Gene/Protein Disease Symptom Drug Enzyme Compound
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This review summarizes occurrence and exposure studies for pollutants in house dust and related indoor air exposures. A standard sampling method and control methods to reduce these exposures are discussed, including recommendations for future research. Infants and toddlers receive a broad and significant range of exposures to lead, pesticides, PAHs, allergens, and VOCs in house dust and indoor air. Carpet dust in eight Columbus and nine Seattle homes contained concentrations of potentially carcinogenic PAHs ranging from 3 to 290 micrograms/g, of lead from 250 to 2250 micrograms/g, and of PCBs from 210 to 1900 ng/g. Dust collected from ten used sofas in Seattle averaged 16.3, 37.2, and 229 micrograms/g for dust mite allergen, cat allergen, and lead, respectively; dust samples showed mutagenic activity. Biological and chemical pollutants in indoor dust and air have been associated with lead poisoning, cancer, allergy, asthma, damage to the nervous system, and sick building symptoms. The 11% of toddlers who have pica tend to have the highest exposures and risks. Further, the exposure of toddlers to lead via the dust pathway can be greater than by other routes. Standard method ASTM 5438.94 for sampling house dust has been used to characterize current and chronic exposure of toddlers in epidemiological studies. The accumulation of dust, dust mites, and tracked-in soil in old carpets, sofas, and mattresses appears to be a major source of exposure to lead, pesticides, allergens, PAHs, and VOCs. Remodeling and energy conservation can reduce ventilation and increase relative humidity, dust, dust mites, molds, VOCs, and other indoor air pollutants. The U.S. faces large and increasing costs from asthma and allergy. Asthma incidence in the U.S. has increased from 0.5% in 1930 to 8%-12% in 1991. Asthma hospitalization rates for children are increasing at the rate of 4%/yr in the U.S. and 14%/yr in Seattle. Such hospital visits would be rare with effective diagnosis, patient education, and control of home exposures. Asthma was estimated to cost $6.2 billion in 1990; hospital visits of children in Seattle cost $2,526,000 in 1993. Forty percent of the U.S. population has been sensitized to allergens; one in three homes has high relative humidity, which favors dust mites, molds, allergies, asthma, and other respiratory diseases. Reducing indoor allergens can reduce costs, severity, and the risk of being sensitized and developing allergic disease. Use of volunteer Master Home Environmentalists to do free in-home surveys and education in Seattle may reduce immediate health costs from allergens as well as long-term risks from lead, carcinogens, and home chemicals.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Exposure of children to pollutants in house dust and indoor air. 750 67

Hospitalization rates for asthma in New York City are highest in poor urban neighborhoods, although the reasons for this are unknown. We performed a small area analysis of asthma hospitalization rates in Boston, to determine whether this pattern of asthma hospitalization also obtained in a medium-sized city and to identify characteristics of neighborhoods with high hospitalization rates, including the relative use of inhaled anti-inflammatory medication. Zip codes were used to define 22 small areas within Boston. The number of asthma hospitalizations for residents of each area in 1992 was obtained from the Codman Research Group. Population and demographic characteristics of each area were obtained from the 1990 US Census. Estimates of inhaled asthma medications (beta-agonists, steroids, and cromolyn) dispensed in each area in 1992 were obtained from IMS America. Asthma hospitalization rates for each of the six areas with the highest rates (5.3 to 9.8 per 1,000 persons) were significantly greater than the city-wide average of 4.2 hospitalizations per thousand persons (p < 0.001 for each comparison). Asthma hospitalization rate was positively correlated with poverty rate and with the proportion of nonwhite residents and inversely correlated with income and educational attainment. Asthma hospitalization rate was inversely correlated with the ratio of inhaled anti-inflammatory to beta-agonist medication use (r = -0.55, p = 0.008). We conclude that asthma hospitalization rates in Boston are highest in poor inner city neighborhoods, and that these high rates affect both genders and all age groups. Underuse of inhaled anti-inflammatory medication may be one of the many factors that contributes to this excess hospitalization.
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PMID:Poverty, race, and medication use are correlates of asthma hospitalization rates. A small area analysis in Boston. 760 72

Asthma in children and young adults is strongly associated with immediate hypersensitivity to indoor allergens, notably those derived from the house dust mite. In addition, outdoor air pollution is considered to aggravate existing asthma. We investigated the prevalence of asthma and the pattern of allergen sensitization in a mite-free environment with low levels of outdoor air pollution. A total of 567 children aged between 12 and 14 attending Los Alamos Middle School, NM (altitude 7,200 feet) were screened using a respiratory questionnaire; 120 children (53 control children) underwent allergen skin testing and serum IgE measurement, and their bronchial reactivity to histamine was measured. Dust was collected from 111 homes and the level of indoor mite and cat allergen measured. The prevalence of respiratory symptoms was high (13%), and from the detailed testing it was estimated that 6.3% of the children had asthma (defined as symptomatic bronchial reactivity). Children with asthma had elevated IgE, 367 (179 to 755) versus 38 (23 to 61), and predominant sensitization to cat, 68 versus 20% (p < 0.001). A high number of households (77%) had a pet cat or dog. The concentration of mite allergen was very low (mean 0.18 micrograms Der p milligrams sieved house dust), whereas that of cat allergen was high in homes with a cat (80.8 micrograms Fel d milligrams) but also in homes with no cat (3.2 micrograms Fel d milligrams). The results show that in a mite-free environment with low levels of outdoor air pollution, asthma was still a major cause of morbidity among schoolchildren.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Association of asthma with serum IgE and skin test reactivity to allergens among children living at high altitude. Tickling the dragon's breath. 903 28

Regional analysis of dust mite species distribution is pertinent to clinical practice as atopic patients should be tested and, when indicated, receive appropriate immunotherapy with house dust mite antigens indigenous to their geographic locale. Surveys in selected areas of the United States have found D. farinae and D. pteronyssinus to be the two most prevalent mite species. None of these surveys encompassed the populous Northeastern corridor of the United States. This present study describes the distribution of Dermatophagoides spp. antigens within the homes of asthma sufferers living in suburban Massachusetts. A total of 60 dust samples were collected from carpets in the homes of 46 patients with chronic asthma and documented house dust mite sensitivity. Dust samples were obtained from bedroom carpets in 46 homes and both bedroom and family room carpets in 14 homes. Dermatophagoides spp. bedroom carpet levels ranged from 2.3 ug/g to 138.5 ug/g; (mean level 36.1 ug/g). D. farinae was the dominant species in the majority (78%) of sampled homes. D. pteronyssinus predominated in only three (7%) homes. Nearly 80% of surveyed homes and carpet dust mite antigen levels exceeding 10 ug/g. Mean bedroom carpet levels were more than two-fold higher than family room levels, 47.7 ug/g versus 19.5 ug/g. Distribution patterns of D. farinae and D. pteronyssinus in bedroom and living room carpets was similar in 13 of 14 surveyed homes. Although D. farinae is clearly the dominant allergen in the surveyed homes, this study suggests that both D. farinae and D. pteronyssinus antigens should be used for diagnostic testing and, when indicated, immunotherapy in the northeastern United States.
Allergy Asthma Proc
PMID:Distribution of Dermatophagoides spp., D. farinae and D. pteronyssinus, antigen in homes of patients with asthma in eastern Massachusetts. 919 45

The objective of this study was to examine the relationship between the indoor environment, atopy and asthma in 7-9-year-old children. Cases and controls were randomly selected from children who participated in the International Study of Asthma and Allergies in Childhood (ISAAC) in Wellington, New Zealand. Cases were children with a previous diagnosis of asthma and current medication use (n = 233) and controls were children with no history of wheezing and no diagnosis of asthma (n = 241). Information was recorded about the indoor environment during the first year of life and currently. Dust was sampled from floors and beds and Der p 1 and Fel d 1 measured using enzyme-linked immunosorbent assays. Skin-prick tests were performed with eight common allergens. Sensitization to Dermatophagoides farinae (OR = 3.19; 95% CI 1.74-5.84), Dermatophagoides pteronyssinus (OR = 2.06; 95% CI 1.16-3.65) and cat (OR = 3.89; 95% CI 1.06-14.30) were independently associated with current asthma. The use of a sheepskin in the first year of life (OR = 1.91; 95% CI 1.11-3.33) was also independently associated with current asthma but current Der p 1 levels showed no association with current asthma. Exposures in early life may be more important than current exposures in determining asthma at age 7-9 years. Prospective studies are needed in New Zealand to determine the relative importance of early life exposures to Der p 1 and other risk factors for asthma.
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PMID:Indoor environment, atopy and the risk of the asthma in children in New Zealand. 1056 61

As part of the Partners in School Asthma Management Program, environmental data were collected from 385 rooms in 60 elementary schools in southeast Texas, using an Environmental Observation Checklist and a Q-TRAK Indoor Air Quality Monitor. Dust samples for allergen analysis were collected from floors, carpets, and area rugs in 80 classrooms in a subset of 20 schools. CO2 levels > 1,000 ppm were found in 86% of rooms; 69% had indoor humidity above recommended levels. Der p I dust mite allergen levels > 2,000 ng/g were present in 20% of rooms, but only 2.5% of rooms had Der f I mite allergen levels exceeding recommended tolerances. Detectable levels of cockroach allergen (Bla g II) were found in all schools (median 5.5 ng/g), with 10% of rooms over the recommended threshold. Almost two-thirds of classrooms had mold spore counts > 10,000 col/g (median, 14,400 col/g; range, 2,000-52,000 col/g).
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PMID:Environmental allergens and irritants in schools: a focus on asthma. 1186 97

The Prevention and Incidence of Asthma and Mite Allergy (PIAMA) study is a birth cohort study that investigates the influence of allergen exposure on the development of allergy and asthma in the first several years of life. The objectives of this study were to investigate the relationship between a family history of allergy and/or asthma and exposure of newborn children to mite and pet allergen and to study the influence of different home and occupant characteristics on mite allergen exposure. Dust was sampled from the child's mattress and the parental mattress at 3 months after birth of the index child and analyzed for mite and pet allergens. Subjects were divided in groups according to history of asthma and allergy in their parents, and allergen exposure was studied in the different groups. Cat allergen exposure was significantly lower on parental mattresses in families with allergic mothers, but dog allergen exposure was not different. Mite allergen exposure was lower on parental mattresses in families with allergic mothers. Use of mite allergen-impermeable mattress covers reduced mite allergen exposure. Some other characteristics such as age of home and mattress were also found to influence mite allergen exposure. Parental mattresses in homes of allergic mothers had lower cat and mite (but not dog) allergen loadings than mattresses in homes of nonallergic parents. Paternal (as opposed to maternal) allergy seemed to have little influence.
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PMID:Mite and pet allergen levels in homes of children born to allergic and nonallergic parents: the PIAMA study. 1241 97

The purpose of this study was to evaluate changes of lung function, respiratory symptoms and indoor air quality after reducing allergens and indoor pollutants in the home environment of people with asthma (n = 21). A quasi-experimental pre-/post-test design with one group of participants was implemented. The interventions included removal of wall-to-wall carpets (n = 14) or improvement of indoor air exchange (n = 7). Participants' lung function, symptoms, medication and type-1 allergy were recorded before and after the intervention. The indoor environment was monitored at house calls by an occupational therapist using conventional physical, biological and chemical methods. There was an improvement of lung function evidenced by an increased mean Forced Expiratory Volume (FEV(1) %) and a reduction of airway obstruction (reversibility, % of baseline value), which indicate an improved asthmatic condition. Lung function assessed by vital capacity, bronchial hyper-responsiveness, mean of Peak Expiratory Flow, symptom score and medicine consumption did not change significantly. There was a tendency that the amount of airborne dust (p=0.06) was reduced in the indoor environment. Relative humidity, carbon dioxide, formaldehyde and house dust mite levels had decreased after the intervention, but not significantly. Asthma symptoms related to the home environment are probably caused by several factors. When people with asthma suffer from increased symptoms in the home, house calls should be performed routinely. Dust samples from beds and carpets for analysis of allergens give information about exposure, and environmental assessments should be performed before interventions. Occupational therapists can make a valuable contribution in evaluating the home environment and suggesting ergonomic adaptations for individuals with asthma.
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PMID:Occupational therapy adaptation of the home environment in Sweden for people with asthma. 1244 95

Little information is available about health impacts of the North American Free Trade Agreement (NAFTA) traffic-related pollution on residents near the major traffic corridors along the U.S.-Canadian border. Here we report on a 10 year (1991-2000) retrospective study of commercial traffic volumes across the Peace Bridge and health care use for asthma in a residential community, which serves as a conduit for traffic crossing between Fort Erie, Ontario, Canada, and Buffalo, New York. We hypothesized that commercial traffic pollution was impacting on residents in close proximity to the trade corridor. Commercial traffic volumes, hospital discharges for asthma, and outpatient visits to area hospitals and clinics were analyzed before and after implementation of NAFTA. Results showed a positive association between increased commercial traffic volume and increased health care use for asthma. Zip codes 14201 and 14213, which surround the Peace Bridge Plaza Complex (PBC), had the highest prevalence rates and health care use rates for asthma. Statistical analysis showed the findings to be significant (p < 0.05) in that residential proximity to the PBC was associated with greater hospital discharge rates for asthma. The findings were strongest (p < 0.000) in the zip codes where the PBC was located (14213) and the major highway I-190 passed through (14201). A yearly excess of 230.2 adult asthma hospital discharges was associated with an increase in traffic volume during the period from 1991 to 1996 in the study area. This is in contrast to an overall decrease in the national rate of hospitalizations for asthma by 7.5% in the same period. The results suggest that NAFTA-related commercial traffic has a negative health impact on asthmatics living in close proximity to the trade corridor. Health and social costs due to traffic pollution need to be included in cost estimates of transport decisions related to the NAFTA corridors. Similar health effects due to NAFTA traffic need to be studied at other U.S.-Canada border crossing points.
J Asthma 2004
PMID:Association between traffic volume and health care use for asthma among residents at a U.S.-Canadian border crossing point. 1526 Apr 62

House-dust mites play an important role in allergic sensitization in Turkey and other countries. The purpose of this study was to analyze the acarofauna in seven zones that differ in climate and altitude. Dust mites were isolated in 173 of 930 (18.6%) samples. The highest prevalence of house-dust mites was found in the most humid regions of Turkey: Mediterranean (48.4%) and Black Sea (46%). Lower levels were found in central and eastern Anatolia regions where humidity and temperature are low. Mites of the Dermatophagoides spp. were predominant (D. pteronyssinus [83%] and D. farinae [12%] making up the majority of the counts). The presence of mites was related to an increase both in mean temperature (> 15 degrees C) and in humidity (> or = 40%) as well as low altitude (< 300 m). This study suggests that the mite population of humid coastal regions of Turkey is as prevalent as in other temperate climates.
Allergy Asthma Proc
PMID:A survey of acarofauna in Turkey: comparison of seven different geographic regions. 1531 24


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