Mould exposure and rhinitis: findings from meta-analyses, longitudinal studies and birth cohorts
| First author [ref.] | Study design | Mould exposure | Main outcomes# | Results |
| Fisk [15] | Meta-analysis 13 cross-sectional + longitudinal studies Children and adults | Dampness and/or mould | Upper respiratory tract symptoms | OR 1.70 (95% CI 1.44–2.00) |
| Antova [5] | Pooled analysis of seven cross-sectional studies as part of the PATY study Children aged 6–12 years | Visible mould | Hay fever | OR 1.35 (95% CI 1.18–1.53) p-value from test for between-country heterogeneity p=0.20 |
| Tischer [7] | Meta-analysis 11 cross-sectional + longitudinal studies Children | Visible mould | Allergic rhinitis or hay fever | OR 1.39 (95% CI 1.28–1.51) |
| Tischer [8] | Pooled analysis of six birth cohorts as part of the ENRIECO initiative | Early exposure to mould | Allergic rhinitis | In early school age (6–8 years) aOR 1.12 (95% CI 1.02–1.23) In childhood (3–10 years) aOR 1.18 (95% CI 1.09–1.28) No significant heterogeneity between the cohorts |
| Jaakkola [48] | Cross-sectional, case–control and cohort studies in children or adults (31 studies overall) | Water damage, dampness, visible mould and mould odour | Allergic rhinitis | EE (95% CI) Dampness: (6 studies) mild heterogeneity 1.50 (1.38–1.62) All EEs >1; 6/6 EEs significant Visible mould: (12 studies) no heterogeneity 1.51 (1.39–1.64) All EEs >1; 6/12 EEs significant Mould odour: (3 studies) strong heterogeneity 1.87 (0.95–3.68) All EEs >1; 2/3 EEs significant |
| Biagini, USA [109] | Birth cohort (CCAPS) with at least one parent with positive SPT n=495 infants with SPT at the age of 1 year | Visible mould during home visit | URTI (sinus or ear infection and antibiotic use) reported in diary Allergic rhinitis = rhinitis symptoms + at least one positive SPT | Visible mould: aOR (95% CI) for URTI (versus ref.= no visible mould) Low 1.5 (1.01–2.3) High 5.1 (2.2–12.0) aOR (95% CI) for allergic rhinitis Low 1.2 (0.6–2.5) High 3.2 (0.7–14.8) |
| Osborne, USA [110] | Birth cohort (CCAPS) with at least one parent with positive SPT n=144 children aged 1–3 years | Long-term air sampling and total fungal spore enumeration in the 8 months around clinical examination | SPT to two food allergens and 15 aeroallergens Questionnaire for parents on rhinitis (sneezing, runny or stuffy nose, when you did not have a cold?) | Positive associations between rhinitis and: total concentration (p=0.10), Ganoderma (p=0.06), basidiospores (p=0.01) Negative associations between rhinitis and: Alternaria (p=0.10) Positive associations between positive SPT and Alternaria (p=0.01), Penicillium/Aspergillus type (p=0.01) Negative associations between positive SPT and Ganoderma (p=0.10), basidiospores (p=0.09) and Cladosporium (p=0.04) |
| Inal, Turkey [105] | 19 children aged 4–13 years with asthma or rhinitis, and monosensitised to mould Follow-up 1 year | Monthly sampling of indoor air | Daily symptom score of rhinitis in diary | No association between exposure to mould (total or Cladosporium, Alternaria, Penicillium or Aspergillus concentration CFU·m−3) and daily symptom score |
| Jaakkola, Finland [111] | Population-based prospective cohort n=1863 children aged 1–7 years, free of allergic rhinitis at baseline in 1991 (n=246 incident cases) | Visible mould, wet spots, water damage and indicator of “any” exposure | Development of allergic rhinitis (incident cases) (history of or current physician-diagnosed allergic rhinitis during the 6-year follow-up period) | OR for allergic rhinitis incidence (compared to ref=no exposure) Visible mould at baseline 1.06 (0.51–2.21); at follow-up 1.98 (1.32–2.99) Mould odour at baseline 0.94 (0.36–2.45); at follow-up 1.45 (0.89–2.37) Any exposure at baseline 1.55 (1.10–2.18); at follow-up 1.62 (1.21–2.18); at baseline and follow-up 1.96 (1.29–2.98) |
| Behbod, USA [28] | Prospective birth cohort 408 children with family history of allergic disease or asthma followed-up to age 13 years | Parental report of home dampness and culturable fungi in bedroom air and dust, and in outdoor air when children were aged 2–3 months Indoor air: Burkard DG18: 1 min 45 L·min−1 Culture: identification of fungal genus | Symptoms/disease onset from birth to age 13 years For rhinitis: parental report of physician-diagnosed hay fever and nasal symptoms (runny nose) Mould sensitisation status tested at ages 7 and 13 years (in n=285) | HR (95% CI) for rhinitis onset Home dampness 1.11 (0.73–1.68) Dust (bedroom floor) Alternaria 0.79 (0.51–1.22) Cladosporium 0.91 (0.77–1.08) Aspergillus 1.39 (1.11–1.74) Penicillium 1.04 (0.89–1.21) Yeasts 1.06 (0.92–1.22) Nonsporulating fungi 1.05 (0.88–1.25) Measures in indoor air: no significant association observed |
| Thacher, Sweden [26] | Birth cohort (BAMSE) n=3798 children with follow-up data at age 16 years | Parental report when the child was 2 months, of mould odour ever in the home, visible mould in the home in the past year or moisture damage in the home | Rhinitis: eye or nose symptoms following exposure to allergens in the past 12 months and/or a doctor's diagnosis of allergic rhinitis (+/- positive Phadiatop test) at age 16 years | OR (95% CI) for rhinitis at age 16 years Visible mould 1.28 (1.04–1.58) Mould odour 1.29 (1.03–1.62) Any mould or dampness indicator for nonallergic rhinitis 1.41 (1.03–1.93); allergic rhinitis 0.88 (0.74–1.05) |
PATY: Pollution and the Young; ENRIECO: Environmental Health Risks in European Birth Cohorts; aOR: adjusted odds ratio; EE: effect estimate; CCAPS: Cincinnati Childhood Allergy and Air Pollution Study; SPT: skin prick test; URTI: upper respiratory tract infection; BAMSE: Barn/Child Allergy Milieu Stockholm Epidemiology. #: other outcomes are considered in the articles cited.