Indoor visible mold associated with rhinitis in adults
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Exposure to visible mold indoors was significantly associated with increased risk for current rhinitis and allergic rhinitis, with stronger associations among patients who never had asthma, according to a letter published in Allergy.
Led by Laurent Orsi, MPH, PhD, epidemiologist and statistician with the Centre for Epidemiology and Population Health in Villejuif, France, the researchers examined data from the Genetics and Environment of Asthma (EGEA2) study.
The population included 966 adults (mean age, 42 years; standard deviation, 16.4; 52.7% women; 24.2% current smokers), including 410 who ever had asthma and 556 who never had asthma.
Researchers classified 61.6% of these participants as having current rhinitis, due to having had sneezing, runny nose or stuffy nose without any cold or flu in the previous 12 months, with 41.4% of those patients classified with allergic rhinitis following at least one positive skin prick test.
Also, 26.5% of participants reported ever exposure to mold based on observing mold on any surface inside their house, except for food, with 17.5% reporting current exposure based on seeing mold in the previous 12 months.
Results showed that ever exposures (adjusted OR = 1.51; 95% CI, 1.1-2.08) and current exposures (aOR = 1.75; 95% CI, 1.18-2.6) to mold had significant associations with current rhinitis.
Associations with allergic rhinitis were statistically significant for ever exposures (aOR = 1.8; 95% CI, 1.25-2.6) and current exposures (aOR = 2.01; 95% CI, 1.3-3.1) as well.
Researchers noted these associations were stronger among those who never had asthma.
When researchers used alternative definitions for allergic and nonallergic rhinitis in sensitivity analyses, along with further adjustments for the center where participants were assessed, findings remained consistent for all participants regardless of asthma status.
Although the researchers said that anamnesis and tests performed by specialists would provide more accurate diagnoses than the questions used in the EGEA2 survey, their findings indicate significant associations between mold exposures and rhinitis.
The researchers also suggested that the stronger associations among participants who did not have asthma could be due to patients with asthma avoiding mold exposure or to the possibility that rhinitis and rhinitis asthma multimorbidity may be distinct diseases with different risk factors.
Finally, the researchers said their findings indicate the need for preventive measures against mold growth indoors.
Perspective
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Indoor mold has been associated with worsening asthma and rhinitis control, leading to recurrent exacerbations, increases in health care utilization (emergency and hospital visits) and increases in over-the-counter medications, as well as work and school absenteeism.
This research letter describes findings from the case-control and familial study on the EGEA2 group, which investigated the association between mold exposure and rhinitis in adults with and without asthma.
The authors observed a positive association between ever and current mold exposures among patients with current rhinitis and allergic rhinitis. The association was stronger in never-asthmatics compared with ever-asthmatics. This finding is slightly surprising as patients with asthma often correlate worsening of their symptoms of asthma with mold exposure.
The authors acknowledge that differences in disease definition and time-course, limited patients in some strata and a qualitative definition of mold exposure may pose limitations for the study.
However, the authors also report that they used alternative definitions of rhinitis in their analysis and still found the association to hold true. They explained that the lack of an association between mold exposure and asthma symptoms may be related to efforts by asthmatic patients to avoid exposure in the first place to reduce asthma exacerbations.
This study provides evidence that ever and current exposure to indoor molds is related to an increased risk for current rhinitis and of allergic rhinitis among adults.
I do not think these findings will necessarily change practice in terms of the advice we provide to patients with rhinitis and asthma to avoid mold exposure. But this study adds an interesting finding that rhinitis symptoms are worse with mold exposure in nonasthma patients rather than asthmatic patients.
Performing visual inspections of areas in the home and at work where dampness is an issue is key to identifying mold growth early. Mold and damp odors indoors are an ominous sign and should precipitate remedial actions to reduce dampness, inspect for mold and remove it.
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