., Farrokhi, S., Naeimi, B., Zaeri, S., Nazmara, S., Keshtkar, M., Sadeghzadeh, F., & Dobaradaran, S. (2017) · Immunological Investigations · doi:10.1080/08820139.2017.1322102 · Cited by 29 · see citing works
“Associations between air- and dustborne fungi and development of allergy diseases have been reported in several studies (Downs et al., 2001; Gent et al., 2002; Stark et al., 2003, 2005; Rosenbaum et al., 2010; Tischer et al., 2011).”
BackgroundGreen, B. J., Schmechel, D., & Summerbell, R. C. (2011) · Wageningen Academic Publishers eBooks · doi:10.3920/978-90-8686-722-6_8 · Cited by 29 · see citing works
Bavbek, S., Erkekol, F. Ö., Çeter, T., Mungan, D., Özer, F., Pinar, M., & Mısırlıgil, Z. (2006) · Journal of Asthma · doi:10.1080/02770900600710706 · Cited by 29 · see citing works
“Although correlations between respiratory allergic symptoms and the presence of fungal spores in the atmosphere have been demonstrated, clinical relevance of mold sensitization is often not clear (22, 23).”
BackgroundTopbaş, M., Tosun, İ., Çan, G., Kaklıkkaya, N., & Aydın, F. (2006) · DergiPark (Istanbul University) · Cited by 28 · see citing works
Yuan, C., Wang, X., & Pecoraro, L. (2022) · Frontiers in Microbiology · doi:10.3389/fmicb.2022.928921 · Cited by 29 · see citing works
Challenges associated with indoor moulds: Health effects, immune response and exposure assessment
Chapman, M. D. (2006) · Medical Mycology · doi:10.1080/13693780600835740 · Cited by 28 · see citing works
Complex Interactions of Pollutant and Allergen Exposures and Their Impact on People With Asthma
Eggleston, P. A. (2009) · PEDIATRICS · doi:10.1542/peds.2008-2233f · Cited by 28 · see citing works
Measuring environmental fungal exposure
Tovey, E. R., & Green, B. J. (2005) · Medical Mycology · doi:10.1080/13693780400020097 · Cited by 27 · see citing works
Murine models of airway fungal exposure and allergic sensitization
Templeton, S. P., Buskirk, A. D., Green, B. J., Beezhold, D. H., & Schmechel, D. (2010) · Medical Mycology · doi:10.3109/13693780903420658 · Cited by 26 · see citing works
Clinical significance of Alternaria alternata sensitization in patients with allergic rhinitis
Katotomichelakis, M., Anastassakis, K., Gouveris, H. T., Tripsianis, G., Paraskakis, E., Maroudias, N., & Danielides, V. (2011) · American Journal of Otolaryngology · doi:10.1016/j.amjoto.2011.07.004 · Cited by 26 · see citing works
“It is therefore crucial to identify early individuals at risk, especially children, for AA sensitivity [5].”
BackgroundThe effect of sunlight on allergen release from spores of the fungus Alternaria
Mitakakis, T. Z., O'Meara, T. J., & Tovey, E. R. (2003) · Grana · doi:10.1080/00173130310008571 · Cited by 28 · see citing works
“While spore concentrations of Alternaria have been positively associated with airway hyper-responsiveness and frequency of both wheeze and bronchodilator use (Downs et al. 2001), associations between spore concentration and clinical outcomes remain rare.”
BackgroundSelf-citationAssociation of Atopy to Asthma Severity and Medication Use in Children
Schwindt, C. D., Tjoa, T. T., Floro, J. N., McLaren, C. E., & Delfino, R. J. (2006) · Journal of Asthma · doi:10.1080/02770900600758234 · Cited by 26 · see citing works
“Other studies have similarly demonstrated that mold sensitization is associated with an increased risk for asthma severity (19, 20).”
BackgroundSrisomboon, Y., Squillace, D. L., Maniak, P. J., Kita, H., & O’Grady, S. M. (2020) · The Journal of Physiology · doi:10.1113/jp279379 · Cited by 25 · see citing works
“Inhalation of these spores can cause respiratory distress and airway hyper-responsiveness in asthma patients sensitized to Alternaria (Downs et al. 2001; Bush & Prochnau, 2004; Grewling et al., 2019).”
BackgroundAlternaria spores at different heights from the ground
Bergamini, B. M., Grillenzoni, S., Andreoni, A. D., Natali, P., Ranzi, A., & Bertolani, M. (2004) · Allergy · doi:10.1111/j.1398-9995.2004.00423.x · Cited by 25 · see citing works
- Authors
- DOWNS, S. H., MITAKAKIS, T. Z., MARKS, G. B., CAR, N. G., BELOUSOVA, E. G., LEÜPPI, J. D., XUAN, W., DOWNIE, S. R., TOBIAS, A., & PEAT, J. K.
- Affiliations
- The University of Sydney (AU)
- Institute of Respiratory Medicine and School of Biological Sciences, University of Sydney, Sydney, Australia; School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, Australia; Clinical Epidemiology Unit, New Children's Hospital, Westmead, NSW, Australia; and Department of Clinical Epidemiology and Public Health, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
- Venue
- American Journal of Respiratory and Critical Care Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2001-08-01
- Volume
- 164
- Issue
- 3
- Pages
- 455-459
- ISSN
- 1073-449X (ISSN-L)
- 1535-4970
- OpenAlex
- W2147199610
- Cited by
- 202
- References
- 41
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 7 · 2023: 7 · 2022: 8 · 2021: 5 · 2020: 8 · 2019: 3 · 2018: 7 · 2017: 5 · 2016: 9 · 2015: 9 · 2014: 3 · 2013: 7 · 2012: 13
- FWCI
- 5.59
- Type
- journal article
- Language
- en
- Open access
- Locations
- American Journal of Respiratory and Critical Care Medicine (publishedVersion)
- PubMed (publishedVersion)
- Charles Sturt University Research Output (CRO) (submittedVersion, other-oa)
- Funders
- National Science Foundation
- Novartis Foundation
- Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung
- Medical Research Council
- National Health and Medical Research Council
- Topics
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Health Sciences › Medicine › Immunology and Allergy › Allergic Rhinitis and Sensitization
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Indoor Air Quality and Microbial Exposure
- Keywords
- Alternaria, fungal allergens, airway hyperresponsiveness, asthma severity, childhood asthma, allergen sensitization, wheezing, bronchodilator use, aeroallergens, elementary school students
- MeSH terms
- Allergens, Alternaria, Asthma, Child, Environmental Exposure, Female, Forced Expiratory Volume, Humans, Hypersensitivity, Male, Severity of Illness Index, Spores, Cohort Studies
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