Fungal exposure, atopy and asthma exacerbations in Puerto Rican children ONLINE DATA SUPPLEMENT

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1 Fungal exposure, atopy and asthma exacerbations in Puerto Rican children ONLINE DATA SUPPLEMENT Joshua Blatter, MD 1, Erick Forno, MD, MPH 1, John Brehm, MD, MPH 1, Edna Acosta- Pérez, PhD 2, María Alvarez, MD 2, Angel Colón-Semidey, MD 2, Peter S. Thorne, PhD 3, Nervana Metwali, PhD 3, Glorisa Canino, PhD 2, Juan C. Celedón, MD, DrPH 1* 1 Division of Pulmonary Medicine, Allergy and Immunology, Department of Pediatrics, Children s Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, PA 2 Behavioral Sciences Research Institute and Department of Pediatrics, University of Puerto Rico, San Juan, PR 3 University of Iowa College of Public Health, Department of Occupational and Environmental Health, University of Iowa, Iowa City, IA *Corresponding author: Juan C. Celedón, M.D., Dr.P.H. Division of Pulmonary Medicine, Allergy and Immunology Children s Hospital of Pittsburgh of UPMC 4401 Penn Avenue, Pittsburgh, PA Phone: ; Fax: juan.celedon@chp.edu

2 Sources of support: Grants HL079966, HL117191, and P30 ES from the U.S. National Institutes of Health, and an endowment from the Heinz Foundation. Online Supporting Information Table of Contents Table S1 Page 3 Figure S1 Page 4 Table S2 Page 5 Table S3 Page 6 Table S4 Page 7 E2

3 Table S1. Comparison of participants who were and were not included in the analysis of glucan and atopy * Characteristics Included (n = 317) Not Included (n = 364) Age, years 10.4 (2.7) 10.1 (2.6) Female gender 149 (47%) 169 (46%) BMI, z-score.51 (1.11).68 (1.18) Current asthma 160 (50%) 191 (52%) Current exposure to second-hand 144 (45%) 124 (34%) tobacco smoke Household income $15,000/year 78 (25%) 157 (45%) Parental history of asthma 152 (48%) 183 (51%) Bla g in house dust, U/g 2.4 (5.0) 1.5 (4.9) Can f in house dust, mcg/g 0.17 (7.5) 0.21 (9.5) Der p in house dust, mcg/g 5.0 (3.2) 3.9 (3.3) Fel d in house dust, mcg/g.05 (10.0).03 (11) Mus m in house dust, ng/g 8.6 (10.0) 12 (8.7) Skin test reactivity to 1 indoor allergen ǁ 202 (73%) 206 (76%) Skin test reactivity to 1 outdoor 151 (57%) 129 (49%) allergen ǁ At least one positive skin test 213 (77%) 208 (76%) Total number of positive skin tests 4.36 (4.23) 3.83 (3.86) FEV1, L 1.94 (0.70) 1.98 (0.72) FEV1/FVC.82 (.096).82 (.085) 1 ED or urgent care visit in the last year ǁ 82 (51%) 95 (50%) * Values are the number (%) for categorical variables and mean (SD) for continuous variables. Percentages expressed as a proportion of subjects with available data. Comparison between included and not included subjects conducted as t test for continuous and chi-square for categorical variables. Comparison between included and not included subjects: P < Comparison between included and not included subjects: P < Allergen levels and eosinophil count analyzed as log10 and presented as mean (SD). ǁ Sensitization to indoor allergens evaluated as 1 skin test among the following: Alternaria, B. tropicalis, cat, cockroach, dog, dust mix, dust mite mix, mold mix, mouse, and penicillum. Sensitization to outdoor allergens evaluated as 1 skin test among the following: grass mix, mugwort/sage, ragweed, tree mix, weed mix. Covariates regarding exacerbations apply to children with asthma only. E3

4 Figure S1. Correlations between glucan, endotoxin, peptidoglycan, and house dust allergens* * Data analyzed on logarithmic (log10) scale. Pearson correlations with P<0.05 have a regression line and 95% confidence intervals based on predicted values. E4

5 Table S2. Confirmatory analysis of glucan and degree of atopy in children with and without asthma Variable Number of positive skin tests * Unadjusted Coefficient (95% confidence interval), P value reference 0.49 (0.15 to 0.83), (0.17 to 0.84), (-0.09 to 0.63), 0.1 Multivariate model Household income $15,000/year reference 0.38 (0.02 to 0.74), (0.12 to 0.82), (-0.11 to 0.66), (-0.34 to 0.21), 0.6 Case (vs. control) 0.16 (-0.12 to 0.44), 0.3 Mus m in house dust, ng/g (-0.30 to -0.04),.009 * Analyzed as count data in negative binomial regression model with robust error calculation. Negative binomial regression coefficients presented. Model additionally adjusted for age, gender, and parental history of asthma. Allergen level was transformed to a logarithmic (log10) scale. E5

6 Table S3. Analysis of glucan and degree of atopy in children with and without asthma, using type of health insurance as a marker of socioeconomic status (SES) Variable Number of positive skin tests * Multivariate model* β (95% confidence interval), P value reference 1.59 (0.18 to 3.01), (0.86 to 3.70), (-0.30 to 2.51), 0.12 Private insurance 0.49 (-0.72 to 1.70), 0.4 Case (vs. control) 0.91 (-0.26 to 2.09), 0.13 Mus m in house dust, ng/g (-1.20 to -0.20),.007 * Model additionally adjusted for age, gender, and parental history of asthma. Allergen level was transformed to a logarithmic (log10) scale. E6

7 Table S4. Analysis of glucan and visits to the Emergency Department (ED) or urgent care for asthma, using type of health insurance as a marker of SES Variable Multivariate model* At least one ED/urgent care visit for asthma Odds ratio (95% confidence interval), P value (0.18 to 1.54), (0.74 to 6.99), (2.60 to 28.7), <.001 Private insurance 0.20 (0.06 to 0.68),.009 Use of inhaled corticosteroids in the prior 6 months 4.20 (1.63 to 10.8),.003 Peptidoglycan in house dust, mcg/mg 0.66 (0.46 to 0.94),.02 * Model additionally adjusted for age, gender, parental history of asthma, and exposure to ETS. Peptidoglycan level was transformed to a logarithmic (log10) scale. E7

Mouse Allergen, Lung Function, and Atopy in Puerto Rican Children

Mouse Allergen, Lung Function, and Atopy in Puerto Rican Children Erick Forno 1, Michelle M. Cloutier 2, Soma Datta 3, Kathryn Paul 3, Jody Sylvia 3, Deanna Calvert 4, Sherell Thornton-Thompson 4, Dorothy