Children and especially infants are most susceptible to mold and fungal diseases because their immune systems are not fully developed. Recent research emphasizes this.
Reactive airways disease in children is increasing in many countries around the world. The clinical diagnosis of asthma or reactive airways disease includes a variable airflow and an increased sensitivity in the airways. This condition can develop after an augmented reaction to a specific agent (allergen) and may cause a life-threatening situation within a very short period of exposure. It can also develop after a long-term exposure to irritating agents that cause an inflammation in the airways in the absence of an allergen.
Several environmental agents have been shown to be associated with the increased incidence of childhood asthma. They include allergens, cat dander, outdoor as well as indoor air pollution, cooking fumes, and infections. There is, however, increasing evidence that mold growth indoors in damp buildings is an important risk factor. About 30 investigations from various countries around the world have demonstrated a close relationship between living in damp homes or homes with mold growth, and the extent of adverse respiratory symptoms in children. Some studies show a relation between dampness/mold and objective measures of lung function. Apart from airways symptoms, some studies demonstrate the presence of general symptoms that include fatigue and headache and symptoms from the central nervous system. At excessive exposures, an increased risk for hemorrhagic pneumonia and death among infants has been reported.
The described effects may have important consequences for children in the early years of life. A child's immune system is developing from birth to adolescence and requires a natural, physiologic stimulation with antigens as well as inflammatory agents. Any disturbances of this normal maturing process will increase the risk for abnormal reactions to inhaled antigens and inflammagenic agents in the environment.
The knowledge about health risks due to mold exposure is not widespread and health authorities in some countries may not be aware of the serious reactions mold exposure can provoke in some children. Individual physicians may have difficulty handling the patients because of the lack of recognition of the relationship between the often complex symptoms and the indoor environment
The workshop was organized to develop a basis for risk assessment and formulation of recommendations, particularly for diagnostic purposes and prevention, and to formulate priorities for future research. The participants were all active researchers with current experience in child health, molds, and respiratory disease. They were engaged in free and intensive discussions on a scientific basis throughout the duration of the 3-day workshop
This monograph contains peer-reviewed papers based on individual presentations at the workshop as well as the workshop conclusions. They are offered to the public health community, administrators, research agencies, physicians, particularly pediatricians, nurses and health workers as information and encouragement to engage themselves in this health problem of importance for the next generation in our population.
Acknowledgments: The workshop received financial support from the U.S. Environmental Protection Agency, the National Center for Environmental Assessment at the U.S. EPA, the Vårdal Foundation (Sweden), Astra Corp (Sweden), the Committee on Organic Dusts, International Commission on Occupational Health. The printing of this document was made possible by a grant from the Center for Indoor Air Research (U.S.). Yvonne Peterson, research secretary, provided excellent and invaluable assistance in the organization and publication efforts.
W. J. STEI NB A C H , Division of Pediatric Infectious Diseases, Department of Pediatrics, Duke University Medical Center, Durham, NC 27710, USAThere is a paucity of specific data on pediatric invasive aspergillosis. While the underlying predisposing patient diseases and treatments differ in children and adults, it also appears that there is a heterogeneity of invasive aspergillosis disease that extends to children. These aspects extend in some reports to the Aspergillus spp. distribution as well as the fundamental pathophysiology of the disease in different age groups. For instance, the newer diagnostic tools hold great promise for adult patients but it appears that they have limited usefulness in children. Only through dedicated pediatric study will clinicians fully discover the nuances and unique findings in children with this deadly disease
Noreen M. Clark,1 Randall W. Brown,2 Edith Parker,1 Thomas G. Robins,3 Daniel G. Remick Jr,2 Martin A. Philbert,3 Gerald J. Keeler,3 and Barbara A. Israel1
1University of Michigan School of Public Health Department of Health, Behavior and Health Education, 2University of Michigan Medical School, 3University of Michigan School of Public Health, Department of Environmental and Industrial Health, Ann Arbor, Michigan USA
Asthma prevalence in children has increased 58% since 1980. Mortality has increased by 78%. The burden of the disease is most acute in urban areas and racial/ethnic minority populations. Hospitalization and morbidity rates for nonwhites are more than twice those for whites. Asthma is characterized by recurrent wheezing, breathlessness, chest tightness, and coughing. Research in the past decade has revealed the importance of inflammation of the airways in asthma and clinical treatment to reduce chronic inflammation. Asthma is associated with production of IgE to common environmental allergens including house dust mite, animal dander, cockroach, fungal spores, and pollens. Some interventions to reduce symptoms through control of dust mite and animal dander have had positive results. Control of symptoms through interventions to reduce exposures to cockroach antigen has not been reported. Studies illustrating causal effects between outdoor air pollution and asthma prevalence are scant. Increases in asthma prevalence have occurred at the same time as general improvements in air quality. However, air quality appears to exacerbate symptoms in the child who already has the disease. Decreased pulmonary function has been associated with exposure to particulates and bronchial hyperresponsiveness to smoke, SO2 and NO2. Symptoms have been correlated with increased levels of respirable particulates, ozone, and SO2. Interventions that reduce the negative outcomes in asthma associated with outdoor environmental factors have not been reported. Control of asthma in children will entail the collaborative efforts of patients, family, clinical professionals, and school personnel, as well as community-wide environmental control measures and conducive national and local policies based on sound research. Key words: asthma control, child health, childhood asthma, environmental precipitants. -- Environ Health Perspect 107(suppl 3):421-429 (1999).
Introduction and Summary: Workshop on Children's Health and Indoor Mold Exposure
Ragnar Rylander1 and Ruth Etzel2
1Department of Environmental Medicine, University of Gothenburg, Gothenburg, Sweden; 2Division of Epidemiology and Risk Assessment, Food Safety and Inspection Service, Washington, DC USA
This article is based on a presentation at the International Conference on Indoor Mold and Children held 21-24 April 1998 in Alexandria, Virginia.