Among inner-city children with atopic asthma, an individualized, home-based, comprehensive environmental intervention decreases exposure to indoor allergens, including cockroach and dust-mite allergens, resulting in reduced asthma-associated morbidity.

Investigators in the Inner-City Asthma Study are listed in the Appendix. We thank the participants for making their homes available to us for 2-week periods. We also thank our excellent staff for performing the many tasks involved in a multiyear, multicity field study.

Background-The percentage of asthma cases attributable to atopy is the subject of debate.

Morton, "Acute respiratory health effects of air pollution on children with asthma in US inner cities" (2008). U.S. Environmental Protection Agency Papers. 12.

Background While sensitization to fungal allergens is prevalent in inner-city children with asthma, the relationship between fungal exposure and morbidity is poorly understood. Objective We examined relationships between fungal sensitization, exposure and asthma morbidity in inner-city children. Methods Participants were 5–11 years old and enrolled in the Inner-City Asthma Study. This report includes the subset of children with at least 1 positive skin test to a fungal allergen extract; for these children, indoor and outdoor airborne culturable fungi were measured at baseline and throughout the 2 year study. Asthma morbidity measures were collected prospectively. The primary outcome was symptom days per 2 weeks. Results At baseline, children with a positive skin test to a fungal allergen extract had significantly more symptom days compared to those without positive skin test to any fungal allergen extract (6.3 vs 5.7 days per 2 weeks, p=0.04). During the study, elevations in total fungal exposure and indoor Penicillium exposure were associated with increases in symptom days and asthma unscheduled visits. Indoor exposures to total fungi and to Penicillium were associated with significant increases in unscheduled visits, even after controlling for outdoor fungal levels. Adverse effects associated with exposure to a specific fungus were stronger among children with positive skin test to that fungal allergen extract compared to skin test negative children. Conclusion Outdoor fungal exposure is primarily associated with increased asthma symptoms and increased risk of exacerbations in this population.