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Wang J, Gueye-Ndiaye S, Castro-Diehl C, Bhaskar S, Li L, Tully M, Rueschman M, Owens J, Gold DR, Chen J, Phipatanakul W, Adamkiewicz G, Redline S. Associations between indoor fine particulate matter (PM 2.5) and sleep-disordered breathing in an urban sample of school-aged children. Sleep Health 2024:S2352-7218(24)00133-5. [PMID: 39095254 DOI: 10.1016/j.sleh.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 05/12/2024] [Accepted: 06/25/2024] [Indexed: 08/04/2024]
Abstract
OBJECTIVES Environmental risk factors may contribute to sleep-disordered breathing. We investigated the association between indoor particulate matter ≤2.5µm in aerodynamic diameter (PM2.5) and sleep-disordered breathing in children in an urban US community. METHODS The sample consisted of children aged 6-12years living in predominantly low-income neighborhoods in Boston, Massachusetts. Indoor PM2.5 was measured in participants' main living areas for 7days using the Environmental Multipollutant Monitoring Assembly device. High indoor PM2.5 exposure was defined as greater than the sample weekly average 80th percentile level (≥15.6 μg/m3). Sleep-disordered breathing was defined as an Apnea-Hypopnea-Index (AHI) or Oxygen-Desaturation-Index (ODI) (≥3% desaturation) of ≥5 events/hour. Habitual loud snoring was defined as caregiver-report of loud snoring (most or all the time each week) over the past 4weeks. We examined the associations of PM2.5 with sleep-disordered breathing or snoring using logistic regression adjusting for potential confounders. RESULTS The sample included 260 children (mean age 9.6years; 41% female), with 32% (n = 76) classified as having sleep-disordered breathing. In a logistic regression model adjusted for socioeconomics and seasonality, children exposed to high indoor PM2.5 levels (n = 53) had a 3.53-fold increased odds for sleep-disordered breathing (95%CI: 1.57, 8.11, p = .002) compared to those with lower indoor PM2.5. This association persisted after additional adjustments for physical activity, outdoor PM2.5, environmental tobacco smoke, and health characteristics. Similar associations were observed for snoring and indoor PM2.5. CONCLUSIONS: Children with higher indoor PM2.5 exposure had greater odds of sleep-disordered breathing and habitual loud snoring, suggesting that indoor air quality contributes to sleep disparities.
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Affiliation(s)
- Jing Wang
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Seyni Gueye-Ndiaye
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Pulmonary and Sleep Medicine, Boston Children's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Cecilia Castro-Diehl
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Sanjana Bhaskar
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Le Li
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Meg Tully
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Michael Rueschman
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Judith Owens
- Division of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Diane R Gold
- Harvard Medical School, Boston, Massachusetts, USA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jarvis Chen
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Wanda Phipatanakul
- Harvard Medical School, Boston, Massachusetts, USA; Division of Allergy and Immunology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Gary Adamkiewicz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
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Bignier C, Havet L, Brisoux M, Omeiche C, Misra S, Gonsard A, Drummond D. Climate change and children's respiratory health. Paediatr Respir Rev 2024:S1526-0542(24)00056-3. [PMID: 39107182 DOI: 10.1016/j.prrv.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 07/19/2024] [Accepted: 07/22/2024] [Indexed: 08/09/2024]
Abstract
Climate change has significant consequences for children's respiratory health. Rising temperatures and extreme weather events increase children's exposure to allergens, mould, and air pollutants. Children are particularly vulnerable to these airborne particles due to their higher ventilation per unit of body weight, more frequent mouth breathing, and outdoor activities. Children with asthma and cystic fibrosis are at particularly high risk, with increased risks of exacerbation, but the effects of climate change could also be observed in the general population, with a risk of impaired lung development and growth. Mitigation measures, including reducing greenhouse gas emissions by healthcare professionals and healthcare systems, and adaptation measures, such as limiting outdoor activities during pollution peaks, are essential to preserve children's respiratory health. The mobilisation of society as a whole, including paediatricians, is crucial to limit the impact of climate change on children's respiratory health.
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Affiliation(s)
| | | | | | | | | | - Apolline Gonsard
- Service de pneumologie et d'allergologie pédiatrique, hôpital universitaire Necker-Enfants-Malades, AP-HP, Paris, France
| | - David Drummond
- Université Paris Cité, Paris, France; Service de pneumologie et d'allergologie pédiatrique, hôpital universitaire Necker-Enfants-Malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France; Inserm UMR 1138, équipe HeKA, Centre de Recherche des Cordeliers, France.
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Kouis P, Galanakis E, Michaelidou E, Kinni P, Michanikou A, Pitsios C, Perez J, Achilleos S, Middleton N, Anagnostopoulou P, Dimitriou H, Revvas E, Stamatelatos G, Zacharatos H, Savvides C, Vasiliadou E, Kalivitis N, Chrysanthou A, Tymvios F, Papatheodorou SI, Koutrakis P, Yiallouros PK. Improved childhood asthma control after exposure reduction interventions for desert dust and anthropogenic air pollution: the MEDEA randomised controlled trial. Thorax 2024; 79:495-507. [PMID: 38388489 DOI: 10.1136/thorax-2023-220877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 02/05/2024] [Indexed: 02/24/2024]
Abstract
INTRODUCTION Elevated particulate matter (PM) concentrations of anthropogenic and/or desert dust origin are associated with increased morbidity among children with asthma. OBJECTIVE The Mitigating the Health Effects of Desert Dust Storms Using Exposure-Reduction Approaches randomised controlled trial assessed the impact of exposure reduction recommendations, including indoor air filtration, on childhood asthma control during high desert dust storms (DDS) season in Cyprus and Greece. DESIGN, PARTICIPANTS, INTERVENTIONS AND SETTING Primary school children with asthma were randomised into three parallel groups: (a) no intervention (controls); (b) outdoor intervention (early alerts notifications, recommendations to stay indoors and limit outdoor physical activity during DDS) and (c) combined intervention (same as (b) combined with indoor air purification with high efficiency particulate air filters in children's homes and school classrooms. Asthma symptom control was assessed using the childhood Asthma Control Test (c-ACT), spirometry (forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC)) and fractional exhaled nitric oxide (FeNO). RESULTS In total, 182 children with asthma (age; mean=9.5, SD=1.63) were evaluated during 2019 and 2021. After three follow-up months, the combined intervention group demonstrated a significant improvement in c-ACT in comparison to controls (β=2.63, 95% CI 0.72 to 4.54, p=0.007), which was more profound among atopic children (β=3.56, 95% CI 0.04 to 7.07, p=0.047). Similarly, FEV1% predicted (β=4.26, 95% CI 0.54 to 7.99, p=0.025), the need for any asthma medication and unscheduled clinician visits, but not FVC% and FeNO, were significantly improved in the combined intervention compared with controls. CONCLUSION Recommendations to reduce exposure and use of indoor air filtration in areas with high PM pollution may improve symptom control and lung function in children with asthma. TRIAL REGISTRATION NUMBER NCT03503812.
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Affiliation(s)
- Panayiotis Kouis
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus
| | | | | | - Paraskevi Kinni
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus
| | - Antonis Michanikou
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus
| | - Constantinos Pitsios
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus
| | | | - Souzana Achilleos
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
- Cyprus International Institute for Environmental and Public Health, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Nicos Middleton
- Department of Nursing, Faculty of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | | | | | | | | | | | - Chrysanthos Savvides
- Air Quality and Strategic Planning Section, Department of Labour Inspection, Ministry of Labour, Welfare and Social Insurance, Nicosia, Cyprus
| | - Emily Vasiliadou
- Air Quality and Strategic Planning Section, Department of Labour Inspection, Ministry of Labour, Welfare and Social Insurance, Nicosia, Cyprus
| | - Nikos Kalivitis
- Department of Chemistry, University of Crete, Heraklion, Greece
| | - Andreas Chrysanthou
- Department of Meteorology, Ministry of Agriculture, Rural Development and Environment, Nicosia, Cyprus
| | - Filippos Tymvios
- Department of Meteorology, Ministry of Agriculture, Rural Development and Environment, Heraklion, Cyprus
| | - Stefania I Papatheodorou
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, Massachusetts, USA
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, New Brunswick, New Jersey, USA
| | - Petros Koutrakis
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, Massachusetts, USA
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Ebrahimifakhar A, Poursadegh M, Hu Y, Yuill DP, Luo Y. A systematic review and meta-analysis of field studies of portable air cleaners: Performance, user behavior, and by-product emissions. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 912:168786. [PMID: 38008326 DOI: 10.1016/j.scitotenv.2023.168786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/08/2023] [Accepted: 11/20/2023] [Indexed: 11/28/2023]
Abstract
Indoor air quality is important for the health of building occupants, and public interest in controlling indoor airborne pathogens increased dramatically with the COVID-19 pandemic. Pollutant concentrations can be controlled locally using portable air cleaners (sometimes called air purifiers), which allow occupants to apply air cleaning technology to meet their needs in the location and times that they find appropriate. This paper provides a systematic review of scientific literature that describes field studies of the effectiveness of portable air cleaners. Over 500 papers were considered, and 148 were reviewed in detail, to extract 35 specific research results (e.g., particulate removal performance) or characteristics (e.g., type of building). These were aggregated to provide an overview of results and approaches to this type of research, and to provide meta-analyses of the results. The review includes: descriptions of the geographical location of the research; rate of publications over time; types of buildings and occupants in the field study; types of air cleaner technology being tested; pollutants being measured; resulting pollutant removal effectiveness; patterns of usage and potential barriers to usage by occupants; and the potential for by-product emissions in some air cleaner technologies. An example result is that 83 of the 148 papers measured reductions in fine particulates (PM2.5) and found a mean reduction of 49 % with standard deviation of 20 %. The aggregated results were approximately normally distributed, ranging from finding no significant reduction up to a maximum above 90 % reduction. Sixteen of the 148 papers considered gaseous pollutants, such as volatile organic compounds, nitrogen dioxide, and ozone; 36 papers considered biological pollutants, such as bacteria, viruses, pollen, fungi, etc. An important challenge, common to several studies, is that occupants run the air cleaners for shorter periods and on low airflow rate settings, because of concerns about noise, drafts, and electricity cost, which significantly reduces air cleaning effectiveness.
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Affiliation(s)
- Amir Ebrahimifakhar
- Delos Labs, Delos, New York, NY 10014, USA; Durham School of Architectural Engineering and Construction, University of Nebraska - Lincoln, 1110 S. 67th Street, Omaha, NE 68182, USA.
| | - Mehrdad Poursadegh
- Durham School of Architectural Engineering and Construction, University of Nebraska - Lincoln, 1110 S. 67th Street, Omaha, NE 68182, USA.
| | - Yifeng Hu
- Durham School of Architectural Engineering and Construction, University of Nebraska - Lincoln, 1110 S. 67th Street, Omaha, NE 68182, USA; Buildings and Transportation Science Division, Oak Ridge National Laboratory, Oak Ridge, TN 37830, USA.
| | - David P Yuill
- Durham School of Architectural Engineering and Construction, University of Nebraska - Lincoln, 1110 S. 67th Street, Omaha, NE 68182, USA.
| | - Yu Luo
- Department of Applied Physics and Applied Mathematics, Columbia University, 500 W. 120th Street, New York, NY 10027, USA.
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Perry TT, Grant TL, Dantzer JA, Udemgba C, Jefferson AA. Impact of socioeconomic factors on allergic diseases. J Allergy Clin Immunol 2024; 153:368-377. [PMID: 37967769 PMCID: PMC10922531 DOI: 10.1016/j.jaci.2023.10.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/13/2023] [Accepted: 10/25/2023] [Indexed: 11/17/2023]
Abstract
Allergic and immunologic conditions, including asthma, food allergy, atopic dermatitis, and allergic rhinitis, are among the most common chronic conditions in children and adolescents that often last into adulthood. Although rare, inborn errors of immunity are life-altering and potentially fatal if unrecognized or untreated. Thus, allergic and immunologic conditions are both medical and public health issues that are profoundly affected by socioeconomic factors. Recently, studies have highlighted societal issues to evaluate factors at multiple levels that contribute to health inequities and the potential steps toward closing those gaps. Socioeconomic disparities can influence all aspects of care, including health care access and quality, diagnosis, management, education, and disease prevalence and outcomes. Ongoing research, engagement, and deliberate investment of resources by relevant stakeholders and advocacy approaches are needed to identify and address the impact of socioeconomics on health care disparities and outcomes among patients with allergic and immunologic diseases.
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Affiliation(s)
- Tamara T Perry
- University of Arkansas for Medical Sciences, Little Rock, Ark; Arkansas Children's Research Institute, Little Rock, Ark.
| | - Torie L Grant
- Johns Hopkins University School of Medicine, Baltimore, Md
| | | | - Chioma Udemgba
- National Institute of Allergic and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Akilah A Jefferson
- University of Arkansas for Medical Sciences, Little Rock, Ark; Arkansas Children's Research Institute, Little Rock, Ark
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Zhang AM, Banzon TM, Phipatanakul W. The spectrum of environmental disparities in asthma. J Allergy Clin Immunol 2024; 153:398-400. [PMID: 37717627 PMCID: PMC11332658 DOI: 10.1016/j.jaci.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/30/2023] [Accepted: 09/07/2023] [Indexed: 09/19/2023]
Affiliation(s)
| | - Tina M Banzon
- Division of Allergy and Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Wanda Phipatanakul
- Division of Allergy and Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Mass.
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7
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Gueye-Ndiaye S, Hauptman M, Yu X, Li L, Rueschman M, Castro-Diehl C, Sofer T, Owens J, Gold DR, Adamkiewicz G, Metwali N, Thorne PS, Phipatanakul W, Redline S. Multilevel Risk Factors for Sleep-Disordered Breathing-Related Symptom Burden in an Urban Pediatric Community-Based Sample. CHEST PULMONARY 2023; 1:100019. [PMID: 38222082 PMCID: PMC10786403 DOI: 10.1016/j.chpulm.2023.100019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
BACKGROUND Pediatric sleep-disordered breathing (SDB) disproportionately affects children with low socioeconomic status (SES). The multilevel risk factors that drive these associations are not well understood. RESEARCH QUESTION What are the associations between SDB risk factors, including individual health conditions (obesity, asthma, and allergies), household SES (maternal education), indoor exposures (environmental tobacco smoke [ETS] and pests), and neighborhood characteristics (neighborhood disadvantage), and pediatric SDB symptoms? STUDY DESIGN AND METHODS Cross-sectional analyses were performed on 303 children (aged 6-12 years) enrolled in the Environmental Assessment of Sleep Youth study from 2018 to 2022. Exposures were determined by caregiver reports, assays of measured settled dust from the child's bedroom, and neighborhood-level Census data (deriving the Childhood Opportunity Index to characterize neighborhood disadvantage). The primary outcome was the SDB-related symptom burden assessed by the OSA-18 questionnaire total score. Using linear regression models, we calculated associations between exposures and SDB-related symptom burden, adjusting for sociodemographic factors, then health conditions, indoor environment, and neighborhood factors. RESULTS The sample included 303 children (39% Hispanic, Latino, Latina, or Spanish origin; 30% Black or African American; 22% White; and 11% other). Increasing OSA-18 total scores were associated with low household SES after adjustment for demographic factors, and with asthma, allergies, ETS, pests (mouse, cockroach, and rodents), and an indoor environmental index (sum of the presence of pests and ETS; 0-2) after adjusting for sociodemographic factors. Even after further adjusting for asthma, allergies, and neighborhood disadvantage, ETS and pest exposure were associated with OSA-18 (ETS: β = 12.80; 95% CI, 7.07-18.53, also adjusted for pest; pest exposure: β = 3.69; 95% CI, 0.44-6.94, also adjusted for ETS). INTERPRETATION In addition to associations with ETS, a novel association was observed for indoor pest exposure and SDB symptom burden. Strategies to reduce household exposure to ETS and indoor allergens should be tested as approaches for reducing sleep health disparities.
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Affiliation(s)
- Seyni Gueye-Ndiaye
- Harvard Medical School (S. G.-N., M. H., X. Y., L. L., M. R., C. C.-D., J. O., D. R. G., W. P., and S. R.); the Division of Sleep and Circadian Disorders (S. G.-N., X. Y., L. L., M. R., C. C.-D., and S. R.), Brigham and Women's Hospital; the Division of Pulmonary and Sleep Medicine(S. G.-N.), Boston Children's Hospital; the Division of General Pediatrics (M. H.), Boston Children's Hospital; the Region1 New England Pediatric Environmental Health Specialty Unit (PEHSU) (M. H.); the Department of Statistics (T. S.), Harvard T.H. Chan School of Public Health; the Division of Neurology (J. O.), Boston Children's Hospital; the Department of Medicine (D. R. G.), Brigham and Women's Hospital; the Department of Environmental Medicine (D. R. G. and G. A.), Harvard T.H. Chan School of Public Health; the Department of Occupational and Environmental Health (N. M. and P. S. T.), University of Iowa College of Public Health; the Division of Allergy/Immunology (W. P.), Boston Children's Hospital; and the Department of Epidemiology (S. R.), Harvard T.H. Chan School of Public Health
| | - Marissa Hauptman
- Harvard Medical School (S. G.-N., M. H., X. Y., L. L., M. R., C. C.-D., J. O., D. R. G., W. P., and S. R.); the Division of Sleep and Circadian Disorders (S. G.-N., X. Y., L. L., M. R., C. C.-D., and S. R.), Brigham and Women's Hospital; the Division of Pulmonary and Sleep Medicine(S. G.-N.), Boston Children's Hospital; the Division of General Pediatrics (M. H.), Boston Children's Hospital; the Region1 New England Pediatric Environmental Health Specialty Unit (PEHSU) (M. H.); the Department of Statistics (T. S.), Harvard T.H. Chan School of Public Health; the Division of Neurology (J. O.), Boston Children's Hospital; the Department of Medicine (D. R. G.), Brigham and Women's Hospital; the Department of Environmental Medicine (D. R. G. and G. A.), Harvard T.H. Chan School of Public Health; the Department of Occupational and Environmental Health (N. M. and P. S. T.), University of Iowa College of Public Health; the Division of Allergy/Immunology (W. P.), Boston Children's Hospital; and the Department of Epidemiology (S. R.), Harvard T.H. Chan School of Public Health
| | - Xinting Yu
- Harvard Medical School (S. G.-N., M. H., X. Y., L. L., M. R., C. C.-D., J. O., D. R. G., W. P., and S. R.); the Division of Sleep and Circadian Disorders (S. G.-N., X. Y., L. L., M. R., C. C.-D., and S. R.), Brigham and Women's Hospital; the Division of Pulmonary and Sleep Medicine(S. G.-N.), Boston Children's Hospital; the Division of General Pediatrics (M. H.), Boston Children's Hospital; the Region1 New England Pediatric Environmental Health Specialty Unit (PEHSU) (M. H.); the Department of Statistics (T. S.), Harvard T.H. Chan School of Public Health; the Division of Neurology (J. O.), Boston Children's Hospital; the Department of Medicine (D. R. G.), Brigham and Women's Hospital; the Department of Environmental Medicine (D. R. G. and G. A.), Harvard T.H. Chan School of Public Health; the Department of Occupational and Environmental Health (N. M. and P. S. T.), University of Iowa College of Public Health; the Division of Allergy/Immunology (W. P.), Boston Children's Hospital; and the Department of Epidemiology (S. R.), Harvard T.H. Chan School of Public Health
| | - Le Li
- Harvard Medical School (S. G.-N., M. H., X. Y., L. L., M. R., C. C.-D., J. O., D. R. G., W. P., and S. R.); the Division of Sleep and Circadian Disorders (S. G.-N., X. Y., L. L., M. R., C. C.-D., and S. R.), Brigham and Women's Hospital; the Division of Pulmonary and Sleep Medicine(S. G.-N.), Boston Children's Hospital; the Division of General Pediatrics (M. H.), Boston Children's Hospital; the Region1 New England Pediatric Environmental Health Specialty Unit (PEHSU) (M. H.); the Department of Statistics (T. S.), Harvard T.H. Chan School of Public Health; the Division of Neurology (J. O.), Boston Children's Hospital; the Department of Medicine (D. R. G.), Brigham and Women's Hospital; the Department of Environmental Medicine (D. R. G. and G. A.), Harvard T.H. Chan School of Public Health; the Department of Occupational and Environmental Health (N. M. and P. S. T.), University of Iowa College of Public Health; the Division of Allergy/Immunology (W. P.), Boston Children's Hospital; and the Department of Epidemiology (S. R.), Harvard T.H. Chan School of Public Health
| | - Michael Rueschman
- Harvard Medical School (S. G.-N., M. H., X. Y., L. L., M. R., C. C.-D., J. O., D. R. G., W. P., and S. R.); the Division of Sleep and Circadian Disorders (S. G.-N., X. Y., L. L., M. R., C. C.-D., and S. R.), Brigham and Women's Hospital; the Division of Pulmonary and Sleep Medicine(S. G.-N.), Boston Children's Hospital; the Division of General Pediatrics (M. H.), Boston Children's Hospital; the Region1 New England Pediatric Environmental Health Specialty Unit (PEHSU) (M. H.); the Department of Statistics (T. S.), Harvard T.H. Chan School of Public Health; the Division of Neurology (J. O.), Boston Children's Hospital; the Department of Medicine (D. R. G.), Brigham and Women's Hospital; the Department of Environmental Medicine (D. R. G. and G. A.), Harvard T.H. Chan School of Public Health; the Department of Occupational and Environmental Health (N. M. and P. S. T.), University of Iowa College of Public Health; the Division of Allergy/Immunology (W. P.), Boston Children's Hospital; and the Department of Epidemiology (S. R.), Harvard T.H. Chan School of Public Health
| | - Cecilia Castro-Diehl
- Harvard Medical School (S. G.-N., M. H., X. Y., L. L., M. R., C. C.-D., J. O., D. R. G., W. P., and S. R.); the Division of Sleep and Circadian Disorders (S. G.-N., X. Y., L. L., M. R., C. C.-D., and S. R.), Brigham and Women's Hospital; the Division of Pulmonary and Sleep Medicine(S. G.-N.), Boston Children's Hospital; the Division of General Pediatrics (M. H.), Boston Children's Hospital; the Region1 New England Pediatric Environmental Health Specialty Unit (PEHSU) (M. H.); the Department of Statistics (T. S.), Harvard T.H. Chan School of Public Health; the Division of Neurology (J. O.), Boston Children's Hospital; the Department of Medicine (D. R. G.), Brigham and Women's Hospital; the Department of Environmental Medicine (D. R. G. and G. A.), Harvard T.H. Chan School of Public Health; the Department of Occupational and Environmental Health (N. M. and P. S. T.), University of Iowa College of Public Health; the Division of Allergy/Immunology (W. P.), Boston Children's Hospital; and the Department of Epidemiology (S. R.), Harvard T.H. Chan School of Public Health
| | - Tamar Sofer
- Harvard Medical School (S. G.-N., M. H., X. Y., L. L., M. R., C. C.-D., J. O., D. R. G., W. P., and S. R.); the Division of Sleep and Circadian Disorders (S. G.-N., X. Y., L. L., M. R., C. C.-D., and S. R.), Brigham and Women's Hospital; the Division of Pulmonary and Sleep Medicine(S. G.-N.), Boston Children's Hospital; the Division of General Pediatrics (M. H.), Boston Children's Hospital; the Region1 New England Pediatric Environmental Health Specialty Unit (PEHSU) (M. H.); the Department of Statistics (T. S.), Harvard T.H. Chan School of Public Health; the Division of Neurology (J. O.), Boston Children's Hospital; the Department of Medicine (D. R. G.), Brigham and Women's Hospital; the Department of Environmental Medicine (D. R. G. and G. A.), Harvard T.H. Chan School of Public Health; the Department of Occupational and Environmental Health (N. M. and P. S. T.), University of Iowa College of Public Health; the Division of Allergy/Immunology (W. P.), Boston Children's Hospital; and the Department of Epidemiology (S. R.), Harvard T.H. Chan School of Public Health
| | - Judith Owens
- Harvard Medical School (S. G.-N., M. H., X. Y., L. L., M. R., C. C.-D., J. O., D. R. G., W. P., and S. R.); the Division of Sleep and Circadian Disorders (S. G.-N., X. Y., L. L., M. R., C. C.-D., and S. R.), Brigham and Women's Hospital; the Division of Pulmonary and Sleep Medicine(S. G.-N.), Boston Children's Hospital; the Division of General Pediatrics (M. H.), Boston Children's Hospital; the Region1 New England Pediatric Environmental Health Specialty Unit (PEHSU) (M. H.); the Department of Statistics (T. S.), Harvard T.H. Chan School of Public Health; the Division of Neurology (J. O.), Boston Children's Hospital; the Department of Medicine (D. R. G.), Brigham and Women's Hospital; the Department of Environmental Medicine (D. R. G. and G. A.), Harvard T.H. Chan School of Public Health; the Department of Occupational and Environmental Health (N. M. and P. S. T.), University of Iowa College of Public Health; the Division of Allergy/Immunology (W. P.), Boston Children's Hospital; and the Department of Epidemiology (S. R.), Harvard T.H. Chan School of Public Health
| | - Diane R Gold
- Harvard Medical School (S. G.-N., M. H., X. Y., L. L., M. R., C. C.-D., J. O., D. R. G., W. P., and S. R.); the Division of Sleep and Circadian Disorders (S. G.-N., X. Y., L. L., M. R., C. C.-D., and S. R.), Brigham and Women's Hospital; the Division of Pulmonary and Sleep Medicine(S. G.-N.), Boston Children's Hospital; the Division of General Pediatrics (M. H.), Boston Children's Hospital; the Region1 New England Pediatric Environmental Health Specialty Unit (PEHSU) (M. H.); the Department of Statistics (T. S.), Harvard T.H. Chan School of Public Health; the Division of Neurology (J. O.), Boston Children's Hospital; the Department of Medicine (D. R. G.), Brigham and Women's Hospital; the Department of Environmental Medicine (D. R. G. and G. A.), Harvard T.H. Chan School of Public Health; the Department of Occupational and Environmental Health (N. M. and P. S. T.), University of Iowa College of Public Health; the Division of Allergy/Immunology (W. P.), Boston Children's Hospital; and the Department of Epidemiology (S. R.), Harvard T.H. Chan School of Public Health
| | - Gary Adamkiewicz
- Harvard Medical School (S. G.-N., M. H., X. Y., L. L., M. R., C. C.-D., J. O., D. R. G., W. P., and S. R.); the Division of Sleep and Circadian Disorders (S. G.-N., X. Y., L. L., M. R., C. C.-D., and S. R.), Brigham and Women's Hospital; the Division of Pulmonary and Sleep Medicine(S. G.-N.), Boston Children's Hospital; the Division of General Pediatrics (M. H.), Boston Children's Hospital; the Region1 New England Pediatric Environmental Health Specialty Unit (PEHSU) (M. H.); the Department of Statistics (T. S.), Harvard T.H. Chan School of Public Health; the Division of Neurology (J. O.), Boston Children's Hospital; the Department of Medicine (D. R. G.), Brigham and Women's Hospital; the Department of Environmental Medicine (D. R. G. and G. A.), Harvard T.H. Chan School of Public Health; the Department of Occupational and Environmental Health (N. M. and P. S. T.), University of Iowa College of Public Health; the Division of Allergy/Immunology (W. P.), Boston Children's Hospital; and the Department of Epidemiology (S. R.), Harvard T.H. Chan School of Public Health
| | - Nervana Metwali
- Harvard Medical School (S. G.-N., M. H., X. Y., L. L., M. R., C. C.-D., J. O., D. R. G., W. P., and S. R.); the Division of Sleep and Circadian Disorders (S. G.-N., X. Y., L. L., M. R., C. C.-D., and S. R.), Brigham and Women's Hospital; the Division of Pulmonary and Sleep Medicine(S. G.-N.), Boston Children's Hospital; the Division of General Pediatrics (M. H.), Boston Children's Hospital; the Region1 New England Pediatric Environmental Health Specialty Unit (PEHSU) (M. H.); the Department of Statistics (T. S.), Harvard T.H. Chan School of Public Health; the Division of Neurology (J. O.), Boston Children's Hospital; the Department of Medicine (D. R. G.), Brigham and Women's Hospital; the Department of Environmental Medicine (D. R. G. and G. A.), Harvard T.H. Chan School of Public Health; the Department of Occupational and Environmental Health (N. M. and P. S. T.), University of Iowa College of Public Health; the Division of Allergy/Immunology (W. P.), Boston Children's Hospital; and the Department of Epidemiology (S. R.), Harvard T.H. Chan School of Public Health
| | - Peter S Thorne
- Harvard Medical School (S. G.-N., M. H., X. Y., L. L., M. R., C. C.-D., J. O., D. R. G., W. P., and S. R.); the Division of Sleep and Circadian Disorders (S. G.-N., X. Y., L. L., M. R., C. C.-D., and S. R.), Brigham and Women's Hospital; the Division of Pulmonary and Sleep Medicine(S. G.-N.), Boston Children's Hospital; the Division of General Pediatrics (M. H.), Boston Children's Hospital; the Region1 New England Pediatric Environmental Health Specialty Unit (PEHSU) (M. H.); the Department of Statistics (T. S.), Harvard T.H. Chan School of Public Health; the Division of Neurology (J. O.), Boston Children's Hospital; the Department of Medicine (D. R. G.), Brigham and Women's Hospital; the Department of Environmental Medicine (D. R. G. and G. A.), Harvard T.H. Chan School of Public Health; the Department of Occupational and Environmental Health (N. M. and P. S. T.), University of Iowa College of Public Health; the Division of Allergy/Immunology (W. P.), Boston Children's Hospital; and the Department of Epidemiology (S. R.), Harvard T.H. Chan School of Public Health
| | - Wanda Phipatanakul
- Harvard Medical School (S. G.-N., M. H., X. Y., L. L., M. R., C. C.-D., J. O., D. R. G., W. P., and S. R.); the Division of Sleep and Circadian Disorders (S. G.-N., X. Y., L. L., M. R., C. C.-D., and S. R.), Brigham and Women's Hospital; the Division of Pulmonary and Sleep Medicine(S. G.-N.), Boston Children's Hospital; the Division of General Pediatrics (M. H.), Boston Children's Hospital; the Region1 New England Pediatric Environmental Health Specialty Unit (PEHSU) (M. H.); the Department of Statistics (T. S.), Harvard T.H. Chan School of Public Health; the Division of Neurology (J. O.), Boston Children's Hospital; the Department of Medicine (D. R. G.), Brigham and Women's Hospital; the Department of Environmental Medicine (D. R. G. and G. A.), Harvard T.H. Chan School of Public Health; the Department of Occupational and Environmental Health (N. M. and P. S. T.), University of Iowa College of Public Health; the Division of Allergy/Immunology (W. P.), Boston Children's Hospital; and the Department of Epidemiology (S. R.), Harvard T.H. Chan School of Public Health
| | - Susan Redline
- Harvard Medical School (S. G.-N., M. H., X. Y., L. L., M. R., C. C.-D., J. O., D. R. G., W. P., and S. R.); the Division of Sleep and Circadian Disorders (S. G.-N., X. Y., L. L., M. R., C. C.-D., and S. R.), Brigham and Women's Hospital; the Division of Pulmonary and Sleep Medicine(S. G.-N.), Boston Children's Hospital; the Division of General Pediatrics (M. H.), Boston Children's Hospital; the Region1 New England Pediatric Environmental Health Specialty Unit (PEHSU) (M. H.); the Department of Statistics (T. S.), Harvard T.H. Chan School of Public Health; the Division of Neurology (J. O.), Boston Children's Hospital; the Department of Medicine (D. R. G.), Brigham and Women's Hospital; the Department of Environmental Medicine (D. R. G. and G. A.), Harvard T.H. Chan School of Public Health; the Department of Occupational and Environmental Health (N. M. and P. S. T.), University of Iowa College of Public Health; the Division of Allergy/Immunology (W. P.), Boston Children's Hospital; and the Department of Epidemiology (S. R.), Harvard T.H. Chan School of Public Health
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8
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Brainard J, Jones NR, Swindells IC, Archer EJ, Kolyva A, Letley C, Pond K, Lake IR, Hunter PR. Effectiveness of filtering or decontaminating air to reduce or prevent respiratory infections: A systematic review. Prev Med 2023; 177:107774. [PMID: 37992976 DOI: 10.1016/j.ypmed.2023.107774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 11/05/2023] [Accepted: 11/07/2023] [Indexed: 11/24/2023]
Abstract
Installation of technologies to remove or deactivate respiratory pathogens from indoor air is a plausible non-pharmaceutical infectious disease control strategy. OBJECTIVE We undertook a systematic review of worldwide observational and experimental studies, published 1970-2022, to synthesise evidence about the effectiveness of suitable indoor air treatment technologies to prevent respiratory or gastrointestinal infections. METHODS We searched for data about infection and symptom outcomes for persons who spent minimum 20 h/week in shared indoor spaces subjected to air treatment strategies hypothesised to change risk of respiratory or gastrointestinal infections or symptoms. RESULTS Pooled data from 32 included studies suggested no net benefits of air treatment technologies for symptom severity or symptom presence, in absence of confirmed infection. Infection incidence was lower in three cohort studies for persons exposed to high efficiency particulate air filtration (RR 0.4, 95%CI 0.28-0.58, p < 0.001) and in one cohort study that combined ionisers with electrostatic nano filtration (RR 0.08, 95%CI 0.01-0.60, p = 0.01); other types of air treatment technologies and air treatment in other study designs were not strongly linked to fewer infections. The infection outcome data exhibited strong publication bias. CONCLUSIONS Although environmental and surface samples are reduced after air treatment by several air treatment strategies, especially germicidal lights and high efficiency particulate air filtration, robust evidence has yet to emerge that these technologies are effective at reducing respiratory or gastrointestinal infections in real world settings. Data from several randomised trials have yet to report and will be welcome to the evidence base.
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Affiliation(s)
- Julii Brainard
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK.
| | - Natalia R Jones
- School of Environmental Sciences, University of East Anglia, Norwich NR4 7TJ, UK.
| | | | - Elizabeth J Archer
- School of Life Sciences, University of Essex, Wivenhoe Park, Colchester CO4 3SQ, UK.
| | - Anastasia Kolyva
- Norfolk and Norwich University Hospital Trust, Norwich NR4 7UY, UK.
| | - Charlotte Letley
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK.
| | - Katharine Pond
- Department of Civil and Environmental Engineering, University of Surrey, Guildford GU2 7XH, UK.
| | - Iain R Lake
- School of Environmental Sciences, University of East Anglia, Norwich NR4 7TJ, UK.
| | - Paul R Hunter
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK.
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9
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Yang X, Xu D, Wen B, Ji J, Zhang Z, Li L, Zhang S, Zhi H, Kong J, Wang C, Wang J, Ruan H, Zhang M, Wei L, Dong B, Wang Q. The mediating role of exhaled breath condensate metabolites in the effect of particulate matter on pulmonary function in schoolchildren: A crossover intervention study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 898:165517. [PMID: 37459994 DOI: 10.1016/j.scitotenv.2023.165517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 07/06/2023] [Accepted: 07/11/2023] [Indexed: 07/27/2023]
Abstract
The role played by metabolites in exhaled breath condensate (EBC) in the effect of PM on schoolchildren's pulmonary function has received little attention. Accordingly, we examined whether metabolites in EBC mediated the effect of PM10, PM2.5, and PM1 on the pulmonary function of schoolchildren at a residential primary school who had received an air-cleaner cross-over intervention. Samples of EBC were collected from a total of 60 schoolchildren and subjected to metabolomics analysis. We found that the effect of PM on six pulmonary function indicators was mediated by the following nine lipid peroxidation-related and energy metabolism-related metabolites present in EBC: 4-hydroxynonenal, arachidoyl ethanolamide, dl-pyroglutamic acid, 5-deoxy-d-glucose, myristic acid, lauric acid, linoleic acid, l-proline, and palmitic acid. However, while all nine of these metabolites mediated the effects of PM on boys' pulmonary function, only 4-hydroxynonenal, arachidoyl ethanolamide, and dl-pyroglutamic acid mediated the effects of PM on girls' pulmonary function. Overall, our results show that (1) short-term exposure to PM affected the schoolchildren's pulmonary function by causing an imbalance between lipid peroxidation and glutathione-based antioxidant activity and by perturbing energy metabolism in respiratory system and (2) there was a sex-dependent antioxidant response to PM exposure, with boys being less resistant than girls.
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Affiliation(s)
- Xiaoyan Yang
- Key Laboratory of Environment and Human Health, Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China; Department of Environmental Toxicology, Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Dongqun Xu
- Key Laboratory of Environment and Human Health, Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China; Department of Air Quality and Health Monitoring, Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China.
| | - Bo Wen
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing 100191, China
| | - Jian Ji
- Hazard Screening and Omic Platform, Analysis and Testing Center, Jiangnan University, Wuxi, Jiangsu 214122, China
| | - Zeyu Zhang
- Jiangxi Academy of Clinical Medical Sciences, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
| | - Li Li
- Department of Environmental Toxicology, Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Shaoping Zhang
- Department of Environmental Toxicology, Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Hong Zhi
- Department of Environmental Toxicology, Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Jian Kong
- Department of Environmental Toxicology, Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Chong Wang
- Department of Environmental Toxicology, Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Jun Wang
- Key Laboratory of Environment and Human Health, Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Hongjie Ruan
- Department of Environmental Toxicology, Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Ming Zhang
- Department of Environmental Toxicology, Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Lan Wei
- Department of Environmental Toxicology, Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Bin Dong
- Department of Air Quality and Health Monitoring, Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Qin Wang
- Key Laboratory of Environment and Human Health, Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China.
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10
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Belsky DW, Baccarelli AA. To promote healthy aging, focus on the environment. NATURE AGING 2023; 3:1334-1344. [PMID: 37946045 DOI: 10.1038/s43587-023-00518-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/27/2023] [Indexed: 11/12/2023]
Abstract
To build health equity for an aging world marked by dramatic disparities in healthy lifespan between countries, regions and population groups, research at the intersections of biology, toxicology and the social and behavioral sciences points the way: to promote healthy aging, focus on the environment. In this Perspective, we suggest that ideas and tools from the emerging field of geroscience offer opportunities to advance the environmental science of aging. Specifically, the capacity to measure the pace and progress of biological processes of aging within individuals from relatively young ages makes it possible to study how changing environments can change aging trajectories from early in life, in time to prevent or delay aging-related disease and disability and build aging health equity.
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Affiliation(s)
- Daniel W Belsky
- Robert N. Butler Columbia Aging Center and Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Andrea A Baccarelli
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA.
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11
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Pham DL, Le KM, Truong DDK, Le HTT, Trinh THK. Environmental allergen reduction in asthma management: an overview. FRONTIERS IN ALLERGY 2023; 4:1229238. [PMID: 37868650 PMCID: PMC10587592 DOI: 10.3389/falgy.2023.1229238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/12/2023] [Indexed: 10/24/2023] Open
Abstract
Asthma is a prevalent non-communicable disease that affects both children and adults. Many patients with severe, uncontrolled asthma could not achieve total control despite using anti-asthmatic drugs. There is increasing evidence that allergy to environmental allergens, including both indoor and outdoor allergens, is associated with asthma symptoms and severe asthma. Frequently reported sensitized allergens were dust mites, cockroaches, grass pollens, molds, pets, and rodents in allergic asthma patients, although the patterns of widespread allergens differed from each country. Allergen avoidance is the cornerstone of asthma management, especially in sensitized subjects. This review summarizes environmental allergen avoidance and clarifies their effects on asthma control. Despite contrasting results about the impact of allergen exposure reduction on asthma control, several studies supported the beneficial effects of reducing asthma-related symptoms or risk of exacerbations as a nondrug therapy. Identifying environmental allergens is helpful for asthma patients, and further studies on clinically effective avoidance methods are required.
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Affiliation(s)
- Duy Le Pham
- Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- University Medical Center Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Kieu-Minh Le
- Center for Molecular Biomedicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Diem D. K. Truong
- Center for Molecular Biomedicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Huyen T. T. Le
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Tu H. K. Trinh
- Center for Molecular Biomedicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
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12
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Yarsky E, Banzon TM, Phipatanakul W. Effects of Allergen Exposure and Environmental Risk Factors in Schools on Childhood Asthma. Curr Allergy Asthma Rep 2023; 23:613-620. [PMID: 37651001 PMCID: PMC11262705 DOI: 10.1007/s11882-023-01108-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE OF REVIEW This review aims to assess the prevalence of common allergen exposures and environmental risk factors for asthma in schools, examine the underlying mechanisms of these environmental risk factors, and explore possible prevention strategies. RECENT FINDINGS Cockroach, mouse, dust mites, fungi, viral infections, ozone pollution, and cleaning products are common allergen exposures and environmental risk factors in schools which may affect asthma morbidity. Novel modifiable environmental risk factors in schools are also being investigated to identify potential associations with increased asthma morbidity. While several studies have investigated the benefit of environmental remediation strategies in schools and their impact on asthma morbidity, future studies are warranted to further define the effects of modifiable risk factors in schools and determine whether school mitigation strategies may help improve asthma symptoms in students with asthma.
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Affiliation(s)
- Eva Yarsky
- Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Tina M Banzon
- Division of Allergy and Immunology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Wanda Phipatanakul
- Division of Allergy and Immunology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
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13
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Grant TL, Wood RA, Chapman MD. Indoor Environmental Exposures and Their Relationship to Allergic Diseases. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2963-2970. [PMID: 37652348 PMCID: PMC10927277 DOI: 10.1016/j.jaip.2023.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/23/2023] [Accepted: 08/23/2023] [Indexed: 09/02/2023]
Abstract
Cockroach, dust mite, cat, dog, mouse, and molds are major indoor allergens that have been associated with the development of allergic diseases and disease morbidity in allergen-sensitized individuals. Physical characteristics, such as allergen particle size, hydrophobicity, and charge, can determine an allergen's propensity to become airborne, location of respiratory tract penetration, and ability to elicit IgE responses in genetically predisposed individuals. Standardization and recent advancements in indoor allergen assessment serve to identify sources and distribution of allergens in a patient's home and public environment, inform public policy, and monitor the efficacy of allergen avoidance and therapeutics. Allergen exposure interventions have yielded mixed results with current US and international asthma guidelines differing on recommendations. A pragmatic, patient-centered approach to allergen avoidance includes: (1) tailoring intervention to the patient's sensitization and exposure status, (2) using a rigorous multifaceted intervention strategy to reduce allergen exposure as much as possible, and (3) beginning the intervention as soon as the patient is diagnosed. Further research into the risks/benefits of early allergen exposure, rapid and affordable in-home allergen assessment, and best practices for environmental control measures for asthma is needed.
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Affiliation(s)
- Torie L Grant
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md.
| | - Robert A Wood
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md
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14
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Abstract
In the United States, asthma and chronic obstructive pulmonary disease (COPD) disproportionately affect African Americans, Puerto Ricans, and other minority groups. Compared with non-Hispanic whites, minorities have been marginalized and more frequently exposed to environmental risk factors such as tobacco smoke and outdoor and indoor pollutants. Such divergent environmental exposures, alone or interacting with heredity, lead to disparities in the prevalence, morbidity, and mortality of asthma and COPD, which are worsened by lack of access to health care. In this article, we review the burden and risk factors for racial or ethnic disparities in asthma and COPD and discuss future directions in this field.
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Affiliation(s)
- Erick Forno
- Division of Pulmonary Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | - Victor E Ortega
- Division of Respiratory Medicine, Department of Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Juan C Celedón
- Division of Pulmonary Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA.
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15
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DeBoer EM, Morgan WJ, Quiros-Alcala L, Rosenfeld M, Stout JW, Davis SD, Gaffin JM. Defining and Promoting Pediatric Pulmonary Health: Assessing Lung Function and Structure. Pediatrics 2023; 152:e2023062292E. [PMID: 37656029 PMCID: PMC10484309 DOI: 10.1542/peds.2023-062292e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/16/2023] [Indexed: 09/02/2023] Open
Abstract
Lifelong respiratory health is rooted in the structural and functional development of the respiratory system in early life. Exposures and interventions antenatally through childhood can influence lung development into young adulthood, the life stage with the highest achievable lung function. Because early respiratory health sets the stage for adult lung function trajectories and risk of developing chronic obstructive pulmonary disease, understanding how to promote lung health in children will have far reaching personal and population benefits. To achieve this, it is critical to have accurate and precise measures of structural and functional lung development that track throughout life stages. From this foundation, evaluation of environmental, genetic, metabolic, and immune mechanisms involved in healthy lung development can be investigated. These goals require the involvement of general pediatricians, pediatric subspecialists, patients, and researchers to design and implement studies that are broadly generalizable and applicable to otherwise healthy and chronic disease populations. This National Institutes of Health workshop report details the key gaps and opportunities regarding lung function and structure.
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Affiliation(s)
- Emily M. DeBoer
- University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Wayne J. Morgan
- Department of Pediatrics, University of Arizona, Tucson, Arizona
| | - Lesliam Quiros-Alcala
- Johns Hopkins University, Bloomberg School of Public Health and Whiting School of Engineering, Environmental Health and Engineering, Baltimore, Maryland
| | - Margaret Rosenfeld
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - James W. Stout
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Stephanie D. Davis
- Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Jonathan M. Gaffin
- Division of Pulmonary Medicine, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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16
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Devadoss D, Surbaugh K, Manevski M, Wickramaratne C, Chaput D, Chung A, de Leon F, Chand HS, Dhau JS. Indoor-air purification by photoelectrochemical oxidation mitigates allergic airway responses to aerosolized cat dander in a murine model. Sci Rep 2023; 13:10980. [PMID: 37414804 PMCID: PMC10325967 DOI: 10.1038/s41598-023-38155-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 07/04/2023] [Indexed: 07/08/2023] Open
Abstract
Portable air purifiers help improve indoor air quality by neutralizing allergens, including animal dander proteins. However, there are limited in-vivo models to assess the efficacy of these devices. Here, we developed a novel animal model of experimental asthma using aerosolized cat dander extract (CDE) exposure and compared the efficacy of select air purification technologies. Mice were exposed to CDE aerosols for 6 weeks in separate custom-built whole-body exposure chambers equipped with either a photoelectrochemical oxidative (PECO) Molekule filtration device (PFD) or a HEPA-assisted air filtration device (HFD) along with positive (a device with no filtration capability) and negative controls. Compared to the positive control group, the CDE-induced airway resistance, and plasma IgE and IL-13 levels were significantly reduced in both air purifier groups. However, PFD mice showed a better attenuation of lung tissue mucous hyperplasia and eosinophilia than HFD and positive control mice, indicating a better efficacy in managing CDE-induced allergic responses. Cat dander protein destruction was evaluated by LCMS proteomic analysis, which revealed the degradation of 2731 unique peptides on PECO media in 1 h. Thus, allergen protein destruction on filtration media enhances air purifier efficacy that could provide relief from allergy responses compared to traditional HEPA-based filtration alone.
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Affiliation(s)
- Dinesh Devadoss
- Department of Immunology and Nano-Medicine, Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA.
| | - Kerri Surbaugh
- Research and Development, Molekule Group, Inc., 3802 Spectrum Blvd, Tampa, FL, 33612, USA
| | - Marko Manevski
- Department of Immunology and Nano-Medicine, Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA
| | - Chatura Wickramaratne
- Research and Development, Molekule Group, Inc., 3802 Spectrum Blvd, Tampa, FL, 33612, USA
| | - Dale Chaput
- Department of Cell Biology, Microbiology and Molecular Biology, University of South Florida, Tampa, FL, 33612, USA
| | - Arianne Chung
- Department of Immunology and Nano-Medicine, Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA
| | - Francisco de Leon
- Department of Immunology and Nano-Medicine, Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA
| | - Hitendra S Chand
- Department of Immunology and Nano-Medicine, Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA
| | - Jaspreet S Dhau
- Research and Development, Molekule Group, Inc., 3802 Spectrum Blvd, Tampa, FL, 33612, USA.
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Simoneau T, Gaffin JM. Socioeconomic determinants of asthma health. Curr Opin Pediatr 2023; 35:337-343. [PMID: 36861771 PMCID: PMC10160003 DOI: 10.1097/mop.0000000000001235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
PURPOSE OF REVIEW The current review provides an assessment of the recent pediatric literature evaluating socioeconomic drivers of asthma incidence and morbidity. The review addresses the specific social determinants of health related to housing, indoor and outdoor environmental exposures, healthcare access and quality, and the impact of systematic racism. RECENT FINDINGS Many social risk factors are associated with adverse asthma outcomes. Children living in low-income, urban neighborhoods have greater exposure to both indoor and outdoor hazards, including molds, mice, second-hand smoke, chemicals, and air pollutants, all of which are associated with adverse asthma outcomes. Providing asthma education in the community - via telehealth, school-based health centers, or peer mentors - are all effective methods for improving medication adherence and asthma outcomes. The racially segregated neighborhoods created by the racist 'redlining' policies implemented decades ago, persist today as hotspots of poverty, poor housing conditions, and adverse asthma outcomes. SUMMARY Routine screening for social determinants of health in clinical settings is important to identify the social risk factors of pediatric patients with asthma. Interventions targeting social risk factors can improve pediatric asthma outcomes, but more studies are needed related to social risk interventions.
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Affiliation(s)
- Tregony Simoneau
- Division of Pulmonary Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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18
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Reddam A, Bollati V, Wu H, Favero C, Tarantini L, Hoxha M, Comfort N, Gold DR, Phipatanakul W, Baccarelli AA. Air pollution and human endogenous retrovirus methylation in the school inner-city asthma intervention study. Toxicol Sci 2023; 193:166-174. [PMID: 37042721 PMCID: PMC10230279 DOI: 10.1093/toxsci/kfad035] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023] Open
Abstract
Human endogenous retroviruses (HERVs) are transposable genomic elements generally repressed through DNA methylation. HERVs can be demethylated and expressed in response to environmental stimuli. Therefore, more research is needed to understand the influence of environmental exposures on HERV methylation. Air pollutants are commonly linked with global hypomethylation, and as HERVs comprise of nearly 8% of repetitive elements in the human genome, our objective was to examine the association between air pollutant exposure and HERV methylation. We investigated 180 students with asthma participating in the School Inner-City Asthma Intervention Study, which evaluated the efficacy of classroom air filters and school-wide pest management on air pollutant/allergen exposure and asthma. Both air pollutants measured in classrooms and asthma outcomes assessed by surveys were collected pre- and post-intervention. Buccal swabs were also collected pre- and post-intervention, and methylation levels from 9 transposable genomic elements (HERV-E, -FRD, -K, -L, -R, -W, -9, and HRES and LINE1) were measured. Adjusting for relevant covariates, the overall air pollutant mixture was cross-sectionally associated with higher HERV-W and lower HERV-L and LINE1 methylation. Coarse PM was cross-sectionally associated with higher HERV-K methylation and CO2 with lower LINE1 methylation. These results suggest that exposure to air pollutants is associated with HERV-W and HERV-K hypermethylation and HERV-L and LINE1 hypomethylation in children with asthma. Future studies are needed to characterize the links between HERV methylation and possible adverse outcomes.
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Affiliation(s)
- Aalekhya Reddam
- Department of Environmental Health Sciences; Mailman School of Public Health, Columbia University, New York, New York 10032, USA
| | - Valentina Bollati
- Department of Clinical Sciences and Community Health, University of Milan, Milan 20122, Italy
| | - Haotian Wu
- Department of Environmental Health Sciences; Mailman School of Public Health, Columbia University, New York, New York 10032, USA
| | - Chiara Favero
- Department of Clinical Sciences and Community Health, University of Milan, Milan 20122, Italy
| | - Letizia Tarantini
- Department of Clinical Sciences and Community Health, University of Milan, Milan 20122, Italy
| | - Mirjam Hoxha
- Department of Clinical Sciences and Community Health, University of Milan, Milan 20122, Italy
| | - Nicole Comfort
- Department of Environmental Health Sciences; Mailman School of Public Health, Columbia University, New York, New York 10032, USA
| | - Diane R Gold
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02115, USA
| | - Wanda Phipatanakul
- Asthma Clinical Research Center, Boston Children’s Hospital, Boston, Massachusetts 02115, USA
| | - Andrea A Baccarelli
- Department of Environmental Health Sciences; Mailman School of Public Health, Columbia University, New York, New York 10032, USA
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19
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Yang B, Wilkie H, Das M, Timilshina M, Bainter W, Woods B, Daya M, Boorgula MP, Mathias RA, Lai P, Petty CR, Weller E, Harb H, Chatila TA, Leung DYM, Beck LA, Simpson EL, Hata TR, Barnes KC, Phipatanakul W, Leyva-Castillo JM, Geha RS. The IL-4Rα Q576R polymorphism is associated with increased severity of atopic dermatitis and exaggerates allergic skin inflammation in mice. J Allergy Clin Immunol 2023; 151:1296-1306.e7. [PMID: 36690254 PMCID: PMC10164706 DOI: 10.1016/j.jaci.2023.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 12/02/2022] [Accepted: 01/05/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND Atopic dermatitis (AD) is characterized by TH2-dominated skin inflammation and systemic response to cutaneously encountered antigens. The TH2 cytokines IL-4 and IL-13 play a critical role in the pathogenesis of AD. The Q576->R576 polymorphism in the IL-4 receptor alpha (IL-4Rα) chain common to IL-4 and IL-13 receptors alters IL-4 signaling and is associated with asthma severity. OBJECTIVE We sought to investigate whether the IL-4Rα R576 polymorphism is associated with AD severity and exaggerates allergic skin inflammation in mice. METHODS Nighttime itching interfering with sleep, Rajka-Langeland, and Eczema Area and Severity Index scores were used to assess AD severity. Allergic skin inflammation following epicutaneous sensitization of mice 1 or 2 IL-4Rα R576 alleles (QR and RR) and IL-4Rα Q576 (QQ) controls was assessed by flow cytometric analysis of cells and quantitative RT-PCR analysis of cytokines in skin. RESULTS The frequency of nighttime itching in 190 asthmatic inner-city children with AD, as well as Rajka-Langeland and Eczema Area and Severity Index scores in 1116 White patients with AD enrolled in the Atopic Dermatitis Research Network, was higher in subjects with the IL-4Rα R576 polymorphism compared with those without, with statistical significance for the Rajka-Langeland score. Following epicutaneous sensitization of mice with ovalbumin or house dust mite, skin infiltration by CD4+ cells and eosinophils, cutaneous expression of Il4 and Il13, transepidermal water loss, antigen-specific IgE antibody levels, and IL-13 secretion by antigen-stimulated splenocytes were significantly higher in RR and QR mice compared with QQ controls. Bone marrow radiation chimeras demonstrated that both hematopoietic cells and stromal cells contribute to the mutants' exaggerated allergic skin inflammation. CONCLUSIONS The IL-4Rα R576 polymorphism predisposes to more severe AD and increases allergic skin inflammation in mice.
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Affiliation(s)
- Barbara Yang
- Division of Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Hazel Wilkie
- Division of Immunology, Boston Children's Hospital, Boston, Mass
| | - Mrinmoy Das
- Division of Immunology, Boston Children's Hospital, Boston, Mass
| | | | - Wayne Bainter
- Division of Immunology, Boston Children's Hospital, Boston, Mass
| | - Brian Woods
- Division of Immunology, Boston Children's Hospital, Boston, Mass
| | - Michelle Daya
- University of Colorado Anschutz Medical Campus, Aurora, Colo
| | | | | | - Peggy Lai
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, Mass
| | - Carter R Petty
- ICCTR Biostatistics and Research Design Center, Boston Children's Hospital, Boston, Mass
| | - Edie Weller
- ICCTR Biostatistics and Research Design Center, Boston Children's Hospital, Boston, Mass
| | - Hani Harb
- Division of Immunology, Boston Children's Hospital, Boston, Mass
| | - Talal A Chatila
- Division of Immunology, Boston Children's Hospital, Boston, Mass
| | | | - Lisa A Beck
- Departments of Dermatology, Medicine, and Pathology, University of Rochester School of Medicine, Rochester, NY
| | - Eric L Simpson
- Department of Dermatology, Oregon Health & Science University, Portland, Ore
| | - Tissa R Hata
- Department of Dermatology, University of California, San Diego, Calif
| | | | | | | | - Raif S Geha
- Division of Immunology, Boston Children's Hospital, Boston, Mass.
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20
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Lee JX, Phipatanakul W, Gaffin JM. Environment and the development of severe asthma in inner city population. Curr Opin Allergy Clin Immunol 2023; 23:179-184. [PMID: 36728241 PMCID: PMC9974609 DOI: 10.1097/aci.0000000000000890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW Higher asthma prevalence and morbidity are seen in inner-city areas, disproportionately affecting low-income families living in substandard housing. Children within these families experience more frequent asthma exacerbations, acute care and emergency department visits, and hospitalizations, thus characterizing severe asthma. In this review, we assess recent published literature focused on indoor and outdoor exposures that contribute to the development and morbidity of asthma. RECENT FINDINGS Many urban environmental exposures contribute to asthma burden, including tobacco/e-cigarette smoke, pest allergens, molds, and possibly synthetic chemicals such as phthalates and bisphenol A, radon, and volatile organic compounds. Individuals living in inner-city areas also experience higher levels of air pollutants and ambient heat, further perpetuating asthma incidence and severity. SUMMARY This article summarizes the latest advances and provides direction for future research on risk factors, interventions, and public policy to help alleviate the burden of asthma due to urban environment exposures.
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Affiliation(s)
- Julia X Lee
- Division of Pulmonary Medicine, Boston Children's Hospital
| | - Wanda Phipatanakul
- Division of allergy and immunology, Boston Children's Hospital
- Harvard Medical School, Boston, Massachusetts, USA
| | - Jonathan M Gaffin
- Division of Pulmonary Medicine, Boston Children's Hospital
- Harvard Medical School, Boston, Massachusetts, USA
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Abstract
PURPOSE OF REVIEW Asthma is the most common chronic disease of childhood. Environmental exposures, such as allergens and pollutants, are ubiquitous factors associated with asthma development and asthma morbidity. In this review, we highlight the most recent studies relevant to childhood asthma risk, onset, and exacerbation related to air pollution exposure. RECENT FINDINGS In this article, we review current research that has been published between 2021 and 2022, demonstrating the effects of early-life exposure to key air pollutants (e.g., particulate matter (PM), nitrogen dioxide (NO 2 ), sulfur dioxide (SO 2 ) and ground-level ozone (O 3 ), environmental tobacco smoke, radon, and volatile organic compounds (VOC) on respiratory health. SUMMARY Air pollution continues to be a global burden with serious consequences related to respiratory health. Interventions aimed at reducing air pollution in the environment must be achieved in an effort to improve asthma outcomes and pediatric health.
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Affiliation(s)
- Lana Mukharesh
- Division of Pulmonary Medicine, Boston Children's Hospital
- Harvard Medical School
| | - Wanda Phipatanakul
- Harvard Medical School
- Division of Allergy and Immunology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jonathan M Gaffin
- Division of Pulmonary Medicine, Boston Children's Hospital
- Harvard Medical School
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22
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Etzel RA. Foreword: Improving Environmental Health in Schools. Curr Probl Pediatr Adolesc Health Care 2023; 53:101406. [PMID: 37422430 DOI: 10.1016/j.cppeds.2023.101406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/10/2023]
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23
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Abstract
PURPOSE OF REVIEW School-based asthma management is an important component of pediatric asthma care that has the potential to provide more universal evidence-based asthma care to children and mitigate asthma-related health inequities. The purpose of this review is to highlight relevant developments in school-based asthma management over the past 2 years. RECENT FINDINGS There have been considerable recent scientific advances in school-based asthma management including robust clinical trials of environmental interventions in the classroom setting, school-nurse led interventions, stock albuterol policy changes, school-based telemedicine approaches and innovative methods to engage community stakeholders in research that have pushed the frontiers of school-based asthma care. SUMMARY Recent scientific work in school-based asthma management demonstrates the potential power of schools in providing access to guideline-based asthma care for all children with asthma and in improving their health outcomes. Future work should focus on the evaluation of methods to promote the adoption of school-based asthma management strategies in real-world practice and support evidence-based policy change and strategic partnerships to improve asthma health outcomes and produce meaningful public health impact for diverse children and families.
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Affiliation(s)
- Ashley A. Lowe
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
- Asthma & Airway Disease Research Center, University of Arizona Health Sciences, University of Arizona, Tucson, Arizona, USA
| | - Ina St Onge
- Department of Pediatrics, Division of Pulmonary Medicine, University of Massachusetts Chan Medical School, UMass Memorial Children’s Medical Center, Worcester, MA, USA
| | - Michelle Trivedi
- Department of Pediatrics, Division of Pulmonary Medicine, University of Massachusetts Chan Medical School, UMass Memorial Children’s Medical Center, Worcester, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical Center, Worcester, MA, USA
- Child Health Equity Center, Department of Pediatrics, UMass Chan Medical School, UMass Memorial Children’s Medical Center, Worcester, MA, USA
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24
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Achilleos S, Michanikou A, Kouis P, Papatheodorou SI, Panayiotou AG, Kinni P, Mihalopoulos N, Kalivitis N, Kouvarakis G, Galanakis E, Michailidi E, Tymvios F, Chrysanthou A, Neophytou M, Mouzourides P, Savvides C, Vasiliadou E, Papasavvas I, Christophides T, Nicolaou R, Avraamides P, Kang CM, Middleton N, Koutrakis P, Yiallouros PK. Improved indoor air quality during desert dust storms: The impact of the MEDEA exposure-reduction strategies. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 863:160973. [PMID: 36539092 DOI: 10.1016/j.scitotenv.2022.160973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/28/2022] [Accepted: 12/12/2022] [Indexed: 06/17/2023]
Abstract
Desert dust storms (DDS) are natural events that impact not only populations close to the emission sources but also populations many kilometers away. Countries located across the main dust sources, including countries in the Eastern Mediterranean, are highly affected by DDS. In addition, climate change is expanding arid areas exacerbating DDS events. Currently, there are no intervention measures with proven, quantified exposure reduction to desert dust particles. As part of the wider "MEDEA" project, co-funded by LIFE 2016 Programme, we examined the effectiveness of an indoor exposure-reduction intervention (i.e., decrease home ventilation during DDS events and continuous use of air purifier during DDS and non-DDS days) across homes and/or classrooms of schoolchildren with asthma and adults with atrial fibrillation in Cyprus and Crete-Greece. Participants were randomized to a control or intervention groups, including an indoor intervention group with exposure reduction measures and the use of air purifiers. Particle sampling, PM10 and PM2.5, was conducted in participants' homes and/or classrooms, between 2019 and 2022, during DDS-free weeks and during DDS days for as long as the event lasted. In indoor and outdoor PM10 and PM2.5 samples, mass and content in main and trace elements was determined. Indoor PM2.5 and PM10 mass concentrations, adjusting for premise type and dust conditions, were significantly lower in the indoor intervention group compared to the control group (PM2.5-intervention/PM2.5-control = 0.57, 95% CI: 0.47, 0.70; PM10-intervention/PM10-control = 0.59, 95% CI: 0.49, 0.71). In addition, the PM2.5 and PM10 particles of outdoor origin were significantly lower in the intervention vs. the control group (PM2.5 infiltration intervention-to-control ratio: 0.49, 95% CI: 0.42, 0.58; PM10 infiltration intervention-to-control ratio: 0.68, 95% CI: 0.52, 0.89). Our findings suggest that the use of air purifiers alongside decreased ventilation measures is an effective protective measure that reduces significantly indoor exposure to particles during DDS and non-DDS in high-risk population groups.
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Affiliation(s)
- Souzana Achilleos
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus; Cyprus International Institute for Environmental and Public Health, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus.
| | - Antonis Michanikou
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus
| | - Panayiotis Kouis
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus
| | - Stefania I Papatheodorou
- Cyprus International Institute for Environmental and Public Health, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Andrie G Panayiotou
- Cyprus International Institute for Environmental and Public Health, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Paraskevi Kinni
- Cyprus International Institute for Environmental and Public Health, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus; Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus; Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Nikos Mihalopoulos
- Department of Chemistry, University of Crete, Heraklion, Crete, Greece; National Observatory of Athens, Athens, Greece
| | - Nikos Kalivitis
- Department of Chemistry, University of Crete, Heraklion, Crete, Greece
| | | | - Emmanouil Galanakis
- Department of Pediatrics, Medical School, University of Crete, Heraklion, Crete, Greece
| | - Eleni Michailidi
- Department of Pediatrics, Medical School, University of Crete, Heraklion, Crete, Greece
| | | | | | - Marina Neophytou
- Environmental Fluid Mechanics Laboratory, Department of Civil and Environmental Engineering, University of Cyprus, Nicosia, Cyprus
| | - Petros Mouzourides
- Environmental Fluid Mechanics Laboratory, Department of Civil and Environmental Engineering, University of Cyprus, Nicosia, Cyprus
| | - Chrysanthos Savvides
- Air Quality and Strategic Planning Section, Department of Labour Inspection, Ministry of Labour and Social Insurance, Nicosia, Cyprus
| | - Emily Vasiliadou
- Air Quality and Strategic Planning Section, Department of Labour Inspection, Ministry of Labour and Social Insurance, Nicosia, Cyprus
| | - Ilias Papasavvas
- Department of Cardiology, Nicosia General Hospital, Nicosia, Cyprus
| | | | - Rozalia Nicolaou
- Department of Cardiology, Nicosia General Hospital, Nicosia, Cyprus
| | | | - Choong-Min Kang
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Nicos Middleton
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Petros Koutrakis
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Baptist AP, Apter AJ, Gergen PJ, Jones BL. Reducing Health Disparities in Asthma: How Can Progress Be Made. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:737-745. [PMID: 36693539 PMCID: PMC10640900 DOI: 10.1016/j.jaip.2022.12.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/23/2022] [Accepted: 12/23/2022] [Indexed: 01/22/2023]
Abstract
Health disparities (recently defined as a health difference closely linked with social, economic, and/or environmental disadvantage) in asthma continue despite the presence of safe and effective treatment. For example, in the United States, Black individuals have a hospitalization rate that is 6× higher than that for White individuals, and an asthma mortality rate nearly 3× higher. This article will discuss the current state of health disparities in asthma in the United States. Factors involved in the creation of these disparities (including unconscious bias and structural racism) will be examined. The types of asthma interventions (including case workers, technological advances, mobile asthma clinics, and environmental remediation) that have and have not been successful to decrease disparities will be reviewed. Finally, current resources and future actions are summarized in a table and in text, providing information that the allergist can use to make an impact on asthma health disparities in 2023.
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Affiliation(s)
- Alan P Baptist
- Division of Allergy and Clinical Immunology, University of Michigan, Ann Arbor, Mich.
| | - Andrea J Apter
- Section of Allergy & Immunology, Division of Pulmonary, Allergy, Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Peter J Gergen
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Bridgette L Jones
- Section of Allergy Asthma Immunology, Department of Pediatrics, University of Missouri Kansas City School of Medicine, Kansas City, Mo; Children's Mercy, Kansas City, Mo
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26
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Feldman JM, Serebrisky D, Starr S, Castaño K, Greenfield N, Silverstein G, Fruchter N, Mammen J, McGovern C, Arcoleo K. Reduced asthma morbidity during COVID-19 in minority children: is medication adherence a reason? J Asthma 2023; 60:468-478. [PMID: 35341432 PMCID: PMC9532462 DOI: 10.1080/02770903.2022.2059510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 03/18/2022] [Accepted: 03/23/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Asthma control improved during the COVID-19 pandemic. This study examined objectively measured medication adherence, asthma morbidity and quality of life (QoL) outcomes in Black and Latinx children by month for January-June 2019 (pre-COVID) compared to January-June 2020 (including first peak of COVID). METHODS Secondary analyses of 94 children with asthma (ages 10-17 years, 64% Latinx, 36% Black) and their caregivers assigned to the comparison group of a longitudinal RCT intervention trial. Outcomes included mean aggregate electronic adherence for controller medications, oral steroid bursts, acute healthcare utilization, caregiver asthma QoL, and the Asthma Control Test. Repeated measures analyses were conducted due to multiple observations. RESULTS Adherence to controller medications declined 48% from 2019 to 2020 (LS Mean = 33.9% vs. 17.6%, p=.0004, f=.92) with levels reaching a low in May 2020. A reduction in steroid bursts was observed over the same timeframe, 1.29 vs. 0.61, p = 0.006, f=.63. Caregiver QoL increased from 2019 to 2020 on total score (5.18 vs. 5.85, p = 0.002, f=.72), activity limitations (5.04 vs. 5.95), and emotional functioning (5.26 vs. 5.80). Although not statistically significant, a clinically meaningful 62% reduction in acute healthcare visits (p = 0.15) was reported in 2020. Children reported better asthma control (OR = 1.47, 95% CI 1.24, 1.73, p < 0.0001) in 2020 versus 2019 driven by improvements from May to June 2020. CONCLUSIONS Decreased asthma morbidity in minority children during COVID was coupled with decreased adherence to controller medications. This observed decrease in morbidity is not explained by improvements in adherence.
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Affiliation(s)
- Jonathan M. Feldman
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY
- Albert Einstein College of Medicine, Children’s Hospital at Montefiore, Department of Pediatrics, Division of Academic General Pediatrics, Bronx, NY
| | | | - Sheena Starr
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY
| | - Katerina Castaño
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY
| | - Naomi Greenfield
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY
| | | | - Natalie Fruchter
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY
| | | | - Colleen McGovern
- University Of North Carolina at Greensboro School of Nursing, Greensboro, NC
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27
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Burbank AJ, Hernandez ML, Jefferson A, Perry TT, Phipatanakul W, Poole J, Matsui EC. Environmental justice and allergic disease: A Work Group Report of the AAAAI Environmental Exposure and Respiratory Health Committee and the Diversity, Equity and Inclusion Committee. J Allergy Clin Immunol 2023; 151:656-670. [PMID: 36584926 PMCID: PMC9992350 DOI: 10.1016/j.jaci.2022.11.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/31/2022] [Accepted: 11/29/2022] [Indexed: 12/29/2022]
Abstract
Environmental justice is the concept that all people have the right to live in a healthy environment, to be protected against environmental hazards, and to participate in decisions affecting their communities. Communities of color and low-income populations live, work, and play in environments with disproportionate exposure to hazards associated with allergic disease. This unequal distribution of hazards has contributed to health disparities and is largely the result of systemic racism that promotes segregation of neighborhoods, disinvestment in predominantly racial/ethnic minority neighborhoods, and discriminatory housing, employment, and lending practices. The AAAAI Environmental Exposure and Respiratory Health Committee and Diversity, Equity and Inclusion Committee jointly developed this report to improve allergy/immunology specialists' awareness of environmental injustice, its roots in systemic racism, and its impact on health disparities in allergic disease. We present evidence supporting the relationship between exposure to environmental hazards, particularly at the neighborhood level, and the disproportionately high incidence and poor outcomes from allergic diseases in marginalized populations. Achieving environmental justice requires investment in at-risk communities to increase access to safe housing, clean air and water, employment opportunities, education, nutrition, and health care. Through policies that promote environmental justice, we can achieve greater health equity in allergic disease.
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Affiliation(s)
- Allison J Burbank
- Division of Pediatric Allergy and Immunology, University of North Carolina School of Medicine, Children's Research Institute, Chapel Hill, NC.
| | - Michelle L Hernandez
- Division of Pediatric Allergy and Immunology, University of North Carolina School of Medicine, Children's Research Institute, Chapel Hill, NC
| | - Akilah Jefferson
- University of Arkansas for Medical Sciences, Little Rock, Ark; Arkansas Children's Research Institute, Little Rock, Ark
| | - Tamara T Perry
- University of Arkansas for Medical Sciences, Little Rock, Ark; Arkansas Children's Research Institute, Little Rock, Ark
| | - Wanda Phipatanakul
- Division of Asthma, Allergy and Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Jill Poole
- Department of Internal Medicine, Division of Allergy and Immunology, University of Nebraska Medical Center, Omaha, Neb
| | - Elizabeth C Matsui
- Departments of Population Health and Pediatrics, Dell Medical School at University of Texas at Austin, Austin, Tex
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28
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Vesper SJ, Wymer L, Coull BA, Koutrakis P, Cunningham A, Petty CR, Metwali N, Sheehan WJ, Gaffin JM, Permaul P, Lai PS, Bartnikas LM, Hauptman M, Gold DR, Baxi SN, Phipatanakul W. HEPA filtration intervention in classrooms may improve some students' asthma. J Asthma 2023; 60:479-486. [PMID: 35341426 PMCID: PMC9548522 DOI: 10.1080/02770903.2022.2059672] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/24/2022] [Accepted: 03/26/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The School Inner-City Asthma Intervention Study 2 (SICAS 2) tested interventions to reduce exposures in classrooms of students with asthma. The objective of this post-hoc analysis was limited to evaluating the effect of high-efficiency particulate (HEPA) filtration interventions on mold levels as quantified using the Environmental Relative Moldiness Index (ERMI) and the possible improvement in the students' asthma, as quantified by spirometry testing. METHODS Pre-intervention dust samples were collected at the beginning of the school year from classrooms and corresponding homes of students with asthma (n = 150). Follow-up dust samples were collected in the classrooms at the end of the HEPA or Sham intervention. For each dust sample, ERMI values and the Group 1 and Group 2 mold levels (components of the ERMI metric) were quantified. In addition, each student's lung function was evaluated by spirometry testing, specifically the percentage predicted forced expiratory volume at 1 sec (FEV1%), before and at the end of the intervention. RESULTS For those students with a higher Group 1 mold level in their pre-intervention classroom than home (n = 94), the FEV1% results for those students was significantly (p < 0.05) inversely correlated with the Group 1 level in their classrooms. After the HEPA intervention, the average Group 1 and ERMI values were significantly lowered, and the average FEV1% test results significantly increased by an average of 4.22% for students in HEPA compared to Sham classrooms. CONCLUSIONS HEPA intervention in classrooms reduced Group 1 and ERMI values, which corresponded to improvements in the students' FEV1% test results.
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Affiliation(s)
- Stephen J. Vesper
- US Environmental Protection Agency, Center for Environmental Measurement and Modeling, Cincinnati, OH, USA
| | - Larry Wymer
- US Environmental Protection Agency, Center for Environmental Measurement and Modeling, Cincinnati, OH, USA
| | - Brent A. Coull
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Petros Koutrakis
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Amparito Cunningham
- Division of Allergy and Immunology, Boston Children's Hospital, Boston, MA, USA
| | - Carter R. Petty
- Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, MA, USA
| | - Nervana Metwali
- Department of Occupational and Environmental Health, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - William J. Sheehan
- Division of Allergy and Immunology, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jonathan M. Gaffin
- Harvard Medical School, Boston, MA, USA
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Perdita Permaul
- Division of Pediatric Pulmonology, Allergy and Immunology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
| | - Peggy S. Lai
- Harvard Medical School, Boston, MA, USA
- Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Lisa M. Bartnikas
- Division of Allergy and Immunology, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Marissa Hauptman
- Harvard Medical School, Boston, MA, USA
- Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA
- Region 1 New England Pediatric Environmental Health Specialty Unit, Boston, MA, USA
| | - Diane R. Gold
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Sachin N. Baxi
- Division of Allergy and Immunology, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Wanda Phipatanakul
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Fong WCG, Kadalayil L, Lowther S, Grevatt S, Potter S, Tidbury T, Bennett K, Larsson M, Nicolas F, Kurukulaaratchy R, Arshad SH. The efficacy of the Dyson air purifier on asthma control: A single-center, investigator-led, randomized, double-blind, placebo-controlled trial. Ann Allergy Asthma Immunol 2023; 130:199-205.e2. [PMID: 36288782 DOI: 10.1016/j.anai.2022.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/02/2022] [Accepted: 10/18/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Air pollution is associated with poor asthma outcomes. High-efficiency particulate air air purifiers may reduce air pollution and thus improve asthma outcomes. However, the efficacy of such devices for this purpose remains inconclusive. OBJECTIVE To investigate the effects of reducing the levels of pollutants on asthma outcomes in adults, using a novel Dyson high-efficiency particulate air air purifier. METHODS In a single-center, double-blinded, randomized controlled trial, participants (N = 50) were randomized at a 1:1 ratio to active filters (intervention) or to dummy filters (placebo) for a total of 78 weeks. The primary outcomes were the changes in Asthma Control Questionnaire 6 (ACQ6) and Asthma-specific Quality of Life Questionnaire (AQLQ) scores from baseline. The secondary outcomes were changes in indoor air pollution and lung function measurements. The coronavirus disease 2019 pandemic limited spirometry measurements to 2 time points and assessment of fractional exhaled nitric oxide and bronchial hyperresponsiveness to baseline only. RESULTS Air pollutant levels were significantly lower in the intervention group compared with the placebo group (P = .0003). Both groups had a significant improvement in their ACQ6 and AQLQ. However, there were no significant between-group differences in ACQ6, AQLQ, or spirometry, compared with baseline in multivariable repeated measures models. CONCLUSION The Dyson air purifier significantly improved air quality. However, there were no significant improvements in asthma control, quality of life, or measures of lung function in the intervention group compared with the control group despite improvements in indoor air quality. Larger, extended studies are required to confirm or refute these findings, especially given that the coronavirus disease 2019 pandemic prevented the procurement of detailed objective data. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT04729530; ttps://clinicaltrials.gov/ct2/show/NCT04729530.
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Affiliation(s)
- Wei Chern Gavin Fong
- David Hide Asthma and Allergy Research Centre, Isle of Wight, United Kingdom; Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Latha Kadalayil
- David Hide Asthma and Allergy Research Centre, Isle of Wight, United Kingdom; Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Scott Lowther
- Dyson Technology Limited, Malmesbury, Wiltshire, United Kingdom
| | - Susan Grevatt
- David Hide Asthma and Allergy Research Centre, Isle of Wight, United Kingdom
| | - Stephen Potter
- David Hide Asthma and Allergy Research Centre, Isle of Wight, United Kingdom
| | - Tracey Tidbury
- David Hide Asthma and Allergy Research Centre, Isle of Wight, United Kingdom
| | - Kaisha Bennett
- David Hide Asthma and Allergy Research Centre, Isle of Wight, United Kingdom
| | - Maria Larsson
- David Hide Asthma and Allergy Research Centre, Isle of Wight, United Kingdom
| | | | - Ramesh Kurukulaaratchy
- David Hide Asthma and Allergy Research Centre, Isle of Wight, United Kingdom; Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom; National Institute for Health Research Southampton Biomedical Research Centre, Southampton General Hospital, Southampton, United Kingdom
| | - Syed Hasan Arshad
- David Hide Asthma and Allergy Research Centre, Isle of Wight, United Kingdom; Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom; National Institute for Health Research Southampton Biomedical Research Centre, Southampton General Hospital, Southampton, United Kingdom.
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Udemgba C, Sarkaria SK, Gleeson P, Bryant-Stephens T, Ogbogu PU, Khoury P, Apter AJ. New considerations of health disparities within allergy and immunology. J Allergy Clin Immunol 2023; 151:314-323. [PMID: 36503854 PMCID: PMC9905264 DOI: 10.1016/j.jaci.2022.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/09/2022] [Accepted: 11/11/2022] [Indexed: 12/13/2022]
Abstract
The pandemic, political upheavals, and social justice efforts in our society have resulted in attention to persistent health disparities and the urgent need to address them. Using a scoping review, we describe published updates to address disparities and targets for interventions to improve gaps in care within allergy and immunology. These disparities-related studies provide a broad view of our current understanding of how social determinants of health threaten patient outcomes and our ability to advance health equity efforts in our field. We outline next steps to improve access to care and advance health equity for patients with allergic/immunologic diseases through actions taken at the individual, community, and policy levels, which could be applied outside of our field. Key among these are efforts to increase the diversity among our trainees, providers, and scientific teams and enhancing efforts to participate in advocacy work and public health interventions. Addressing health disparities requires advancing our understanding of the interplay between social and structural barriers to care and enacting the needed interventions in various key areas to effect change.
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Affiliation(s)
- Chioma Udemgba
- National Institute of Allergic and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Sandeep K Sarkaria
- Section of Allergy and Immunology, Department of Pulmonary & Critical Care, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Patrick Gleeson
- Section of Allergy & Immunology, Division of Pulmonary, Allergy, & Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa
| | - Tyra Bryant-Stephens
- Department of Pediatrics, Division of General Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa
| | - Princess U Ogbogu
- Division of Pediatric Allergy, Immunology, and Rheumatology, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio; Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Paneez Khoury
- National Institute of Allergic and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Andrea J Apter
- Section of Allergy & Immunology, Division of Pulmonary, Allergy, & Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa.
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Busgang SA, Andra SS, Curtin P, Colicino E, Mazzella MJ, Bixby M, Sanders AP, Meeker JD, Hauptman M, Yelamanchili S, Phipatanakul W, Gennings C. A cross-validation based approach for estimating specific gravity in elementary-school aged children using a nonlinear model. ENVIRONMENTAL RESEARCH 2023; 217:114793. [PMID: 36414110 PMCID: PMC9879698 DOI: 10.1016/j.envres.2022.114793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/28/2022] [Accepted: 11/10/2022] [Indexed: 05/12/2023]
Abstract
Environmental research often relies on urinary biomarkers which require dilution correction to accurately measure exposures. Specific gravity (SG) and creatinine (UCr) are commonly measured urinary dilution factors. Epidemiologic studies may assess only one of these measures, making it difficult to pool studies that may otherwise be able to be combined. Participants from the National Health and Nutrition Examination Survey 2007-2008 cycle were used to perform k-fold validation of a nonlinear model estimating SG from UCr. The final estimated model was applied to participants from the School Inner-City Asthma Intervention Study, who submitted urinary samples to the Children's Health Exposure Analysis Resource. Model performance was evaluated using calibration metrics to determine how closely the average estimated SG was to the measured SG. Additional models, with interaction terms for age, sex, body mass index, race/ethnicity, relative time of day when sample was collected, log transformed 4-(Methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), and asthma status were estimated and assessed for improvement. The association between monobenzyl phthalate (MBZP) and asthma symptom days, controlling for measured UCr, measured SG, and each estimated SG were compared to assess validity of the estimated SG. The model estimating SG from UCr alone, resulted in a beta estimate of 1.10 (95% CI: 1.01, 1.19), indicating agreement between model-predicted SG and measured SG. Inclusion of age and sex in the model improved estimation (β = 1.06, 95% CI: 0.98, 1.15). The full model accounting for all interaction terms with UCr resulted in the best agreement (β = 1.01, 95% CI: 0.93,1.09). Associations between MBZP and asthma symptoms days, controlling for each estimated SG, were within the range of effect estimates when controlling for measured SG and measured UCr (Rate ratios = 1.28-1.34). Our nonlinear modeling provides opportunities to estimate SG in studies that measure UCr or vice versa, enabling data pooling despite differences in urine dilution factors.
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Affiliation(s)
- Stefanie A Busgang
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Syam S Andra
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Paul Curtin
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Elena Colicino
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Matthew J Mazzella
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Moira Bixby
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alison P Sanders
- Department of Environmental and Occupational Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - John D Meeker
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Marissa Hauptman
- Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA; Region 1: New England Pediatric Environmental Health Specialty Unit, Boston, MA, USA
| | - Shirisha Yelamanchili
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Wanda Phipatanakul
- Harvard Medical School, Boston, MA, USA; Division of Allergy and Immunology, Boston Children's Hospital, Boston, MA, USA
| | - Chris Gennings
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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32
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Azevedo A, Liddie J, Liu J, Schiff JE, Adamkiewicz G, Hart JE. Effects of portable air cleaners and A/C unit fans on classroom concentrations of particulate matter in a non-urban elementary school. PLoS One 2022; 17:e0278046. [PMID: 36454721 PMCID: PMC9714748 DOI: 10.1371/journal.pone.0278046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 11/08/2022] [Indexed: 12/05/2022] Open
Abstract
Given the increased use of air cleaners as a prevention measure in classrooms during the COVID-19 pandemic, this study aimed to investigate the effects of portable air cleaners with HEPA filters and window A/C fans on real-time (1 minute) concentrations of PM less than 2.5 microns (PM2.5) or less than 1 microns (PM1.0) in two classrooms in a non-urban elementary school in Rhode Island. For half of each school day, settings were randomized to "high" or "low" for the air cleaner and "on" or "off" for the fan. Descriptive statistics and linear mixed models were used to evaluate the impacts of each set of conditions on PM2.5 and PM1.0 concentrations. The mean half-day concentrations ranged from 3.4-4.1 μg/m3 for PM2.5 and 3.4-3.9 μg/m3 for PM1.0. On average, use of the fan when the air cleaner was on the low setting decreased PM2.5 by 0.53 μg/m3 [95% CI: -0.64, -0.42] and use of the filter on high (compared to low) when the fan was off decreased PM2.5 by 0.10 μg/m3 [95% CI: -0.20, 0.005]. For PM1.0, use of the fan when the air cleaner was on low decreased concentrations by 0.18 μg/m3 [95% CI: -0.36, -0.01] and use of the filter on high (compared to low) when the fan was off decreased concentrations by 0.38 μg/m3 [95% CI: -0.55, -0.21]. In general, simultaneous use of the fan and filter on high did not result in additional decreases in PM concentrations compared to the simple addition of each appliance's individual effect estimates. Our study suggests that concurrent or separate use of an A/C fan and air cleaner in non-urban classrooms with low background PM may reduce classroom PM concentrations.
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Affiliation(s)
- Alexandra Azevedo
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Jahred Liddie
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Jason Liu
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Jessica E. Schiff
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Gary Adamkiewicz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Jaime E. Hart
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
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33
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Jouneau S, Chapron A, Ropars C, Marette S, Robert AM, Gouyet T, Belleguic C, Rochefort-Morel C, Guillot S, Mailloux C, Desrues B, Viel JF. Prevalence and risk factors of asthma in dairy farmers: Ancillary analysis of AIRBAg. ENVIRONMENTAL RESEARCH 2022; 214:114145. [PMID: 35998695 DOI: 10.1016/j.envres.2022.114145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 07/07/2022] [Accepted: 08/16/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Prolonged occupational agricultural exposure is associated with an increase in asthma diagnosis. This study aimed to identify the prevalence and risk factors for asthma in dairy farmers. METHODS AIRBAg was a cross-sectional study including 1203 representative dairy farmers. They completed a self-administered questionnaire and underwent a health respiratory check-up. Referral to a pulmonologist was made for any participant with wheezing, dyspnoea, chronic bronchitis, a chronic cough or a FEV1/FEV6 ratio<80%. They underwent further examinations such as spirometry with a reversibility test. Controls (non-asthmatic dairy farmers and non-farm employees) were matched to each asthma case for sex and age (±5 years). The odds ratios (OR) between asthma and different risk factors were estimated using conditional multivariate logistic regression models. RESULTS Active asthma was diagnosed in 107 (8.9%) farmers. Compared with control dairy farmers, there was a positive association with family history of allergy (OR = 8.68; 95% CI [4.26-17.69]), personal history of eczema (OR = 3.39; 95% CI [1.61-7.13]), hay manipulation (OR = 5.36, 95% CI [1.59-18.01]), and a negative association with farm area (OR = 0.92; 95% CI [0.85-0.99]) and handling treated seeds (OR = 0.47; 95% CI [0.23-0.95]). Compared with control non-farm employees, there was a positive association between asthma and family history of allergy (OR = 95.82, 95% CI [12.55-731.47]). CONCLUSIONS The prevalence of active asthma in dairy farmers was somewhat higher than the rate observed in the general population but may be controlled by reducing exposure to airborne organic contaminants through occupational adaptions on farms.
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Affiliation(s)
- Stéphane Jouneau
- Univ Rennes, CHU Rennes, Department of Respiratory Medicine, F-35033, Rennes, France; Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, F-35000, Rennes, France
| | - Anthony Chapron
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, F-35000, Rennes, France; Univ Rennes, CHU Rennes, Department of General Practice, F-35000, Rennes, France; INSERM, CIC-1414, Primary Care Research Team, F-35000, Rennes, France.
| | - Cécile Ropars
- Univ Rennes, CHU Rennes, Department of Respiratory Medicine, F-35033, Rennes, France
| | - Solenne Marette
- Univ Rennes, CHU Rennes, Department of Occupational Pathology, University Hospital, F-35033, Rennes, France
| | - Ange-Marie Robert
- Univ Rennes, CHU Rennes, Department of Clinical Research, F-35033, Rennes, France
| | - Thomas Gouyet
- Univ Rennes, CHU Rennes, Department of Occupational Pathology, University Hospital, F-35033, Rennes, France
| | - Chantal Belleguic
- Univ Rennes, CHU Rennes, Department of Respiratory Medicine, F-35033, Rennes, France
| | | | - Stéphanie Guillot
- Univ Rennes, CHU Rennes, Department of Pulmonary Function Tests, F-35033, Rennes, France
| | - Carole Mailloux
- Mutualité Sociale Agricole des Portes de Bretagne, F-35170, Bruz, France
| | - Benoît Desrues
- Univ Rennes, CHU Rennes, Department of Respiratory Medicine, F-35033, Rennes, France; INSERM, U1242-COSS, CLCC Eugène Marquis, Rennes 1 University, F-35000, Rennes, France
| | - Jean-François Viel
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, F-35000, Rennes, France; Univ Rennes, CHU Rennes, Department of Epidemiology and Public Health, F-35033, Rennes, France
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Akar-Ghibril N, Petty CR, Cunningham A, Permaul P, Gaffin JM, Phipatanakul W, Sheehan WJ. Mouse allergen levels in schools over the decade. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:3024-3025. [PMID: 35940510 DOI: 10.1016/j.jaip.2022.07.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Nicole Akar-Ghibril
- Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Mass; Division of Immunology, Allergy, and Rheumatology, Joe DiMaggio Children's Hospital, Hollywood, Fla
| | - Carter R Petty
- Research Center, Boston Children's Hospital, Boston, Mass
| | - Amparito Cunningham
- Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Perdita Permaul
- Division of Pediatric Pulmonology, Allergy and Immunology, NY-Presbyterian Hospital/Weill Cornell Medicine, Weill Cornell Medical College, New York, NY
| | - Jonathan M Gaffin
- Division of Pulmonary Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Wanda Phipatanakul
- Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Mass.
| | - William J Sheehan
- Division of Allergy/Immunology, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC
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Ruran HB, Maciag MC, Murphy SE, Phipatanakul W, Hauptman M. Cross-sectional study of urinary biomarkers of environmental tobacco and e-cigarette exposure and asthma morbidity. Ann Allergy Asthma Immunol 2022; 129:378-380. [PMID: 35688366 PMCID: PMC9814889 DOI: 10.1016/j.anai.2022.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 01/07/2023]
Affiliation(s)
- Hana B Ruran
- Hopkinton High School, Hopkinton, Massachusetts; Division of Allergy and Immunology, Boston Children's Hospital, Boston, Massachusetts
| | - Michelle C Maciag
- Division of Allergy and Immunology, Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Sharon E Murphy
- University of Minnesota Masonic Cancer Center, Minneapolis, Minnesota
| | - Wanda Phipatanakul
- Division of Allergy and Immunology, Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Marissa Hauptman
- Harvard Medical School, Boston, Massachusetts; Division of General Pediatrics, Pediatric Environmental Health Center, Boston Children's Hospital, Boston, Massachusetts; Region 1 New England Pediatric Environmental Health Specialty Unit, Boston, Massachusetts.
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36
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Mortelliti CL, Banzon TM, Phipatanakul W, Vieira CZ. Environmental Exposures Impact Pediatric Asthma Within the School Environment. Immunol Allergy Clin North Am 2022; 42:743-760. [DOI: 10.1016/j.iac.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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37
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Banzon TM, Kelly MS, Bartnikas LM, Sheehan WJ, Cunningham A, Harb H, Crestani E, Valeri L, Greco KF, Chatila TA, Phipatanakul W, Lai PS. Atopic Dermatitis Mediates the Association Between an IL4RA Variant and Food Allergy in School-Aged Children. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:2117-2124.e4. [PMID: 35589010 PMCID: PMC9811396 DOI: 10.1016/j.jaip.2022.04.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/14/2022] [Accepted: 04/30/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Atopic dermatitis (AD) and food allergy (FA) may share genetic risk factors. It is unknown whether genetic factors directly cause FA or are mediated through AD, as the dual-allergen hypothesis suggests. OBJECTIVE To test the hypothesis that AD mediates the relationship between an IL-4 receptor alpha chain gene (IL4RA) variant, the human IL-4 receptor alpha chain protein-R576 polymorphism, and FA. METHODS A total of 433 children with asthma enrolled in the School Inner-City Asthma Study underwent genotyping for the IL4RA576 allele. Surveys were administered to determine FA, AD, and associated allergic responses. Mediation analysis was performed adjusting for race and ethnicity, age, sex, and household income. Multivariate models were used to determine the association between genotype and FA severity. RESULTS AD was reported in 193 (45%) and FA in 80 children (19%). Each risk allele increased odds of AD 1.39-fold ([1.03-1.87], P = .03), and AD increased odds of FA 3.67-fold ([2.05- 6.57], P < .01). There was an indirect effect of genotype, mediated by AD, predicting FA; each risk allele increased the odds of FA by 1.13 (odds ratio [95% CI], Q/R = 1.13 [1.02-1.24], R/R = 1.28 [1.04-1.51]; P < .01). Each risk allele increased the odds of severe FA symptoms 2.68-fold ([1.26-5.71], P = .01). CONCLUSIONS In a cohort of children with asthma, AD is part of the causal pathway between an IL4RA variant and FA. This variant is associated with increased risk of severe FA reactions. Addressing AD in children with an IL4RA polymorphism may modulate the risk of FA.
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Affiliation(s)
- Tina M. Banzon
- Division of Allergy and Immunology, Boston Children’s Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | - Michael S. Kelly
- Harvard Medical School, Boston, MA,Department of Internal Medicine, Massachusetts General Hospital, Boston, MA
| | - Lisa M. Bartnikas
- Division of Allergy and Immunology, Boston Children’s Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | - William J. Sheehan
- Division of Allergy and Immunology, Children’s National Hospital, Washington DC,George Washington University School of Medicine and Health Sciences, Washington DC
| | | | - Hani Harb
- Division of Allergy and Immunology, Boston Children’s Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | - Elena Crestani
- Division of Allergy and Immunology, Boston Children’s Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | - Linda Valeri
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY
| | - Kimberly F. Greco
- Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, MA
| | - Talal A. Chatila
- Division of Allergy and Immunology, Boston Children’s Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | - Wanda Phipatanakul
- Division of Allergy and Immunology, Boston Children’s Hospital, Boston, MA,Harvard Medical School, Boston, MA,Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, MA
| | - Peggy S. Lai
- Harvard Medical School, Boston, MA,Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, MA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA
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38
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Banzon TM, Phipatanakul W. Environmental Interventions for Asthma. Semin Respir Crit Care Med 2022; 43:720-738. [PMID: 35803266 DOI: 10.1055/s-0042-1749453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Exposure and sensitization to environmental factors play a fundamental role in asthma development and is strongly associated with asthma morbidity. While hereditary factors are critical determinants of asthma, exposures to environmental factors are implicated in the phenotypic expression of asthma and have been strongly associated in the risk of its development. Significant interest has thus been geared toward potentially modifiable environmental exposures which may lead to the development of asthma. Allergen exposure, in particular indoor allergens, plays a significant role in the pathogenesis of asthma, and remediation is a primary component of asthma management. In the home, multifaceted and multitargeted environmental control strategies have been shown to reduce home exposures and improve asthma outcomes. In addition to the home environment, assessment of the school, daycare, and workplace environments of patients with asthma is necessary to ensure appropriate environmental control measures in conjunction with medical care. This article will discuss the role of the environment on asthma, review targeted environmental therapy, and examine environmental control measures to suppress environmental exposures in the home and school setting.
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Affiliation(s)
- Tina M Banzon
- Deparmtent of Allergy and Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Wanda Phipatanakul
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.,Division of Immunology, Clinical Research Center, Boston Children's Hospital, Asthma, Allergy and Immunology, Boston, Massachusetts
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39
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Maciag MC, Phipatanakul W. Update on indoor allergens and their impact on pediatric asthma. Ann Allergy Asthma Immunol 2022; 128:652-658. [PMID: 35227902 DOI: 10.1016/j.anai.2022.02.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/08/2022] [Accepted: 02/11/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVE In recent decades, many indoor allergens have been identified, including dust mite, cat, dog, mouse, cockroach, and indoor molds, which have important health effects particularly in sensitized individuals with asthma. This review aims to update our understanding regarding the extent of these exposures in the indoor environment, review strategies for reducing their levels in the environment, and highlight innovative recent trials targeting these exposures and their impact on pediatric asthma morbidity. DATA SOURCES Recent practice parameter updates on indoor allergen exposures, seminal studies, and recent peer-reviewed journal articles are referenced. STUDY SELECTIONS This review cites recent cohort studies of well-characterized pediatric patients with asthma and innovative randomized controlled trials evaluating exposure to environmental allergens, interventions to limit these exposures, and their outcomes. RESULTS Links between indoor aeroallergen exposures and health outcomes have been well established. However, only some allergen reduction interventions have been successful in improving health outcomes. CONCLUSION There are many complicating factors involved in allergic exposures and health outcomes. The interplay between patient genetic factors, indoor allergic triggers, airborne irritants and pollutants, and microbial exposures complicates the study of indoor allergen exposures and their impact on asthma morbidity.
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Affiliation(s)
- Michelle C Maciag
- Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Asthma and Allergy Affiliates, Salem, Massachusetts
| | - Wanda Phipatanakul
- Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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40
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Kalayci O, Miligkos M, Pozo Beltrán CF, El-Sayed ZA, Gómez RM, Hossny E, Le Souef P, Nieto A, Phipatanakul W, Pitrez PM, Xepapadaki P, Jiu-Yao W, Papadopoulos NG. The role of environmental allergen control in the management of asthma. World Allergy Organ J 2022; 15:100634. [PMID: 35341023 PMCID: PMC8917313 DOI: 10.1016/j.waojou.2022.100634] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 01/08/2022] [Accepted: 02/01/2022] [Indexed: 11/26/2022] Open
Abstract
Allergen exposure may exacerbate asthma symptoms in sensitized patients. Allergen reduction or avoidance measures have been widely utilized; however, there is ongoing controversy on the effectiveness of specific allergen control measures in the management of children with asthma. Often, allergen avoidance strategies are not recommended by guidelines because they can be complex or burdensome, although individual patients may benefit. Here we explore the potential for intervention against exposure to the major allergens implicated in asthma (ie, house dust mites, indoor molds, rodents, cockroaches, furry pets, and outdoor molds and pollens), and subsequent effects on asthma symptoms. We critically assess the available evidence regarding the clinical benefits of specific environmental control measures for each allergen. Finally, we underscore the need for standardized and multifaceted approaches in research and real-life settings, which would result in the identification of more personalized and beneficial prevention strategies.
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