Everything you wanted to know
" Have you got asthma?"


Claude MOLINA* & Jacques GAYRAUD**

1. Pertussis and asthma
2. Anti-influenza vaccination of egg-allergic persons
3. Archive fungi (F) and occupational allergy
4. Exposition of asthmatic children to home fungal species
5. From rhinitis to asthma : the role of workplace humidity

1.  Pertussis and asthma

Theme: asthma, infection
Key words: asthma, pertussis, measles, anti-pertussis vaccination

The recent pertussis (P) outbreak in California, following that in Minnesota in 2004, despite vaccination, has induced C.R.Capilli of the Mayo Clinic (JACI 2012 129 4 957-963) to determine whether in a case-control population asthmatics (A) were more prone to contract P than non-asthmatics.

223 cases of P, identified in 2004 and 2005 by PCR (Polymerase Chain Reaction) on nasopharyngeal sampling on As, were studied but only 164 subjects were enrolled with 328 controls. 50% were male, 80% white, with a median age 14. 62 (38%) of them were suffering from A before contracting P as opposed to 85 (26%) of the 328 controls (OR 1.73  P=.013).

To sum up the statistical data of the study, it appears that within a population like the USA’s with a high prevalence of A, the risk for an asthmatic person of catching P is 17%.

This means that asthmatics constitute a ‘target’ group for anti-P vaccination, with boosters and recall every 10 years at least, even in adults, and associated with anti-tetanus and anti-diphtheria vaccination, as is the case in France with the traditional DTCOQ.

Another point of view : P seems to be, like measles (M), a risk factor for child asthma, as shown by a study conducted in the Australian island of Tasmania by J.A.Burgess et al. (Chest  March 2012 early view on-line) among 7-year old children. The authors recorded over a 37-year period from a school medical data base, cases of children’s respiratory infections and their possible association with incidental, persistent or established asthma, all supported by a statistical logistic regression analysis. They were able to conclude that, while most children’s infections protected them against the occurrence of adult A, as well as against chicken pox or rubella, P and M were, on the contrary, significantly associated with adolescent incidence of A for the latter and pre-adolescent incidence of the former. Another reason, according to the authors, for recommending vaccination against P and M to reduce the incidence of asthma.

2.  Anti-influenza vaccination of egg- allergic patients

Theme: allergy, vaccination
Key words: anti-flu vaccine, egg, ovalbumin

The administration to an egg-allergic person of the anti-influenza vaccine (AIV) coming from an egg-grown virus and ovalbumin-laden virus is considered with some reluctance by doctors and families, above all when the child or the adult has a history of serious anaphylaxis (An) caused by this allergen. Yet AIV is unquestionably beneficial for public health, is generally harmless, and egg allergies are rare.

Two researchers from Philadelphia, USA (I.Feung et J.M.Spergel JACI 2012 129 4 1157-1159) undertook a retrospective review of 56 An-suffering children monitored between 2007 and 2009, who received 119 vaccinations using the Sanofi-Pasteur AIV (H1N1 excepted). 113 first underwent vaccine prick-tests (SPTs); children under 3 years of age received a 0.25-ml dose, those over that age 0.50ml in 2 or 3 doses.

Two children had a vaccine reaction : one of them, aged 2, had 2 reactions, he had had a positive SPT before the 1st vaccination but was not affected the following year, while the other, aged 18 months, suffering from asthma and for whom the SPT was not considered useful, had a reaction which was both moderate and reversible by simple anti-histamines.

On the whole, the authors concluded that AIV was harmless for the egg-allergic who have suffered a more or less recent An episode (on average 2 years before AIV). Besides, at the same time, 520 egg-allergy sufferers, without A, had only limited local reactions.

The authors refer to a few cases found in publications, from which it appears that AIV can be administered without serious problems to the egg-allergic, including subjects having had an An reaction.

The ovalbumin content (O) incriminated does not seem to play a negative role, as high O dosage vaccines did not provoke an increase in the risk of A. The AIV used in this study had a median ovalbumin concentration higher than those of other brands of vaccine.

As to the preliminary SPTs, these present no great interest, and neither does dose fractioning in 2 or 3 injections.

Allergists may therefore reassure their patients and families as to the harmlessness of AIV: post-vaccination monitoring of a few minutes or hours is nevertheless a necessity.

3.  Archives, fungi (F) and occupational allergy

Theme: allergens, environment
Key words: fungi, archives, Penicillium Chrysogenum, Cladosporium sphaerospermum, Aspergillus versicolor

A French team of scientists from the Besancon University undertook an original survey on the possible contamination of the National Archives by fungi, trying to identify and quantify them through state-of-the-art techniques, to evaluate their concentration in the air and inside the documents, and finally to assess their effect on archivists’ and research assistants’ health, searching among other symptoms for allergic manifestations (S.Roussel et al Indoor Air 2012 22 2 early view). After an appeal on the National Archives website, the authors enrolled 10 volunteer centres for the survey.

2 techniques were used in the search for 50 or so F varieties: Air Impactor for the air, and Electrostatic Dust Collector for the archive zones.

2 methods were used and compared for F identification: culture-based analysis and quantitative PCR (Polymerase Chain Reaction). The criterion of 170 Colony Forming Units (CFU) per m3 was considered as potentially pathogen.

An inventory of symptoms suffered by subjects in contact with the archives was drawn up using a conventional self-report questionnaire distributed among the staff.

The results were as follows:

3 main F were isolated in terms of frequency and quantity : Penicillium Chrysogenum,  Cladosporium sphaerospermum and Aspergillus versicolor, with converging results for the two techniques (the PCRq also helped to isolate Stachybotris chartarum considered as a potent toxin generator). On the whole, archive contamination was found to be moderate. Median concentrations ranged between 30 and 465 CFU/m3, with 93% between low and medium : only 3% of the archives showed high concentrations.

As regards the question of health, subjects working in contaminated zones did not report more frequent allergy symptoms than their fellows. However, they did report headaches, eye and throat irritation, coughing and rhinorrhea. Only eye irritation was statistically significant.

These reassuring results corroborate observations made in rare similar studies conducted abroad, and which may concern a large number of subjects (over 1 million worldwide).

4.  Exposition of asthmatic children to home fungal species

Theme: asthma, environment
Key words: asthma, cladosporium, penicillium, aspergillus, basidiospores, epicoccum, pithomycea

Exposition to fungi (F) is known to play an important role in the development of asthma (A) and atopy, by increasing symptoms intensity and encouraging A exacerbation.

A group of American paediatricians from Kansas City focused on fungal species in the homes of asthmatic children, trying to identify them in a large number of Middle West homes, according to geographical location, seasons, and the presence of at least one asthmatic child (J.Meng et al Clin. Exp.Allergy 2012  21 March  accepted article).

Flats and houses enrolled in the study were part of a research project on home hygiene, which means that the more or less unsanitary ones were dropped and those with relatively comfortable conditions were given priority.

88 homes with one asthmatic child (aged 2-18) were then explored, particularly at the end of spring and in the autumn, when asthmatic and allergic subjects consult the doctor more frequently, and were compared to 85 control homes (with no asthmatic child), and during the influenza season depending on the frequency of paediatrician consultations.

The technique consisted in sampling fungal spores from the child’s bedroom and the living area, as well as in the outdoor environment, counting them per cubic metre of air, and cultivating them for CFU (Colony Forming Unit) identification and count.

Results reveal that 18 viable and potentially pathogenic species were isolated and 165 families out of 173 (97%) were host to at least one viable species.

Among them : Cladosporium in the first place, Penicillium, Aspergillus, Basidiospore, Epicoccum and  Pitomyces were identified more often and in higher concentration in homes with an asthmatic child than in control homes, even after adjustment for outdoor fungal spore concentration. The cultures confirm these observations after adjusting for seasonal factors. It is surprising to observe that Alternaria spores were not found more frequently in asthmatic homes than in controls. The responsibility of these fungi in the symptoms shown by the study asthmatics remains to be established through research already planned for the future (76% of them presented superior airway manifestations, 63% asthma-like symptoms, 43% skin signs). But we know that many of these F species are allergenic. This means that their detection followed by their elimination cannot but improve the treatment of asthma and benefit the asthmatic child.

5.  From rhinitis to asthma : the role of workplace humidity

Theme: asthma, environment
Key words: rhinitis, asthma, moulds, flooding, fungus index

It is well known that exposure to fungi in a damp environment increases the risk of allergic rhino-sinusitis, but there is little information on the progression of rhinitis towards asthma in an occupational context in a water-damaged building. American authors (J.H.Park et al Indoor air  avril 2012 early view) conducted 4 successive environmental and health surveys by questionnaires, in a 20-storey building in North East USA, built in 1985 and damaged by water flooding. Occupied in 1994, the building had been recognised as responsible for asthma cases and hypersensitivity pneumopathy among its occupants in the autumn of 2000, in relation with the inhalation of soil moulds. After several attempts to repair the damage in 2004, the authors monitored the evolution of 131 subjects between 2001 and 2007 initially suffering from rhinitis, compared to a control group of 361 other occupants.

Using logistic regression models they analysed the risk of asthma development among these two groups, adjusting for demographic data, possible smoking habits, duration of occupation of the premises and exposure to fungi, endotoxin and ergosterol expelled by fungal cell membranes.

The findings suggest that the rhino-sinusitis group were at least twice more likely to contract asthma than the control group (OR=2.2, CI95%=1.3-3.6). This risk was even higher when the rhino-sinusitis group was exposed to the building’s highest fungal concentration zones (OR=7.4, CI 2.8-19.9).

It is then possible to conclude with the authors that, in professional, water-damaged premises, the incidence of rhino-sinusitis among occupants may presage increased risk of asthma onset in the future.

An article in the same journal by a Japanese author (K.Abe  Indoor Air 2012 22 3 June 173-185 ) is therefore all the more interesting. It presents a fungus detector encapsulating as sensitizer either xerophilic fungus spores (Eurotium herbariorum or Aspergillus penicillioides) for use in not very damp premises, or hydrophilic fungus spores (Alternaria Alternata) in the case of extreme damp. This would mean that a fungus index could be set up, which would be of use to architects and owners of water-damaged business or residential premises, and in very different climates.

Comments and questions welcome :

Pr. Claude Molina    and/or    Dr Jacques Gayraud
* **