Asthma and lower airway diseaseIndoor fungal diversity and asthma: A meta-analysis and systematic review of risk factors
Section snippets
Search strategy
Electronic searches were conducted on April 18, 2013, and limited to studies published after 1990 in accordance with our protocol (PROSPERO reference: CRD42013004333). In addition to electronic searches, author contacts and references of included studies were conducted in August 2013. The full search strategy was used on all 10 databases (listed in Appendix E1 in this article's Online Repository at www.jacionline.org) to identify eligible articles. The screening process was managed in Endnote
Synthesis
We provide an overarching narrative synthesis of included studies and a meta-analysis of studies of similar design and those reporting ORs and CIs. We included 7 studies in a meta-analysis of Salo et al,30 Araki et al,31 Dales et al,32 Jones et al,33 Li and Hsu,34 Rosenbaum et al,35 and Dharmage et al36 because these met our inclusion criteria for conducting a meta-analysis; the other 10 studies were too heterogeneous to be included. We had planned to prioritize studies rated more highly on the
Discussion
Our findings suggest that exposure to Aspergillus, Penicillium, Cladosporium, Ulocladium, Acremonium, Aureobasidium, Epicoccum, Scopulariopsis, Trichoderma, Alternaria, and Wallemia species might represent a respiratory health risk to asthmatic patients living in homes with increased fungal concentrations. These analyses do not provide sufficient detail to assess whether these fungi exacerbated asthma symptoms or potential health outcomes resulting from increased exposure to known allergenic
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R.A.S.’s PhD scholarship was funded by the European Social Fund Convergence Programme for Cornwall and the Isles of Scilly and was undertaken in collaboration with Coastline Housing (ESF Phase 1: 09099NCO5 and ESF Phase 2: 11200NCO5). The European Centre for Environment and Human Health (part of the University of Exeter Medical School) is partially financed by the European Regional Development Fund Programme 2007 to 2013 (ERDF Phase 1: 202497 and ERDF Phase 2: 500020) and European Social Fund Convergence Programme for Cornwall and the Isles of Scilly.
Disclosure of potential conflict of interest: N. J. Osborne has received research support from the European Union, the European Union Social Fund, and the European Union Regional Development Fund; has received consultancy fees from the Centers for Disease Control and Prevention, Office of Science of the National Center for Environmental Health/Agency for Toxic Substances and Disease Registry; and has received payment for manuscript preparation from Living with Environmental Change, United Kingdom. The rest of the authors declare that they have no relevant conflicts of interest.