1
|
Sander I, Lotz A, Neumann HD, Czibor C, Zahradnik E, Raulf M. Reliability and Correlation Between Indoor Allergen Concentrations from Vacuumed Surface Samples and Electrostatic Dust Collectors. Ann Work Expo Health 2020; 64:165-174. [PMID: 31773159 DOI: 10.1093/annweh/wxz090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 10/18/2019] [Accepted: 11/08/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Most studies on indoor allergen exposure used vacuumed surface samples for quantification. One alternative is electrostatic dust collectors (EDCs), which sample previously airborne settled dust. The aim of this study was to compare allergen quantification using two different sampling methods, with respect to repeatability, and to determine how well the results agree with one another. METHODS Four times a year, measurements were made from samples that were either collected from the vacuuming of surfaces, or from EDCs, from 20 German day-care centers totaling 167 rooms. Overall, 504 vacuumed samples collected from smooth floors, 435 samples from carpets, 291 samples from upholstered furniture and beds, and 605 EDC samples were analyzed using six fluorescence enzyme immunoassays recognizing Fel d 1, Can f 1, Mus m 1, domestic mite (DM), Dermatophagoides pteronyssinus (Dp), and Tyrophagus putrescentiae (Tp) antigens. Variances and correlations among the repeat measurements over the course of the year within each sample type, and the correlations between surface samples and the corresponding EDC samples were calculated. RESULTS Repeat measurements over the year correlated significantly with one another. However, only Fel d 1, Can f 1, and DM in the EDC samples; DM, Dp, Tp, and Fel d 1 in the upholstered furniture samples; and DM in the carpet samples show representative results of single measurements according to their variance ratios (within-room/between-room variance <1). The highest correlation between surface and EDC samples was found for Fel d 1 on the upholstered furniture (r 0.52), followed by Can f 1 on the upholstered furniture and Can f 1 on carpets (r 0.47 and 0.45, respectively). The maximum correlation for mite antigens was between carpet samples and EDC (DM r 0.27, Dp r 0.33). Mus m 1 and Tp antigens for the most part did not correlate to the EDC results. CONCLUSIONS Both vacuumed dust from upholstered furniture and EDC samples were suitable for repeatable quantification of several allergens in day-care centers within a year. However, there was little agreement among the different collection methods, especially for Mus m 1 and certain mite antigens. Therefore, the method and location used for collection may greatly influence allergen exposure assessment and study results.
Collapse
Affiliation(s)
- Ingrid Sander
- Institut für Prävention und Arbeitsmedizin der Deutschen Gesetzlichen Unfallversicherung (IPA), Kompetenz-Zentrum für Allergologie/Immunologie, Institut der Ruhr-Universität Bochum, Bochum, Germany
| | - Anne Lotz
- Institut für Prävention und Arbeitsmedizin der Deutschen Gesetzlichen Unfallversicherung (IPA), Kompetenz-Zentrum für Epidemiologie, Institut der Ruhr-Universität Bochum, Bochum, Germany
| | - Heinz-Dieter Neumann
- Unfallkasse Nordrhein-Westfalen der Deutschen Gesetzlichen Unfallversicherung, Dezernat Prävention, Biologische, chemische und physikalische Einwirkungen, Düsseldorf, Germany
| | - Christina Czibor
- Institut für Prävention und Arbeitsmedizin der Deutschen Gesetzlichen Unfallversicherung (IPA), Kompetenz-Zentrum für Allergologie/Immunologie, Institut der Ruhr-Universität Bochum, Bochum, Germany
| | - Eva Zahradnik
- Institut für Prävention und Arbeitsmedizin der Deutschen Gesetzlichen Unfallversicherung (IPA), Kompetenz-Zentrum für Allergologie/Immunologie, Institut der Ruhr-Universität Bochum, Bochum, Germany
| | - Monika Raulf
- Institut für Prävention und Arbeitsmedizin der Deutschen Gesetzlichen Unfallversicherung (IPA), Kompetenz-Zentrum für Allergologie/Immunologie, Institut der Ruhr-Universität Bochum, Bochum, Germany
| |
Collapse
|
2
|
Umweltmikrobiom. Monatsschr Kinderheilkd 2017. [DOI: 10.1007/s00112-017-0271-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
3
|
Allergic sensitisation in early childhood: Patterns and related factors in PARIS birth cohort. Int J Hyg Environ Health 2016; 219:792-800. [PMID: 27649627 DOI: 10.1016/j.ijheh.2016.09.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 08/30/2016] [Accepted: 09/01/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Allergic sensitisation is poorly documented in infants. This study aims to provide new insights into allergic sensitisation patterns and related factors in infancy. METHODS This study concerns 1860 infants involved in the Pollution and Asthma Risk: an Infant Study (PARIS) population-based birth cohort who had a standardised health examination when 18 months old, from 2004 to 2008. Sensitisation was assessed by measurements of serum specific IgE to 12 food and 4 inhalant allergens and defined by IgE≥0.35kUA/L. Information regarding lifestyle and environment were obtained from questionnaires prospectively administered. RESULTS Prevalence of allergic sensitisation to any allergen, to food allergens, and to aeroallergens was 13.8%, 12.3%, and 2.3%, respectively. Multiple sensitisation (to at least two allergens) concerned 6.2% of toddlers. Intrinsic factors such as male gender, family history of allergy, and high birth weight increased the risk of food allergen sensitisation and multiple sensitisation. Caesarean section was also positively associated with multiple sensitisation. Day-care attendance was negatively related to food allergen, aeroallergen, and multiple sensitisation. A cat entering the baby's room in early life was strongly associated with aeroallergen sensitisation (ORa 3.21, 95%CI: 1.29-8.01). An introduction of meat in infant's diet after 6 months of age was negatively related to food allergen sensitisation (ORa 0.46, 95%CI: 0.24-0.91). CONCLUSION Our results suggest that intrinsic factors and indicators of exposure to microorganisms such as caesarean section and day-care attendance may be associated with inhalant as well as food allergen sensitisation in infancy. For example, male gender, family history of allergy, high birth weight, and caesarean section could be positively related whereas day-care attendance could be negatively related to both aeroallergen and food allergen sensitisation. Conversely, early life exposure to inhalant allergens or food allergens may be specifically linked to either aeroallergen sensitisation or food allergen sensitisation, respectively.
Collapse
|
4
|
von Mutius E. The microbial environment and its influence on asthma prevention in early life. J Allergy Clin Immunol 2016; 137:680-9. [PMID: 26806048 DOI: 10.1016/j.jaci.2015.12.1301] [Citation(s) in RCA: 131] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 11/27/2015] [Accepted: 12/05/2015] [Indexed: 12/27/2022]
Abstract
There is accumulating evidence to suggest that the environmental microbiome plays a significant role in asthma development. The very low prevalence of asthma in populations highly exposed to microbial environments (farm children and Amish populations) highlights its preventive potential. This microbial diversity might be necessary to instruct a well-adapted immune response and regulated inflammatory responses to other inhaled and ingested environmental elements, such as allergens, particles, and viruses. Like the internal gut microbiome, which is increasingly recognized as an important instructor of immune maturation, the external environmental microbiome might shape immune responses on the skin, airway mucosal surfaces, and potentially also the gut early in life. The diversity of the external microbial world will ensure that of the many maladapted pathways leading to asthma development, most, if not all, will be counterbalanced. Likewise, important contributors to asthma, such as allergen sensitization and allergic manifestations early in life, are being suppressed. Thus the facets of innate immunity targeted by microbes and their compounds and metabolites might be the master switch to asthma and allergy protection, which has been found in environments rich in microbial exposures.
Collapse
Affiliation(s)
- Erika von Mutius
- Department of Pediatrics, Dr von Hauner Children's Hospital of Ludwig Maximilian University of Munich, Munich, Germany.
| |
Collapse
|
5
|
Apfelbacher C, Frew E, Xiang A, Apfel A, Smith H. Assessment of pet exposure by self-report in epidemiological studies of allergy and asthma: a systematic review. J Asthma 2016; 53:363-73. [PMID: 26539692 DOI: 10.3109/02770903.2015.1099161] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE In epidemiological studies that aim to investigate the relationship between pet exposure and allergy/asthma, pet exposure is often ascertained by means of a questionnaire, but it is unclear which questionnaire items are used. The objective of this study was to systematically review self-reported pet exposure assessment in questionnaires used in epidemiological studies which explore the associations between pets and allergy/asthma. METHODS A systematic literature search was conducted in PubMed and papers were selected according to pre-specified eligibility criteria. The pet exposure questions used were classified within a framework including direct pet contact, indirect pet contact (e.g. through carers or grandparents) and avoidance behaviour. Authors were contacted when the questions used were not reported in detail. RESULTS Ninety-six full text papers were systematically reviewed. All studies assessed direct pet contact, but less than half (45%) explicitly assessed whether pets were allowed indoors. The vast majority of studies assessed both pet exposures during the first year of life and after the first year of life. The minority (13%) assessed whether pet(s) were kept at places regularly visited by the child and pet exposure in utero (15%). Even fewer studies assessed indirect contact to pets (n = 8) and avoidance behaviour (n = 10). CONCLUSIONS In epidemiological studies, the ascertainment of pet exposure through questionnaires appears to vary greatly. This variation might partly explain the inconsistent and contradictory results of the effects of pet exposure on the development of allergy and asthma.
Collapse
Affiliation(s)
- Christian Apfelbacher
- a Division of Public Health and Primary Care , Brighton and Sussex Medical School , Brighton , UK and.,b Department of Medical Sociology , Institute of Epidemiology and Preventive Medicine, University of Regensburg , Regensburg , Germany
| | - Edward Frew
- a Division of Public Health and Primary Care , Brighton and Sussex Medical School , Brighton , UK and
| | - Ally Xiang
- a Division of Public Health and Primary Care , Brighton and Sussex Medical School , Brighton , UK and
| | - Alex Apfel
- a Division of Public Health and Primary Care , Brighton and Sussex Medical School , Brighton , UK and
| | - Helen Smith
- a Division of Public Health and Primary Care , Brighton and Sussex Medical School , Brighton , UK and
| |
Collapse
|
6
|
Tischer C, Zock JP, Valkonen M, Doekes G, Guerra S, Heederik D, Jarvis D, Norbäck D, Olivieri M, Sunyer J, Svanes C, Täubel M, Thiering E, Verlato G, Hyvärinen A, Heinrich J. Predictors of microbial agents in dust and respiratory health in the Ecrhs. BMC Pulm Med 2015; 15:48. [PMID: 25929252 PMCID: PMC4425915 DOI: 10.1186/s12890-015-0042-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 04/17/2015] [Indexed: 01/05/2023] Open
Abstract
Background Dampness and mould exposure have been repeatedly associated with respiratory health. However, less is known about the specific agents provoking or arresting health effects in adult populations. We aimed to assess predictors of microbial agents in mattress dust throughout Europe and to investigate associations between microbial exposures, home characteristics and respiratory health. Methods Seven different fungal and bacterial parameters were assessed in mattress dust from 956 adult ECRHS II participants in addition to interview based home characteristics. Associations between microbial parameters and the asthma score and lung function were examined using mixed negative binomial regression and linear mixed models, respectively. Results Indoor dampness and pet keeping were significant predictors for higher microbial agent concentrations in mattress dust. Current mould and condensation in the bedroom were significantly associated with lung function decline and current mould at home was positively associated with the asthma score. Higher concentrations of muramic acid were associated with higher mean ratios of the asthma score (aMR 1.37, 95%CI 1.17-1.61). There was no evidence for any association between fungal and bacterial components and lung function. Conclusion Indoor dampness was associated with microbial levels in mattress dust which in turn was positively associated with asthma symptoms. Electronic supplementary material The online version of this article (doi:10.1186/s12890-015-0042-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Christina Tischer
- Institute of Epidemiology I, Helmholtz Zentrum München, Ingolstädter Landstrasse 1,German Research Centre for Environmental Health, D-85764, Neuherberg, Germany. .,Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.
| | - Jan-Paul Zock
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain. .,Universitat Pompeu Fabra (UPF), Barcelona, Spain. .,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain. .,Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands.
| | - Maria Valkonen
- Living Environment and Health Unit, National Institute for Health and Welfare, Kuopio, Finland.
| | - Gert Doekes
- Institute for Risk Assessment Sciences, Division Environmental Epidemiology, Utrecht University, Utrecht, the Netherlands.
| | - Stefano Guerra
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain. .,Universitat Pompeu Fabra (UPF), Barcelona, Spain. .,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain. .,Arizona Respiratory Center, University of Arizona, Tucson, AZ, USA.
| | - Dick Heederik
- Institute for Risk Assessment Sciences, Division Environmental Epidemiology, Utrecht University, Utrecht, the Netherlands.
| | - Deborah Jarvis
- Respiratory Epidemiology and Public Health Group, Imperial College London, London, UK. .,MRC-HPA Centre for Environment Health, King's College London, London, UK.
| | - Dan Norbäck
- The Department of Medical Science, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden.
| | - Mario Olivieri
- Department of Occupational Medicine, University of Verona, Verona, Italy.
| | - Jordi Sunyer
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain. .,Universitat Pompeu Fabra (UPF), Barcelona, Spain. .,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain. .,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
| | - Cecilie Svanes
- Department of Occupational Medicine, Centre for International Health, University of Bergen and , Haukeland University Hospital, Bergen, Norway.
| | - Martin Täubel
- Living Environment and Health Unit, National Institute for Health and Welfare, Kuopio, Finland.
| | - Elisabeth Thiering
- Institute of Epidemiology I, Helmholtz Zentrum München, Ingolstädter Landstrasse 1,German Research Centre for Environmental Health, D-85764, Neuherberg, Germany. .,Division of Metabolic Diseases and Nutritional Medicine, Dr von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany.
| | - Giuseppe Verlato
- Epidemiology and Medical Statistics, University of Verona, Verona, Italy.
| | - Anne Hyvärinen
- Living Environment and Health Unit, National Institute for Health and Welfare, Kuopio, Finland.
| | - Joachim Heinrich
- Institute of Epidemiology I, Helmholtz Zentrum München, Ingolstädter Landstrasse 1,German Research Centre for Environmental Health, D-85764, Neuherberg, Germany.
| |
Collapse
|
7
|
Exposure to cats: update on risks for sensitization and allergic diseases. Curr Allergy Asthma Rep 2013; 12:413-23. [PMID: 22878928 DOI: 10.1007/s11882-012-0288-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Cats are the pets most commonly implicated in the etiology of asthma and allergic disease. However, systematic reviews have concluded that there is a lack of evidence to support the idea that cat exposure in early life increases the risk of allergic disease. Indeed, it appears most likely that cat exposure is protective against allergic diseases. Recent large prospective studies have shown that living with a cat during childhood, especially during the first year of a child's life, could be protective. However, any advice given to the parents should also incorporate how new acquisition of cats can affect other family members, especially those who are already sensitized. Research is urgently needed to determine whether the suggested impact of acquisition of cats in adult life is modified by the person's childhood pet ownership, to help parents who seek advice on whether or not to get a cat.
Collapse
|
8
|
Gehring U, Casas M, Brunekreef B, Bergström A, Bonde JP, Botton J, Chévrier C, Cordier S, Heinrich J, Hohmann C, Keil T, Sunyer J, Tischer CG, Toft G, Wickman M, Vrijheid M, Nieuwenhuijsen M. Environmental exposure assessment in European birth cohorts: results from the ENRIECO project. Environ Health 2013; 12:8. [PMID: 23343014 PMCID: PMC3564791 DOI: 10.1186/1476-069x-12-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 01/08/2013] [Indexed: 05/24/2023]
Abstract
Environmental exposures during pregnancy and early life may have adverse health effects. Single birth cohort studies often lack statistical power to tease out such effects reliably. To improve the use of existing data and to facilitate collaboration among these studies, an inventory of the environmental exposure and health data in these studies was made as part of the ENRIECO (Environmental Health Risks in European Birth Cohorts) project. The focus with regard to exposure was on outdoor air pollution, water contamination, allergens and biological organisms, metals, pesticides, smoking and second hand tobacco smoke (SHS), persistent organic pollutants (POPs), noise, radiation, and occupational exposures. The review lists methods and data on environmental exposures in 37 European birth cohort studies. Most data is currently available for smoking and SHS (N=37 cohorts), occupational exposures (N=33), outdoor air pollution, and allergens and microbial agents (N=27). Exposure modeling is increasingly used for long-term air pollution exposure assessment; biomonitoring is used for assessment of exposure to metals, POPs and other chemicals; and environmental monitoring for house dust mite exposure assessment. Collaborative analyses with data from several birth cohorts have already been performed successfully for outdoor air pollution, water contamination, allergens, biological contaminants, molds, POPs and SHS. Key success factors for collaborative analyses are common definitions of main exposure and health variables. Our review emphasizes that such common definitions need ideally be arrived at in the study design phase. However, careful comparison of methods used in existing studies also offers excellent opportunities for collaborative analyses. Investigators can use this review to evaluate the potential for future collaborative analyses with respect to data availability and methods used in the different cohorts and to identify potential partners for a specific research question.
Collapse
Affiliation(s)
- Ulrike Gehring
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Maribel Casas
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Hospital del Mar Research Institute (IMIM), Barcelona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Pamplona, Spain
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anna Bergström
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jens Peter Bonde
- Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen NV, Denmark
| | - Jérémie Botton
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Hospital del Mar Research Institute (IMIM), Barcelona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Pamplona, Spain
| | - Cecile Chévrier
- INSERM U1085 - IRSET, University of Rennes I, Rennes, France
| | | | - Joachim Heinrich
- Helmholtz Zentrum, München & German Research Centre for Environmental Health, Institute of Epidemiology I, Neuherberg, Germany
| | - Cynthia Hohmann
- Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medical Center Berlin, Berlin, Germany
| | - Thomas Keil
- Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medical Center Berlin, Berlin, Germany
| | - Jordi Sunyer
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Hospital del Mar Research Institute (IMIM), Barcelona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Pamplona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Christina G Tischer
- Helmholtz Zentrum, München & German Research Centre for Environmental Health, Institute of Epidemiology I, Neuherberg, Germany
| | - Gunnar Toft
- Department of Occupational Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Magnus Wickman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Martine Vrijheid
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Hospital del Mar Research Institute (IMIM), Barcelona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Pamplona, Spain
| | - Mark Nieuwenhuijsen
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Hospital del Mar Research Institute (IMIM), Barcelona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Pamplona, Spain
| |
Collapse
|
9
|
Platts-Mills TAE, Woodfolk JA. Allergens and their role in the allergic immune response. Immunol Rev 2011; 242:51-68. [PMID: 21682738 DOI: 10.1111/j.1600-065x.2011.01021.x] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Allergens are recognized as the proteins that induce immunoglobulin E (IgE) responses in humans. The proteins come from a range of sources and, not surprisingly, have many different biological functions. However, the delivery of allergens to the nose is exclusively on particles, which carry a range of molecules in addition to the protein allergens. These molecules include pathogen-associated molecular patterns (PAMPs) that can alter the response. Although the response to allergens is characterized by IgE antibodies, it also includes other isotypes (IgG, IgA, and IgG4), as well as T cells. The challenge is to identify the characteristics of these exposures that favor the production of this form of response. The primary features of the exposure appear to be the delivery in particles, such as pollen grains or mite feces, containing both proteins and PAMPs, but with overall low dose. Within this model, there is a simple direct relationship between the dose of exposure to mite or grass pollen and the prevalence of IgE responses. By contrast, the highest levels of exposure to cat allergen are associated with a lower prevalence of IgE responses. Although the detailed mechanisms for this phenomenon are not clear, it appears that enhanced production of interleukin-10 in response to specific Fel d 1 peptides could influence the response. However, it is striking that the animal sources that are most clearly associated with decreased responses at high allergen dose are derived from animals from which humans evolved more recently (∼65 million years ago). Although the nose is still recognized as the primary route for sensitization to inhalant allergens, there is increasing evidence that the skin is also an important site for the generation of IgE antibody responses. By contrast, it is now evident that delivery of foreign proteins by the oral route or sublingually will favor the generation of tolerance.
Collapse
Affiliation(s)
- Thomas A E Platts-Mills
- Asthma and Allergic Diseases Center, University of Virginia Health System, Charlottesville, VA 22908-1355, USA.
| | | |
Collapse
|
10
|
Contaminación biológica intradomiciliaria y su relación con síntomas respiratorios indicativos de asma bronquial en preescolares de Bucaramanga, Colombia. BIOMEDICA 2011. [DOI: 10.7705/biomedica.v31i3.364] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|