Original Article
Exposure to an Aeroallergen as a Possible Precipitating Factor in Respiratory Arrest in Young Patients with Asthma
N Engl J Med 1991; 324:359-363February 7, 1991
- Abstract
Background.
Exposure to airborne spores of the common mold Alternaria alternata has been implicated in asthma attacks. Such exposure is particularly frequent in the Midwest during the summer and fall months. To determine the role of A. alternata in triggering severe asthma attacks, we investigated the cases of 11 patients with asthma who had sudden respiratory arrest and determined the frequency of sensitivity to this allergen in these patients.
Methods.
The 11 patients (age range, 11 to 25 years) with initial episodes of respiratory arrest, which was fatal in 2 patients, were identified in the course of their care in our pediatric and adult clinical allergy practice and by a retrospective review of all Mayo Clinic records of patients with severe asthma cared for between 1980 and 1989. Skin-test reactivity to A. alternata and levels of IgE antibody against this mold in the 11 patients were compared with those in 99 matched controls with asthma who had no history of respiratory arrest.
Results.
All the patients came from the upper Midwest, and the episodes of respiratory arrest occurred in the summer or early fall. Ten of the 11 patients with asthma who had respiratory arrest (91 percent) had positive skin-puncture tests for sensitivity to alternaria, as compared with 31 percent of the controls (P<0.001), and the serum levels of IgE antibodies to alternaria were elevated in all 9 patients tested. Among the covariates we examined (age, sex, adn distance from the Mayo Clinic), only age was a significant confounder. After adjustment for age, alternaria skin-test reactivity was found to be associated with an increase of approximately fold in the risk of respiratory arrest (adjusted odds ratio, 189.5; 95 percent confidence interval, 6.5 to 5535.8).
Conclusions.
Exposure to the aeroallergen A. alternata is a risk factor for respiratory arrest in children and young adults with asthma.
Media in This Article
Figure 1
The Alternaria Season in Southeastern Minnesota in 1985, Indicated by Spore Counts (Solid Circles) and Concentrations of the Major Alternaria Allergen Alt a I (Open Circles).Figure 2
Timing of Episodes of Respiratory Arrest in Young Patients with Asthma. Each numbered circle corresponds to one episode; each number corresponds to the patient number in Table 1.Article Activity
- Article
AT one time, asthma was considered to be a mild disease, a "slight ailment that promotes longevity" in Osler's words.1 Although deaths from asthma are uncommon, the rates of mortality from asthma appear to be increasing in England,2-4 New Zealand,5,6 the United States,7-10 Australia,9,11 and Denmark.9 Of particular interest have been reports describing rapid decompensation leading to respiratory arrest, sudden death, or both in young patients with otherwise stable asthma.9,12-16 Risk factors for sudden respiratory arrest or death have included lability of the lower airways, lack of appreciation of the severity of airflow obstruction on the part of primary care physicians, and psychological factors, including emotional instability, depressive symptoms, and family dysfunction.8,13,14,16-19
In this paper we describe 11 patients evaluated at out institution in whom 18 episodes of sudden respiratory arrest occurred from 1980 to 1989; 2 of these episodes were fatal. We evaluated the occurrence of these episodes in relation to the peak outdoor moldsporulation season in the Midwest and determined the prevalence of IgE antibodies specific to Alternaria alternata, a common fungal aeroallergen, in the 11 patients.
Methods
Study Patients
Nine patients (age, 10 to 25 years) were identified in the course of their care in our pediatric and adult clinical allergy practice. A retrospective review of all Mayo Clinic records of young patients (age, 25 or less) who were treated between 1980 and 1989 and who had respiratory arrest, had severe asthma, or were hospitalized because of asthma identified an additional two patients. Thus, our study population consisted of 11 patients with asthma (9 female and 2 male) who had a total of 18 episodes of respiratory arrest. Between 1980 and 1989, approximately 625 patients with asthma between the ages of 10 and 25 were evaluated each year in our allergy practice.
Control Patients
The records of all 699 patients between the ages of 10 and 25 who underwent allergy testing at the Mayo Clinic during 1985 were reviewed retrospectively. Because the aim of this study was to assess the risk of exposure to alternaria in patients with asthma, we restricted the control group to the 99 patients who had asthma. All 99 control patients were followed to October 1, 1990, for possible intervening episodes of respiratory arrest or death. No episodes of respiratory arrest or deaths were noted.
Skin Tests
All skin tests were performed by the puncture technique with use of commercial extracts. The antigens included alternaria (concentration, 245,920 radioallergosorbent-test [RAST] inhibition units per milliliter); cladosporium and aspergillus; house-dust mites; short-ragweed, timothy-grass, June-grass, oak, birch, and elm pollens; and cat- and dog-dander extracts. As positive and negative controls, we tested histamine phosphate (5 mg per milliliter) and diluent. The formation of a wheal more than 3 mm in diameter was considered to indicate a positive response.
IgE Antibodies
When serum was available, IgE antibodies to alternaria were measured by radioimmunoassay with use of commercial solid-phase allergens (Pharmacia Diagnostics). Serum IgE antibodies to Alt a I, a major alternaria allergen, were measured with Alt a I linked to microcrystalline cellulose particles.20 IgE antibody levels were expressed in terms of the amount of radioactivity bound by the patient's serum divided by the amount bound by negative control serum, multiplied by 100. Binding above 300 percent of the negative control value was considered positive.
Alternaria Aeroallergens
The alternaria season in southeastern Minnesota for 1985 through 1987 was determined by performing alternaria spore counts with a rotoslide apparatus21 and by immunochemical quantitation of alternaria aeroallergens.22 (Alternaria spore counts were also provided for Madison, Wisconsin, for 1985, 1986, and 1987 by Robert K. Bush, M.D.) In the latter procedure, outdoor air samplers were operated continuously from May to December. At a rate of 0.75 to 1.19 liters per second, air was passed through fiberglass or polytetrafluoroethylene filters that retained all particles more than 0.3 μm in mean aerodynamic diameter. The fiberglass filter sheets were processed by descending elution; the polytetrafluoroethylene sheets were eluted directly into buffer.22 Filter eluates were tested by RAST inhibition with crude alternaria extract adsorbed to plastic microtiter plates and an IgE antibody—containing serum pool derived from seven untreated alternaria-sensitive patients.23 Multiple dilutions of crude alternaria extract (Greer Laboratories) were assayed for the standard curve, and the alternaria-allergen contents of filter sheets were calculated by interpolation from this standard curve.
Statistical Analysis
Univariate associations between variables were assessed with the chi-square and Fisher's exact tests. Multivariate relations were studied with logistic regression; the dependent variable was an indicator of case versus control status (1,0). The independent variables considered were age, sex, presence of antibodies to IgE alternaria, and distance from the Mayo Clinic (computed from the geographic coordinates of the patients' ZIP Codes). Distance from our institution was included because it might reflect a referral selection bias, particularly for the study patients. Only two-tailed P values are reported; a value less than or equal to 0.05 was considered to reflect statistical significance.
Results
Study Patients
All 11 patients had unexpected, rapid decompensation of asthma with respiratory arrest (defined as a failure in respiration that required resuscitation) within minutes after the onset of worsening symptoms (Table 1Table 1
Characteristics of Patients with Asthma and Respiratory Arrest.). Two of the 11 patients died. In the nine nonfatal cases, six patients required intubation, two were resuscitated by ventilation with bag and mask, and one required intubation once and was resuscitated once by ventilation with bag and mask. Seven patients survived a second episode. All episodes of respiratory arrest occurred between 5 p.m. and 1 a.m., and three episodes occurred while the patients were in bed.None of the 11 patients had an underlying seizure disorder. However, four episodes of respiratory decompensation were accompanied by a general tonic— clonic seizure. Retrospective review of patients' charts may fail to identify psychiatric disorders or family dysfunction because of incomplete data, but at least four of our patients had had psychiatric symptoms or family difficulties. There was considerable diversity in the medication regimens of the patients at the time of the respiratory arrest. Three did not have any regular daily regimen but were receiving theophylline or albuterol orally as needed, in combination with inhaled albuterol during exacerbations of asthma (Patients 4, 5, and 10). Nine patients had received short-term treatment with high-dose prednisone at some time in the past. Seven patients were receiving inhaled corticosteroids daily at the time of respiratory arrest, and only one patient (Patient 11) was receiving prednisone orally (10 mg per day). Both patients who died after a first episode of respiratory arrest had completed an oral course of prednisone (60 mg per day for five days) within one month of their deaths (Patient 2, one week before; Patient 3, three weeks before).
Pulmonary-function data were available for six patients but were not temporally relevant to the episodes of respiratory arrest.
Ten of the 11 patients had positive reactions to alternaria on skin-puncture testing, and in 3 of these 10 (Patients 5, 6, and 8) this was the only positive skin test (Table 2Table 2
Summary of Allergy-Test Data on 11 Study Patients.). Moreover, the levels of serum IgE antibodies to Alt a I were elevated in all nine patients tested. Patients 2, 3, 4, 7, and 10 had positive skin-test responses to allergens that would be extremely unlikely to have been present at the time of the respiratory arrest. Only in the cases of Patients 1, 9, and 11 could the patients have been exposed to an identified allergen other than alternaria at the time of the respiratory arrest. As far as can be determined from their histories, the patients had no preexisting sensitivities to aspirin, nonsteroidal antiinflammatory agents, or metabisulfites.Controls
To ascertain the frequency with which alternaria sensitivity occurs in persons between the ages of 10 and 25 years, the records of all patients in this age group who underwent allergy testing at the Mayo Clinic during 1985 were reviewed retrospectively. Of the 99 control patients with asthma, 31 percent had positive skin-test responses to alternaria. Fifty-four of these controls were female, and were male; 90 were from the upper Midwest (51 from Minnesota, 13 from Iowa, from Wisconsin, 10 from Illinois, and 6 from Indiana). The difference in the prevalence of alternaria skin-test reactivity between the controls (31 percent) and the respiratory-arrest group (91 percent) was statistically significant P<0.001 by two-tailed Fisher's exact test). Among the covariates that we examined (age, sex, and distance from the Mayo Clinic), only age was identified as a potential confounder of the association between alternaria skin-test reactivity and respiratory arrest.After adjustment for age, alternaria skin-test reactivity was associated with an increase of approximately 200-fold in the risk of respiratory arrest (adjusted odds ratio, 189.5; 95 percent confidence interval, 6.5 to 5535.8).
Atmospheric Tests
In 1985, the highest atmospheric concentrations of Alt a I were observed in the months of June, July, August, and September (Fig. 1Figure 1
The Alternaria Season in Southeastern Minnesota in 1985, Indicated by Spore Counts (Solid Circles) and Concentrations of the Major Alternaria Allergen Alt a I (Open Circles).). Atmospheric concentrations of Alt a I were lower but still elevated in October and early November. Alternaria spore counts were increased from late May through the first week in November. Similar results were obtained in 1986 and 1987 (data not shown). Spore counts from Madison, Wisconsin, for the same years were similar in magnitude and duration (data not shown), confirming the alternaria season for the upper Midwest. All episodes of respiratory arrest occurred during the alternaria aeroallergen season (Fig. 2Figure 2Timing of Episodes of Respiratory Arrest in Young Patients with Asthma. Each numbered circle corresponds to one episode; each number corresponds to the patient number in Table 1.).Discussion
Three groups of patients with asthma have been described who may be at risk of dying of their disease19: those with unexpected episodes of severe, overwhelming asthma; those with chronic, progressive worsening of asthma symptoms requiring long-term steroid use; and those who fit neither of these categories but have extremely poor control of their asthma in the month before death. All of the 11 patients in this series belonged to the first group; they had unexpected, severe, life-threatening asthma that resulted in respiratory arrest.
Other investigators have identified risk factors for fatal asthma attacks. These include increased bronchial hyperresponsiveness,23 wide, rapid fluctuations in pulmonary function from normal to abnormal,24 too-rapid tapering of oral glucocorticosteroid therapy,15,19 incorrect use of inhaled steroid medications,15,19 underestimation of the severity of the disease by primary care physicians,19,25 psychological factors,14,19,25 and age.15,25 Recurrent nocturnal asthma, a history of noncompliance with the medication regimen, more than three visits to the emergency room in the preceding year, previous life-threatening asthma attacks, and hospitalization within the past year may also be risk factors.15,25,26
Our patients had some of these risk factors for sudden respiratory arrest or death from asthma: sudden, rapid decompensation of pulmonary function, suggesting highly labile lower-respiratory airways; coexisting psychosocial disturbances; and membership in an age group that appears to be at increased risk. Seven of our patients, furthermore, had repeated episodes of respiratory arrest.
To this list of risk factors, we add increased exposure to aeroallergens, especially to the outdoor mold alternaria. This is one of the most common atmospheric mold spores throughout the United States and reaches its greatest abundance in grain-growing areas such as the Midwest. Alternaria has often been discussed as an important causal agent for asthma in humans.27,28
Alternaria allergens (Alt a I) have been isolated and characterized.20,29 Atmospheric levels of Alt a I correlate with airborne spore counts of alternaria,22 and the presence of IgE specific to Alt a I may be demonstrated by both skin and radioallergosorbent testing.20 Bronchial provocation with purified Alt a I induces an asthmatic response in sensitive patients.28,30
Natural inhalation of intact ambient alternaria mold spores may produce both immediate and delayed (late) asthmatic responses.31 Furthermore, alternaria has been shown to produce a late asthmatic response in 90 percent of patients undergoing bronchial provocation with that allergen, as compared with approximately 50 percent of patients undergoing bronchial provocation with pollen.32 In some patients, sequential inhalation challenges with alternaria may induce a new late asthmatic response that resolves after cessation of the challenges.32 The late asthmatic response produced by inhalation challenge with alternaria was attenuated or lost in the majority of patients who received immunotherapy with that antigen in one study.33 We have constructed a strong circumstantial case for alternaria sensitivity as a risk factor for sudden, severe episodes of asthma. Ten of our 11 patients had evidence of IgE specific to alternaria on allergen skin testing and on RAST, when performed. All had respiratory arrest during the alternaria season, which was determined on the basis of immunochemical quantification of airborne Alt a I level and spore counts.
Weiss has reported a seasonal pattern of asthma deaths34 and noted that, in patients between 5 and 35 years of age in the United States, mortality peaked in June through August from 1982 to 1986. Reviews of death certificates nationwide may not reflect regional seasonal trends, however.35 Several studies have shown a marked correlation between the number of emergency room visits and local climatologic conditions, including both pollen and mold-spore counts.36-39
We postulate that in our patients there was a gradual increase in both specific and nonspecific bronchial hyperresponsiveness as a result of the inhalation of alternaria allergen over an extended period. Models for this phenomenon exist for prolonged exposure to other allergens,40,41 and experimental data suggest that the same phenomenon may occur with alternaria.32 If bronchial challenge with histamine or methacholine is used, the severity of asthma can be categorized on the basis of bronchial hyperresponsiveness.23,42,43 Furthermore, when bronchial hyperresponsiveness is severe, the risk of death is greatly increased.23 These data suggest that the common factor among patients who die of sudden, unexpected asthma is extreme lability of the airways, resulting from marked bronchial hyperresponsiveness.
Given the propensity of inhaled alternaria to provoke a late asthmatic response and cause markedly increased bronchial hyperresponsiveness, further specific stimulation by alternaria, with or without concomitant nonspecific stimulation (e.g., exercise or viral infection), may result in sudden, severe asthma and respiratory arrest. Therefore, seasonal or perennial exposure to allergens should be added to the list of risk factors for sudden, severe respiratory arrest in patients with asthma.
Supported in part by the Mayo Foundation.
We are indebted to Mark C. Swanson for technical data and to Marlice A. Boland for assistance in the preparation of the manuscript.
Source Information
From the Division of Allergic Diseases and Internal Medicine (M.T.O., J.W.Y.), the Department of Health Sciences Research (K.P.O., D.J.B.), and the Section of General Pediatrics and Pediatric Allergy and Immunology (J.W.Y., M.J.S., E.J.O., M.I.S.), Mayo Clinic and Mayo Foundation, Rochester, Minn. Address reprint requests to Dr. Sachs at the Mayo Clinic, 200 First St., S.W., Rochester, MN 55905.
- References
References
1
Siegel
CrossRef | Web of Science | Medline2
Burney
CrossRef | Web of Science | Medline3
Burney
CrossRef | Web of Science | Medline4
British Thoracic Association
CrossRef | Web of Science5
Sears
CrossRef | Web of Science | Medline6
Jackson
CrossRef | Web of Science | Medline7
Evans
CrossRef | Web of Science | Medline8
Benatar
Full Text | Web of Science | Medline9
Sly
Medline10
Sly
Medline11
Commonwealth Bureau of Census and Statistics . Causes of death: Australia 1968-1979. Canberra, Australia: CBCS annual reports.
12
Markham
Web of Science13
Rubinstein
Medline14
Strunk
CrossRef | Web of Science | Medline15
Kravis
Web of Science | Medline16
Sears
Medline17
Hogg
CrossRef | Web of Science | Medline18
Drazen
CrossRef | Web of Science | Medline19
Strunk
CrossRef | Web of Science | Medline20
Yunginger
CrossRef | Web of Science | Medline21
Ogden
CrossRef | Medline22
Agarwal
CrossRef | Web of Science | Medline23
Woolcock
Web of Science | Medline24
Rea
CrossRef | Web of Science | Medline25
Sears
CrossRef | Web of Science | Medline26
Sears
CrossRef | Web of Science | Medline27
Solomon WR, Mathews KP. Aerobiology and inhalant allergens. In: Middleton E Jr, Reed CE, Ellis EF, Adkinson NF Jr, Yunginger JW, eds.Allergy: principles and practice. 3rd ed. Vol. 1. St. Louis: C.V. Mosby,1988:312-72.
28
Licorish
CrossRef | Web of Science | Medline29
Nyholm
CrossRef | Web of Science | Medline30
Miles
CrossRef | Web of Science | Medline31
Richerson
Medline32
Richerson HB, Metzger WJ, Hunninghake GW. Experimental models of bronchial asthma in man and the rabbit. In: Kay AB, ed. Asthma: clinical pharmacology and therapeutic progress. Oxford, England: Blackwell Scientific, 1986:23-32.
33
Metzger
CrossRef | Web of Science34
Weiss
Web of Science35
Sly
CrossRef | Web of Science | Medline36
Piccolo
Medline37
Salvaggio
CrossRef | Medline38
Pollart
CrossRef | Web of Science | Medline39
Reid
CrossRef | Web of Science | Medline40
Platts-Mills
CrossRef | Web of Science | Medline41
O'Byrne
CrossRef | Web of Science | Medline42
Cockcroft
CrossRef | Medline43
Yan
CrossRef | Web of Science | Medline
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1
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CrossRef2
Sabit Cakmak, Robert E. Dales, Frances Coates. (2011) Does air pollution increase the effect of aeroallergens on hospitalization for asthma?. Journal of Allergy and Clinical Immunology
CrossRef3
G. Reboux, A.-P. Bellanger, S. Roussel, F. Grenouillet, L. Millon. (2011) Moisissures et habitat : risques pour la santé et espèces impliquées. Archives des Maladies Professionnelles et de l'Environnement 72:4, 352-362
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Ritesh Agarwal, Vijay Noel, Ashutosh N. Aggarwal, Dheeraj Gupta, Arunaloke Chakrabarti. (2011) Clinical significance of Aspergillus sensitisation in bronchial asthma. Mycoses 54:5, e531-e538
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J. Just. (2011) L’asthme sévère est souvent allergique chez l’enfant. Revue Française d'Allergologie
CrossRef6
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CrossRef7
Ping An, Emily A. Barron-Casella, Robert C. Strunk, Robert G. Hamilton, James F. Casella, Michael R. DeBaun. (2011) Elevation of IgE in children with sickle cell disease is associated with doctor diagnosis of asthma and increased morbidity. Journal of Allergy and Clinical Immunology 127:6, 1440-1446
CrossRef8
Michael N Pakdaman, Amber Luong. (2011) The links between chronic rhinosinusitis and asthma. Current Opinion in Otolaryngology & Head and Neck Surgery 19:3, 218-223
CrossRef9
C. Fernández, E. Bevilacqua, N. Fernández, P. Gajate, A. G. de la Cámara, M. Garcimartín, R. Vives, J. Rodríguez. (2011) Asthma related to Alternaria sensitization: an analysis of skin-test and serum-specific IgE efficiency based on the bronchial provocation test. Clinical & Experimental Allergy 41:5, 649-656
CrossRef10
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CrossRef11
Todd W. Lyons, Dorothy B. Wakefield, Michelle M. Cloutier. (2011) Mold and Alternaria skin test reactivity and asthma in children in Connecticut. Annals of Allergy, Asthma & Immunology 106:4, 301-307
CrossRef12
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CrossRef13
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CrossRef14
Yoshinori Matsuwaki, Kota Wada, Hiroshi Moriyama, Hirohito Kita. (2011) Human Eosinophil Innate Response to <i>Alternaria </i>Fungus through Protease-Activated Receptor-2. International Archives of Allergy and Immunology 155:s1, 123-128
CrossRef15
Justin M. Hettick, Brett J. Green, Amanda D. Buskirk, James E. Slaven, Michael L. Kashon, Donald H. Beezhold. 2011. Discrimination of Fungi by MALDI-TOF Mass Spectrometry. , 35-50.
CrossRef16
Mohammed H. Abu-Dieyeh, Raghda Barham, Khaled Abu-Elteen, Radhi Al-Rashidi, Inaam Shaheen. (2010) Seasonal variation of fungal spore populations in the atmosphere of Zarqa area, Jordan. Aerobiologia 26:4, 263-276
CrossRef17
Marcella Pozzan, Massimo Milani. (2010) Efficacy of sublingual specific immunotherapy in patients with respiratory allergy to Alternaria alternata : a randomised, assessor-blinded, patient-reported outcome, controlled 3-year trial. Current Medical Research and Opinion 26:12, 2801-2806
CrossRef18
A. P. Knutsen, H. M. Vijay, V. Kumar, B. Kariuki, L. A. Santiago, R. Graff, J. D. Wofford, M. R. Shah. (2010) Mold-sensitivity in children with moderate-severe asthma is associated with HLA-DR and HLA-DQ. Allergy 65:11, 1367-1375
CrossRef19
Andrew Bush, Sejal Saglani. (2010) Management of severe asthma in children. The Lancet 376:9743, 814-825
CrossRef20
Joseph P. Forester, Michael S. Tankersley. (2010) Returning the Athlete to Sports After a Near-Fatal Asthma Event. Annals of Allergy, Asthma & Immunology 105:3, 243-244
CrossRef21
Steven P. Templeton, Amanda D. Buskirk, Brett J. Green, Donald H. Beezhold, Detlef Schmechel. (2010) Murine models of airway fungal exposure and allergic sensitization. Medical Mycology 48:2, 217-228
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CrossRef23
Z. A. Randriamanantany, I. Annesi-Maesano, D. Moreau, C. Raherison, D. Charpin, C. Kopferschmitt, F. Lavaud, A. Taytard, F. De Blay, D. Caillaud. (2010) Alternaria sensitization and allergic rhinitis with or without asthma in the French Six Cities study. Allergy 65:3, 368-375
CrossRef24
Yasser Madani, Andrew Barlow, Furqan Taher. (2010) Severe Asthma with Fungal Sensitization: A Case Report and Review of Literature. Journal of Asthma 47:1, 2-6
CrossRef25
Robin B Gore. (2010) The utility of antifungal agents for asthma. Current Opinion in Pulmonary Medicine 16:1, 36-41
CrossRef26
Mitsuhiko Nambu. (2010) Nihon Shoni Arerugi Gakkaishi. The Japanese Journal of Pediatric Allergy and Clinical Immunology 24:2, 203-216
CrossRef27
Gonzalo Astray, F. Javier Rodríguez-Rajo, J. Angel Ferreiro-Lage, María Fernández-González, Victoria Jato, J. Carlos Mejuto. (2010) The use of artificial neural networks to forecast biological atmospheric allergens or pathogens only as Alternaria spores. Journal of Environmental Monitoring 12:11, 2145
CrossRef28
Shuaib M. Nasser, Thomas B. Pulimood. (2009) Allergens and thunderstorm asthma. Current Allergy and Asthma Reports 9:5, 384-390
CrossRef29
Mitsuhiko Nambu, Hisashi Kouno, Maki Aihara-Tanaka, Hideharu Shirai, Kosuke Takatori. (2009) Detection of Fungi in Indoor Environments and Fungus-Specific IgE Sensitization in Allergic Children. World Allergy Organization Journal 2:9, 208-212
CrossRef30
David L. Goldman, Gary B. Huffnagle. (2009) Potential contribution of fungal infection and colonization to the development of allergy. Medical Mycology 47:5, 445-456
CrossRef31
Annemarie Sykes, Sebastian L. Johnston. (2008) Etiology of asthma exacerbations. Journal of Allergy and Clinical Immunology 122:4, 685-688
CrossRef32
Mitsuhiko Nambu, Hideharu Shirai, Masahiro Sakaguchi, Maki Aihara, Kosuke Takatori. (2008) Effect of House Dust Mite-Free Pillow on Clinical Course of Asthma and IgE Level—A Randomized, Double-Blind, Controlled Study. Pediatric Asthma, Allergy & Immunology 21:3, 137-144
CrossRef33
Christopher B. Lawrence, Thomas K. Mitchell, Kelly D. Craven, Yang-Rae Cho, Robert A. Cramer, Kwang-Hyung Kim. (2008) At Death's Door: Alternaria Pathogenicity Mechanisms. The Plant Pathology Journal 24:2, 101-111
CrossRef34
Junenette L. Peters, Michael L. Muilenberg, Christine A. Rogers, Harriet A. Burge, John D. Spengler. (2008) Alternaria measures in inner-city, low-income housing by immunoassay and culture-based analysis. Annals of Allergy, Asthma & Immunology 100:4, 364-369
CrossRef35
Jay M. Portnoy, Charles S. Barnes, Kevin Kennedy. (2008) Importance of mold allergy in asthma. Current Allergy and Asthma Reports 8:1, 71-78
CrossRef36
Birgit Simon-Nobbe, Ursula Denk, Verena Pöll, Raphaela Rid, Michael Breitenbach. (2008) The Spectrum of Fungal Allergy. International Archives of Allergy and Immunology 145:1, 58-86
CrossRef37
Richard Beasley, Neil Pearce, Julian Crane. 2007. International Trends in Asthma Mortality. , 140-159.
CrossRef38
Guy B. Marks, Robert K. Bush. (2007) It's blowing in the wind: New insights into thunderstorm-related asthma. Journal of Allergy and Clinical Immunology 120:3, 530-532
CrossRef39
Thomas B. Pulimood, Julie M. Corden, Clare Bryden, Linda Sharples, Shuaib M. Nasser. (2007) Epidemic asthma and the role of the fungal mold Alternaria alternata. Journal of Allergy and Clinical Immunology 120:3, 610-617
CrossRef40
Harold S. Nelson. (2007) Allergen immunotherapy: Where is it now?. Journal of Allergy and Clinical Immunology 119:4, 769-777
CrossRef41
James M. Seltzer, Marion J. Fedoruk. (2007) Health Effects of Mold in Children. Pediatric Clinics of North America 54:2, 309-333
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Ahmed Ragab, Peter Clement. (2007) The role of fungi in the airway of chronic rhinosinusitis patients. Current Opinion in Allergy and Clinical Immunology 7:1, 17-24
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G.G. Alvarez, J.M. FitzGerald. (2007) A Systematic Review of the Psychological Risk Factors Associated with Near Fatal Asthma or Fatal Asthma. Respiration 74:2, 228-236
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P. B. Schneider, U. Denk, M. Breitenbach, K. Richter, P. Schmid-Grendelmeier, S. Nobbe, M. Himly, A. Mari, C. Ebner, B. Simon-Nobbe. (2006) Alternaria alternata NADP-dependent mannitol dehydrogenase is an important fungal allergen. Clinical & Experimental Allergy 36:12, 1513-1524
CrossRef45
Kathryn Blake. (2006) Review of Guidelines and the Literature in the Treatment of Acute Bronchospasm in Asthma. Pharmacotherapy 26:9part2, 148S-155S
CrossRef46
Charles Barnes, Jay Portnoy, Michelle Sever, Samuel Arbes, Ben Vaughn, Darryl C. Zeldin. (2006) Comparison of enzyme immunoassay-based assays for environmental Alternaria alternata. Annals of Allergy, Asthma & Immunology 97:3, 350-356
CrossRef47
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Brett James Green, Eija Yli-Panula, Euan Roger Tovey. (2006) Halogen Immunoassay, a New Method for the Detection of Sensitization to Fungal Allergens; Comparisons with Conventional Techniques. Allergology International 55:2, 131-139
CrossRef49
Martin D. Chapman. (2006) Challenges associated with indoor moulds: Health effects, immune response and exposure assessment. Medical Mycology 44:s1, 29-32
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Brett J. Green, Euan R. Tovey, Jason K. Sercombe, Francoise M. Blachere, Donald H. Beezhold, Detlef Schmechel. (2006) Airborne fungal fragments and allergenicity. Medical Mycology 44:s1, 245-255
CrossRef51
A. A. Woodcock, N. Steel, C. B. Moore, S. J. Howard, A. Custovic, D. W. Denning. (2006) Fungal contamination of bedding. Allergy 61:1, 140-142
CrossRef52
Brett James Green, Detlef Schmechel, Jason Kingsley Sercombe, Euan Roger Tovey. (2005) Enumeration and detection of aerosolized Aspergillus fumigatus and Penicillium chrysogenum conidia and hyphae using a novel double immunostaining technique. Journal of Immunological Methods 307:1-2, 127-134
CrossRef53
P.-O. Girodet, A. Casset, A. Magnan, F. de Blay, P. Chanez, J.M. Tunon De Lara. (2005) Immunoglobuline E et maladies respiratoires. Revue des Maladies Respiratoires 22:6, 967-981
CrossRef54
R.C. Vickery. 2005. Bronchial Asthma. .
CrossRef55
R.C. Vickery. 2005. Leukemias. .
CrossRef56
Kevin R. Murphy, William E. Berger. (2005) The variability of asthma. Current Medical Research and Opinion 21:10, 1519-1526
CrossRef57
Hsiao-Man Ho, Carol Y. Rao, Hsiao-Hsien Hsu, Yueh-Hsiu Chiu, Chi-Ming Liu, H. Jasmine Chao. (2005) Characteristics and determinants of ambient fungal spores in Hualien, Taiwan. Atmospheric Environment 39:32, 5839-5850
CrossRef58
M. C. Matheson, M. J. Abramson, S. C. Dharmage, A. B. Forbes, J. M. Raven, F. C. K. Thien, E. H. Walters. (2005) Changes in indoor allergen and fungal levels predict changes in asthma activity among young adults. Clinical <html_ent glyph="@amp;" ascii="&"/> Experimental Allergy 35:7, 907-913
CrossRef59
Abdel Hameed A. Awad. (2005) Vegetation: A source of air fungal bio-contaminant. Aerobiologia 21:1, 53-61
CrossRef60
Sabit Cakmak, Robert E. Dales, Stan Judek, Frances Coates. (2005) Does Socio-demographic Status Influence the Effect of Pollens and Molds on Hospitalization for Asthma? Results from a Time-series Study in 10 Canadian Cities. Annals of Epidemiology 15:3, 214-218
CrossRef61
Sung-Yon Choi, Myung Hyun Sohn, Hye-Yung Yum, Byoung-Chul Kwon, Kyu-Earn Kim. (2005) Correlation between inhalant allergen-specific IgE and pulmonary function in children with asthma. Pediatric Pulmonology 39:2, 150-155
CrossRef62
Elizabeth A. Erwin, Thomas A.E. Platts-Mills. (2005) Allergens. Immunology and Allergy Clinics of North America 25:1, 1-14
CrossRef63
Ignacio Ibarrola, María Suárez-Cervera, M. Carmen Arilla, Alberto Martínez, Javier Monteseirín, José Conde, Juan A. Asturias. (2004) Production profile of the major allergen Alt a 1 in Alternaria alternata cultures. Annals of Allergy, Asthma & Immunology 93:6, 589-593
CrossRef64
T. A. E. Platts-Mills, E. A. Erwin, M. Perzanowski, J. Woodfolk. (2004) The paradoxical relationship between animal dander, exposure, sensitization and asthma: is there a hierarchy of inhalant allergens?. Clinical <html_ent glyph="@amp;" ascii="&"/> Experimental Allergy Reviews 4:s2, 237-241
CrossRef65
B. M. Bergamini, S. Grillenzoni, A. D. Andreoni, P. Natali, A. Ranzi, M. F. Bertolani. (2004) Alternaria spores at different heights from the ground. Allergy 59:7, 746-752
CrossRef66
R. Michael Sly. (2004) Continuing decreases in asthma mortality in the United States. Annals of Allergy, Asthma & Immunology 92:3, 313-318
CrossRef67
Luke Curtis, Allan Lieberman, Martha Stark, William Rea, Marsha Vetter. (2004) Adverse Health Effects of Indoor Molds. Journal of Nutritional and Environmental Medicine 14:3, 261-274
CrossRef68
Michelle J. De Vera, Sol Drapkin, James N. Moy. (2003) Association of recurrent wheezing with sensitivity to cockroach allergen in inner-city children. Annals of Allergy, Asthma & Immunology 91:5, 455-459
CrossRef69
Henk F. Kauffman, Sicco Heide. (2003) Exposure, sensitization, and mechanisms of fungus-induced asthma. Current Allergy and Asthma Reports 3:5, 430-437
CrossRef70
Kari Reijula, Marina Leino, Helena Mussalo-Rauhamaa, Marjo Nikulin, Harri Alenius, Jari Mikkola, Peter Elg, Osmo Kari, Soili Mäkinen-Kiljunen, Tari Haahtela. (2003) IgE-mediated allergy to fungal allergens in Finland with special reference toAlternaria alternata and Cladosporium herbarum. Annals of Allergy, Asthma & Immunology 91:3, 280-287
CrossRef71
Arthur Helbling, Andrea Reimers. (2003) Immunotherapy in fungal allergy. Current Allergy and Asthma Reports 3:5, 447-453
CrossRef72
Graham Roberts, Gideon Lack. (2003) Food allergy and asthma—what is the link?. Paediatric Respiratory Reviews 4:3, 205-212
CrossRef73
Mario Plebani. (2003) Clinical value and measurement of specific IgE. Clinical Biochemistry 36:6, 453-469
CrossRef74
H J Sidebotham, W R Roche. (2003) Asthma deaths; persistent and preventable mortality. Histopathology 43:2, 105-117
CrossRef75
V. Siroux, M.-P. Oryszczyn, E. Paty, F. Kauffmann, C. Pison, D. Vervloet, I. Pin. (2003) Relationships of allergic sensitization, total immunoglobulin E and blood eosinophils to asthma severity in children of the EGEA Study. Clinical <html_ent glyph="@amp;" ascii="&"/> Experimental Allergy 33:6, 746-751
CrossRef76
Charles S. Barnes. (2003) Fungus research can grow on you. Annals of Allergy, Asthma & Immunology 90:5, 464-465
CrossRef77
Juan A. Asturias, M. Carmen Arilla, Ignacio Ibarrola, Elena Eraso, Roberto González-Rioja, Alberto Martínez. (2003) A sensitive two-site enzyme-linked immunosorbent assay for measurement of the major Alternaria alternata allergen Alt a 1. Annals of Allergy, Asthma & Immunology 90:5, 529-535
CrossRef78
A. A. A. Kwaasi. (2003) Date palm and sandstorm-borne allergens. Clinical <html_ent glyph="@amp;" ascii="&"/> Experimental Allergy 33:4, 419-426
CrossRef79
Robert K. Bush. 2003. Fungal Allergy and Allergens. .
CrossRef80
Michelle B. Lierl, Richard W. Hornung. (2003) Relationship of outdoor air quality to pediatric asthma exacerbations. Annals of Allergy, Asthma & Immunology 90:1, 28-33
CrossRef81
Teresa Z Mitakakis, Timothy J O'meara, Euan R Tovey. (2003) The effect of sunlight on allergen release from spores of the fungus Alternaria. Grana 42:1, 43-46
CrossRef82
G. L. Chew, C. Rogers, H. A. Burge, M. L. Muilenberg, D. R. Gold. (2003) Dustborne and airborne fungal propagules represent a different spectrum of fungi with differing relations to home characteristics. Allergy 58:1, 13-20
CrossRef83
Manuel E. Soto-Quiros, Manuel Soto-Martinez, Lars A. Hanson. (2002) Epidemiological studies of the very high prevalence of asthma and related symptoms among school children in Costa Rica from 1989 to 1998. Pediatric Allergy and Immunology 13:5, 342-349
CrossRef84
Jaroslaw P Siwik, Richard M Nowak, Edward M Zoratti. (2002) The evaluation and management of acute, severe asthma. Medical Clinics of North America 86:5, 1049-1071
CrossRef85
C. Karihaloo, E. R. Tovey, T. Z. Mitakakis, D. L. Duffy, W. J. Britton. (2002) Evidence for the genetic control of immunoglobulin E reactivity to the allergens of Alternaria alternata. Clinical <html_ent glyph="@amp;" ascii="&"/> Experimental Allergy 32:9, 1316-1322
CrossRef86
Anne-Maree Kelly, Colin Powell, Debra Kerr. (2002) Patients with a longer duration of symptoms of acute asthma are more likely to require admission to hospital. Emergency Medicine Australasia 14:2, 142-145
CrossRef87
L. D. Vailes, M. S. Perzanowski, L. M. Wheatley, T. A. E. Platts-Mills, M. D. Chapman. (2001) IgE and IgG antibody responses to recombinant Alt a 1 as a marker of sensitization to Alternaria in asthma and atopic dermatitis. Clinical <html_ent glyph="@amp;" ascii="&"/> Experimental Allergy 31:12, 1891-1895
CrossRef88
Estelle Levetin, Peter Water. (2001) Environmental contributions to allergic disease. Current Allergy and Asthma Reports 1:6, 506-514
CrossRef89
Richard W. Weber. (2001) On the Cover. Annals of Allergy, Asthma & Immunology 87:5, A4
CrossRef90
G. Nolles, M. O. Hoekstra, J. P. Schouten, J. Gerritsen, H. F. Kauffman. (2001) Prevalence of immunoglobulin E for fungi in atopic children. Clinical <html_ent glyph="@amp;" ascii="&"/> Experimental Allergy 31:10, 1564-1570
CrossRef91
Mark S. Schubert. (2001) A superantigen hypothesis for the pathogenesis of chronic hypertrophic rhinosinusitis, allergic fungal sinusitis, and related disorders. Annals of Allergy, Asthma & Immunology 87:3, 181-188
CrossRef92
Laura Dziadzio, Robert K. Bush. (2001) Assessment and control of fungal allergens. Current Allergy and Asthma Reports 1:5, 455-460
CrossRef93
G. Liccardi, A. Custovic, M. Cazzola, M. Russo, M. D'Amato, G. D'Amato. (2001) Avoidance of allergens and air pollutants in respiratory allergy. Allergy 56:8, 705-722
CrossRef94
A. Custovic, A. Woodcock. (2001) On allergens and asthma (again): does exposure to allergens in homes exacerbate asthma?. Clinical <html_ent glyph="@amp;" ascii="&"/> Experimental Allergy 31:5, 670-673
CrossRef95
Huey-Jen Jenny Su, Pei-Chih Wu, Chia-Ying Lin. (2001) Fungal Exposure of Children at Homes and Schools: A Health Perspective. Archives of Environmental Health: An International Journal 56:2, 144-149
CrossRef96
Bart Ostro, Michael Lipsett, Jennifer Mann, Hazel Braxton-Owens, and Mary White. (2001) Air Pollution and Exacerbation of Asthma in African-American Children in Los Angeles. Epidemiology 12:2, 200-208
CrossRef97
Mackay, Ian R., Rosen, Fred S., , Busse, William W., Lemanske, Robert F. Jr., . (2001) Asthma. New England Journal of Medicine 344:5, 350-362
Full Text98
Teresa Z. Mitakakis, Alan Clift, Peter A. McGee. (2001) The effect of local cropping activities and weather on the airborne concentration of allergenic Alternaria spores in rural Australia. Grana 40:4-5, 230-239
CrossRef99
R Michael Sly. (2000) Decreases in asthma mortality in the United States. Annals of Allergy, Asthma & Immunology 85:2, 121-127
CrossRef100
Andrew J. Sandford, Tabassum Chagani, Shoukang Zhu, Tracey D. Weir, Tony R. Bai, John J. Spinelli, J.Mark FitzGerald, Nasser A. Behbehani, Wan C. Tan, Peter D. Paré. (2000) Polymorphisms in the IL4, IL4RA, and FCERIB genes and asthma severity. Journal of Allergy and Clinical Immunology 106:1, 135-140
CrossRef101
Paul J Hannaway. (2000) Demographic characteristics of patients experiencing near-fatal and fatal asthma: results of a regional survey of 400 asthma specialists. Annals of Allergy, Asthma & Immunology 84:6, 587-593
CrossRef102
P. N. Black, A. A. Udy, S. M. Brodie. (2000) Sensitivity to fungal allergens is a risk factor for life-threatening asthma. Allergy 55:5, 501-504
CrossRef103
Malamatenia Arvanitidou, Kalliopi Kanellou, Theodoros Constantinidis, Vassilios Katsouyannopoulos. (2000) Higher prevalence of Alternaria spp. in marine and river waters than in potable samples. Microbiological Research 155:1, 49-51
CrossRef104
Galloway. (2000) Oilseed rape - allergen or irritant?. Clinical <html_ent glyph="@amp;" ascii="&"/> Experimental Allergy 30:3, 308-309
CrossRef105
Karen L. Warman. (2000) Management of Asthma Exacerbations: Home Treatment. Journal of Asthma 37:6, 461-468
CrossRef106
Charles Barnes, Keith Schreiber, Freddy Pacheco, Julie Landuyt, Frank Hu, Jay Portnoy. (2000) Comparison of outdoor allergenic particles and allergen levels. Annals of Allergy, Asthma & Immunology 84:1, 47-54
CrossRef107
F. de Blay, S. Casel, C. Mbazoa-Amougou. (2000) Atopie et environnement domestique. Revue Française d'Allergologie et d'Immunologie Clinique 40:1, 110-118
CrossRef108
W. ELLIOTT HORNER, JANET M. HUGHES, MANUEL LOPEZ, SAMUEL B. LEHRER. (2000) Basidiomycete Skin Test Reactivity Is a Risk Factor for Asthma. Pediatric Asthma, Allergy & Immunology 14:1, 69-74
CrossRef109
Sergio Salmeron, M. Bard, F. X. Blanc, A. Ellrodt. (1999) Severe acute asthma. Clinical Reviews in Allergy & Immunology 17:4, 449-458
CrossRef110
Richard W. Watts. (1999) ASTHMA MANAGEMENT IN RURAL AUSTRALIA. Australian Journal of Rural Health 7:4, 249-252
CrossRef111
Robert K. Bush, Hiram Sanchez, David Geisler. (1999) Molecular cloning of a major Alternaria alternata allergen, rAlt a 2. Journal of Allergy and Clinical Immunology 104:3, 665-671
CrossRef112
Catherine Neukirch, Christine Henry, Bénédicte Leynaert, Renata Liard, Jean Bousquet, Françoise Neukirch. (1999) Is sensitization to Alternaria alternata a risk factor for severe asthma? A population-based study. Journal of Allergy and Clinical Immunology 103:4, 709-711
CrossRef113
Peter Burney. (1999) Air pollution and asthma: the dog that doesn't always bark. The Lancet 353:9156, 859-860
CrossRef114
Gary S. Rachelefsky. (1999) National guidelines needed to manage rhinitis and prevent complications. Annals of Allergy, Asthma & Immunology 82:3, 296-305
CrossRef115
(1999) Environmental allergen avoidance in allergic asthma. Journal of Allergy and Clinical Immunology 103:2, 203-205
CrossRef116
Katz, Verleger, Barr, Rachmiel, Kiviti, Kuttin. (1999) Indoor survey of moulds and prevalence of mould atopy in Israel. Clinical <html_ent glyph="@amp;" ascii="&"/> Experimental Allergy 29:2, 186-192
CrossRef117
Ather Siddiqi, Venkata Bandi. (1999) Case discussions on the pathophysiology and clinical features of near-fatal asthma episodes. Current Opinion in Pulmonary Medicine 5:1, 47
CrossRef118
M. Soto-Quiros, I. Gutierrez, N. Calvo, C. Araya, J. Karlberg, L. A. Hanson, L. Belin. (1998) Allergen sensitization of asthmatic and nonasthmatic schoolchildren in Costa Rica. Allergy 53:12, 1141-1147
CrossRef119
Martinez. (1998) Gene by environment interactions in the development of asthma. Clinical <html_ent glyph="@amp;" ascii="&"/> Experimental Allergy 28:Suppl. 5, 21-25
CrossRef120
Boner, Bodini, Piacentini. (1998) Environmental allergens and childhood asthma. Clinical <html_ent glyph="@amp;" ascii="&"/> Experimental Allergy 28:Suppl. 5, 76-81
CrossRef121
Yssel, Abbal, Pene, Bousquet. (1998) The role of IgE in asthma. Clinical <html_ent glyph="@amp;" ascii="&"/> Experimental Allergy 28:Suppl. 5, 104-109
CrossRef122
Johnston. (1998) Mechanisms of asthma exacerbation. Clinical <html_ent glyph="@amp;" ascii="&"/> Experimental Allergy 28:Suppl. 5, 181-186
CrossRef123
Custovic, Woodcock. (1998) Indoor environmental factors and respiratory illness. Clinical <html_ent glyph="@amp;" ascii="&"/> Experimental Allergy 28:10, 1178-1181
CrossRef124
M. D. Chapman. (1998) Environmental allergen monitoring and control. Allergy 53, 48-53
CrossRef125
Prescott G. Woodruff, Stephen D. Emond, Anita K. Singh, Carlos A. Camargo Jr.. (1998) Sudden-onset Severe Acute Asthma: Clinical Features and Response to Therapy. Academic Emergency Medicine 5:7, 695-701
CrossRef126
A. A. A. Kwaasi, V. R. S. Parhar, F. A. A. Al-Mohanna, H. A. Harfi, K. S. Collison, S. T. Al-Sedairy. (1998) Aeroallergens and viable microbes in sandstorm dust.. Allergy 53:3, 255-265
CrossRef127
David A Sterling, Roger D Lewis. (1998) Pollen and Fungal Spores Indoor and Outdoor of Mobile Homes. Annals of Allergy, Asthma & Immunology 80:3, 279-285
CrossRef128
J. K. Peat, J. Dickerson, J. Li. (1998) Effects of damp and mould in the home on respiratory health: a review of the literature. Allergy 53:2, 120-128
CrossRef129
Dick Menzies, Paul Comtois, Joe Pasztor, Fatima Nunes, James A. Hanley. (1998) Aeroallergens and work-related respiratory symptoms among office workers. Journal of Allergy and Clinical Immunology 101:1, 38-44
CrossRef130
Leonard Bielory, Avi Deener. (1998) Seasonal Variation in the Effects of Major Indoor and Outdoor Environmental Variables on Asthma. Journal of Asthma 35:1, 7-48
CrossRef131
Renato Corsico, Barbara Cinti, Vincenzo Feliziani, Maria Teresa Gallesio, Gennaro Liccardi, Anna Loreti, Giorgio Lugo, Francesco Marcucci, Guido Marcer, Antonio Meriggi, Mauro Minelli, Gemma Gherson, Gilda Nardi, Arsenio Corrado Negrini, Giovanni Piu, Angelo Passaleva, Marcella Pozzan, Francesco Purello D'Ambrosio, Alberto Venuti, Pietro Zanon, Romano Zerboni. (1998) Prevalence of Sensitization to Alternaria in Allergic Patients in Italy. Annals of Allergy, Asthma & Immunology 80:1, 71-76
CrossRef132
J.Mark FitzGerald, Mark O Turner. (1997) Delivering asthma education to special high risk groups. Patient Education and Counseling 32, S77-S86
CrossRef133
N Fakim, A H Subratty, M Manraj, S K Surrun, K Hoolooman. (1997) Asthma Mortality in Mauritius: 1982-1991. Annals of Allergy, Asthma & Immunology 79:5, 423-426
CrossRef134
John N. Klironomos, Matthias C. Rillig, Michael F. Allen, Donald R. Zak, Kurt S. Pregitzer, Mark E. Kubiske. (1997) Increased levels of airborne fungal spores in response to Populus tremuloides grown under elevated atmospheric CO 2. Canadian Journal of Botany 75:10, 1670-1673
CrossRef135
Stephen A. Tilles, Emil J. Bardana. (1997) Seasonal variation in bronchial hyperreactivity (BHR) in allergic patients. Clinical Reviews in Allergy & Immunology 15:2, 169-185
CrossRef136
R Michael Sly, Regina O'Donnell. (1997) Stabilization of Asthma Mortality. Annals of Allergy, Asthma & Immunology 78:4, 347-354
CrossRef137
(1997) COMPONENT 2: CONTROL OF FACTORS CONTRIBUTING TO ASTHMA SEVERITY. Pediatric Asthma, Allergy & Immunology 11:3, 41-55
CrossRef138
(1997) Pharmacologic Therapy: Managing Exacerbations of Asthma. Pediatric Asthma, Allergy & Immunology 11:3, 105-121
CrossRef139
Diana Bass, Geoffrey Morgan. (1997) A three year (1993–1995) calendar of pollen and Alternaria mould in the atmosphere of south western Sydney. Grana 36:5, 293-300
CrossRef140
Antonio Meriggi, Stefano Ricci, Mariella Bruni, Renato Corsico. (1996) Aerobiological monitoring for fungal spores in a rehabilitation hospital in Northern Italy. Aerobiologia 12:1, 233-237
CrossRef141
Antonio Meriggi, Stefano Ricci, Mariella Bruni, Renato Corsico. (1996) Aerobiological monitoring for fungal spores in a rehabilitation hospital in Northern Italy. Aerobiologia 12:4, 233-237
CrossRef142
Nan-Shan ZHONG. (1996) New insights into risk factors of asthma. Respirology 1:3, 159-166
CrossRef143
Robert P. Nelson, Roberto DiNicolo, Enrique Fernández-Caldas, Mitchell J. Seleznick, Richard F. Lockey, Robert A. Good. (1996) Allergen-specific IgE levels and mite allergen exposure in children with acute asthma first seen in an emergency department and in nonasthmatic control subjects. Journal of Allergy and Clinical Immunology 98:2, 258-263
CrossRef144
S. M. TARIQ, S. M. MATTHEWS, M. STEVENS, E. A. HAKIM. (1996) Sensitization to Alternaria and Cladosporium by the age of 4 years. Clinical <html_ent glyph="@amp;" ascii="&"/> Experimental Allergy 26:7, 794-798
CrossRef145
J.M. FitzGerald, M.D, P. Macklem, M.D. (1996) FATAL ASTHMA. Annual Review of Medicine 47:1, 161-168
CrossRef146
Robert G Townley. (1996) Beta-adrenergic receptors and mechanisms in asthma. Allergology International 45:1, 13-22
CrossRef147
Sean LeSon, M. Eric Gershwin. (1996) Risk Factors for Asthmatic Patients Requiring Intubation. III. Observations in Young Adults. Journal of Asthma 33:1, 27-35
CrossRef148
A. J. Woolcock, J. K. Peat, L. M. Trevillion. (1995) Is the increase in asthma prevalence linked to increase in allergen load?. Allergy 50:12, 935-940
CrossRef149
G. D'Amato, F. Th. M. Spieksma. (1995) Aerobiologic and clinical aspects of mould allergy in Europe. Allergy 50:11, 870-877
CrossRef150
Stefano Ricci, Mariella Bruni, Antonio Meriggi, Renato Corsico. (1995) Aerobiological monitoring ofAlternaria fungal spores: a comparison between surveys in 1992 and 1993 and local meteorological conditions. Aerobiologia 11:3, 195-199
CrossRef151
De-Wei Li, Bryce Kendrick. (1995) Indoor aeromycota in relation to residential characteristics and allergic symptoms. Mycopathologia 131:3, 149-157
CrossRef152
Sean Leson, M. Eric Gershwin. (1995) Risk Factors for Asthmatic Patients Requiring Intubation. II. Observations in Teenagers. Journal of Asthma 32:5, 379-389
CrossRef153
Wolfgang Wenzel Schaubschläger, Wolf-Meinhard Becker, Gertraud Mazur, Martin Gödde. (1994) Occupational sensitization to Plasmopara viticola. Journal of Allergy and Clinical Immunology 93:2, 457-463
CrossRef154
Michael Abramson, Lesley Pearson, Jozica Kutin, Daniel Czarny, Linas Dziukas, Glenn Bowes. (1994) Allergies, Upper Respiratory Tract Infections, and Asthma. Journal of Asthma 31:5, 367-374
CrossRef155
Anto, Josep M.Sunyer, JordiReed, Charles E.Sabria, JosefinaMartinez, FrancescMorell, FerranCodina, RosaRodriguez-Roisin, RobertRodrigo, Maria J.Roca, JosepSaez, Marc. (1993) Preventing Asthma Epidemics Due to Soybeans by Dust-Control Measures. New England Journal of Medicine 329:24, 1760-1763
Full Text156
Schenker, Marc, . (1993) Air Pollution and Mortality. New England Journal of Medicine 329:24, 1807-1808
Full Text157
P. K. PATTEMORE, S. T. HOLGATE. (1993) Bronchial hyperresponsiveness and its relationship to asthma in childhood. Clinical <html_ent glyph="@amp;" ascii="&"/> Experimental Allergy 23:11, 886-900
CrossRef158
H.W. Staudinger, J.F. Haas. (1993) Respiratory Medicine 87:8, 636-637
CrossRef159
A. C. Day, A. P. N. Rankin, J. A. Judson. (1993) Grading asthma severity: using the APS component of the Apache II system. Intensive Care Medicine 19:4, 221-226
CrossRef160
R. B. SPORIK, L. K. ARRUDA, J. WOODFOLK, M. D. CHAPMAN, T. A. E. PLATTS-MILLS. (1993) Environmental exposure to Aspergillus fumigatus allergen (Asp f I). Clinical & Experimental Allergy 23:4, 326-331
CrossRef161
R. SPORIK, M. D. CHAPMAN, T A. E. PLATTS-MILLS. (1992) House dust mite exposure as a cause of asthma. Clinical <html_ent glyph="@amp;" ascii="&"/> Experimental Allergy 22:10, 897-906
CrossRef162
Peter J. Gergen, Paul C. Turkeltaub. (1992) The association of individual allergen reactivity with respiratory disease in a national sample: Data from the second National Health and Nutrition Examination Survey, 1976–1980 (NHANES II). Journal of Allergy and Clinical Immunology 90:4, 579-588
CrossRef163
N. A. MOLFINO, A. S. SLUTSKY, N. ZAMEL. (1992) The effects of air pollution on allergic bronchial responsiveness. Clinical <html_ent glyph="@amp;" ascii="&"/> Experimental Allergy 22:7, 667-672
CrossRef164
C. McSharry. (1992) New aeroallergens in agricultural and related practice. Clinical <html_ent glyph="@amp;" ascii="&"/> Experimental Allergy 22:4, 423-426
CrossRef165
Richard A. Nicklas. (1992) Current Issues on Asthma Drugs: Impact on Clinical Trial Methodology. Journal of Asthma 29:2, 69-72
CrossRef166
Thomas A.E. Platts-Mills. (1991) Atopic allergy: asthma and atopic dermatitis. Current Opinion in Immunology 3:6, 874-880
CrossRef167
(1991) Exposure to an Aeroallergen and Respiratory Arrest in Patients with Asthma. New England Journal of Medicine 325:3, 206-208
Full Text168
McFadden, E.R. Jr., . (1991) Fatal and Near-Fatal Asthma. New England Journal of Medicine 324:6, 409-411
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