Asthma exacerbations in Aspergillus fumigatus-sensitized adults with asthma differs by race

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: We sought to 1) identify factors associated with allergic sensitization to molds and 2) 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 in a large health system between 1/1/2017-6/30/2023 and received aeroallergen testing to Aspergillus fumigatus, Penicillium, Alternaria, and Cladosporium. We used logistic regression models to evaluate factors associated with 1) mold sensitization and 2) the effect of mold sensitization on asthma exacerbations in the 12 months before testing, overall and then stratified by race.

RESULTS: 2,732 patients met inclusion criteria. Sensitization to each mold was negatively associated with being a woman (odds ratios (ORs)≤0.59, p≤0.001 in five models) and positively associated with Black race (ORs≥2.16 versus White, p<0.0005 in five models). In the full cohort, sensitization to molds were not associated with asthma exacerbations (ORs 0.95-1.40, p≥0.003 in five models and all above the corrected p-value threshold). Among 1,032 Black patients, sensitization to Aspergillus fumigatus, but not to other molds, was associated with increased odds of asthma exacerbations (OR 2.04, p<0.0005).

CONCLUSION: Being a man and Black race were associated with allergic sensitization to molds. Sensitization to Aspergillus fumigatus was associated with asthma exacerbations among Black patients but not the overall cohort, suggesting that Aspergillus fumigatus allergy is a source of disparities in asthma outcomes according to race.

National Heart, Lung, And Blood Institute
National Institute of Environmental Health Sciences
Pennsylvania Allergy Education Research Fund
Patient-Centered Outcomes Research Institute

Patrick K Gleeson, Knashawn H Morales, Meeta Prasad Kerlin, Olajumoke O Fadugba, Andrea J Apter, Jason D Christie, Blanca E Himes