Domestic fungal exposure and asthma morbidity in New York City children following Superstorm Sandy.

BACKGROUND: Following Superstorm Sandy (SS), domestic fungal growth and the associated respiratory health impacts concerned New York City (NYC) residents, especially those with asthma. OBJECTIVES: Test hypotheses that compared to non-damaged homes, SS-damaged homes would have different fungal profiles and children living in SS-damaged homes would have higher asthma morbidity. METHODS: We recruited 59 families with asthmatic children from SS-damaged NYC homes 6-18 months following the storm to compare with 68 asthmatic children from non-damaged homes in a concurrent study. Home visits included questionnaires, physical health assessments, and settled floor dust collection. We measured fungi in dust using quantitative polymerase chain reaction (qPCR) and next-generation DNA sequencing (NGS). RESULT: Compared with non-damaged homes, SS-damaged homes had lower fungal diversity (Shannon index) and higher total and allergenic fungal concentrations. NGS and qPCR revealed different genera compositions (e.g., elevated Epicoccum and Cladosporium in damaged homes). Repeat measures in damaged homes revealed that the persistence of these changes was variable (e.g. fungal diversity increased; sustained increase in Epicoccum over the following year). There were no statistically significant differences in asthma symptom frequency, atopy to fungi, lung function, or exhaled nitric oxide among children living in SS-damaged vs. non-damaged homes. Findings were consistent when among SS-damaged homes either with mold odors or visible mold. SIGNIFICANCE: qPCR and NGS revealed that SS-damaged homes experienced persistently higher total and allergenic fungal concentrations and lower diversity, compared to non-damaged homes. Such fungal profiles have previously been associated with asthma development and exacerbation. While we identified health-relevant differences in fungal profiles, we did not observe differences in health outcomes between SS-damaged and non-damages homes. We elaborate on potential reasons for the null health findings including: the study population's relatively mild asthma, recruitment timing, statistical power, and ceiling effects. IMPACT: Despite the wide population impacted by Superstorm Sandy, and the popularization of terms like "Sandy cough," there have been no studies, to our knowledge, characterizing changes in the fungal profile in Sandy-damaged homes and their asthma-related health impacts. Comparing Sandy-damaged homes to non-damaged homes, quantitative polymerase chain reaction and next-generation DNA sequencing methods revealed higher total and allergenic fungal concentrations and lower diversity in damaged homes- profiles that have previously been associated with asthma development and morbidity. However, these fungal differences were not consistently associated with asthma outcomes.