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Mendell MJ, Macher JM, Kumagai K. Measured moisture in buildings and adverse health effects: A review. INDOOR AIR 2018; 28:488-499. [PMID: 29683210 DOI: 10.1111/ina.12464] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Accepted: 04/13/2018] [Indexed: 06/08/2023]
Abstract
It has not yet been possible to quantify dose-related health risks attributable to indoor dampness or mold (D/M), to support setting specific health-related limits for D/M. An overlooked target for assessing D/M is moisture in building materials, the critical factor allowing microbial growth. A search for studies of quantified building moisture and occupant health effects identified 3 eligible studies. Two studies assessed associations between measured wall moisture content and respiratory health in the UK. Both reported dose-related increases in asthma exacerbation with higher measured moisture, with 1 study reporting an adjusted odds ratio of 7.0 for night-time asthma symptoms with higher bedroom moisture. The third study assessed relationships between infrared camera-determined wall moisture and atopic dermatitis in South Korea, reporting an adjusted odds ratio of 14.5 for water-damaged homes and moderate or severe atopic dermatitis. Measuring building moisture has, despite extremely limited available findings, potential promise for detecting unhealthy D/M in homes and merits more research attention. Further research to validate these findings should include measured "water activity," which directly assesses moisture availability for microbial growth. Ultimately, evidence-based, health-related thresholds for building moisture, across specific materials and measurement devices, could better guide assessment and remediation of D/M in buildings.
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Affiliation(s)
- M J Mendell
- Indoor Air Quality Section, California Department of Public Health, Richmond, CA, USA
| | - J M Macher
- Indoor Air Quality Section, California Department of Public Health, Richmond, CA, USA
| | - K Kumagai
- Indoor Air Quality Section, California Department of Public Health, Richmond, CA, USA
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102
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Vincent M, Corazza F, Chasseur C, Bladt S, Romano M, Huygen K, Denis O, Michel O. Relationship between mold exposure, specific IgE sensitization, and clinical asthma: A case-control study. Ann Allergy Asthma Immunol 2018; 121:333-339. [PMID: 29944956 DOI: 10.1016/j.anai.2018.06.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 06/13/2018] [Accepted: 06/18/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Most of the findings related to the noxious effect of mold sensitization on asthma come from investigations based on Alternaria alternata, Cladosporium herbarum, and Aspergillus fumigatus. However, species such as Penicillium spp, Cladosporium sphaerospermum, Cladosporium cladosporioides, or Aspergillus versicolor display a more pronounced indoor tropism, and their potential harmful respiratory effects cannot be neglected. OBJECTIVE The goal of this work was to relate mold sensitizations with asthma severity and with the level of indoor mold contamination among mold-sensitized patients with asthma and nonsensitized patients with asthma. METHODS A case-control study was conducted and several asthma severity markers were compared between patients with asthma with and without mold sensitization. Indoor contamination of patients' dwellings was also investigated. RESULTS Our findings confirmed the association between sensitization to A fumigatus and severity for patients with asthma in contrast with sensitization to other species. Indoor mold contamination was detected in approximately 90% of dwellings. Overall mold exposure was not associated with asthma severity. However, regardless of the sensitization, exposure to A fumigatus and Penicillium spp in dust was linked to an increased risk of severe asthma. CONCLUSION The harmful nature of mold sensitization and mold exposure for patients with asthma was not confirmed in this study. However, sensitization to A fumigatus was associated with an increased risk for severe asthma. A better investigation of the properties of Penicillium spp is recommended because its exposure was found to be associated with a more pronounced impairment of lung function.
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Affiliation(s)
- Muriel Vincent
- Program Allergology, Scientific Service Immunology, WIV-ISP (site Uccle), Brussels, Belgium.
| | - Francis Corazza
- Laboratory of Immunology and of Translational Research, CHU Brugmann (Université Libre de Bruxelles-ULB), Brussels, Belgium
| | - Camille Chasseur
- Program Health and Environment, Scientific Service Food, drugs and consumers security, WIV-ISP (site Ixelles), Brussels, Belgium
| | | | - Marta Romano
- Program Host-Pathogen Interaction, Scientific Service Immunology, WIV-ISP (site Uccle), Brussels, Belgium
| | - Kris Huygen
- Program Allergology, Scientific Service Immunology, WIV-ISP (site Uccle), Brussels, Belgium; Program Host-Pathogen Interaction, Scientific Service Immunology, WIV-ISP (site Uccle), Brussels, Belgium
| | - Olivier Denis
- Program Allergology, Scientific Service Immunology, WIV-ISP (site Uccle), Brussels, Belgium
| | - Olivier Michel
- Clinic of Immunology and Allergology, CHU Brugmann (Université Libre de Bruxelles-ULB), Brussels, Belgium
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103
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Caillaud D, Leynaert B, Keirsbulck M, Nadif R. Indoor mould exposure, asthma and rhinitis: findings from systematic reviews and recent longitudinal studies. Eur Respir Rev 2018; 27:27/148/170137. [PMID: 29769295 DOI: 10.1183/16000617.0137-2017] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 03/15/2018] [Indexed: 12/22/2022] Open
Abstract
Starting from the Institute of Medicine (IOM) and World Health Organization (WHO) reports, this review provides an overview of the literature published from 2006 to 2017 on the associations between indoor mould exposure and asthma and rhinitis separately in children and adults with a focus on longitudinal epidemiological studies.A systematic search of peer-reviewed literature was performed, including systematic reviews and meta-analyses, longitudinal, incident case-control and panel studies. 61 publications were identified reporting visible mould or mould odour or quantitative assessment of culturable fungi or mould species.In children, visible mould and mould odour were associated with the development and exacerbations of asthma, providing sufficient evidence of a causal relationship. Results from population-based studies in adults were too few and divergent to conclude at more than a limited level of evidence. Exposure to mould in a work building was associated with the incidence and exacerbations of occupational asthma, and we concluded at a sufficient evidence for an association. Systematic reviews, meta-analyses and longitudinal studies on the relationships between mould exposure and allergic rhinitis provide sufficient evidence of an association.This review extended the conclusions of the IOM and WHO reports, and highlighted the need for further longitudinal studies on asthma in adults, and on rhinitis.
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Affiliation(s)
- Denis Caillaud
- Pulmonary and Allergology Dept, CHU Clermont-Ferrand, Clermont Auvergne University, Clermont-Ferrand, France
| | - Benedicte Leynaert
- INSERM, UMR1152, Pathophysiology and Epidemiology of Respiratory Diseases. Epidemiology, Paris, France.,Univ Paris Diderot Paris 7, UMR 1152, Paris, France
| | - Marion Keirsbulck
- ANSES (French Agency for Food, Environmental and Occupational Health and Safety), Maisons-Alfort, France
| | - Rachel Nadif
- INSERM, U1168, VIMA: Ageing and Chronic Diseases, Epidemiological and Public Health Approaches, Villejuif, France.,Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, Montigny le Bretonneux, France
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104
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Cross Section of Legislative Approaches to Reducing Indoor Dampness and Mold. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2018; 23:388-395. [PMID: 27977504 PMCID: PMC5457817 DOI: 10.1097/phh.0000000000000491] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Exposure to indoor dampness and mold is associated with numerous adverse respiratory conditions, including asthma. While no quantitative health-based threshold currently exists for mold, the conditions that support excessive dampness and mold are known and preventable; experts agree that controlling these conditions could lead to substantial savings in health care costs and improvement in public health. This article reviews a sample of state and local policies to limit potentially harmful exposures. Adoption of laws to strengthen building codes, specify dampness and mold in habitability laws, regulate mold contractors, and other legislative approaches are discussed, as are key factors supporting successful implementation. Communicating these lessons learned could accelerate the process for other jurisdictions considering similar approaches. Information about effectiveness of legislation as prevention is lacking; thus, evaluation could yield important information to inform the development of model state or local laws that significantly address mold as a public health concern.
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105
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Tähtinen K, Lappalainen S, Karvala K, Remes J, Salonen H. Association between Four-Level Categorisation of Indoor Exposure and Perceived Indoor Air Quality. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15040679. [PMID: 29617335 PMCID: PMC5923721 DOI: 10.3390/ijerph15040679] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 03/16/2018] [Accepted: 03/31/2018] [Indexed: 11/16/2022]
Abstract
The aim of this study was to develop and test a tool for assessing urgency of indoor air quality (IAQ) measures. The condition of the 27 buildings were investigated and results were categorized. Statistical test studied the differences between the categories and the employees’ complaints about their work environment. To study the employees’ experiences of the work premises, a validated indoor air (IA) questionnaire was used. This study reveals a multifaceted problem: many factors affecting IAQ may also affect perceived IAQ, making it difficult to separate the impurity sources and ventilation system deficiencies affecting to employee experiences. An examination of the relationship between the categories and perceived IAQ revealed an association between the mould odour perceived by employees and mould detected by the researcher. A weak link was also found between the assessed categories and environmental complaints. However, we cannot make far-reaching conclusions regarding the assessed probability of abnormal IA exposure in the building on the basis of employee experiences. According to the results, categorising tool can partly support the assessment of the urgency for repairs when several factors that affect IAQ are taken into account.
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Affiliation(s)
- Katja Tähtinen
- Department of Civil Engineering, Aalto University, 02150 Espoo, Finland.
- Finnish Institute of Occupational Health, Healthy Workspaces, P.O. Box 40, 00032 Työterveyslaitos, Finland.
| | - Sanna Lappalainen
- Finnish Institute of Occupational Health, Healthy Workspaces, P.O. Box 40, 00032 Työterveyslaitos, Finland.
| | - Kirsi Karvala
- Finnish Institute of Occupational Health, Healthy Workspaces, P.O. Box 40, 00032 Työterveyslaitos, Finland.
| | - Jouko Remes
- Finnish Institute of Occupational Health, Healthy Workspaces, P.O. Box 40, 00032 Työterveyslaitos, Finland.
| | - Heidi Salonen
- Department of Civil Engineering, Aalto University, 02150 Espoo, Finland.
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106
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Järvi K, Hyvärinen A, Täubel M, Karvonen AM, Turunen M, Jalkanen K, Patovirta R, Syrjänen T, Pirinen J, Salonen H, Nevalainen A, Pekkanen J. Microbial growth in building material samples and occupants' health in severely moisture-damaged homes. INDOOR AIR 2018; 28:287-297. [PMID: 29151276 DOI: 10.1111/ina.12440] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 11/09/2017] [Indexed: 06/07/2023]
Abstract
There is no commonly approved approach to detect and quantify the health-relevant microbial exposure in moisture-damaged buildings. In 39 single-family homes with severe moisture damage, we studied whether concentrations of viable microbes in building material samples are associated with health among 71 adults and 68 children, and assessed with symptoms questionnaires, exhaled NO, and peak expiratory flow (PEF) variability. Symptoms were grouped into three scores: upper respiratory symptoms, lower respiratory symptoms, and general symptoms. The homes were divided into three groups based on viable counts of fungi, actinomycetes, and total bacteria cultivated from building material samples. Highest group of actinomycete counts was associated with more general symptoms, worse perceived health, and higher daily PEF variability (aOR 12.51; 1.10-141.90 as compared to the lowest group) among adults, and with an increase in lower respiratory symptoms in children, but the confidence intervals were wide. We observed significant associations of fungal counts and total microbial score with worse perceived health in adults. No associations with exhaled NO were observed.
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Affiliation(s)
- K Järvi
- Environmental Health Unit, National Institute for Health and Welfare, Kuopio, Finland
- School of Engineering, Aalto University, Espoo, Finland
| | - A Hyvärinen
- Environmental Health Unit, National Institute for Health and Welfare, Kuopio, Finland
| | - M Täubel
- Environmental Health Unit, National Institute for Health and Welfare, Kuopio, Finland
| | - A M Karvonen
- Environmental Health Unit, National Institute for Health and Welfare, Kuopio, Finland
| | - M Turunen
- Environmental Health Unit, National Institute for Health and Welfare, Kuopio, Finland
| | - K Jalkanen
- Environmental Health Unit, National Institute for Health and Welfare, Kuopio, Finland
| | - R Patovirta
- Department of Respiratory Medicine, Kuopio University Hospital, Kuopio, Finland
| | - T Syrjänen
- The Organisation for Respiratory Health in Finland, Helsinki, Finland
| | - J Pirinen
- The Organisation for Respiratory Health in Finland, Helsinki, Finland
- Ministry of Environment, Helsinki, Finland
| | - H Salonen
- School of Engineering, Aalto University, Espoo, Finland
| | - A Nevalainen
- Environmental Health Unit, National Institute for Health and Welfare, Kuopio, Finland
| | - J Pekkanen
- Environmental Health Unit, National Institute for Health and Welfare, Kuopio, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
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107
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Kader R, Kennedy K, Portnoy JM. Indoor Environmental Interventions and their Effect on Asthma Outcomes. Curr Allergy Asthma Rep 2018; 18:17. [PMID: 29470668 DOI: 10.1007/s11882-018-0774-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE OF REVIEW The use of environmental interventions to improve outcomes in asthmatics has long been an elusive goal. While numerous interventions have been studied, the results of clinical trials have been mixed. This review aims to identify combinations of interventions that have been proven to be effective and to propose a model for using them in a clinical setting. RECENT FINDINGS An NIH workshop emphasized a need for research to identify effective interventions for reducing indoor exposures and improving asthma outcomes. A number of innovative measures were described, though evidence supporting their use was lacking. A recent systematic review described various interventions for which evidence is available. The greatest challenge for this approach is the same as that for the medical approach to treatment: nonadherence. Given evidence for effective interventions, control of environmental exposures should lead to improved asthma outcomes. Methods to improve adherence need to be identified.
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Affiliation(s)
- Rebin Kader
- Division of Allergy, Asthma & Immunology, Children's Mercy Hospitals & Clinics, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Kevin Kennedy
- Division of Toxicology and Environmental Health, Children's Mercy, Kansas City, USA
| | - Jay M Portnoy
- Division of Allergy, Asthma & Immunology, Children's Mercy Hospitals & Clinics, 2401 Gillham Road, Kansas City, MO, 64108, USA.
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108
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Shi Z, Qian H, Zheng X, Lv Z, Li Y, Liu L, Nielsen PV. Seasonal variation of window opening behaviors in two naturally ventilated hospital wards. BUILDING AND ENVIRONMENT 2018; 130:85-93. [PMID: 32287980 PMCID: PMC7115766 DOI: 10.1016/j.buildenv.2017.12.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 11/28/2017] [Accepted: 12/18/2017] [Indexed: 06/11/2023]
Abstract
Natural ventilation enables personal control, and occupant behaviors in window opening play a decisive role on natural ventilation performance, indoor air quality (IAQ), and/or airborne infection risk in a hospital setting. The occupant behaviors differ significantly from different building types with different functions and living habits. Based on a one-year field measurement in two general hospital wards in Nanjing, China, the effects of air quality (i.e. indoor CO2 concentration and outdoor PM2.5 concentration) and the climatic parameters (i.e. indoor/outdoor temperature, relative humidity, and outdoor wind speed, wind direction and rainfall) on window opening/closing behaviors are analyzed. Indoor air temperature or relative humidity is found to be a dominant factor for window opening behaviors. Seasonal differences are observed for the different influences of physical factors. The outdoor temperature is found to be associated with the window opening probability negatively during the cooling season, but positively during the transition and heating seasons. The indoor relative humidity positively affects the window opening probability during the transition season while a negative impact appears during the cooling and heating seasons. Based on the seasonal variation of window opening behaviors, Logistic regression models in different seasons (cooling, transition and heating seasons) are developed to predict the window opening/closing state and are verified to be promisingly adaptable with results of accuracy bigger than 70%.
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Affiliation(s)
- Zhenni Shi
- School of Energy and Environment, Southeast University, Nanjing, 210096, China
| | - Hua Qian
- School of Energy and Environment, Southeast University, Nanjing, 210096, China
| | - Xiaohong Zheng
- School of Energy and Environment, Southeast University, Nanjing, 210096, China
| | - Zhengfei Lv
- Jiangsu Province Hospital, Nanjing, 210096, China
| | - Yuguo Li
- The Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, China
| | - Li Liu
- Department of Civil Engineering, Aalborg University, Aalborg, Denmark
| | - Peter V. Nielsen
- Department of Civil Engineering, Aalborg University, Aalborg, Denmark
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109
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Croston TL, Lemons AR, Beezhold DH, Green BJ. MicroRNA Regulation of Host Immune Responses following Fungal Exposure. Front Immunol 2018; 9:170. [PMID: 29467760 PMCID: PMC5808297 DOI: 10.3389/fimmu.2018.00170] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 01/19/2018] [Indexed: 12/12/2022] Open
Abstract
Fungal bioaerosols are ubiquitous in the environment and human exposure can result in a variety of health effects ranging from systemic, subcutaneous, and cutaneous infections to respiratory morbidity including allergy, asthma, and hypersensitivity pneumonitis. Recent research has focused on the role of microRNAs (miRNAs) following fungal exposure and is overlooked, yet important, group of regulators capable of influencing fungal immune responses through a variety of cellular mechanisms. These small non-coding ribose nucleic acids function to regulate gene expression at the post-transcriptional level and have been shown to participate in multiple disease pathways including cancer, heart disease, apoptosis, as well as immune responses to microbial hazards and occupational allergens. Recent animal model studies have characterized miRNAs following the exposure to inflammatory stimuli. Studies focused on microbial exposure, including bacterial infections, as well as exposure to different allergens have shown miRNAs, such as miR-21, miR-146, miR-132, miR-155, and the let-7 family members, to be involved in immune and inflammatory responses. Interestingly, the few studies have assessed that the miRNA profiles following fungal exposure have identified the same critical miRNAs that have been characterized in other inflammatory-mediated and allergy-induced experimental models. Review of available in vitro, animal and human studies of exposures to Aspergillus fumigatus, Candida albicans, Cryptococcus neoformans, Paracoccidioides brasiliensis, and Stachybotrys chartarum identified several miRNAs that were shared between responses to these species including miR-125 a/b (macrophage polarization/activation), miR-132 [toll-like receptor (TLR)2-mediated signaling], miR-146a (TLR mediated signaling, alternative macrophage activation), and miR-29a/b (natural killer cell function, C-leptin signaling, inhibition of Th1 immune response). Although these datasets provide preliminary insight into the role of miRNAs in fungal exposed models, interpretation of miRNA datasets can be challenging for researchers. To assist in navigating this rapidly evolving field, the aim of this review is to describe miRNAs in the framework of host recognition mechanisms and provide initial insight into the regulatory pathways in response to fungal exposure.
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Affiliation(s)
- Tara L Croston
- Allergy and Clinical Immunology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, United States
| | - Angela R Lemons
- Allergy and Clinical Immunology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, United States
| | - Donald H Beezhold
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, United States
| | - Brett J Green
- Allergy and Clinical Immunology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, United States
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110
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Hyytiäinen HK, Jayaprakash B, Kirjavainen PV, Saari SE, Holopainen R, Keskinen J, Hämeri K, Hyvärinen A, Boor BE, Täubel M. Crawling-induced floor dust resuspension affects the microbiota of the infant breathing zone. MICROBIOME 2018; 6:25. [PMID: 29394954 PMCID: PMC5797336 DOI: 10.1186/s40168-018-0405-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 01/18/2018] [Indexed: 05/21/2023]
Abstract
BACKGROUND Floor dust is commonly used for microbial determinations in epidemiological studies to estimate early-life indoor microbial exposures. Resuspension of floor dust and its impact on infant microbial exposure is, however, little explored. The aim of our study was to investigate how floor dust resuspension induced by an infant's crawling motion and an adult walking affects infant inhalation exposure to microbes. RESULTS We conducted controlled chamber experiments with a simplified mechanical crawling infant robot and an adult volunteer walking over carpeted flooring. We applied bacterial 16S rRNA gene sequencing and quantitative PCR to monitor the infant breathing zone microbial content and compared that to the adult breathing zone and the carpet dust as the source. During crawling, fungal and bacterial levels were, on average, 8- to 21-fold higher in the infant breathing zone compared to measurements from the adult breathing zone. During walking experiments, the increase in microbial levels in the infant breathing zone was far less pronounced. The correlation in rank orders of microbial levels in the carpet dust and the corresponding infant breathing zone sample varied between different microbial groups but was mostly moderate. The relative abundance of bacterial taxa was characteristically distinct in carpet dust and infant and adult breathing zones during the infant crawling experiments. Bacterial diversity in carpet dust and the infant breathing zone did not correlate significantly. CONCLUSIONS The microbiota in the infant breathing zone differ in absolute quantitative and compositional terms from that of the adult breathing zone and of floor dust. Crawling induces resuspension of floor dust from carpeted flooring, creating a concentrated and localized cloud of microbial content around the infant. Thus, the microbial exposure of infants following dust resuspension is difficult to predict based on common house dust or bulk air measurements. Improved approaches for the assessment of infant microbial exposure, such as sampling at the infant breathing zone level, are needed.
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Affiliation(s)
- Heidi K. Hyytiäinen
- Environmental Health Unit, National Institute for Health and Welfare, Kuopio, Finland
| | | | - Pirkka V. Kirjavainen
- Environmental Health Unit, National Institute for Health and Welfare, Kuopio, Finland
- Department of Clinical Nutrition, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Sampo E. Saari
- Aerosol Physics Unit, Faculty of Natural Sciences, Tampere University of Technology, Tampere, Finland
- VTT Technical Research Centre of Finland, Tampere, Finland
| | - Rauno Holopainen
- Finnish Institute of Occupational Health, Helsinki, Finland
- Oulu University of Applied Sciences, Oulu, Finland
| | - Jorma Keskinen
- Aerosol Physics Unit, Faculty of Natural Sciences, Tampere University of Technology, Tampere, Finland
| | - Kaarle Hämeri
- Division of Atmospheric Sciences, Department of Physics, University of Helsinki, Helsinki, Finland
| | - Anne Hyvärinen
- Environmental Health Unit, National Institute for Health and Welfare, Kuopio, Finland
| | - Brandon E. Boor
- Lyles School of Civil Engineering, Purdue University, West Lafayette, IN USA
- Ray W. Herrick Laboratories, Center for High Performance Buildings, Purdue University, West Lafayette, IN USA
| | - Martin Täubel
- Environmental Health Unit, National Institute for Health and Welfare, Kuopio, Finland
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111
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Shorter C, Crane J, Pierse N, Barnes P, Kang J, Wickens K, Douwes J, Stanley T, Täubel M, Hyvärinen A, Howden-Chapman P. Indoor visible mold and mold odor are associated with new-onset childhood wheeze in a dose-dependent manner. INDOOR AIR 2018; 28:6-15. [PMID: 28779500 DOI: 10.1111/ina.12413] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 07/30/2017] [Indexed: 06/07/2023]
Abstract
Evidence is accumulating that indoor dampness and mold are associated with the development of asthma. The underlying mechanisms remain unknown. New Zealand has high rates of both asthma and indoor mold and is ideally placed to investigate this. We conducted an incident case-control study involving 150 children with new-onset wheeze, aged between 1 and 7 years, each matched to two control children with no history of wheezing. Each participant's home was assessed for moisture damage, condensation, and mold growth by researchers, an independent building assessor and parents. Repeated measures of temperature and humidity were made, and electrostatic dust cloths were used to collect airborne microbes. Cloths were analyzed using qPCR. Children were skin prick tested for aeroallergens to establish atopy. Strong positive associations were found between observations of visible mold and new-onset wheezing in children (adjusted odds ratios ranged between 1.30 and 3.56; P ≤ .05). Visible mold and mold odor were consistently associated with new-onset wheezing in a dose-dependent manner. Measurements of qPCR microbial levels, temperature, and humidity were not associated with new-onset wheezing. The association between mold and new-onset wheeze was not modified by atopic status, suggesting a non-allergic association.
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Affiliation(s)
- Caroline Shorter
- Wellington Asthma Research Group, Department of Medicine, University of Otago, Wellington, New Zealand
| | - Julian Crane
- Wellington Asthma Research Group, Department of Medicine, University of Otago, Wellington, New Zealand
| | - Nevil Pierse
- He Kainga Oranga/Housing and Health Research Group, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Phillipa Barnes
- Wellington Asthma Research Group, Department of Medicine, University of Otago, Wellington, New Zealand
| | - Janice Kang
- Wellington Asthma Research Group, Department of Medicine, University of Otago, Wellington, New Zealand
| | - Kristin Wickens
- Wellington Asthma Research Group, Department of Medicine, University of Otago, Wellington, New Zealand
| | - Jeroen Douwes
- Centre for Public Health Research, Massey University, Wellington, New Zealand
| | - Thorsten Stanley
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
| | - Martin Täubel
- Department of Health Protection, National Institute for Health and Welfare (THL), Kuopio, Finland
| | - Anne Hyvärinen
- Department of Health Protection, National Institute for Health and Welfare (THL), Kuopio, Finland
| | - Philippa Howden-Chapman
- He Kainga Oranga/Housing and Health Research Group, Department of Public Health, University of Otago, Wellington, New Zealand
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112
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Heinzow HS, Heinzow BGJ. Commentary: Severe Sequelae to Mold-Related Illness As Demonstrated in Two Finnish Cohorts. Front Immunol 2017; 8:1694. [PMID: 29270170 PMCID: PMC5725433 DOI: 10.3389/fimmu.2017.01694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 11/16/2017] [Indexed: 11/30/2022] Open
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113
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Lin TH, Su HH, Kang HY, Chang TH. The Interactive Roles of Lipopolysaccharides and dsRNA/Viruses on Respiratory Epithelial Cells and Dendritic Cells in Allergic Respiratory Disorders: The Hygiene Hypothesis. Int J Mol Sci 2017; 18:ijms18102219. [PMID: 29065558 PMCID: PMC5666898 DOI: 10.3390/ijms18102219] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 10/18/2017] [Accepted: 10/19/2017] [Indexed: 12/15/2022] Open
Abstract
The original hygiene hypothesis declares "more infections in early childhood protect against later atopy". According to the hygiene hypothesis, the increased incidence of allergic disorders in developed countries is explained by the decrease of infections. Epithelial cells and dendritic cells play key roles in bridging the innate and adaptive immune systems. Among the various pattern-recognition receptor systems of epithelial cells and dendritic cells, including toll-like receptors (TLRs), nucleotide-binding oligomerization domain (NOD)-like receptors (NLRs) and others, TLRs are the key systems of immune response regulation. In humans, TLRs consist of TLR1 to TLR10. They regulate cellular responses through engagement with TLR ligands, e.g., lipopolysaccharides (LPS) acts through TLR4 and dsRNA acts through TLR3, but there are certain common components between these two TLR pathways. dsRNA activates epithelial cells and dendritic cells in different directions, resulting in allergy-related Th2-skewing tendency in epithelial cells, and Th1-skewing tendency in dendritic cells. The Th2-skewing effect by stimulation of dsRNA on epithelial cells could be suppressed by the presence of LPS above some threshold. When LPS level decreases, the Th2-skewing effect increases. It may be via these interrelated networks and related factors that LPS modifies the allergic responses and provides a plausible mechanism of the hygiene hypothesis. Several hygiene hypothesis-related phenomena, seemingly conflicting, are also discussed in this review, along with their proposed mechanisms.
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Affiliation(s)
- Tsang-Hsiung Lin
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Kaohsiung 81362, Taiwan.
| | - Hsing-Hao Su
- Department of Otorhinolaryngology-Head & Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan.
| | - Hong-Yo Kang
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Kaohsiung 81362, Taiwan.
- Hormone Research Center and Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan.
| | - Tsung-Hsien Chang
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan.
- Department of Medical Laboratory Science and Biotechnology, Chung Hwa University of Medical Technology, Tainan 71703, Taiwan.
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114
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Vincent M, Percier P, De Prins S, Huygen K, Potemberg G, Muraille E, Romano M, Michel O, Denis O. Investigation of inflammatory and allergic responses to common mold species: Results from in vitro experiments, from a mouse model of asthma, and from a group of asthmatic patients. INDOOR AIR 2017; 27:933-945. [PMID: 28370571 DOI: 10.1111/ina.12385] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 03/25/2017] [Indexed: 06/07/2023]
Abstract
Most studies on molds focus on Alternaria alternata and Aspergillus fumigatus. Here, we report on inflammatory and allergenic properties of more typical indoor species Aspergillus versicolor, P. chrysogenum, C. cladosporioïdes, and C. sphaerospermum that were compared to A. alternata and A. fumigatus. In a mouse model, after intranasal instillation, A. alternaria, A. versicolor, and C. sphaerospermum induced the early recruitment of neutrophils and the strong expression of inflammatory markers in the bronchoalveolar lavages fluids. A. fumigatus also induced the early accumulation of neutrophils but with lower levels of inflammatory markers. Chronic treatment induced variable response according to species: P. chrysogenum and A. fumigatus appeared strong pro-allergenic inducers compared to A. alternata and C. sphaerospermum while A. versicolor and C. cladosporioides induced a mixed pro-allergenic/pro-inflammatory response. In mold-sensitized asthmatics, mold-specific Immunoglobulin E (IgE) were detected with an in-house dot-blot assay. A. fumigatus and A. alternata were the most frequent sensitizers. Altogether, P. chrysogenum, P. brevicompactum, C. sphaerospermum, and C. cladosporïoides were the "major sensitizer" (defined as the strongest response against a single mold species) for almost 30% of the asthmatics. These results show that, not only A. alternata and A. fumigatus, but also indoor species have strong inflammatory and allergic properties and a harmful potency.
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Affiliation(s)
- M Vincent
- Scientific Service Immunology, WIV-ISP, Bruxelles, Belgium
| | - P Percier
- Scientific Service Immunology, WIV-ISP, Bruxelles, Belgium
| | - S De Prins
- Scientific Service Immunology, WIV-ISP, Bruxelles, Belgium
| | - K Huygen
- Scientific Service Immunology, WIV-ISP, Bruxelles, Belgium
| | - G Potemberg
- Unité de Recherche en Biologie des Microorganismes, Laboratoire d'Immunologie et de Microbiologie, NARILIS, Université de Namur, Namur, Belgium
| | - E Muraille
- Unité de Recherche en Biologie des Microorganismes, Laboratoire d'Immunologie et de Microbiologie, NARILIS, Université de Namur, Namur, Belgium
- Laboratoire de Parasitologie, Faculté de Médecine, Université Libre de Bruxelles, Bruxelles, Belgium
| | - M Romano
- Scientific Service Immunology, WIV-ISP, Bruxelles, Belgium
| | - O Michel
- Clinic of Immunology and Allergology, CHU Brugmann, Université Libre de Bruxelles, Bruxelles, Belgium
| | - O Denis
- Scientific Service Immunology, WIV-ISP, Bruxelles, Belgium
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115
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Norbäck D, Zock JP, Plana E, Heinrich J, Tischer C, Jacobsen Bertelsen R, Sunyer J, Künzli N, Villani S, Olivieri M, Verlato G, Soon A, Schlünssen V, Gunnbjörnsdottir MI, Jarvis D. Building dampness and mold in European homes in relation to climate, building characteristics and socio-economic status: The European Community Respiratory Health Survey ECRHS II. INDOOR AIR 2017; 27:921-932. [PMID: 28190279 DOI: 10.1111/ina.12375] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 02/07/2017] [Indexed: 06/06/2023]
Abstract
We studied dampness and mold in homes in relation to climate, building characteristics and socio-economic status (SES) across Europe, for 7127 homes in 22 centers. A subsample of 3118 homes was inspected. Multilevel analysis was applied, including age, gender, center, SES, climate, and building factors. Self-reported water damage (10%), damp spots (21%), and mold (16%) in past year were similar as observed data (19% dampness and 14% mold). Ambient temperature was associated with self-reported water damage (OR=1.63 per 10°C; 95% CI 1.02-2.63), damp spots (OR=2.95; 95% CI 1.98-4.39), and mold (OR=2.28; 95% CI 1.04-4.67). Precipitation was associated with water damage (OR=1.12 per 100 mm; 95% CI 1.02-1.23) and damp spots (OR=1.11; 95% CI 1.02-1.20). Ambient relative air humidity was not associated with indoor dampness and mold. Older buildings had more dampness and mold (P<.001). Manual workers reported less water damage (OR=0.69; 95% CI 0.53-0.89) but more mold (OR=1.27; 95% CI 1.03-1.55) as compared to managerial/professional workers. There were correlations between reported and observed data at center level (Spearman rho 0.61 for dampness and 0.73 for mold). In conclusion, high ambient temperature and precipitation and high building age can be risk factors for dampness and mold in homes in Europe.
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Affiliation(s)
- D Norbäck
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - J-P Zock
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Municipal Institute of Medical Research (IMIM-Hospital del Mar), Barcelona, Spain
- CIBER Epidemiologia y Salud Publica, (CIBERESP), Madrid, Spain
| | - E Plana
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Municipal Institute of Medical Research (IMIM-Hospital del Mar), Barcelona, Spain
- CIBER Epidemiologia y Salud Publica, (CIBERESP), Madrid, Spain
| | - J Heinrich
- German Research Centre for Environmental Health, Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - C Tischer
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Municipal Institute of Medical Research (IMIM-Hospital del Mar), Barcelona, Spain
- CIBER Epidemiologia y Salud Publica, (CIBERESP), Madrid, Spain
| | - R Jacobsen Bertelsen
- Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | - J Sunyer
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Municipal Institute of Medical Research (IMIM-Hospital del Mar), Barcelona, Spain
- CIBER Epidemiologia y Salud Publica, (CIBERESP), Madrid, Spain
- Pompeu Fabra University, (UFP), Barcelona, Spain
| | - N Künzli
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - S Villani
- Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, University of Pavia, Pavia, Italy
| | - M Olivieri
- Occupational Medicine, University of Verona, Verona, Italy
| | - G Verlato
- Epidemiology and Medical Statistics, University of Verona, Verona, Italy
| | - A Soon
- Department of Public Health, University of Tartu, Tartu, Estonia
- Estonian Research Council, Tartu, Estonia
| | - V Schlünssen
- Department of Public health, Aarhus University, Aarhus, Denmark
- The National Research Center for the Working Environment, Copenhagen, Denmark
| | | | - D Jarvis
- Respiratory Epidemiology and Public Health Group, National Heart and Lung Institute, Imperial College, London, UK
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116
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Ahlroth Pind C, Gunnbjörnsdottír M, Bjerg A, Järvholm B, Lundbäck B, Malinovschi A, Middelveld R, Sommar JN, Norbäck D, Janson C. Patient-reported signs of dampness at home may be a risk factor for chronic rhinosinusitis: A cross-sectional study. Clin Exp Allergy 2017; 47:1383-1389. [PMID: 28695715 DOI: 10.1111/cea.12976] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 06/22/2017] [Accepted: 06/27/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND An association between dampness at home and respiratory conditions has been convincingly demonstrated in children. Fewer studies have been performed in adults, and data are lacking for chronic rhinosinusitis (CRS). With a prevalence of 10.9% in Europe, CRS imposes a significant burden on quality of life, as well as economy. OBJECTIVE Our aim was to study CRS and other respiratory conditions in relation to dampness at home in a representative sample of adults. METHODS The Swedish GA2 LEN questionnaire was answered by 26 577 adults (16-75 years) and included questions on respiratory symptoms, smoking, education and environmental exposure. CRS was defined according to the EP3 OS criteria. Dampness was defined as reporting water damage, floor dampness or visible moulds in the home during the last 12 months. The dampness score was ranked from 0 to 3, counting the number of signs of dampness reported. RESULTS Dampness at home was reported by 11.3% and was independently related to respiratory conditions after adjustment for demographic and socio-economic factors and smoking: CRS odds ratio (OR) 1.71; allergic rhinitis OR 1.24; current asthma OR 1.21; wheeze OR 1.37; nocturnal dyspnoea OR 1.80; nocturnal coughing OR 1.34; and chronic bronchitis OR 1.64. The risk of CRS and most of the other respiratory conditions was further elevated in subjects reporting multiple signs of dampness. CONCLUSIONS AND CLINICAL RELEVANCE This study demonstrated an independent association between dampness at home and CRS in adults. The high burden of this and the other respiratory conditions studied is a strong argument in favour of countering indoor dampness by improving building standards.
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Affiliation(s)
- C Ahlroth Pind
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - M Gunnbjörnsdottír
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.,Department of Respiratory Medicine and Sleep, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - A Bjerg
- The Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.,Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - B Järvholm
- Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - B Lundbäck
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - A Malinovschi
- Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden
| | - R Middelveld
- The Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.,The Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - J Nilsson Sommar
- Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - D Norbäck
- Department of Medical Sciences, Environmental and Occupational Medicine, Uppsala University, Uppsala, Sweden
| | - C Janson
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
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117
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Somppi TL. Non-Thyroidal Illness Syndrome in Patients Exposed to Indoor Air Dampness Microbiota Treated Successfully with Triiodothyronine. Front Immunol 2017; 8:919. [PMID: 28824644 PMCID: PMC5545575 DOI: 10.3389/fimmu.2017.00919] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 07/20/2017] [Indexed: 01/21/2023] Open
Abstract
Long-term exposure to dampness microbiota induces multi-organ morbidity. One of the symptoms related to this disorder is non-thyroidal illness syndrome (NTIS). A retrospective study was carried out in nine patients with a history of mold exposure, experiencing chronic fatigue, cognitive disorder, and different kinds of hypothyroid symptoms despite provision of levothyroxine (3,5,3',5'-tetraiodothyronine, LT4) monotherapy. Exposure to volatile organic compounds present in water-damaged buildings including metabolic products of toxigenic fungi and mold-derived inflammatory agents can lead to a deficiency or imbalance of many hormones, such as active T3 hormone. Since the 1970s, the synthetic prohormone, levothyroxine (LT4), has been the most commonly prescribed thyroid hormone in replacement monotherapy. It has been presumed that the peripheral conversion of T4 (3,5,3',5'-tetraiodothyronine) into T3 (3,5,3'-triiodothyronine) is sufficient to satisfy the overall tissue requirements. However, evidence is presented that this not the case for all patients, especially those exposed to indoor air molds. This retrospective study describes the successful treatment of nine patients in whom NTIS was treated with T3-based thyroid hormone. The treatment was based on careful interview, clinical monitoring, and laboratory analysis of serum free T3 (FT3), reverse T3 (rT3) and thyroid-stimulating hormone, free T4, cortisol, and dehydroepiandrosterone (DHEA) values. The ratio of FT3/rT3 was calculated. In addition, some patients received adrenal support with hydrocortisone and DHEA. All patients received nutritional supplementation and dietary instructions. During the therapy, all nine patients reported improvements in all of the symptom groups. Those who had residual symptoms during T3-based therapy remained exposed to indoor air molds in their work places. Four patients were unable to work and had been on disability leave for a long time during LT4 monotherapy. However, during the T3-based and supportive therapy, all patients returned to work in so-called "healthy" buildings. The importance of avoiding mycotoxin exposure via the diet is underlined as DIO2 genetic polymorphism and dysfunction of DIO2 play an important role in the development of symptoms that can be treated successfully with T3 therapy.
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118
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Denning DW, Chakrabarti A. Pulmonary and sinus fungal diseases in non-immunocompromised patients. THE LANCET. INFECTIOUS DISEASES 2017; 17:e357-e366. [PMID: 28774699 DOI: 10.1016/s1473-3099(17)30309-2] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 10/16/2016] [Accepted: 03/24/2017] [Indexed: 12/19/2022]
Abstract
The human respiratory tract is exposed daily to airborne fungi, fungal enzymes, and secondary metabolites. The endemic fungi Histoplasma capsulatum, Coccidioides spp, Blastomyces dermatitidis, and Paracoccidioides brasiliensis, and occasionally Aspergillus fumigatus, are primary pulmonary pathogens of otherwise healthy people. Such infections resolve in most people, and only a few infections lead to disease. However, many fungi are directly allergenic by colonising the respiratory tract or indirectly through contact with cell wall constituents and proteases, causing or exacerbating allergic disease. Increasing evidence implicates high indoor fungal exposures as a precipitant of asthma in children and in worsening asthma symptoms. Lung or airways infection by endemic fungi or aspergillus can be diagnosed with respiratory sample culture or serum IgG testing. Sputum, induced sputum, or bronchial specimens are all suitable specimens for detecting fungi; microscopy, fungal culture, galactomannan antigen, and aspergillus PCR are useful tests. Antifungal treatment is indicated in almost all patients with chronic cavitary pulmonary infections, chronic invasive and granulomatous rhinosinusitis, and aspergillus bronchitis. Most patients with fungal asthma benefit from antifungal therapy. Adverse reactions to oral azoles, drug interactions, and azole resistance in Aspergillus spp limit therapy. Environmental exposures, genetic factors, and structural pulmonary risk factors probably underlie disease but are poorly understood.
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Affiliation(s)
- David W Denning
- Global Action Fund for Fungal Infections, Geneva, Switzerland; The National Aspergillosis Centre, University Hospital of South Manchester, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
| | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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119
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Wang J, Engvall K, Smedje G, Nilsson H, Norbäck D. Current wheeze, asthma, respiratory infections, and rhinitis among adults in relation to inspection data and indoor measurements in single-family houses in Sweden-The BETSI study. INDOOR AIR 2017; 27:725-736. [PMID: 28005296 DOI: 10.1111/ina.12363] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 12/16/2016] [Indexed: 06/06/2023]
Abstract
In the Swedish Building Energy, Technical Status and Indoor environment study, a total of 1160 adults from 605 single-family houses answered a questionnaire on respiratory health. Building inspectors investigated the homes and measured temperature, air humidity, air exchange rate, and wood moisture content (in attic and crawl space). Moisture load was calculated as the difference between indoor and outdoor absolute humidity. Totally, 7.3% were smokers, 8.7% had doctor' diagnosed asthma, 11.2% current wheeze, and 9.5% current asthma symptoms. Totally, 50.3% had respiratory infections and 26.0% rhinitis. The mean air exchange rate was 0.36/h, and the mean moisture load 1.70 g/m3 . Damp foundation (OR=1.79, 95% CI 1.16-2.78) was positively associated while floor constructions with crawl space (OR=0.49, 95% CI 0.29-0.84) was negatively associated with wheeze. Concrete slabs with overlying insulation (OR=2.21, 95% CI 1.24-3.92) and brick façade (OR=1.71, 95% CI 1.07-2.73) were associated with rhinitis. Moisture load was associated with respiratory infections (OR=1.21 per 1 g/m3 , 95% CI 1.04-1.40) and rhinitis (OR=1.36 per 1 g/m3 , 95% CI 1.02-1.83). Air exchange rate was associated with current asthma symptoms (OR=0.85 per 0.1/h, 95% CI 0.73-0.99). Living in homes with damp foundation, concrete slabs with overlying insulation, brick façade, low ventilation flow, and high moisture load are risk factors for asthma, rhinitis, and respiratory infections.
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Affiliation(s)
- J Wang
- Department of Medical Sciences, Uppsala University and University Hospital, Uppsala, Sweden
| | - K Engvall
- Department of Medical Sciences, Uppsala University and University Hospital, Uppsala, Sweden
| | - G Smedje
- Department of Medical Sciences, Uppsala University and University Hospital, Uppsala, Sweden
| | - H Nilsson
- Division of Building Service and Energy Systems, School of Architecture and the Built Environment, KTH Royal Institute of Technology, Stockholm, Sweden
| | - D Norbäck
- Department of Medical Sciences, Uppsala University and University Hospital, Uppsala, Sweden
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120
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Liu AH, Anderson WC, Dutmer CM, Searing DA, Szefler SJ. Advances in asthma 2015: Across the lifespan. J Allergy Clin Immunol 2017; 138:397-404. [PMID: 27497278 DOI: 10.1016/j.jaci.2016.06.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/21/2016] [Accepted: 06/23/2016] [Indexed: 12/19/2022]
Abstract
In 2015, progress in understanding asthma ranged from insights to asthma inception, exacerbations, and severity to advancements that will improve disease management throughout the lifespan. 2015's insights to asthma inception included how the intestinal microbiome affects asthma expression with the identification of specific gastrointestinal bacterial taxa in early infancy associated with less asthma risk, possibly by promoting regulatory immune development at a critical early age. The relevance of epigenetic mechanisms in regulating asthma-related gene expression was strengthened. Predicting and preventing exacerbations throughout life might help to reduce progressive lung function decrease and disease severity in adulthood. Although allergy has long been linked to asthma exacerbations, a mechanism through which IgE impairs rhinovirus immunity and underlies asthma exacerbations was demonstrated and improved by anti-IgE therapy (omalizumab). Other key molecular pathways underlying asthma exacerbations, such as cadherin-related family member 3 (CDHR3) and orosomucoid like 3 (ORMDL3), were elucidated. New anti-IL-5 therapeutics, mepolizumab and reslizumab, were US Food and Drug Administration approved for the treatment of patients with severe eosinophilic asthma. In a clinical trial the novel therapeutic inhaled GATA3 mRNA-specific DNAzyme attenuated early- and late-phase allergic responses to inhaled allergen. These current findings are significant steps toward addressing unmet needs in asthma prevention, severity modification, disparities, and lifespan outcomes.
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Affiliation(s)
- Andrew H Liu
- Breathing Institute and Pulmonary Medicine Section, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colo.
| | - William C Anderson
- Allergy & Immunology Section, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colo
| | - Cullen M Dutmer
- Allergy & Immunology Section, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colo
| | - Daniel A Searing
- Allergy & Immunology Section, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colo
| | - Stanley J Szefler
- Breathing Institute and Pulmonary Medicine Section, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colo
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121
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Thacher JD, Gruzieva O, Pershagen G, Melén E, Lorentzen JC, Kull I, Bergström A. Mold and dampness exposure and allergic outcomes from birth to adolescence: data from the BAMSE cohort. Allergy 2017; 72:967-974. [PMID: 27925656 PMCID: PMC5434946 DOI: 10.1111/all.13102] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Exposure to moldy or damp indoor environments is associated with allergic disease in young children, but it is unclear whether the effects persist to adolescence. Our objective was to assess whether exposure to mold or dampness during infancy increases the risk of asthma, rhinitis, or IgE sensitization in children followed from birth to 16 years of age. METHODS We collected questionnaire derived reports of mold or dampness indicators and allergic outcomes from 3798 children in a Swedish birth cohort (BAMSE). Sensitization was assessed from blood samples in 3293 children. Longitudinal associations between prevalent asthma, rhinitis, and IgE sensitization and mold or dampness indicators were assessed using generalized estimating equations. RESULTS Exposure to any mold or dampness indicator was associated with asthma up to 16 years of age (OR 1.31; 95% CI 1.08-1.59), while exposure to mold odor (OR 1.29; 95% CI 1.03-1.62) and visible mold (OR 1.28; 95% CI 1.04-1.58) were associated with rhinitis. Increased risks were observed for nonallergic asthma (OR 1.80; 95% CI 1.27-2.55) and rhinitis (OR 1.41; 95% CI 1.03-1.93). No association was observed between mold or dampness indicators and IgE sensitization. Exposure to any mold or dampness indicator was associated with persistent asthma (OR 1.73; 95% CI 1.20-2.50), but not with early-transient or late-onset asthma. CONCLUSION Exposure to mold or dampness during infancy increased the risk of asthma and rhinitis up to 16 years of age, particularly for nonallergic disease. Early exposure to mold or dampness appeared particularly associated with persistent asthma through adolescence.
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Affiliation(s)
- J. D. Thacher
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
| | - O. Gruzieva
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
| | - G. Pershagen
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
- Centre for Occupational and Environmental Medicine; Stockholm County Council; Stockholm Sweden
| | - E. Melén
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
- Sachs’ Children's and Youths Hospital; Södersjukhuset; Stockholm Sweden
| | - J. C. Lorentzen
- Centre for Occupational and Environmental Medicine; Stockholm County Council; Stockholm Sweden
| | - I. Kull
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
- Sachs’ Children's and Youths Hospital; Södersjukhuset; Stockholm Sweden
- Department of Clinical Science and Education; Södersjukhuset; Karolinska Institutet; Stockholm Sweden
| | - A. Bergström
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
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Abstract
INTRODUCTION fungi produce substances that contain pathogen-associated molecular patterns (pamps) and damage-associated molecular patterns (damps) which bind to pattern recognition receptors, stimulating innate immune responses in humans. they also produce allergens that induce production of specific ige. Areas covered: In this review we cover both innate and adaptive immune responses to fungi. Some fungal products can activate both innate and adaptive responses and in doing so, cause an intense and complex health effects. Methods of testing for fungal allergy and evidence for clinical treatment including environmental control are also discussed. In addition, we describe controversial issues including the role of Stachybotrys and mycotoxins in adverse health effects. Expert commentary: Concerns about long-term exposure to fungi have led some patients, attorneys and fungus advocates to promote fears about a condition that has been termed toxic mold syndrome. This syndrome is associated with vague symptoms and is believed to be due to exposure to mycotoxins, though this connection has not been proven. Ultimately, more precise methods are needed to measure both fungal exposure and the resulting health effects. Once that such methods become available, much of the speculation will be replaced by knowledge.
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Affiliation(s)
- Amanda Rudert
- a Division of Allergy, Asthma & Immunology , Children's Mercy Hospitals & Clinics , Kansas City , MO , USA
| | - Jay Portnoy
- a Division of Allergy, Asthma & Immunology , Children's Mercy Hospitals & Clinics , Kansas City , MO , USA
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123
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Macher JM, Mendell MJ, Chen W, Kumagai K. Development of a method to relate the moisture content of a building material to its water activity. INDOOR AIR 2017; 27:599-608. [PMID: 27740697 DOI: 10.1111/ina.12346] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 10/10/2016] [Indexed: 06/06/2023]
Abstract
Subjective indicators of building dampness consistently have been linked to health, but they are, at best, semi-quantitative, and objective and quantitative assessments of dampness are also needed to study dampness-related health effects. Investigators can readily and non-destructively measure the "moisture content" (MC) of building materials with hand-held moisture meters. However, MC does not indicate the amount of the water in a material that is available to microorganisms for growth, that is, the "water activity" (Aw ). Unfortunately, Aw has not been readily measurable in the field and is not relatable to MC unless previously determined experimentally, because for the same moisture meter reading, Aw can differ across materials as well as during moisture adsorption vs desorption. To determine the Aw s that correspond to MC levels, stable air relative humidities were generated in a glove box above saturated, aqueous salt solutions, and the Aw of gypsum board and the relative humidity of the chamber air were tracked until they reached equilibrium. Strong correlations were observed between meter readings and gravimetrically determined MC (r=.91-1.00), among readings with three moisture meters (r=.87-.98), and between meter readings and gypsum board Aw (r=.77-.99).
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Affiliation(s)
- J M Macher
- California Department of Public Health, Environmental Health Laboratory Branch, Richmond, CA, USA
| | - M J Mendell
- California Department of Public Health, Environmental Health Laboratory Branch, Richmond, CA, USA
| | - W Chen
- California Department of Public Health, Environmental Health Laboratory Branch, Richmond, CA, USA
| | - K Kumagai
- California Department of Public Health, Environmental Health Laboratory Branch, Richmond, CA, USA
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124
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Mendell MJ, Kumagai K. Observation-based metrics for residential dampness and mold with dose-response relationships to health: A review. INDOOR AIR 2017; 27:506-517. [PMID: 27663473 DOI: 10.1111/ina.12342] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 09/19/2016] [Indexed: 05/06/2023]
Abstract
An important proportion of respiratory illness is considered attributable to residential dampness or mold (D/M). Developing health-protective D/M guidelines has been challenging, in part because unhealthy levels of indoor D/M cannot be defined using available microbiological measurements. This review paper explores reported multilevel, observation-based (eg visual or olfactory) D/M metrics for potential in defining unhealthy levels of residential D/M. For many of the 33 multilevel residential D/M metrics identified, health risks generally increased as observed D/M increased. Although some metrics seemed too complex for practical use, simple metrics had among the strongest associations with health outcomes. Available findings suggest the feasibility of setting observation-based D/M thresholds to trigger remedial action, using further improved D/M metrics without microbiological measurements (at least until the actual dampness-related agents that cause illness are better quantified). Additional data would allow setting health-protective D/M thresholds more precisely. Also, metrics could better reflect hidden D/M by more strongly emphasizing mold odor, which has demonstrated strong associations with health effects.
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Affiliation(s)
- M J Mendell
- Indoor Air Quality Section, California Department of Public Health, Richmond, CA, USA
| | - K Kumagai
- Indoor Air Quality Section, California Department of Public Health, Richmond, CA, USA
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125
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Vesper S, Robins T, Lewis T, Dombkowski K, Wymer L, Villegas R, Batterman S. Use of Medicaid and housing data may help target areas of high asthma prevalence. J Asthma 2017; 54:230-238. [PMID: 27435833 PMCID: PMC6482379 DOI: 10.1080/02770903.2016.1212370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 07/10/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To determine if there was a significant difference between mold contamination and asthma prevalence in Detroit and non-Detroit Michigan homes, between newer and older homes, and if there is a correlation between mold contamination and measures of Medicaid use for asthma in the 25 Detroit zip codes. METHODS Settled dust was collected from homes (n = 113) of Detroit asthmatic children and from a representative group of Michigan homes (n = 43). The mold contamination for each home was measured using the Environmental Relative Moldiness Index (ERMI) scale and the mean ERMI values in Detroit and non-Detroit homes were statistically compared. Michigan Medicaid data (13 measures related to asthma) in each of the 25 zip codes in Detroit were tested for correlation to ERMI values for homes in those zip codes. RESULTS The mean ERMI value (14.5 ± 8.0) for Detroit asthmatic childrens' homes was significantly (Student's t-test, p < 0.001) greater than the mean ERMI value (2.1 ± 6.2) for the non-Detroit homes. Detroit homes > 60 years old had significantly (p = 0.01) greater mean ERMI values than Detroit homes ≤ 60 years old (15.87 vs. 11.25). The percentage of children that underwent spirometry testing for their persistent asthma (based on Medicaid data) was significantly, positively correlated with the mean ERMI values of the homes in the 25 zip codes. CONCLUSIONS Applying Medicaid-use data for spirometry testing and locating a city's older housing stock might help find foci of homes with high ERMI values.
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Affiliation(s)
- Stephen Vesper
- a United States Environmental Protection Agency, National Exposure Research Laboratory , Cincinnati , OH , USA
| | - Thomas Robins
- b University of Michigan School of Public Health , Department of Environmental Health Sciences , Ann Arbor , MI , USA
| | - Toby Lewis
- b University of Michigan School of Public Health , Department of Environmental Health Sciences , Ann Arbor , MI , USA
- c School of Medicine, University of Michigan , Ann Arbor , MI , USA
| | - Kevin Dombkowski
- d University of Michigan Child Health Evaluation and Research (CHEAR) Unit , Ann Arbor , MI , USA
| | - Larry Wymer
- a United States Environmental Protection Agency, National Exposure Research Laboratory , Cincinnati , OH , USA
| | - Rebeca Villegas
- e Southwest Detroit Environmental Vision , Detroit , MI , USA
| | - Stuart Batterman
- b University of Michigan School of Public Health , Department of Environmental Health Sciences , Ann Arbor , MI , USA
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126
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Gautier C, Charpin D. Environmental triggers and avoidance in the management of asthma. J Asthma Allergy 2017; 10:47-56. [PMID: 28331347 PMCID: PMC5349698 DOI: 10.2147/jaa.s121276] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Identifying asthma triggers forms the basis of environmental secondary prevention. These triggers may be allergenic or nonallergenic. Allergenic triggers include indoor allergens, such as house dust mites (HDMs), molds, pets, cockroaches, and rodents, and outdoor allergens, such as pollens and molds. Clinical observations provide support for the role of HDM exposure as a trigger, although avoidance studies provide conflicting results. Molds and their metabolic products are now considered to be triggers of asthma attacks. Pets, dogs, and especially cats can undoubtedly trigger asthmatic symptoms in sensitized subjects. Avoidance is difficult and rarely adhered to by families. Cockroach allergens contribute to asthma morbidity, and avoidance strategies can lead to clinical benefit. Mouse allergens are mostly found in inner-city dwellings, but their implication in asthma morbidity is debated. In the outdoors, pollens can induce seasonal asthma in sensitized individuals. Avoidance relies on preventing pollens from getting into the house and on minimizing seasonal outdoor exposure. Outdoor molds may lead to severe asthma exacerbations. Nonallergenic triggers include viral infections, active and passive smoking, meteorological changes, occupational exposures, and other triggers that are less commonly involved. Viral infection is the main asthma trigger in children. Active smoking is associated with higher asthma morbidity, and smoking cessation interventions should be personalized. Passive smoking is also a risk factor for asthma exacerbation. The implementation of public smoking bans has led to a reduction in the hospitalization of asthmatic children. Air pollution levels have been linked with asthmatic symptoms, a decrease in lung function, and increased emergency room visits and hospitalizations. Since avoidance is not easy to achieve, clean air policies remain the most effective strategy. Indoor air is also affected by air pollutants, such as cigarette smoke and volatile organic compounds generated by building and cleaning materials. Occupational exposures include work-exacerbated asthma and work-related asthma.
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Affiliation(s)
| | - Denis Charpin
- Department of Pulmonology and Allergy, North Hospital; Faculty of Medicine, Aix-Marseille University, Marseille, France
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Oluwole O, Kirychuk SP, Lawson JA, Karunanayake C, Cockcroft DW, Willson PJ, Senthilselvan A, Rennie DC. Indoor mold levels and current asthma among school-aged children in Saskatchewan, Canada. INDOOR AIR 2017; 27:311-319. [PMID: 27108895 DOI: 10.1111/ina.12304] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Accepted: 04/12/2016] [Indexed: 06/05/2023]
Abstract
Current knowledge regarding the association between indoor mold exposures and asthma is still limited. The objective of this case-control study was to investigate the relationship between objectively measured indoor mold levels and current asthma among school-aged children. Parents completed a questionnaire survey of health history and home environmental conditions. Asthma cases had a history of doctor-diagnosed asthma or current wheeze without a cold in the past 12 months. Controls were age- and sex-matched to cases. Vacuumed dust samples were collected from the child's indoor play area and mattress. Samples were assessed for mold levels and quantified in colony-forming units (CFU). Sensitization to mold allergens was also determined by skin testing. Being a case was associated with family history of asthma, pet ownership, and mold allergy. Mold levels (CFU/m2 ) in the dust samples of children's mattress and play area floors were moderately correlated (r = 0.56; P < 0.05). High mold levels (≥30 000 CFU/m2 ) in dust samples from play [adjusted odds ratio (aOR) = 2.6; 95% CI: 1.03-6.43] and mattress (aOR) = 3.0; 95% CI: 1.11-8.00) areas were significantly associated with current asthma. In this study high levels of mold are a risk factor for asthma in children.
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Affiliation(s)
- O Oluwole
- Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - S P Kirychuk
- Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
- Department of Medicine, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - J A Lawson
- Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
- Department of Medicine, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - C Karunanayake
- Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - D W Cockcroft
- Department of Medicine, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - P J Willson
- Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
- Vaccine and Infectious Disease Organization, University of Saskatchewan, Saskatoon, SK, Canada
| | - A Senthilselvan
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - D C Rennie
- Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
- College of Nursing, University of Saskatchewan, Saskatoon, SK, Canada
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128
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Mensah-Attipoe J, Täubel M, Hernandez M, Pitkäranta M, Reponen T. An emerging paradox: Toward a better understanding of the potential benefits and adversity of microbe exposures in the indoor environment. INDOOR AIR 2017; 27:3-5. [PMID: 28025873 DOI: 10.1111/ina.12344] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Macher JM, Mendell MJ, Kumagai K, Holland NT, Camacho JM, Harley KG, Eskenazi B, Bradman A. Higher measured moisture in California homes with qualitative evidence of dampness. INDOOR AIR 2016; 26:892-902. [PMID: 26660492 DOI: 10.1111/ina.12276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 12/06/2015] [Indexed: 06/05/2023]
Abstract
Relationships between measured moisture and qualitative dampness indicators (mold odor, visible mold, visible water damage, or peeling paint) were evaluated using data collected from California homes in a prospective birth cohort study when the infants were 6 or 12 months of age (737 home visits). For repeated visits, agreement between observation of the presence/absence of each qualitative indicator at both visits was high (71-87%, P < 0.0001). Among individual indicators, musty odor and visible mold were most strongly correlated with elevated moisture readings. Measured moisture differed significantly between repeated visits in opposite seasons (P < 0.0001), and dampness increased with the number of indicators in a home. Linear mixed-effect models showed that 10-unit increases in maximum measured moisture were associated with the presence of 0.5 additional dampness indicators (P < 0.001). Bedroom (BR) walls were damper than living room (LR) walls in the same homes (P < 0.0001), although both average and maximum readings were positively correlated across room type (r = 0.75 and 0.67, respectively, both P < 0.0001). Exterior walls were significantly damper than interior walls (P < 0.0001 in both LRs and BRs), but no differences were observed between maximum wall readings and measurements at either window corners or sites of suspected dampness.
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Affiliation(s)
- J M Macher
- Environmental Health Laboratory Branch, California Department of Public Health, Richmond, CA, USA
| | - M J Mendell
- Environmental Health Laboratory Branch, California Department of Public Health, Richmond, CA, USA
| | - K Kumagai
- Environmental Health Laboratory Branch, California Department of Public Health, Richmond, CA, USA
| | - N T Holland
- Center for Children's Environmental Health Research, School of Public Health, University of California, Berkeley, CA, USA
| | - J M Camacho
- Natividad Medical Center, Center for the Health Assessment of Mothers and Children of Salinas (CHAMACOS), Salinas, CA, USA
| | - K G Harley
- Center for Children's Environmental Health Research, School of Public Health, University of California, Berkeley, CA, USA
| | - B Eskenazi
- Center for Children's Environmental Health Research, School of Public Health, University of California, Berkeley, CA, USA
| | - A Bradman
- Center for Children's Environmental Health Research, School of Public Health, University of California, Berkeley, CA, USA
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130
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Eiffert S, Noibi Y, Vesper S, Downs J, Fulk F, Wallace J, Pearson M, Winquist A. A Citizen-Science Study Documents Environmental Exposures and Asthma Prevalence in Two Communities. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2016; 2016:1962901. [PMID: 28003835 PMCID: PMC5143781 DOI: 10.1155/2016/1962901] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 10/25/2016] [Indexed: 11/17/2022]
Abstract
A citizen-science study was conducted in two low-income, flood-prone communities in Atlanta, Georgia, in order to document environmental exposures and the prevalence of occupant asthma. Teams consisting of a public-health graduate student and a resident from one of the two communities administered a questionnaire, inspected residences for mold growth, and collected a dust sample for quantifying mold contamination. The dust samples were analyzed for the 36 molds that make up the Environmental Relative Moldiness Index (ERMI). Most residents (76%) were renters. The median duration of residence was 2.5 years. Although only 12% of occupants reported a history of flooding, 46% reported at least one water leak. Homes with visible mold (35%) had significantly (P < 0.05) higher mean ERMI values compared to homes without (14.0 versus 9.6). The prevalence of self-reported, current asthma among participants was 14%. In logistic regression models controlling for indoor smoking, among participants residing at their current residence for two years or less, a positive association was observed between asthma and the homes' ERMI values (adjusted odds ratio per unit increase in ERMI = 1.12, 95% confidence intervals (CI): 1.01-1.25; two-tailed P = 0.04). Documentation of the exposures and asthma prevalence has been presented to the communities and public officials. Community-based organizations have taken responsibility for planning and implementing activities in response to the study findings.
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Affiliation(s)
- Samantha Eiffert
- Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Yomi Noibi
- ECO-Action, 250 Georgia Avenue, SE 309, Atlanta, GA 30312, USA
| | - Stephen Vesper
- National Exposure Research Laboratory, United States Environmental Protection Agency, 26 West M. L. King Drive, Cincinnati, OH 45268, USA
| | - Jonathan Downs
- Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Florence Fulk
- National Exposure Research Laboratory, United States Environmental Protection Agency, 26 West M. L. King Drive, Cincinnati, OH 45268, USA
| | - Juanita Wallace
- ECO-Action, 250 Georgia Avenue, SE 309, Atlanta, GA 30312, USA
| | - Melanie Pearson
- Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Andrea Winquist
- Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
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131
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Development of a Dot-Blot Assay for the Detection of Mould-Specific IgE in the Belgian Population. Mycopathologia 2016; 182:319-329. [DOI: 10.1007/s11046-016-0091-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 11/08/2016] [Indexed: 10/20/2022]
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132
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Lanthier-Veilleux M, Baron G, Généreux M. Respiratory Diseases in University Students Associated with Exposure to Residential Dampness or Mold. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13111154. [PMID: 27869727 PMCID: PMC5129364 DOI: 10.3390/ijerph13111154] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 11/08/2016] [Accepted: 11/15/2016] [Indexed: 11/20/2022]
Abstract
University students are frequently exposed to residential dampness or mold (i.e., visible mold, mold odor, dampness, or water leaks), a well-known contributor to asthma, allergic rhinitis, and respiratory infections. This study aims to: (a) describe the prevalence of these respiratory diseases among university students; and (b) examine the independent contribution of residential dampness or mold to these diseases. An online survey was conducted in March 2014 among the 26,676 students registered at the Université de Sherbrooke (Quebec, Canada). Validated questions and scores were used to assess self-reported respiratory diseases (i.e., asthma-like symptoms, allergic rhinitis, and respiratory infections), residential dampness or mold, and covariates (e.g., student characteristics). Using logistic regressions, the crude and adjusted odd ratios between residential dampness or mold and self-reported respiratory diseases were examined. Results from the participating students (n = 2097; response rate: 8.1%) showed high prevalence of allergic rhinitis (32.6%; 95% CI: 30.6–34.7), asthma-like symptoms (24.0%; 95% CI: 22.1–25.8) and respiratory infections (19.4%; 95% CI: 17.7–21.2). After adjustment, exposure to residential dampness or mold was associated with allergic rhinitis (OR: 1.25; 95% CI: 1.01–1.55) and asthma-like symptoms (OR: 1.70; 95% CI: 1.37–2.11), but not with respiratory infections (OR: 1.07; 95% CI: 0.85–1.36). Among symptomatic students, this exposure was also associated with uncontrolled and burdensome respiratory symptoms (p < 0.01). University students report a high prevalence of allergic rhinitis, asthma-like symptoms and respiratory infections. A common indoor hazard, residential dampness or mold, may play a role in increasing atopic respiratory diseases and their suboptimal control in young adults. These results emphasize the importance for public health organizations to tackle poor housing conditions, especially amongst university students who should be considered “at-risk”.
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Affiliation(s)
- Mathieu Lanthier-Veilleux
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada.
| | - Geneviève Baron
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada.
- Public Health Department of Eastern Townships, 300 King East, Sherbrooke, QC J1G 1B1, Canada.
| | - Mélissa Généreux
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada.
- Public Health Department of Eastern Townships, 300 King East, Sherbrooke, QC J1G 1B1, Canada.
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133
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Mitchell CA, Pitt A, Hulin J, Lawson R, Ashby F, Appelqvist I, Delaney B. Respiratory health screening for opiate misusers in a specialist community clinic: a mixed-methods pilot study, with integrated staff and service user feedback. BMJ Open 2016; 6:e012823. [PMID: 27742632 PMCID: PMC5073511 DOI: 10.1136/bmjopen-2016-012823] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 08/22/2016] [Accepted: 09/15/2016] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Increased rates of illicit drug inhalation are thought to expose opiate misusers (OMUs) to an enhanced risk of respiratory health problems. This pilot study aimed to determine the feasibility of undertaking respiratory screening of OMUs in a community clinic. SETTING Single-centre UK community substance misuse clinic. PARTICIPANTS All clinic attendees receiving treatment for opiate misuse were eligible to participate. 36 participants (mean age=37) were recruited over a 5-week period. The sample included 26 males and 10 females. OUTCOME MEASURES Spirometry without bronchodilation; health related quality of life EQ-5D-3L; Asthma Control Test; Mini Asthma Quality of Life; Clinical COPD Questionnaire and the Treatment Outcome Profile were used to assess the respiratory health of participants. Findings were discussed with staff and service users in 2 patient and public involvement events and feedback was analysed thematically. RESULTS 34 participants reported that they had smoked heroin. 8 participants diagnosed with asthma, scored under 13 on the Asthma Control Test, suggesting poorly controlled asthma. Participants (n=28), without a diagnosis of asthma completed the Lung Function Questionnaire. Of these, 79% produced scores under 18, indicating symptoms associated with the development of chronic obstructive pulmonary disease. Spirometry showed 14% of all participants had forced expiratory volume in 1 s/forced vital capacity <0.7 (without bronchodilator), indicating potential obstructive lung disease. Feedback from service users and staff suggested a willingness and capacity to deliver respiratory health screening programmes. Insight towards the difficulties service users have in accessing services and the burden of respiratory health was also provided. CONCLUSIONS It is feasible to undertake respiratory health screening of OMUs in a community clinic. Larger screening studies are warranted to determine the prevalence of respiratory health problems in this population. Research regarding asthma medicines adherence and access to healthcare among OMUs is also required.
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Affiliation(s)
| | - Alice Pitt
- Academic Unit of Primary Care, The University of Sheffield, Sheffield, UK
| | - Joe Hulin
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Rod Lawson
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Fleur Ashby
- Barnsley NHS Trust/Phoenix Futures, Wakefield, UK
| | | | - Brigitte Delaney
- Academic Unit of Primary Care, The University of Sheffield, Sheffield, UK
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134
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An C, Yamamoto N. Fungal compositions and diversities on indoor surfaces with visible mold growths in residential buildings in the Seoul Capital Area of South Korea. INDOOR AIR 2016; 26:714-723. [PMID: 26509799 DOI: 10.1111/ina.12261] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 10/23/2015] [Indexed: 06/05/2023]
Abstract
Indoor visible mold growths are known to be associated with allergies and respiratory illnesses. However, a question remains of their compositions and diversities. Using swab sampling and high-throughput DNA sequencing, this study analyzed taxonomic compositions and diversities of fungi on indoor surfaces laden with visible mold growths in residential apartments in South Korea. The sequencing results showed low species diversities with Shannon indices ranging from 0.14 to 2.29 (mean = 1.11). Several allergy-related genera were detected on the same surface, where the most abundant Cladosporium with a mean relative abundance of 41% co-occurred with less abundant Aspergillus (0.094%), Rhodotorula (6.3%), Cryptococcus (3.7%), Alternaria (4.1%), and Crivellia (17%). β diversity analyses showed significant differences in the fungal communities between enclosed balconies and other indoor areas (P < 0.05, ANOSIM), emphasizing a need to sample at multiple indoor locations when assessments are made for indoor visible mold growths. High-throughput sequencing is powerful in characterizing compositions and diversities of fungal communities. Future studies should examine the relationships between taxonomic compositions and diversities of indoor visible molds and health outcomes of allergies and respiratory illnesses in residential buildings.
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Affiliation(s)
- C An
- Department of Environmental Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, South Korea
| | - N Yamamoto
- Department of Environmental Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, South Korea.
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135
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Abstract
The advent and application of high-throughput molecular techniques for analyzing microbial communities in the indoor environment have led to illuminating findings and are beginning to change the way we think about human health in relation to the built environment. Here I review recent studies on the microbiology of the built environment, organize their findings into 12 major thematic categories, and comment on how these studies have or have not advanced knowledge in each area beyond what we already knew from over 100 years of applying culture-based methods to building samples. The advent and application of high-throughput molecular techniques for analyzing microbial communities in the indoor environment have led to illuminating findings and are beginning to change the way we think about human health in relation to the built environment. Here I review recent studies on the microbiology of the built environment, organize their findings into 12 major thematic categories, and comment on how these studies have or have not advanced knowledge in each area beyond what we already knew from over 100 years of applying culture-based methods to building samples. I propose that while we have added tremendous complexity to the rich existing knowledge base, the practical implications of this added complexity remain somewhat elusive. It remains to be seen how this new knowledge base will change how we design, build, and operate buildings. Much more research is needed to better understand the complexity with which indoor microbiomes may affect human health in both positive and negative ways.
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136
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Stephens B. What Have We Learned about the Microbiomes of Indoor Environments? mSystems 2016. [PMID: 27822547 DOI: 10.1128/msystems.00083-16.editor] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
The advent and application of high-throughput molecular techniques for analyzing microbial communities in the indoor environment have led to illuminating findings and are beginning to change the way we think about human health in relation to the built environment. Here I review recent studies on the microbiology of the built environment, organize their findings into 12 major thematic categories, and comment on how these studies have or have not advanced knowledge in each area beyond what we already knew from over 100 years of applying culture-based methods to building samples. I propose that while we have added tremendous complexity to the rich existing knowledge base, the practical implications of this added complexity remain somewhat elusive. It remains to be seen how this new knowledge base will change how we design, build, and operate buildings. Much more research is needed to better understand the complexity with which indoor microbiomes may affect human health in both positive and negative ways.
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Affiliation(s)
- Brent Stephens
- Department of Civil, Architectural and Environmental Engineering, Illinois Institute of Technology, Chicago, Illinois, USA
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137
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Cox-Ganser JM. Indoor dampness and mould health effects - ongoing questions on microbial exposures and allergic versus nonallergic mechanisms. Clin Exp Allergy 2016; 45:1478-82. [PMID: 26372722 DOI: 10.1111/cea.12601] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- J M Cox-Ganser
- Division of Respiratory Disease Studies, National Institute for Occupational Health, Morgantown, WV, USA
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138
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Sharpe RA, Thornton CR, Tyrrell J, Nikolaou V, Osborne NJ. Variable risk of atopic disease due to indoor fungal exposure in NHANES 2005-2006. Clin Exp Allergy 2016; 45:1566-78. [PMID: 25845975 DOI: 10.1111/cea.12549] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 02/27/2015] [Accepted: 03/23/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Exposure to damp indoor environments is associated with increased risk of eczema, allergy and asthma. The role of dampness-related exposures and risk of allergic diseases are yet to be fully explored in the US population. OBJECTIVE We assess whether exposure to fungi, house dust mites and endotoxin increases the risk of eczema, allergy and asthma in children and adults participating in NHANES 2005-2006. METHODS A total of 8412 participants (2849 were children aged between 6 and 17 years) were recruited in the 2005-2006 survey. We used multiple logistic regression to investigate whether mildew/musty odour and increased concentrations of Alternaria alternata allergen, Aspergillus fumigatus antigens, house dust mite and endotoxin antigens increase the risk of eczema, allergy and asthma. We stratified models by total IgE < 170 and ≥ 170 KU/L to assess allergic and non-allergic asthma outcomes. Exposure to multiple biological agents and risk of reporting eczema, allergy and asthma were also investigated. RESULTS Reporting of a mildew/musty odour was associated with increased risk of childhood asthma (OR 1.60; 95% CI 1.17-2.19), and adult eczema, allergy and asthma (OR 1.92; 95% CI 1.39-2.63, OR 1.59 95% CI 1.26-2.02 and OR 1.61 95% CI 1.00-2.57, respectively). Risk of asthma was associated with total IgE ≥ 170 KU/L in children (OR 1.81; 95% CI 1.01-3.25) and total IgE < 170 KU/L in adults (OR 1.91; 95% CI 1.07-3.42). Children and adults exposed to more than eight biological agents present in the home were at reduced risk of eczema (OR 0.17; 95% CI 0.04-0.77) and asthma (OR 0.49; 95% CI 0.25-0.97), respectively. CONCLUSION Exposure to a mildew/musty odour, as a proxy for exposure to fungus, was implicated in an increased risk of atopic diseases. Sensitisation may play a different role in children and adults, and exposure to multiple allergens may reduce the risk of atopic disease.
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Affiliation(s)
- R A Sharpe
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, UK
| | - C R Thornton
- Biosciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - J Tyrrell
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, UK
| | - V Nikolaou
- University of Exeter Medical School, Exeter, UK
| | - N J Osborne
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, UK.,Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia.,Department of Clinical Pharmacology, Sydney Medical School, University of Sydney, Sydney, N.S.W., Australia
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139
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Valuing the Economic Costs of Allergic Rhinitis, Acute Bronchitis, and Asthma from Exposure to Indoor Dampness and Mold in the US. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2016; 2016:2386596. [PMID: 27313630 PMCID: PMC4903120 DOI: 10.1155/2016/2386596] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 03/10/2016] [Accepted: 04/13/2016] [Indexed: 11/17/2022]
Abstract
Two foundational methods for estimating the total economic burden of disease are cost of illness (COI) and willingness to pay (WTP). WTP measures the full cost to society, but WTP estimates are difficult to compute and rarely available. COI methods are more often used but less likely to reflect full costs. This paper attempts to estimate the full economic cost (2014$) of illnesses resulting from exposure to dampness and mold using COI methods and WTP where the data is available. A limited sensitivity analysis of alternative methods and assumptions demonstrates a wide potential range of estimates. In the final estimates, the total annual cost to society attributable to dampness and mold is estimated to be $3.7 (2.3-4.7) billion for allergic rhinitis, $1.9 (1.1-2.3) billion for acute bronchitis, $15.1 (9.4-20.6) billion for asthma morbidity, and $1.7 (0.4-4.5) billion for asthma mortality. The corresponding costs from all causes, not limited to dampness and mold, using the same approach would be $24.8 billion for allergic rhinitis, $13.5 billion for acute bronchitis, $94.5 billion for asthma morbidity, and $10.8 billion for asthma mortality.
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140
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Lin Z, Norback D, Wang T, Zhang X, Shi J, Kan H, Zhao Z. The first 2-year home environment in relation to the new onset and remission of asthmatic and allergic symptoms in 4246 preschool children. THE SCIENCE OF THE TOTAL ENVIRONMENT 2016; 553:204-210. [PMID: 26925732 DOI: 10.1016/j.scitotenv.2016.02.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 02/05/2016] [Accepted: 02/06/2016] [Indexed: 06/05/2023]
Abstract
The home environment can influence childhood allergies and respiratory health but there is little information on associations between early life exposure at home and new onset and remission of the asthmatic or allergic symptoms in preschool children. A questionnaire survey was performed in a random cluster sample of 4246 preschool children in Urumqi, China. Information on the home environment (perceptions of odors and indicators of pollution sources) and children's health (wheeze, rhinitis and eczema) was collected for the first 2 years of life and the last year (before answering the questionnaire) from one of the parents or another guardian of the child. Associations between the home environment the first 2 years of life and new onset and remission of childhood symptoms were analyzed by multiple logistic regression. Home environment factors reported for the first 2 years of life were consistently positively associated with new onset of symptoms and negatively associated with remission of symptoms. Visible mold (OR 1.46, 95% CI 1.12-1.90), moldy odor (OR 2.15, 95% CI 1.45-3.18), air dryness (OR 1.31, 95% CI 1.08-1.59), stuffy odor (OR 1.25, 95% CI 1.01-1.54) and parental smoking (OR 1.36, 95% CI 1.13-1.65) were associated with new onset of symptoms. These factors were negatively associated with the remission of symptoms. In conclusion, mold contamination at home (moldy odor/visible mold), poor indoor air quality (stuffy odor, air dryness) and exposure to environmental tobacco smoke (ETS) in the first 2 years of life can increase the incidence of asthmatic and allergic symptoms and decrease the remission from these symptoms in preschool children.
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Affiliation(s)
- Zhijin Lin
- Department of Environmental Health, School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai 200032, PR China
| | - Dan Norback
- Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala SE-751, Sweden
| | - Tingting Wang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Xinjiang Medical University, Urumqi 830011, PR China
| | - Xin Zhang
- Institute of Environmental Science, Shanxi University, Taiyuan 030006, PR China
| | - Jingjin Shi
- Department of Environmental Health, School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai 200032, PR China
| | - Haidong Kan
- Department of Environmental Health, School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai 200032, PR China
| | - Zhuohui Zhao
- Department of Environmental Health, School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai 200032, PR China.
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141
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Chew GL, Horner WE, Kennedy K, Grimes C, Barnes CS, Phipatanakul W, Larenas-Linnemann D, Miller JD. Procedures to Assist Health Care Providers to Determine When Home Assessments for Potential Mold Exposure Are Warranted. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 4:417-422.e2. [PMID: 27021632 DOI: 10.1016/j.jaip.2016.01.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 01/10/2016] [Accepted: 01/29/2016] [Indexed: 11/19/2022]
Abstract
Drawing evidence from epidemiology and exposure assessment studies and recommendations from expert practice, we describe a process to guide health care providers helping their patients who present with symptoms that might be associated with living in damp housing. We present the procedures in the form of a guided 2-part interview. The first part has 5 questions that triage the patient toward a more detailed questionnaire that reflects features of housing conditions known to be reliably associated with exposures to mold and dampness contaminants. We chose the questions based on the conditions associated with moisture problems in homes across the United States and Canada. The goal is to facilitate the clinician's effort to help patients reduce exposure to environmental triggers that elicit symptoms to better manage their disease.
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Affiliation(s)
- Ginger L Chew
- National Center for Environmental Health, Air Pollution and Respiratory Health Branch, Centers for Disease Control and Prevention (CDC), Atlanta, Ga.
| | | | - Kevin Kennedy
- Center for Environmental Health, Children's Mercy Hospital, Kansas City, Mo
| | | | - Charles S Barnes
- Center for Environmental Health, Children's Mercy Hospital, Kansas City, Mo
| | - Wanda Phipatanakul
- Division of Immunology and Allergy, Harvard Medical School and Boston Children's Hospital, Boston, Mass
| | | | - J David Miller
- Department of Chemistry, Carleton University, Ottawa, Ontario, Canada
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142
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Rottier BL, Eber E, Hedlin G, Turner S, Wooler E, Mantzourani E, Kulkarni N. Monitoring asthma in childhood: management-related issues. Eur Respir Rev 2016; 24:194-203. [PMID: 26028632 PMCID: PMC9487817 DOI: 10.1183/16000617.00003814] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Management-related issues are an important aspect of monitoring asthma in children in clinical practice. This review summarises the literature on practical aspects of monitoring including adherence to treatment, inhalation technique, ongoing exposure to allergens and irritants, comorbid conditions and side-effects of treatment, as agreed by the European Respiratory Society Task Force on Monitoring Asthma in Childhood. The evidence indicates that it is important to discuss adherence to treatment in a non-confrontational way at every clinic visit, and take into account a patient's illness and medication beliefs. All task force members teach inhalation techniques at least twice when introducing a new inhalation device and then at least annually. Exposure to second-hand tobacco smoke, combustion-derived air pollutants, house dust mites, fungal spores, pollens and pet dander deserve regular attention during follow-up according to most task force members. In addition, allergic rhinitis should be considered as a cause for poor asthma control. Task force members do not screen for gastro-oesophageal reflux and food allergy. Height and weight are generally measured at least annually to identify individuals who are susceptible to adrenal suppression and to calculate body mass index, even though causality between obesity and asthma has not been established. In cases of poor asthma control, before stepping up treatment the above aspects of monitoring deserve closer attention. ERS review summarising and discussing the management-related issues regarding the monitoring of asthma in childhoodhttp://ow.ly/JfjGs
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Affiliation(s)
- Bart L Rottier
- Dept of Pediatric Pulmonology and Allergology, GRIAC Research Institute, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ernst Eber
- Respiratory and Allergic Disease Division, Dept of Paediatrics and Adolescence Medicine, Medical University of Graz, Graz, Austria
| | - Gunilla Hedlin
- Dept of Women's and Children's Health and Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden Astrid Lindgren Children's Hospital, Stockholm, Sweden
| | - Steve Turner
- Dept of Paediatrics, University of Aberdeen, Aberdeen, UK
| | | | - Eva Mantzourani
- Dept of Paediatrics, University Hospital of Heraklion, University of Crete, Heraklion, Greece
| | - Neeta Kulkarni
- Leicestershire Partnership Trust and Dept of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
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143
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Baxi SN, Portnoy JM, Larenas-Linnemann D, Phipatanakul W. Exposure and Health Effects of Fungi on Humans. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 4:396-404. [PMID: 26947460 DOI: 10.1016/j.jaip.2016.01.008] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 01/04/2016] [Accepted: 01/13/2016] [Indexed: 01/28/2023]
Abstract
Fungi are ubiquitous microorganisms that are present in outdoor and indoor environments. Previous research has found relationships between environmental fungal exposures and human health effects. We reviewed recent articles focused on fungal exposure and dampness as risk factors for respiratory disease development, symptoms, and hypersensitivity. In particular, we reviewed the evidence suggesting that early exposure to dampness or fungi is associated with the development of asthma and increased asthma morbidity. Although outdoor exposure to high concentrations of spores can cause health effects such as asthma attacks in association with thunderstorms, most people appear to be relatively unaffected unless they are sensitized to specific genera. Indoor exposure and dampness, however, appears to be associated with an increased risk of developing asthma in young children and asthma morbidity in individuals who have asthma. These are important issues because they provide a rationale for interventions that might be considered for homes and buildings in which there is increased fungal exposure. In addition to rhinitis and asthma, fungus exposure is associated with a number of other illnesses including allergic bronchopulmonary mycoses, allergic fungal sinusitis, and hypersensitivity pneumonitis. Additional research is necessary to establish causality and evaluate interventions for fungal- and dampness-related health effects.
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144
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Abstract
A gathering body of evidence has repeatedly revealed associations between indoor fungi and initiation, promotion, and exacerbation of allergic respiratory disease. The relationship between the exposure and outcome are complicated by the difficulties in measuring both exposure and outcome, the multifactorial nature of the disease, and the wide range of potential confounders. New technologies are becoming available that may enable better measurement of exposure and tighter case definitions so as to build more confidence in the associations discovered. The growing strength of the evidence base will aid the design of future public health interventions and generate new hypotheses on the cause of the rapid increase in allergic respiratory disease prevalence.
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145
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Lanthier-Veilleux M, Généreux M, Baron G. Prevalence of Residential Dampness and Mold Exposure in a University Student Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:194. [PMID: 26861364 PMCID: PMC4772214 DOI: 10.3390/ijerph13020194] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 01/17/2016] [Accepted: 01/29/2016] [Indexed: 11/16/2022]
Abstract
The impact of residential dampness or mold on respiratory health is well established but few studies have focused on university students. This study aims to: (a) describe the prevalence of exposure to residential dampness or mold in university students according to socio-geographic factors and (b) identify associated housing characteristics. A web survey was conducted in 2014 among the 26,676 students registered at the Université de Sherbrooke (QC, Canada). Residential dampness and mold being closely intertwined, they were considered as a single exposure and assessed using a validated questionnaire. Exposure was compared according to socio-geographic and housing characteristics using chi-square tests and logistic regressions. Among the 2097 participants included in the study (response rate: 8.1%), over 80% were tenants. Residential exposure to dampness or mold was frequent (36.0%, 95% CI: 33.9-38.1). Marked differences for this exposure were noted according to home ownership (39.7% vs. 25.5% among tenants and owners respectively; OR = 1.92%, 95% CI: 1.54-2.38). Campus affiliation, household composition and the number of residents per building were associated with exposure to dampness or mold (p < 0.01), while sex and age were not. Exposure was also associated with older buildings, and buildings in need of renovations and lacking proper ventilation (p < 0.001). This study highlights the potential risk of university students suffering from mold-related health effects given their frequent exposure to this agent. Further research is needed to fully evaluate the mold-related health impact in this at risk group.
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Affiliation(s)
- Mathieu Lanthier-Veilleux
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada.
| | - Mélissa Généreux
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada.
- Eastern Township's Public Health Department, 300, King Est street, Sherbrooke, QC J1G 1B1, Canada.
| | - Geneviève Baron
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada.
- Eastern Township's Public Health Department, 300, King Est street, Sherbrooke, QC J1G 1B1, Canada.
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146
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Vesper S, Wymer L. The relationship between environmental relative moldiness index values and asthma. Int J Hyg Environ Health 2016; 219:233-8. [PMID: 26861576 DOI: 10.1016/j.ijheh.2016.01.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 01/26/2016] [Accepted: 01/27/2016] [Indexed: 01/22/2023]
Abstract
Indoor mold exposures have been qualitatively linked to asthma for more than 25 years. Our goal has been to turn this qualitative link into a quantitative assessment of asthma risk from mold exposures as estimated by the home's environmental relative moldiness index (ERMI) value. The home's ERMI value is derived from the quantitative PCR analysis of 36 molds in a dust sample. Six epidemiological studies of the relationship between ERMI values and asthma, in cities across the U.S., showed that both children and adults with asthma were living in homes with significantly higher ERMI values than the control or comparison homes. Based on these six studies, the accuracy of the ERMI value's link to occupant asthma was analyzed using receiver operating characteristic (ROC) curve and area under the curve (AUC) statistical analysis. The AUC was 0.69 which places the test accuracy in the "fair to good" range for a medical diagnostic test. A logistic regression analysis of the six studies was performed to generate an equation that can be used to predict occupant asthma at specific ERMI values. The ERMI metric may be a useful tool to link the quantification of mold contamination in U.S. homes to some asthma health effects.
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Affiliation(s)
- Stephen Vesper
- United States Environmental Protection Agency, National Exposure Research Laboratory, Cincinnati, OH, USA.
| | - Larry Wymer
- United States Environmental Protection Agency, National Exposure Research Laboratory, Cincinnati, OH, USA
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147
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Orphan immunotherapies for allergic diseases. Ann Allergy Asthma Immunol 2016; 116:194-8. [PMID: 26837608 DOI: 10.1016/j.anai.2015.12.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 12/28/2015] [Accepted: 12/30/2015] [Indexed: 01/12/2023]
Abstract
OBJECTIVE As confirmed by systematic reviews and meta-analyses, allergen immunotherapy is clinically effective in the treatment of allergic diseases. In particular, subcutaneous immunotherapy is a pivotal treatment in patients with severe reactions to Hymenoptera venom, whereas subcutaneous immunotherapy and sublingual immunotherapy are indicated in the treatment of allergic rhinitis and asthma by inhalant allergens. Other allergies related to animal dander (other than cat, which is the most studied), such as dog, molds, occupational allergens, and insects, have also been recognized. For these allergens, immunotherapy is poorly studied and often unavailable. Thus, use of the term orphan immunotherapies is appropriate. DATA SOURCES We used MEDLINE to search the medical literature for English-language articles. STUDY SELECTION Randomized, controlled, masked studies for orphan immunotherapies were selected. In the remaining cases, the available reports were described. RESULTS The literature on food desensitization is abundant, but for other orphan allergens, such as mosquito, Argas reflexus, dog, or occupational allergens, there are only a few studies, and most are small studies or case reports. CONCLUSION Orphan immunotherapy is associated with insufficient evidence of efficacy from controlled trials, an erroneous belief of the limited importance of some allergen sources, and the unlikelihood for producers to have a profit in making commercially available extracts (with an expensive process for registration) to be used in few patients. It should be taken into consideration that adequate preparations should be available also for orphan allergens.
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148
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von Mutius E. The microbial environment and its influence on asthma prevention in early life. J Allergy Clin Immunol 2016; 137:680-9. [PMID: 26806048 DOI: 10.1016/j.jaci.2015.12.1301] [Citation(s) in RCA: 131] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 11/27/2015] [Accepted: 12/05/2015] [Indexed: 12/27/2022]
Abstract
There is accumulating evidence to suggest that the environmental microbiome plays a significant role in asthma development. The very low prevalence of asthma in populations highly exposed to microbial environments (farm children and Amish populations) highlights its preventive potential. This microbial diversity might be necessary to instruct a well-adapted immune response and regulated inflammatory responses to other inhaled and ingested environmental elements, such as allergens, particles, and viruses. Like the internal gut microbiome, which is increasingly recognized as an important instructor of immune maturation, the external environmental microbiome might shape immune responses on the skin, airway mucosal surfaces, and potentially also the gut early in life. The diversity of the external microbial world will ensure that of the many maladapted pathways leading to asthma development, most, if not all, will be counterbalanced. Likewise, important contributors to asthma, such as allergen sensitization and allergic manifestations early in life, are being suppressed. Thus the facets of innate immunity targeted by microbes and their compounds and metabolites might be the master switch to asthma and allergy protection, which has been found in environments rich in microbial exposures.
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Affiliation(s)
- Erika von Mutius
- Department of Pediatrics, Dr von Hauner Children's Hospital of Ludwig Maximilian University of Munich, Munich, Germany.
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149
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Sharpe RA, Cocq KL, Nikolaou V, Osborne NJ, Thornton CR. Identifying risk factors for exposure to culturable allergenic moulds in energy efficient homes by using highly specific monoclonal antibodies. ENVIRONMENTAL RESEARCH 2016; 144:32-42. [PMID: 26546982 DOI: 10.1016/j.envres.2015.10.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 10/19/2015] [Accepted: 10/27/2015] [Indexed: 06/05/2023]
Abstract
The aim of this study was to determine the accuracy of monoclonal antibodies (mAbs) in identifying culturable allergenic fungi present in visible mould growth in energy efficient homes, and to identify risk factors for exposure to these known allergenic fungi. Swabs were taken from fungal contaminated surfaces and culturable yeasts and moulds isolated by using mycological culture. Soluble antigens from cultures were tested by ELISA using mAbs specific to the culturable allergenic fungi Aspergillus and Penicillium spp., Ulocladium, Alternaria, and Epicoccum spp., Cladosporium spp., Fusarium spp., and Trichoderma spp. Diagnostic accuracies of the ELISA tests were determined by sequencing of the internally transcribed spacer 1 (ITS1)-5.8S-ITS2-encoding regions of recovered fungi following ELISA. There was 100% concordance between the two methods, with ELISAs providing genus-level identity and ITS sequencing providing species-level identities (210 out of 210 tested). Species of Aspergillus/Penicillium, Cladosporium, Ulocladium/Alternaria/Epicoccum, Fusarium and Trichoderma were detected in 82% of the samples. The presence of condensation was associated with an increased risk of surfaces being contaminated by Aspergillus/Penicillium spp. and Cladosporium spp., whereas moisture within the building fabric (water ingress/rising damp) was only associated with increased risk of Aspergillus/Penicillium spp. Property type and energy efficiency levels were found to moderate the risk of indoor surfaces becoming contaminated with Aspergillus/Penicillium and Cladosporium which in turn was modified by the presence of condensation, water ingress and rising damp, consistent with previous literature.
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Affiliation(s)
- Richard A Sharpe
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro TR1 3HD, United Kingdom
| | - Kate Le Cocq
- Rothamsted Research, North Wyke, Okehampton EX20 2SB, United Kingdom
| | - Vasilis Nikolaou
- University of Exeter Medical School, The Veysey Building, Salmon Pool Lane, Exeter EX2 4SG, United Kingdom
| | - Nicholas J Osborne
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro TR1 3HD, United Kingdom; Clinical Pharmacology and Toxicology Research Group, Discipline of Pharmacology, Sydney Medical School, The University of Sydney, NSW, Australia
| | - Christopher R Thornton
- Biosciences, College of Life and Environmental Sciences, University of Exeter, Exeter EX4 4QD, United Kingdom.
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150
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Wang X, Liu W, Hu Y, Zou Z, Shen L, Huang C. Home environment, lifestyles behaviors, and rhinitis in childhood. Int J Hyg Environ Health 2015; 219:220-31. [PMID: 26712524 DOI: 10.1016/j.ijheh.2015.11.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 11/05/2015] [Accepted: 11/25/2015] [Indexed: 11/24/2022]
Abstract
The prevalence of children allergic rhinitis has been increasing in China and associated factors still are not clear. In the present paper, we selected 13,335 parent-reported questionnaires of 4-6 years-old children, in a cross-sectional study from April 2011 to April 2012 in Shanghai city, and investigated associations of various factors with parent-reported allergic rhinitis (doctor-diagnosed) and rhinitis symptoms in childhood. After adjusted by age, sex, family history of atopy, and respondent of questionnaire, we find that no siblings, mother in older age during pregnancy, shorter breastfeeding, using antibiotics in the first year, and home dampness-related exposures, had significant associations with increased prevalence of the studied diseases. Location, type, building area, decoration materials and construction period of the residence, also had significant associations with these diseases. Current parental smoking and pet-keeping had no significant associations with the studied diseases. Incense-burning and using mosquito coils had significant associations with reduced risk of allergic rhinitis and with increased risk of rhinitis symptoms. Using air cleaner and cleaning the residence in high frequency had associations with increased risk, but eating fast food and ice cream often had associations with the reduced risk, of the studied diseases. Families with children being diagnosed allergic rhinitis likely change their lifestyle behaviors. In conclusion, childhood rhinitis could be influenced by heredity and many "environmental exposures". Avoidance behaviors and reverse causation in parental smoking, pet-keeping, and dietary habits for childhood rhinitis should be carefully considered.
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Affiliation(s)
- Xueying Wang
- Department of Building Environment and Energy Engineering, School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, PR China
| | - Wei Liu
- Department of Building Environment and Energy Engineering, School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, PR China
| | - Yu Hu
- Tongji Architectural Design (Group) Company Limited (TJAD), Shanghai, PR China
| | - Zhijun Zou
- Department of Building Environment and Energy Engineering, School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, PR China
| | - Li Shen
- R&B Technology (Shanghai) Company Limited, Shanghai, PR China
| | - Chen Huang
- Department of Building Environment and Energy Engineering, School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, PR China.
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