TABLE 4

Mould exposure and rhinitis: findings from meta-analyses, longitudinal studies and birth cohorts

First author [ref.]Study designMould exposureMain outcomes#Results
Fisk [15]Meta-analysis
13 cross-sectional + longitudinal studies
Children and adults
Dampness and/or mouldUpper respiratory tract symptomsOR 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 mouldHay feverOR 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 mouldAllergic rhinitis or hay feverOR 1.39 (95% CI 1.28–1.51)
Tischer [8]Pooled analysis of six birth cohorts as part of the ENRIECO initiativeEarly exposure to mouldAllergic rhinitisIn 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 odourAllergic rhinitisEE (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 visitURTI (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 examinationSPT 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 airDaily symptom score of rhinitis in diaryNo 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” exposureDevelopment 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 genusSymptoms/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 homeRhinitis: 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 yearsOR (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.