Racial differences in odds of asthma exacerbations among Aspergillus fumigatus-sensitized adults with asthma
Patrick K Gleeson1, Knashawn H Morales2, Meeta Prasad Kerlin3
1Section of Allergy and Immunology, Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Background:
Allergic sensitization to mold is a risk factor for poor asthma outcomes, but whether it accounts for disparities in asthma outcomes according to race or socioeconomic status is not well-studied.
Objective:
To identify factors associated with allergic sensitization to molds and evaluate associations of sensitization to molds with asthma exacerbations after stratifying by race.
Methods:
We conducted a retrospective cohort study of adults with asthma who had an outpatient visit to a large health system between January 1, 2017 and June 30, 2023 and received aeroallergen testing to Aspergillus fumigatus, Penicillium, Alternaria, and Cladosporium. We used logistic regression models to evaluate factors associated with mold sensitization and the effect of mold sensitization on asthma exacerbations in the 12 months before testing, overall and then stratified by race.
Results:
A total of 2732 patients met the inclusion criteria. Sensitization to each mold was negatively associated with being a woman (odds ratios [ORs] ≤ 0.59, P ≤ .001 in 5 models) and positively associated with the Black race (ORs ≥ 2.16 vs White, P < .0005 in 5 models). In the full cohort, sensitization to molds was not associated with asthma exacerbations (ORs = 0.95-1.40, P ≥ .003 in 5 models and all above the corrected P value threshold). Among 1032 Black patients, sensitization to A fumigatus, but not to other molds, was associated with increased odds of asthma exacerbations (OR = 2.04, P < .0005).
Conclusion:
Being a man and Black race were associated with allergic sensitization to molds. Sensitization to A fumigatus was associated with asthma exacerbations among Black patients but not the overall cohort, suggesting that A fumigatus allergy is a source of disparities in asthma outcomes according to race.
Insights
Black men show higher mold sensitization, a risk factor for asthma exacerbations. Aspergillus fumigatus allergy specifically impacts asthma outcomes in Black patients, contributing to health disparities.
Area of Science:
- Environmental health
- Allergy and immunology
- Pulmonary medicine
Background:
- Allergic sensitization to molds is a known risk factor for severe asthma.
- Existing research has not adequately explored if mold allergy contributes to racial disparities in asthma outcomes.
Purpose of the Study:
- To identify factors linked to mold sensitization.
- To assess the association between mold sensitization and asthma exacerbations, stratified by race.
Main Methods:
- Retrospective cohort study of 2732 adult asthma patients with aeroallergen testing.
- Logistic regression models used to analyze factors associated with mold sensitization and its impact on asthma exacerbations.
Main Results:
- Black race and male sex were significantly associated with increased mold sensitization.
- Overall, mold sensitization did not correlate with asthma exacerbations.
- Among Black patients, Aspergillus fumigatus sensitization was linked to higher odds of asthma exacerbations.
Conclusions:
- Male sex and Black race are risk factors for mold sensitization.
- Aspergillus fumigatus allergy may be a key driver of racial disparities in asthma exacerbations.
Related Concept Videos
01:29Asthma-I: Introduction
01:26Asthma-II: Pathophysiology and Classification
Additionally, environmental and genetic factors play crucial roles in determining an individual's susceptibility to asthma and the severity of their condition.
Critical processes in asthma pathophysiology include:
01:24Asthma-III: Symptoms and Complications
Classification of Asthma
01:20Asthma: Pathogenesis and Management
Asthma is classified as allergic and non-allergic. Allergens such as dust mites, pollen, and pet dander trigger allergic asthma, while factors like cold air, intense emotions, or exercise can induce non-allergic asthma.
01:30Asthma-IV: Diagnostic and Management
Clinical Assessment for Asthma:
This is the first step in diagnosing and managing asthma. It includes:
01:25Antiasthma Drugs: Mast Cell Stabilizers and Anti-IgE Drugs
Mast cell stabilizers, such as cromolyn (also known as sodium cromoglycate) and nedocromil (Tilade), are effective drugs in asthma management. These stabilizers hinder histamine release by skillfully obstructing the activation of mast cells and other cellular entities. Notably, they navigate this task without...