The relationship between atopic dermatitis and indoor environmental factors: a cross-sectional study among Japanese elementary school children

Prenatal risk factors of indoor environment and incidence of childhood eczema in the Japan Environment and Children's Study

The quality of indoor environment is a risk factor for early childhood eczema and atopic dermatitis; however, its influence during pregnancy on childhood eczema in Japan has not been investigated. In this study, we aimed to determine the indoor environmental factors that are associated with eczema in children up to 3 years of age, using national birth cohort data from the Japan Environment and Children's Study (JECS). Information on indoor environments and eczema symptoms until 3 years of age was collected using self-administered questionnaires to the mothers. A total of 71,883 and 58,639 mother-child pairs at 1.5- and 3-years-old, respectively, were included in the former analyses. To account for prenatal indoor risk factors, 17,568 (1.5-years-old) and 7063 (3-years-old) children without indoor mold and/or ETS exposure were included in the final analysis. A higher mold index, gas heater use, parquet flooring use, and frequent insecticide use showed significantly increased risks for childhood eczema up to 3 years of age. These associations were consistent after stratification analysis among children whose parents did not have a history of allergies. The updated WHO guidelines on indoor air quality should be implemented based on recent findings regarding the effects of prenatal exposure to indoor dampness on health effects of children further in life, including asthma, respiratory effects, eczema, and other immunological effects.

Associations between home environmental factors and childhood eczema and related symptoms in different cities in China

Previous studies have shown significant associations between home environmental factors and childhood eczema. However, few studies have compared how associations differ in different regions. This study investigated associations between home environmental factors and childhood eczema ever, and related symptoms including itchy rash (IR) and being awakened by itchy rash at night (awake by IR) in 4 cities located in different regions of China, based on cross-sectional investigations during 2010-2012. We used two-step analysis to explore the associations between influencing factors and eczema/related symptoms: first, group Least Absolute Shrinkage and Selection Operator (LASSO) was conducted to identify important factors among a list of candidates; then, the associations in total study population and in each city were estimated using logistic regression. We found these home environmental factors to be risk factors for eczema or related symptoms: large residence size, shared room, air cleaner at home, abnormal smell, perceived dry air, visible mold or damp stains, cooking with coal or wood, painted wall, incense, mice, new furniture during pregnancy, abnormal smell at birth, window condensation at birth and environmental tobacco smoke at birth. Environmental protective factors were rural house location and window ventilation. Associations of factors with eczema/related symptoms differed across cities. For example, air conditioning was protective for eczema in Beijing and awakening by IR in Shanghai with ORs of 0.70 (95%CI: 0.52, 0.95) and 0.33 (95%CI: 0.14, 0.81) respectively, but not significant in other cities. Our results have implications for improving home environments to reduce the risk of childhood eczema/related symptoms in different regions of China.

12-month prevalence of atopic dermatitis in resource-rich countries: a systematic review and meta-analysis

There is a lack of robust prevalence estimates of atopic dermatitis (AD) globally and trends over time due to wide variation of populations and age groups studied, different study methodologies and case definitions used. We sought to characterize 12-month AD prevalence across the life span and change over time in resource-rich countries focusing on population-based studies and using a standardized AD case definition. This systematic review was conducted according to PRISMA guidelines. Medline (Ovid), Embase, WOS core collection, Cinahl, and Popline were searched for studies published since inception through August 15, 2016. Studies were synthesized using random effects meta-analysis. Sources of heterogeneity were investigated using subgroup analyses and meta-regression. From 12,530 records identified, 45 studies met the inclusion criteria. Meta-analysis with random effects revealed the 12-month period prevalence of 9.2% (95% confidence interval 8.4–10.1%). The prevalence was significantly higher among 0–5-year-old children (16.2%; 95% confidence interval 14.2–18.7%) than in older age groups. Studies using a random sampling strategy yielded lower prevalence estimates than studies relying on other sampling methods. There was no clear time trend in AD prevalence over the period of 1992–2013.

Time-trends for eczema prevalences among children and adults from 1985 to 2015 in China: a systematic review

Background

Several studies have reported that childhood prevalence of eczema has been increasing worldwide. However, none study quantitatively evaluated prevalence trends of eczema among children and adults in the last 30 years in China.

Methods and Findings

Via a systematic review of literature databases in English and Chinese, we summarized all studies reporting eczema prevalences from 1985 to 2015 in China as well as diagramed prevalence and eczematous population trends against year for different age groups. A total of 93 studies and 17 studies (16 for children and one for adults) were selected for qualitative and quantitative synthesis, respectively. Childhood lifetime-ever eczema prevalences ranged from 10.0% to 30.0%. Prevalences among 3-12-year-olds children showed increasing trends in most specific cities, but national lifetime-ever eczema prevalences among 13-14-year-olds children decreased from 10.6% in 2001 to 8.6% in 2009 in mainland China. We estimated that about 1.5 million children aged 13-14-year-olds in 2009 and 15.5 million children aged 3-6-year-olds in 2012 had lifetime-ever eczema in mainland China. Similar studies were too few to ascertain time-trends of eczema prevalence among adults. About 39.4, 20.0, and 11.6 million adults aged 15-86-year-olds in 2010 had contact dermatitis, seborrheic dermatitis, and atopic dermatitis in the mainland China, respectively.

Conclusions

The burden of eczema became heavier in young children, whereas perhaps had been reduced in adolescent in China. More studies for eczema prevalence in adults are warranted.

Regional Differences in the Prevalence of Atopic Dermatitis among Schoolchildren in Japan and Its Associated Factors from 2006 to 2018

The trends in the prevalence of atopic dermatitis for each prefecture over recent years have not been investigated in Japan, and no studies investigating the factors associated with the prevalence using nationwide data have been conducted. We investigated the trends in the prevalence of atopic dermatitis among schoolchildren for each prefecture in Japan from 2006 to 2018 and identified the factors associated with regional differences in prevalence. The data on the atopic dermatitis prevalence in schoolchildren aged 6–17 years were collected as part of the School Health Statistics Research. The demographic, socioeconomic, medical, and environmental characteristics of the prefectures were examined for possible associations with the prevalence. The age-standardized prevalence rates of atopic dermatitis were calculated separately for boys and girls and by prefecture and year. We examined the associations between the age-standardized prevalence rates and prefectural characteristics using an ecological study. The age-standardized prevalence rates of atopic dermatitis tended to be stable for Japan as a whole, whereas the trend in the age-standardized prevalence rates differed across prefectures. In the regression analysis, the year was negatively associated and the number of medical clinics per 100,000 persons was positively associated with the age-standardized prevalence in girls. The taxable income per capita was positively associated with the age-standardized prevalence both in boys and in girls.

Interaction between Thermal Comfort, Indoor Air Quality and Ventilation Energy Consumption of Educational Buildings: A Comprehensive Review

Thermal comfort and indoor air quality (IAQ) of educational buildings can affect students’ academic performance and well-being and are closely related to ventilation energy consumption. Demands of the indoor environmental quality within the classroom generally vary with the education levels and result in ventilation energy consumption accounting for a considerable proportion of the total energy use in bulk educational buildings. Its huge energy-saving potential is attracting worldwide attention from scholars and governments. Therefore, appropriate operation strategies of ventilation systems should be adopted to effectively reduce energy consumption without sacrificing thermal comfort and IAQ. However, the absence of relevant standards and guidelines for designing a quality classroom environment considering the special features of educational buildings remains an important research question. This study conducts a comprehensive review to determine research gaps and identify future directions for the interaction between thermal comfort, IAQ and ventilation energy consumption for educational buildings. The review results show that: (1) The thermal comfort prediction model should consider the influences of genders, ages and socioeconomic backgrounds; (2) The mixed-mode ventilation coupling the natural and mechanical approaches is preferred given its advantage of lower energy consumption and improved thermal comfort, but its control strategies need further exploration; (3) Optimizing passive design parameters of buildings (e.g., window to wall ratios, window orientations and sun shading installations) can significantly reduce the ventilation demands while maintaining indoor thermal comfort; (4) More studies are required for investigating thermal comfort in educational buildings during the heating period; and (5) IAQ of university buildings clearly requires further studies, especially on bacterial and fungal aerosol pollutants, for a more comprehensive assessment of the built environment.

The Association between the Concentration of Heavy Metals in the Indoor Atmosphere and Atopic Dermatitis Symptoms in Children Aged between 4 and 13 Years: A Pilot Study

BACKGROUND

A correlation between the harmful effects of air pollutants and atopic dermatitis has been reported. There are few studies on the correlation between the concentration of heavy metals in the indoor atmosphere and symptoms of atopic dermatitis.

METHODS

Twenty-two homes of children showing atopic dermatitis symptoms were enrolled, and eighteen homes with similarly aged children without symptoms or a history of atopic dermatitis participated as a control group. We measured the concentrations of various air pollutants (particulate matter 10, carbon dioxide, carbon monoxide, formaldehyde, nitrogen dioxide, volatile organic compounds (VOCs), ozone, radon, bacterial aerosols, and mold) as well as various heavy metals, such as lead, cadmium, and mercury, in the living room and children's bedroom of each home.

RESULTS

Lead was more commonly detected in the indoor air in houses of children with atopic dermatitis (15/22) as compared to in the control group (3/18) (chi square test, p = 0.002). In adjusted logistic regression analysis, VOCs and lead were significantly associated with atopic dermatitis (p < 0.05).

CONCLUSION

Our study shows that lead in indoor air might be associated with atopic dermatitis, even if the concentrations of airborne lead are below the safety levels suggested by health guidelines.

Prenatal and perinatal home environment and reported onset of wheeze, rhinitis and eczema symptoms in preschool children in Northern China

Early life environment can affect asthma and allergies but few cohort studies on this issue are available from China. Our aim was to investigate reported onset of childhood wheeze, rhinitis and eczema symptoms in relation to prenatal, perinatal and postnatal home environment. Data on home environment and symptoms (ISAAC based questions) in first two years of life and in the past 12 months were reported by parents of the children (3-6 y) in a cross-sectional questionnaire survey in ten day care centers in Taiyuan, northern China (N = 3606). Changes of symptoms from the first 2 years of life to the past 12 months (recall period) were calculated retrospectively. Multilevel logistic regression analysis was applied. Reported onset of wheeze, rhinitis and eczema were 11.8%, 22.2% and 3.3%, respectively. Redecorating during pregnancy increased reported onset of rhinitis (OR = 2.29) and eczema (OR = 4.91). New furniture during pregnancy increased reported onset of rhinitis (OR = 1.47). Perinatal indoor mould increased reported onset of wheeze (OR = 1.51), rhinitis (OR = 1.65) and eczema (OR = 1.91). Perinatal mould odour increased reported onset of wheeze (OR = 1.85). Perinatal window pane condensation increased reported onset of wheeze (OR = 1.54) and rhinitis (OR = 1.24). Perinatal stuffy air and dry air in the home increased reported onset of all three symptoms (ORs 1.46-2.24). Dog keeping increased reported onset of wheeze (OR = 1.69) and eczema (OR = 2.13). Based on principal component analysis, four exposure scores were calculated (renovation, new furniture, mould and indoor air quality scores). Dose-response relationships were observed between these exposure scores and reported onset of symptoms. In conclusion, prenatal and postnatal exposure to emissions from renovation and new furniture can increase reported onset of childhood wheeze, rhinitis and eczema. Perinatal indoor mould, mould odour, condensation on window panes and impaired indoor air quality at home can be associated with reported development of wheeze, rhinitis and eczema in preschoolers in northern China.

Onset and remission of eczema at pre-school age in relation to prenatal and postnatal air pollution and home environment across China

We investigated associations between prenatal and postnatal environmental factors and onset and remission of preschool childhood eczema across China. The study population was preschoolers in randomized day care centers in seven cities (N = 39,782). Data on eczema and prenatal and postnatal indoor and outdoor environment were obtained from a cross-sectional questionnaire sent to parents or other guardians. Reports on eczema in the first 2 years and in the past year was used to retrospectively calculate onset and remission (changes of reported eczema). Prenatal and postnatal outdoor temperature, NO₂ and PM₁₀ were modelled from official air pollution data. Associations were estimated by two-level logistic regression. Calculated onset rate was 3.2%/y and remission rate 29.2%/y. Exposure to NO₂ during pregnancy was associated with onset of eczema, similarly for all trimesters. Postnatal PM₁₀ and NO₂ were related to decreased remission. Postnatal outdoor temperature was associated with onset of eczema. Pre-natal and current redecoration or buying new furniture, and perinatal as well as current dampness and indoor mould, were associated with increased onset and decreased remission. Cockroaches in current home was another indoor risk factors. Prenatal exposure to farm environment and large family size were all negatively associated with eczema. In conclusion, a warmer climate and prenatal NO₂ can be associated with increased onset of eczema in Chinese preschoolers. Postnatal PM₁₀ and NO₂ can be associated with reduced remission. Perinatal and current dampness, indoor mould and cockroaches may increase onset and decrease remission. Exposure to chemical emissions from indoor materials after first year of life may increase onset. Prenatal exposure to farm environment and large family size could be protective.

Lifestyle behaviors and home and school environment in association with sick building syndrome among elementary school children: a cross-sectional study

Background

Sick building syndrome (SBS) refers to the combination of symptoms experienced by occupants of specific building characteristics. This study investigated the associations of children’s lifestyle behaviors, allergies, home, and school environment with SBS symptoms.

Methods

A total of 4408 elementary school children living in Sapporo City, Japan participated in this study. SBS was determined on parental answers to MM080 standardized school questionnaires on symptoms that were weekly experienced by these children, and if the symptom is attributed to their home or school environment. The Japanese version of the International Study of Asthma and Allergies in Childhood questionnaire was used to assess wheeze, rhino-conjunctivitis, and eczema. A logistic regression analysis was conducted to evaluate the associations between SBS symptoms and variables by controlling the potential confounders (gender, grade, school, and parental history of allergies). A stepwise backward elimination was conducted to assess independent variables related to SBS.

Results

Participants revealed mucosal (6.9%), skin (2.0%), and general (0.8%) symptoms. The presence of one or more allergy was associated with increased mucosal and skin symptoms. Children who skipped breakfast, displayed faddiness (like/dislike of food), had constipation, have insufficient sleep, did not feel refreshed after sleep, and lacked deep sleep showed significantly high odds ratios with SBS symptoms. The stepwise analysis showed faddiness for mucosal symptoms and not feeling refreshed after sleep for mucosal and skin symptoms, whereas constipation and lacking deep sleep for general symptoms were independent variables in increasing the symptoms. We found no significant relationship between SBS in children and schools. Considering children’s home, old building, no ventilation, wall-to-wall carpet, and heavy nearby traffic were associated with elevated mucosal symptom, while living in a multifamily home increased general symptoms. Home dampness was an independent variable in increasing all SBS symptoms.

Conclusions

Allergies and lifestyle behaviors were associated with increased SBS in children, including skipping breakfast, displaying faddiness, constipation, insufficient sleep, not feeling refreshed after sleep, and the lack of deep sleep. Further, dampness at home was associated with increase in all SBS symptoms. Lifestyle (e.g., eating and sleeping habits) and home (i.e., dampness) improvements might alleviate SBS symptoms in children.

How does parental history of atopic disease predict the risk of atopic dermatitis in a child? A systematic review and meta-analysis

BACKGROUND

Parental history of atopic disease is a well-established risk factor for the development of atopic dermatitis (AD), but several aspects of this association remain unclear.

OBJECTIVE

We sought to determine the association of parental history of atopic disease with AD in offspring.

METHODS

We searched PubMed and EMBASE through June 2018 for relevant records and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pooled odds ratios (ORs) with 95% CI were calculated using random-effects models.

RESULTS

A total of 163 records covering 149 unique studies were included. Of these, 119 studies were included in the meta-analysis. Individuals with parental history of atopic disease had increased odds of AD (OR, 1.81; 95% CI, 1.65-1.99). Parental asthma (OR, 1.56; 95% CI, 1.18-2.05) and allergic rhinitis (OR, 1.68; 95% CI, 1.34-2.11) had a smaller effect than AD (OR, 3.30; 95% CI, 2.46-4.42). The effect of maternal and paternal history was comparable for all atopic diseases. An increase in odds was observed when comparing the effect of having 1 (OR, 1.30; 95% CI, 1.15-1.47) or 2 atopic parents (OR, 2.08; 95% CI, 1.83-2.36), as well as having a parent with 1 (OR, 1.49; 95% CI, 1.28-1.74) or more atopic diseases (OR, 2.32; 95% CI, 1.92-2.81).

CONCLUSIONS

This study provides evidence-based risk estimates that may guide physicians who counsel parents with a history of atopic disease about their children's risk of AD. This information is of particular importance for future efforts toward establishing prophylactic interventions for AD on a general population level.

Asthma, allergic rhinitis and eczema among parents of preschool children in relation to climate, and dampness and mold in dwellings in China

The main aim was to study associations between asthma, allergic rhinitis and eczema among adults across China and dampness and mold at home. Young adults (N = 40,279) in eight cities in China answered a questionnaire in 2010-2012 (response rate 75.0%). Data on asthma, allergic rhinitis, eczema and the home environment was assessed by the questionnaire. Climate data was obtained from China Meteorological Administration and the website of Weather Underground. Health associations were analyzed by two-level logistic regression models, adjusting for covariates. Totally 1.6% had asthma, 6.6% allergic rhinitis and 2.2% eczema. Mold odor was associated with asthma (OR = 1.90) and allergic rhinitis (OR = 1.25-1.44). Window pane condensation in winter was associated with asthma (OR = 1.39), allergic rhinitis (OR = 1.26-1.58) and eczema (OR = 1.36-1.77). Presence of mold spots or damp stains was related to asthma (OR = 1.58-2.49), allergic rhinitis (OR = 1.35-1.76) and eczema (OR = 1.47-1.70). Water damage was related to asthma (OR = 1.69-1.82), allergic rhinitis (OR = 1.40-1.45) and eczema (OR = 1.44-1.96). Damp bed clothing was related to asthma (OR = 1.23), allergic rhinitis (OR = 1.23) and eczema (OR = 1.35). A higher dampness score was associated with increased odds ratios for diseases. Those living in older buildings had more asthma (OR = 1.39-1.76) and allergic rhinitis (OR = 1.16-1.21). Those living in suburban or rural areas had less asthma, allergic rhinitis and eczema as compared to those living in urban areas (OR values from 0.24 to 0.66). Stronger health associations with dampness and mold were found in southern China and in newer buildings (constructed after 2005). In conclusion, dampness and mold at home can be risk factors for asthma, allergic rhinitis and eczema among adults in China. Living in older buildings can be risk factors for asthma or allergic rhinitis while living in less urbanized areas can be protective.

Biomonitoring of organophosphate flame retardants and plasticizers in children: Associations with house dust and housing characteristics in Japan

Indoor environments contain a wide range of new chemicals such as phosphate flame retardants and plasticizers (PFRs). Despite recent epidemiological evidence suggesting that children might be affected by widespread exposure to PFRs, questions remain about the various exposure pathways to these chemicals. Therefore, the aim of this study was to investigate exposure to PFRs by measuring the concentrations a set of urinary metabolites for schoolchildren from Japan (n = 128) and associating them with house dust concentrations and housing characteristics. Detectable concentrations of both diaryl and dialkyl phosphates (DAPs) and hydroxylated metabolites (HO-PFRs) were found in urine samples of almost all children. 2-Hydroxyethyl bis(2-butoxyethyl) phosphate (BBOEHEP) was the most frequently detected metabolite (98%) followed by 1-hydroxy-2-propyl bis(1-chloro-2-propyl) phosphate (BCIPHIPP, 95%) and tris(chloroethyl) phosphate (TCEP). Next to BBOEHEP, two other metabolites of tris(2-butoxyethyl) phosphate (TBOEP) were also frequently detected. Significant correlations of moderate strength were found between parent compounds detected in high concentrations in house dust (TBOEP, tris(2-chloroisopropyl) phosphate (TCIPP)) and their corresponding metabolites, suggesting that dust is a primary exposure source for these PFRs. Several personal and housing characteristics, such as gender, income, and the use of PVC and ventilation were associated with metabolite concentrations in multivariate linear regression. Overall, this study showed that Japanese schoolchildren are exposed to a wide range of PFRs.

Associations between allergic symptoms and phosphate flame retardants in dust and their urinary metabolites among school children

BACKGROUND

Phosphate flame retardants (PFRs) are ubiquitously detected in indoor environments. Despite increasing health concerns pertaining to PFR exposure, few epidemiological studies have examined PFR exposure and its effect on children's allergies.

OBJECTIVES

To investigate the association between PFRs in house dust, their metabolites in urine, and symptoms of wheeze and allergies among school-aged children.

METHODS

A total of 128 elementary school-aged children were enrolled. House dust samples were collected from upper-surface objects. Urine samples were collected from the first morning void. Levels of 11 PFRs in dust and 14 PFR metabolites in urine were measured. Parent-reported symptoms of wheeze, rhinoconjunctivitis, and eczema were evaluated using the International Study of Asthma and Allergies in Childhood questionnaire. The odds ratios (ORs) of the Ln transformed PFR concentrations and categorical values were calculated using a logistic regression model adjusted for sex, grade, dampness index, annual house income, and creatinine level (for PFR metabolites only).

RESULTS

The prevalence rates of wheeze, rhinoconjunctivitis, and eczema were 22.7%, 36.7%, and 28.1%, respectively. A significant association between tris(1,3-dichloroisopropyl) phosphate (TDCIPP) in dust and eczema was observed: OR (95% confidence interval), 1.44 (1.13-1.82) (>limit of detection (LOD) vs <LOD). The ORs for rhinoconjunctivitis (OR = 5.01 [1.53-16.5]) and for at least one symptom of allergy (OR = 3.87 [1.22-12.3]) in the 4th quartile of Σtris(2-chloro-isopropyl) phosphate (TCIPP) metabolites was significantly higher than those in the 1st quartile, with significant p-values for trend (P_trend) (0.013 and 0.024, respectively). A high OR of 2.86 (1.04-7.85) (>LOD vs <LOD) was found for hydroxy tris(2-butoxyethyl) phosphate (TBOEP)-OH and eczema. OR of the 3rd tertile of bis (1,3-dichloro-2-propyl) phosphate (BDCIPP) was higher than the 1st tertile as a reference for at least one symptom (OR = 3.91 [1.25-12.3]), with a significant P_trend = 0.020.

CONCLUSIONS

We found that TDCIPP in house dust, and metabolites of TDCIPP, TBOEP and TCIPP were associated with children's allergic symptoms. Despite some limitations of this study, these results indicate that children's exposure to PFR may impact their allergic symptoms.

[New Scientific Evidence-based Public Health Guidelines and Practical Manual for Prevention of Sick House Syndrome]

Recently, we have published a book containing evidence-based public health guidelines and a practical manual for the prevention of sick house syndrome. The manual is available through the homepage of the Ministry of Health, Labour and Welfare (http://www.mhlw.go.jp/file/06-Seisakujouhou-11130500-Shokuhinanzenbu/0000155147.pdf). It is an almost completely revised version of the 2009 version. The coauthors are 13 specialists in environmental epidemiology, exposure sciences, architecture, and risk communication. Since the 1970s, health problems caused by indoor chemicals, biological pollution, poor temperature control, humidity, and others in office buildings have been recognized as sick building syndrome (SBS) in Western countries, but in Japan it was not until the 1990s that people living in new or renovated homes started to describe a variety of nonspecific subjective symptoms such as eye, nose, and throat irritation, headache, and general fatigue. These symptoms resembled SBS and were designated "sick house syndrome (SHS)." To determine the strategy for prevention of SHS, we conducted a nationwide epidemiological study in six cities from 2003-2013 by randomly sampling 5,709 newly built houses. As a result 1,479 residents in 425 households agreed to environmental monitoring for indoor aldehydes and volatile organic compounds (VOCs). After adjustment for possible risk factors, some VOCs and formaldehyde were dose-dependently shown to be significant risk factors. We also studied the dampness of the houses, fungi, allergies, and others. This book is fully based on the scientific evidence collected through these studies and other newly obtained information, especially from the aspect of architectural engineering. In addition to SHS, we included chapters on recent information about "multi-chemical sensitivity."

Household environment, lifestyle behaviors, and dietary habits in relation to childhood atopic eczema in Shanghai, China

PURPOSES

We aim to investigate associations of the child's individual characteristics, building characteristics, home environmental exposures, family lifestyle behaviors, and dietary habits on childhood eczema during lifetime-ever and in the last year before the survey.

METHODS

During April 2011-April 2012, we conducted a cross-sectional study and collected 13,335 parents-reported questionnaires of 4-6-year-old children from 72 kindergartens in Shanghai, China. Logistic regression model was used to investigate associations.

RESULTS

After adjusted for sex, age, family history of atopy, and questionnaire reporter, the factors which were strongly associated (increased odds >30% and p value <0.05) with lifetime-ever eczema included mother employed during pregnancy (adjusted OR 1.33), residence renovated during pregnancy (1.49) and in the child's first year of life (1.31), using laminate (1.58) and solid (1.42) wood as material of floor covering (compared to using cement), residence located in urban district (1.38), and dampness-related exposures in the early residence (mold spots/stains: 1.41; mold odor: 1.41) and in the current residence (water damage: 1.33; damp stains: 1.34; mold spots: 1.32; and windows pane condensation: 1.31). Parental smoking, pet-keeping, and incense-burning had no significant associations with childhood eczema. Similar associations were found for eczema in the last year before the survey. Families with sick children likely changed lifestyle behaviors and dietary habits.

CONCLUSIONS

Childhood eczema could be influenced by many household environmental and non-environmental factors. Exposures during early lifetime likely have greater impact on childhood eczema than current exposures. Associations of lifestyle behaviors and dietary habits with childhood eczema could be modified by family avoidance behaviors.

Exposure to phthalates in house dust and associated allergies in children aged 6-12years

Phthalates are widely used as plasticizers in household products. Several studies have reported an association between phthalate exposure and an increased risk of allergies. The present study estimated phthalate exposure in children aged 6-12years and assessed potential correlations with allergies. House dust samples were collected from floors and multi-surface objects >35cm above the floor. Urine samples were collected from the first morning void of the day. Daily phthalate intake (DI_dust and DI) was estimated using both house dust and urinary metabolite concentrations. Exposure to di-2-ethylhexyl phthalate (DEHP) in floor dust was associated with parental-reported rhino-conjunctivitis. After stratification by gender, this trend was found to only occur in boys. Furthermore, urinary mono-isobutyl phthalate was inversely associated with parental-reported wheeze in boys. DI_dust of benzyl butyl phthalate (BBzP) and DEHP were significantly correlated with DI_BBzP and DI_DEHP, respectively. These correlations were stronger with floor than with multi-surface dust. Our results suggest that, among Japanese children, house dust from low surfaces, such as living room floors, might play a meaningful role in the indoor environmental exposure pathway for BBzP and DEHP.

Spectrum of skin diseases presented at LAUTECH Teaching Hospital, Osogbo, southwest Nigeria

BACKGROUND

Patterns of skin disease in developing nations are changing as frequencies of non-communicable diseases continue to increase. Appraisal of the current status of the disease profile is of utmost importance for health planning and resource allocation.

METHODS

A prospective analysis of 895 cases of outpatient consultation during the years 2005-2010 was conducted.

RESULTS

The mean ± standard deviation age of patients was 31.1 ± 19.1 years. Non-infectious skin diseases accounted for 80.9% of all cases. Eczemas/dermatitis (27.0%), urticarias/erythemas (11.0%), fungal infections (9.5%), skin appendage disorders (8.9%), papulosquamous diseases (8.2%), pigmentary diseases (8.2%), viral infections (6.8%), and tumors and malignant skin lesions (5.4%) represented the most common presentations. Atopic dermatitis was the most common type of eczema (29.8%) among children (odds ratio [OR] 1.53, 95% confidence interval [CI] 1.09-2.13; P = 0.013), in whom cornification disorders (OR 3.90, 95% CI 1.73-8.92; P < 0.001) and viral infections (OR 1.80, 95% CI 1.09-3.25; P = 0.021) were also frequent. Adults were more likely to be diagnosed with drug eruptions (OR 3.58, 95% CI 1.09-11.80; P = 0.003), tumors/malignancy (OR 4.97, 95% CI 1.53-16.10; P = 0.030), or autoimmune connective tissue disorders (OR 8.13, 95% CI 1.09-60.20; P = 0.015). Female subjects were significantly affected by urticarias (OR 1.53, 95% CI 1.00-2.33; P = 0.030) and papulosquamous diseases (OR 1.80, 95% CI 1.09-3.03; P = 0.019).

CONCLUSIONS

The present pattern shows that non-infectious skin diseases are predominant. Occurrences of eczemas and urticarias are increasing at similar rates, whereas infectious skin diseases are decreasing in frequency. Resources and research should be directed towards the prevention of non-infectious skin diseases at this time as the campaign for a cleaner environment continues.

The effect of environmentally friendly wallpaper and flooring material on indoor air quality and atopic dermatitis: a pilot study

Background

Formaldehyde (FA) and other volatile organic compounds (VOCs) are considered among the main causes of atopic aggravation. Their main sources include wallpapers, paints, adhesives, and flooring materials.

Objective

To assess the effects of environmentally friendly wallpaper and flooring material on indoor air quality and atopic dermatitis severity.

Methods

Thirty patients with atopic dermatitis were enrolled in this study. To improve air quality, the wallpaper and flooring in the homes of the subjects were replaced with plant- or silica-based materials. The indoor air concentration of FA and the total VOCs (TVOCs) were measured before remodeling and 2, 6, and 10 weeks thereafter. Pruritus and the severity of atopic eczema were evaluated by using a questionnaire and the eczema area and severity index (EASI) score before and at 4, 8, and 12 weeks after remodeling. The subjects were instructed to continue their therapy for atopic dermatitis.

Results

The houses of 24 subjects were remodeled; all subjects completed the study. The concentration of FA in ambient air significantly decreased within 2 weeks after remodeling. The TVOC level showed a decrease at week 2 but increased again at weeks 6 and 10. The reduction of pruritus and EASI score was statistically significant in patients whose baseline EASI score was >3.

Conclusion

Replacing the wallpaper and flooring of houses with environmentally friendly material reduced FA in ambient air and improved pruritus and the severity of atopic eczema. The improvement of pruritus and eczema was statistically significant in patients whose baseline EASI score was >3.

Infrared camera-proven water-damaged homes are associated with the severity of atopic dermatitis in children

BACKGROUND

Moisture problems in dwellings have been linked to respiratory symptoms, but little is known about their association with symptoms of atopic dermatitis (AD). Moreover, the questionnaire-based survey or visual inspection for water damage does not use a standardized approach for assessing dampness.

OBJECTIVE

To determine water damage in the houses of children with AD by assessing variations in surface temperature with an infrared camera, an interview-led questionnaire, and evaluation of the relation between the presence of water damage and the severity of AD.

METHODS

Fifty-two homes of patients with AD were visited, and air samples were obtained from the living room and a child's bedroom. Water damage was determined by thermal assessments using an infrared camera and by the presence of visible mold or water stains. The effect of water damage on the severity of AD was analyzed by comparing the presence or absence of water damage and other aggravating factors between water-damaged and undamaged homes.

RESULTS

Water damage was observed in 31 of 52 homes (59.6%), and the concentrations of airborne mold were significantly higher in water-damaged homes than in undamaged homes (P = .0013). However, there was no difference in airborne mold levels between homes with and those without visible mold or water stains. Logistic regression analyses showed that water-damaged homes were significantly related to moderate to severe AD (adjusted odds ratio 14.52, 95% confidence interval 1.75-121.13, P = .0025).

CONCLUSION

Water-damaged homes affect the severity of AD in children. Infrared camera-driven assessment is a promising tool for determining moisture problems in buildings.

Association of mechanical ventilation and flue use in heaters with asthma symptoms in Japanese schoolchildren: a cross-sectional study in Sapporo, Japan

Background

Use of fuel heaters is associated with childhood asthma. However, no studies have evaluated the associations of flue use and mechanical ventilation (ventilation) with asthma symptoms in schoolchildren.

Methods

This cross-sectional study investigated schoolchildren in grades 1 through 6 (age 6–12 years) in Sapporo, Japan. From November 2008 through January 2009, parents completed questionnaires regarding their home environment and their children’s asthma symptoms.

Results

In total, 4445 (69.5%) parents of 6393 children returned the questionnaire. After excluding incomplete responses, data on 3874 children (60.6%) were analyzed. The prevalence of current asthma symptoms and ever asthma symptoms were 12.8% and 30.9%, respectively. As compared with electric heaters, current asthma symptoms was associated with use of flued heaters without ventilation (OR = 1.62; 95% CI, 1.03–2.64) and unflued heaters with ventilation (OR = 1.77; 95% CI, 1.09–2.95) or without ventilation (OR = 2.23; 95% CI, 1.31–3.85). Regardless of dampness, unflued heaters were significantly associated with current asthma symptoms in the presence and absence of ventilation.

Conclusions

Use of unflued heaters was associated with current asthma symptoms, regardless of dampness. In particular, the prevalence of current asthma symptoms was higher in the absence of ventilation than in the presence of ventilation. Ever asthma symptoms was only associated with use of unflued heaters without ventilation. Consequently, use of fuel heaters, especially those that have no flue or ventilation, deserves attention, as their use might be associated with childhood asthma symptoms.

Detection and intake assessment of organophosphate flame retardants in house dust in Japanese dwellings

The demand for phosphorus flame retardants (PFRs) has recently increased as an alternative to polybrominated diphenyl ether (PBDE). PFRs have been detected in house dust, but little is known about the concentrations of PFRs in private homes and the effects on human health. We measured the levels of 10 PFRs in indoor floor dust and upper surface dust from 128 Japanese dwellings of families with children in elementary school. The median (min-max) concentrations (μg/g) of PFRs were as follows: tris(2-butoxyethyl) phosphate (TBOEP), 30.88 (<0.61-936.65); tris(2-chloro-iso-propyl) phosphate (TCIPP), 0.74 (<0.56-392.52); and triphenyl phosphate (TPHP), 0.87 (<0.80-23.35). These values exceeded 50% detection rates, and the rates are median over the LOD in floor dust. The concentrations (μg/g) of TBOEP 26.55 (<0.61-1933.24), TCIPP 2.23 (<0.56-621.23), TPHP 3.13 (<0.80-27.47), tris(2-chloroethyl) phosphate (TCEP) 1.17 (<0.65-92.22), and tributyl phosphate (TNBP) 0.74 (<0.36-60.64) exceeded 50% detection rates in the upper surface dust. A significant positive correlation (P<0.05) between the concentrations of TCIPP and TBOEP was shown in floor dust and upper surface dust (n=48). Estimated median and 95th percentile daily intake was calculated for toddlers and elementary school children and was compared with reference dose values (RfD) from the literature. For TBOEP, the estimated 95th percentile intake from floor dust was 14% of RfD for toddlers and 4% for school children. The estimated intake from upper surface dust was somewhat lower. Estimated median intake of TBOEP and median intake for the other PFRs were less than 1% of the RfD. TBOEP, TCIPP and TPHP were the main PFRs in the dust. The median levels of PFRs are well below the RfD values.

Associations of phthalate concentrations in floor dust and multi-surface dust with the interior materials in Japanese dwellings

Phthalates are widely used as plasticizers in numerous products. However, there has been some concern about the various effects they may have on human health. Thus, household phthalate levels are an important public health issue. While many studies have assessed phthalate levels in house dust, the association of these levels with building characteristics has scarcely been examined. The present study investigated phthalate levels in house dust samples collected from the living areas of homes, and examined associations between these phthalate levels and the interior materials. Dust was collected from two portions of the living area: floor dust from the entire floor surface, and multi-surface dust from objects more than 35 cm above the floor. The levels of seven phthalates were measured using gas chromatography/mass spectrometry in selective ion monitoring mode. Phthalate levels were higher in multi-surface dust than in floor dust. Among floor dust samples, those from dwellings with compressed wooden flooring had significantly higher levels of di-iso-butyl phthalate compared to those with other floor materials, while polyvinyl chloride (PVC) flooring was associated with higher di-2-ethylhexyl phthalate (DEHP) levels. Among multi-surface dust samples, higher levels of DEHP and di-iso-nonyl phthalate (DINP) were found in samples from homes with PVC wallpaper than without. The number of PVC interior materials was significantly positively correlated with the levels of DEHP and DINP in multi-surface dust. The phthalate levels in multi-surface dust were associated with the interior surface materials, and those in floor dust were directly related to the flooring materials. Our findings show that when using house dust as an exposure assessment, it is very important to note where the samples were collected from. The present report provides useful information about the association between phthalates and dust inside dwellings, which will assist with establishing public health provisions.