Aeroallergens and work-related respiratory symptoms among office workers

Reduction of airborne and surface-borne bacteria in a medical center burn intensive care unit using active, upper-room, germicidal ultraviolet (GUV) disinfection

OBJECTIVE

To determine the effectiveness of active, upper-room, germicidal ultraviolet (GUV) devices in reducing bacterial contamination in patient rooms in air and on surfaces as a supplement to the central heating, ventilation, and air conditioning (HVAC) air handling unit (AHU) with MERV 14 filters and UV-C disinfection.

METHODS

This study was conducted in an academic medical center, burn intensive care unit (BICU), for 4 months in 2022. Room occupancy was monitored and recorded. In total, 402 preinstallation and postinstallation bacterial air and non-high-touch surface samples were obtained from 10 BICU patient rooms. Airborne particle counts were measured in the rooms, and bacterial air samples were obtained from the patient-room supply air vents and outdoor air, before and after the intervention. After preintervention samples were obtained, an active, upper-room, GUV air disinfection system was deployed in each of the patient rooms in the BICU.

RESULTS

The average levels of airborne bacteria of 395 CFU/m3 before GUV device installation and 37 CFU/m3 after installation indicated an 89% overall decrease (P < .0001). Levels of surface-borne bacteria were associated with a 69% decrease (P < .0001) after GUV device installation. Outdoor levels of airborne bacteria averaged 341 CFU/m3 in March before installation and 676 CFU/m3 in June after installation, but this increase was not significant (P = .517).

CONCLUSIONS

Significant reductions in air and surface contamination occurred in all rooms and areas and were not associated with variations in outdoor air concentrations of bacteria. The significant decrease of surface bacteria is an unexpected benefit associated with in-room GUV air disinfection, which can potentially reduce overall bioburden.

Comparing the concentration levels of allergens and endotoxins in employees' homes and offices

Objective

The aim of the study was to find out whether allergen and endotoxin concentrations in offices differ from those measured at the homes of employees, and identify the parameters that influence exposure.

Methods

Electrostatic dust collectors (EDCs) were placed in five office buildings (68 rooms, 436 EDCs), as well as the homes of the office workers (145 rooms, 405 EDCs) for 14 days, four times a year. In addition, surface samples were collected from the offices four times a year by vacuuming the carpeted floors. Domestic mite (DM), and the major cat and dog allergens (Fel d 1 and Can f 1) were quantified in all samples using fluorescence enzyme immunoassays. Endotoxin was measured in the EDC samples, using the Limulus amoebocyte lysate assay. The allergen and endotoxin concentrations were log transformed and analysed with multilevel models.

Results

Endotoxin concentrations were significantly higher in personal homes compared to levels measured in the offices, and depended on the number of persons living in each household, as well as the presence of a dog. DM allergens were significantly higher in households than in offices, and were significantly higher in bedrooms compared to living rooms. Offices occupied by cat owners had significantly higher Fel d 1 concentrations than offices or homes without. Additionally, Can f 1 concentrations were significantly higher in offices occupied by dog owners compared to those without.

Conclusions

Pet owners appear to transfer cat and dog allergens to their offices. Therefore, in case of allergy complaints at the office, employers and physicians might consider possible contamination by cat and dog allergens.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00420-021-01794-9.

Outdoor air pollution, meteorological conditions and indoor factors in dwellings in relation to sick building syndrome (SBS) among adults in China

Indoor environment is associated with the sick building syndrome (SBS), but little is known about the contribution of outdoor air pollution and meteorological conditions to SBS. We studied associations between outdoor air pollution, meteorological parameters and selected indoor exposure and building characteristics at home and weekly SBS symptoms in a standardized questionnaire study among 3485 randomly selected adults in China. Outdoor factors included particulate matters with diameter <10μm (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), outdoor temperature (T), relative air humidity (RH), and wind speed (WS) during last three months. Multiple logistic regression was applied calculating odds ratios (OR) with 95% confidence interval (95% CI). Asthma or allergic rhinitis (atopy) was associated with all types of SBS symptoms except fatigue. Indoor factors played a major role in SBS symptoms. Mold/dampness on the floor/ceiling was associated with fatigue OR=1.60 (1.11-2.30) and headache OR=1.80 (1.07-3.04). Moldy odor was associated with fatigue OR=1.59 (1.07-2.37) and dermal symptoms OR=1.91 (1.21-3.02). Window pane condensation in winter was associated with fatigue OR=1.73 (1.30-2.31) and throat symptoms OR=1.53 (1.01-2.31). Damp bed clothing was related with throat symptom OR=1.62 (1.09-2.40). Home redecoration was associated with fatigue OR=1.49 (1.07-2.06). Frequent window opening was associated with less nose symptoms OR=0.54 (0.36-0.82) and mechanical ventilation in the bathroom reduced dermal symptoms OR=0.66 (0.44-0.99). Females were more susceptible to redecoration and window pane condensation than men. No associations with SBS were observed for outdoor air pollutants or meteorological parameters in the final models combining indoor and outdoor factors, although SO2, T, and RH were associated with some SBS symptoms (fatigue, eyes and nose symptoms) in the separate outdoor models. In conclusion, indoor mold/dampness, air pollution from redecoration and poorer ventilation conditions in dwellings can be risk factors for SBS symptoms in an adult Chinese population, especially among females.

Outbreak of eczema and rhinitis in a group of office workers in Greenland

INTRODUCTION

Disturbed indoor climate may in some cases be associated with illness. In the present paper, we report the results from a thorough investigation of office workers in Greenland, who developed skin and/or airway problems after moving into renewed offices.

MATERIAL AND METHODS

In 2009 the office of the Bank of Greenland had a total renovation of the building, including new furniture and carpets. Symptoms developed within the first year after moving back into the renewed buildings. After removal of carpets in the building, symptoms significantly improved. Workers were examined in 2009 and re-examined in 2013, including clinical examination, patch test and when relevant also skin prick tests and histamine release test. Isothiazolinones and fumarates, both able to cause airway as well as skin symptoms, were isolated from carpets before testing, and included in the test series.

RESULTS

In total, 32 out of 80 workers (40%) developed symptoms; 27 reported eczema, 20 rhinitis and 4 urticaria. Eczema was located on the hands and/or lower arms in 18 workers, on the face in 10 workers and on legs/trunk in 12 workers. After intervention in the office, 22 workers with eczema reported significant improvement, all cases of hand eczema cleared and 16 workers with rhinitis also improved. Positive patch tests to carpet extracts were found significantly more frequent in the worker cohort than in a control group comprising 47 dermatitis patients (p<0.001). Only few workers reacted with a positive response to skin prick test or in the HR test, no obvious pattern in reactions was found, and no conclusions can be made from these reactions.

CONCLUSION

The results indicate that the reported symptoms are related to exposures from the building after renovation in 2009. A specific triggering exposure could not be identified, although chemicals from the glued carpets are suspected. The study is an example of a work place investigation, and illustrates the diversity of symptoms and exposures involved in "Sick Building" cases.

Asthma, Airway Symptoms and Rhinitis in Office Workers in Malaysia: Associations with House Dust Mite (HDM) Allergy, Cat Allergy and Levels of House Dust Mite Allergens in Office Dust

A prevalence study was conducted among office workers in Malaysia (N= 695). The aim of this study was to examine associations between asthma, airway symptoms, rhinitis and house dust mites (HDM) and cat allergy and HDM levels in office dust. Medical data was collected by a questionnaire. Skin prick tests were performed for HDM allergens (Dermatophagoides pteronyssinus, Dermatophagoides farinae) and cat allergen Felis domesticus. Indoor temperature and relative air humidity (RH) were measured in the offices and vacuumed dust samples were analyzed for HDM allergens. The prevalence of D. pteronyssinus, D. farinae and cat allergy were 50.3%, 49.0% and 25.5% respectively. Totally 9.6% had doctor-diagnosed asthma, 15.5% had current wheeze and 53.0% had current rhinitis. The Der p 1 (from D. pteronyssinus) and Der f 1 (from D. farinae) allergens levels in dust were 556 ng/g and 658 ng/g respectively. Statistical analysis was conducted by multilevel logistic regression, adjusting for age, gender, current smoking, HDM or cat allergy, home dampness and recent indoor painting at home. Office workers with HDM allergy had more wheeze (p= 0.035), any airway symptoms (p= 0.032), doctor-diagnosed asthma (p= 0.005), current asthma (p= 0.007), current rhinitis (p= 0.021) and rhinoconjuctivitis (p< 0.001). Cat allergy was associated with wheeze (p= 0.021), wheeze when not having a cold (p= 0.033), any airway symptoms (p= 0.034), doctor-diagnosed asthma (p= 0.010), current asthma (p= 0.020) and nasal allergy medication (p= 0.042). Der f 1 level in dust was associated with daytime breathlessness (p= 0.033) especially among those with HDM allergy. Der f 1 levels were correlated with indoor temperature (p< 0.001) and inversely correlated with RH (p< 0.001). In conclusion, HDM and cat allergies were common and independently associated with asthma, airway symptoms and rhinitis. Der f 1 allergen can be a risk factor for daytime breathlessness.

Pyroglyphid mites as a source of work-related allergens

Pyroglyphid mites are primarily associated with allergen exposure at home; hence the name house dust mites. However, we have found numerous studies reporting pyroglyhid mite levels in public and occupational settings. This review presents the findings of house dust mite allergens (family Pyroglyphidae, species Dermatophagoides) as potential work-related risk factors and proposes occupations at risk of house dust mite-related diseases. Pyroglyphid mites or their allergens are found in various workplaces, but clinically relevant exposures have been observed in hotels, cinemas, schools, day-care centres, libraries, public transportation (buses, trains, taxies, and airplanes), fishing-boats, submarines, poultry farms, and churches. Here we propose a classification of occupational risk as low (occasional exposure to mite allergen levels up to 2 μg g(-1)), moderate (exposure between 2 μg g(-1) and 10 μg g(-1)), and high (exposure >10 μg g(-1)). The classification of risk should include factors relevant for indoor mite population (climate, building characteristics, and cleaning schedule). To avoid development or aggravation of allergies associated with exposure to house dust mites at work, occupational physicians should assess exposure risk at work, propose proper protection, provide vocational guidance to persons at risk and conduct pre-employment and periodic examinations to diagnose new allergy cases. Protection at work should aim to control dust mite levels at work. Measures may include proper interior design and regular cleaning and building maintenance.

Fungal spores: a critical review of the toxicological and epidemiological evidence as a basis for occupational exposure limit setting

Fungal spores are ubiquitous in the environment. However, exposure levels in workplaces where mouldy materials are handled are much higher than in common indoor and outdoor environments. Spores of all tested species induced inflammation in experimental studies. The response to mycotoxin-producing and pathogenic species was much stronger. In animal studies, nonallergic responses dominated after a single dose. Allergic responses also occurred, especially to mycotoxin-producing and pathogenic species, and after repeated exposures. Inhalation of a single spore dose by subjects with sick building syndrome indicated no observed effect levels of 4 x 10(3) Trichoderma harzianum spores/m(3) and 8 x 10(3) Penicillium chrysogenum spores/m(3) for lung function, respiratory symptoms, and inflammatory cells in the blood. In asthmatic patients allergic to Penicillium sp. or Alternaria alternata, lowest observed effect levels (LOELs) for reduced airway conductance were 1 x 10(4) and 2 x 10(4) spores/m(3), respectively. In epidemiological studies of highly exposed working populations lung function decline, respiratory symptoms and airway inflammation began to appear at exposure levels of 10(5) spores/m(3). Thus, human challenge and epidemiological studies support fairly consistent LOELs of approximately 10(5) spores/m(3) for diverse fungal species in nonsensitised populations. Mycotoxin-producing and pathogenic species have to be detected specifically, however, because of their higher toxicity.

Identification of bacterial and fungal components in tobacco and tobacco smoke

The microbiological composition of tobacco products was studied using culture and chemical analysis (of tobacco leaves) or chemical analysis only (tobacco and tobacco smoke). The chemical analyses utilized gas chromatography-tandem mass spectrometry for determining 3-hydroxy fatty acids, muramic acid, and ergosterol as markers of respectively lipopolysaccharide (LPS), peptidoglycan, and fungal biomass. Mesophilic bacteria dominated in both fresh and cured tobacco leaves; a range of additional bacteria and fungi were also found albeit in minor amounts. The peptidoglycan and LPS concentrations were approximately the same in tobacco leaves as in cigarette tobacco. The concentrations of the measured microbial components were much lower in some cigarettes locally produced in China, Korea, and Vietnam than in cigarettes of international brands purchased in the same countries, and the concentrations in the smoke were in general agreement with the concentrations in cigarette tobacco. No differences in microbial load in tobacco of "light" and "full flavor" cigarettes were seen. Storing cigarettes at high humidity resulted in elevated levels of fungi in the cigarette tobacco leading to increased ergosterol concentrations in the smoke. The fact that tobacco smoke is a bioaerosol may help to explain the high prevalence of respiratory disorders among smokers and non-smokers exposed to second hand smoke since the same symptoms are also commonly associated with exposure to bioaerosols.

Indoor air particles and bioaerosols before and after renovation of moisture-damaged buildings: the effect on biological activity and microbial flora

Many building-related health problems coincide with moisture damage and mold growth within a building. Their elimination is assumed to improve indoor air quality. The aim of this study was to follow the success of remediation in two individual buildings by analyzing the microbial flora and immunotoxicological activity of filter samples. We compare results from samples collected from indoor air in the moisture-damaged buildings before and after renovation and results from matched reference buildings and outdoor air. The microbial characteristics of the samples were studied by analyzing ergosterol content and determining the composition of fungal flora with quantitative polymerase chain reaction (QPCR). In addition, the concentrations of particles were monitored with optical particle counter (OPC). The immunotoxicological activity of collected particle samples was tested by exposing mouse macrophages (RAW264.7) for 24 h to particle suspension extracted from the filters, and measuring the viability of the exposed cells (MTT-test) and production of inflammatory mediators (nitric oxide, IL-6 and TNF*) in cell culture medium by enzyme-linked immunoassay (ELISA). The results show that for Location 1 the renovation decreased the immunotoxicological activity of the particles collected from damaged building, whereas no difference was detected in the corresponding samples collected from the reference building. Interestingly, only slight differences were seen in the concentration of fungi. In the Location 2, a decrease was seen in the concentration of fungi after the renovation, whereas no effect on the immunotoxicological responses was detected. In this case, the immunotoxicological responses to the indoor air samples were almost identical to those caused by the samples from outdoor air. This indicates that the effects of remediation on the indoor air quality may not necessarily be readily measurable either with microbial or toxicological parameters. This may be associated with different spectrum of harmful agents in different mold and moisture-damaged buildings.

Nasal hyperreactivity in allergic and non-allergic rhinitis: a potential risk factor for non-specific building-related illness

Self-reported non-allergic nasal symptom triggers in non-allergic ('vasomotor') rhinitis overlap with commonly identified environmental exposures in non-specific building-related illness. These include extremes of temperature and humidity, cleaning products, fragrances, and tobacco smoke. Some individuals with allergic rhinitis also report non-allergic triggers. We wished to explore the phenotypic overlap between allergic and non-allergic rhinitis by ascertaining self-reported non-allergic nasal symptom triggers among allergic rhinitics. Sixty subjects without work-related respiratory exposures or symptoms, aged 19-68 years, stratified by age, gender and (skin test-proven) allergic rhinitis status, were queried with regard to self-reported non-allergic nasal symptom triggers (aggregate score 0-8). In this sample, the number of self-reported non-allergic triggers was bimodal, with peaks at 1 and 5. Forty-two percent of seasonal allergic rhinitic subjects reported more than three non-allergic triggers, compared with only 3% of non-allergic non-rhinitics (P < 0.01). Subjects over 35 years were more likely to report one or more non-allergic triggers, particularly tobacco smoke (P < 0.05). Allergic rhinitics reported more non-allergic symptom triggers than did non-allergic, non-rhinitics. As indexed by self-reported reactivity to non-specific physical and chemical triggers, both non-allergic rhinitics and a subset of allergic rhinitics may constitute susceptible populations for non-specific building-related illness.

PRACTICAL IMPLICATIONS

Judging by self-report, a substantial subset of individuals with allergic rhinitis--along with all individuals with nonallergic rhinitis (by definition)--are hyperreactive to non-allergic triggers. There is overlap between these triggers (elicited in the process of obtaining a clinical diagnosis) and environmental characteristics associated with ''problem buildings.'' Since individuals with self-identified rhinitis report an excess of symptoms in most epidemiologic studies of problem buildings (even in the absence of unusual aeroallergen levels), rhintics may be acting as a ''sentinel'' subgroup when indoor air quality is suboptimal. Together, non-allergic rhinitics plus allergic rhinitics with prominent non-allergic triggers, are thought to constitute approximately one-sixth of the US population.

Public health and economic impact of dampness and mold

The public health risk and economic impact of dampness and mold exposures was assessed using current asthma as a health endpoint. Individual risk of current asthma from exposure to dampness and mold in homes from W.J. Fisk, Q. Lei-Gomez & M.J. Mendell [(2007) Indoor Air, [corrected] 17, 284-296], and [corrected] asthma risks calculated from additional studies that reported the prevalence of dampness and mold in homes were used to estimate the proportion of US current asthma cases that are attributable to dampness and mold exposure at 21% (95% confidence internal 12-29%). An examination of the literature covering dampness and mold in schools, offices, and institutional buildings, which is summarized in the Appendix, suggests that risks from exposure in these buildings are similar to risks from exposures in homes. Of the 21.8 million people reported to have asthma in the USA, approximately 4.6 (2.7-6.3) million cases are estimated to be attributable to dampness and mold exposure in the home. Estimates of the national cost of asthma from two prior studies were updated to 2004 and used to estimate the economic impact of dampness and mold exposures. By applying the attributable fraction to the updated national annual cost of asthma, the national annual cost of asthma that is attributable to dampness and mold exposure in the home is estimated to be $3.5 billion ($2.1-4.8 billion). Analysis indicates that exposure to dampness and mold in buildings poses significant public health and economic risks in the USA. These findings are compatible with public policies and programs that help control moisture and mold in buildings.

PRACTICAL IMPLICATIONS

There is a need to control moisture in both new and existing construction because of the significant health consequences that can result from dampness and mold. This paper demonstrates that dampness and mold in buildings is a significant public health problem with substantial economic impact.

Airborne fungal spores in a cross-sectional study of office buildings

Airborne fungal spores were measured in 44 office buildings in the summer and winter throughout the continental United States, as part of the Building Assessment, Survey and Evaluation (BASE) program. Six indoor air and two outdoor air samples were collected on a single day from each building. The cross-sectional and repeated measure design afforded evaluation of between-building and within-building variability of fungal spore levels in buildings. Total fungal spore concentrations in indoor air ranged from < 24 to 1000 spores/m3, except for one building with natural ventilation where indoor levels were approximately 9000 spores/m3. Indoor air concentrations of total spores did not vary significantly between winter and summer or morning and afternoon monitoring periods or among climate zones or locations within a test area. Indoor-outdoor ratios of total spore concentrations typically ranged between 0.01 and 0.1 and were approximately seven times greater in winter than summer because of relatively low outdoor levels in the winter. The indoor-outdoor ratio of total spore concentrations for a building was consistent (reliability coefficient = 0.91) among repeated measures. Distributions of rank correlation coefficients for spore types in pairs of individual indoor-outdoor and indoor-indoor samples were weakly correlated (Spearman correlation = 0.2 on average). When spore type data were aggregated among samples from the same building, the central tendency of the rank correlation coefficients increased to 0.45. Rank correlation coefficients were also proportional to the number of spore types present in the samples that were compared. The BASE study provides normative data on concentrations of fungal spores that can aid in identification of problematic levels of mold in buildings.

Microbial Contamination in Airplane Cabins:Health Effects and Remediation

Microorganisms that affect human health are found in all indoor environments, including cabins of commercial aircraft. Those that arise from human sources can be transmitted by direct contact, droplets, or the airborne route. Infections from human sources include Influenza, Rhinovirus, SARS and tuberculosis. Transmission by the airborne route can be reduced by sterilizing the air with ultraviolet germicidal irradiation, or by diluting the contaminated air with outdoor air through ventilation. Microbes arising from environmental sources include bacteria, fungi and other organisms such as protozoa. These usually have very simple requirements for growth – water and a simple substrate such as dust. They cause health effects through direct infection rarely (one example is Legionnella), but more commonly cause immune reactions resulting in hypersensitivity or allergy mediated diseases. Environmental sources of microbial contamination are best prevented, but can be remediated through cleaning, germicidal chemicals, or ultraviolet germicidal irradiation. Airborne microbial substances including toxins, antigens and viable organisms can be removed by outdoor air ventilation or filtration. In aircraft cabins transmission of pathogens from human sources is difficult to control, but airborne transmission can be reduced through increased outdoor air ventilation or filtration. Environmental microbial contamination can, and does occur in aircraft cabins. These microbial sources are best prevented but, if detected, can be removed through cleaning or disinfection. Ultraviolet germicidal irradiation is an under-utilized technology that may be useful for sterilizing air as well as potential environmental sources.

Association of air-conditioning with respiratory symptoms in office workers in tropical climate

To evaluate the association of heating, ventilation and air-conditioning systems (HVAC) and respiratory symptoms in a tropical city, self-administered questionnaires were given to 2000 individuals working in air-conditioned office buildings and to 500 control workers in naturally ventilated buildings. Reported symptoms from the two populations were analyzed using chi-square tests, univariate and multiple logistic regressions models. Symptoms were the outcome variable and the odds ratios were adjusted by gender, age, accumulated work time, smoking habits and atopic background. There was a 79.8% response rate and there was a positive association of nasal symptoms (odds ratio, OR = 1.59, 95% confidence interval, CI = 1.11-2.28), naso-ocular symptoms (OR = 1.58, 95% CI = 1.05-2.38), persistent cough (OR = 3.04, 95% CI = 2.00-4.63) sinusitis symptoms (OR = 1.85, 95% CI = 1.27-2.71) and building-related worsening of the symptoms (OR = 4.92, 95% CI = 2.93-8.27) with working in air-conditioned buildings. In conclusion, our study suggests that artificial air-conditioning is a matter of concern for respiratory symptoms in cities with hot and humid climate.

PRACTICAL IMPLICATIONS

This study suggests that indoor air-related respiratory symptoms are a matter of concern in places with hot and humid climate. The regression models were adjusted by confounders that could be used in further reanalysis of indoor air quality related symptoms and ventilation systems with expanded variety of climatic conditions.

Concentrations of cat and dust-mite allergens in dust samples from 92 large US office buildings from the BASE Study

The concentrations of cat (Fel d1) and dust-mite (Der f1 and Der p1) allergens were measured in 92 large office buildings in the US Environmental Protection Agency's Building Assessment Survey and Evaluation (BASE) Study (251 dust samples; one to four samples per building). Fel d1 was detected in almost all buildings and samples (91 buildings, 99%; 235 samples, 94%; range: <0.01-19 microg/g; median: 0.3 microg/g). Cat allergen exceeded 1 microg/g (a lower symptom threshold) in 56 samples (22%) from 45 buildings, but exceeded 8 microg/g (a sensitization threshold) in only two samples (1%) from two buildings. Der f1 or Der p1 was found in approximately half of all buildings and samples (63 and 70% of buildings; 45 and 51% of samples; range: <0.01-53 microg/g and <0.01-25 microg/g; median: <0.02 and 0.03 microg/g, respectively). Mite allergen exceeded 2 microg/g (a sensitization threshold) in seven samples (3%) from five buildings and exceeded 10 microg/g (a symptom threshold) in three samples (1%) from three buildings. Fel d1 concentration was significantly higher in samples collected in summer (June to September, 48 buildings), but cat allergen was not correlated with either mite allergen. Der f1, but not Der p1, concentration tended to be higher in samples collected in winter (December to April, 44 buildings), and the two mite allergens were significantly correlated only in winter. Cat and mite allergens were detected in 78% of representative US office buildings, but the concentrations seldom exceeded levels associated with sensitization or symptom provocation.

PRACTICAL IMPLICATIONS

The information on the concentrations of cat and dust-mite allergens in representative large US offices has expanded the baseline data available for interpretation of measurements from other building investigations. With suggested refinements, the BASE protocol for measurement of allergen concentrations in dust samples may serve as a guide to future studies of building characteristics, bioaerosol concentrations, and occupant perceptions of the indoor environment.

Approaches to testing for food and chemical sensitivities

Testing for food and chemical sensitivities usually becomes necessary as part of the evaluation of otolaryngology patients who have chronic illness. The more complex the patient, and the more recalcitrant the problem is to treatment, the more likely it is that allergies, and especially food or chemical sensitivities, are involved in the pathogenesis of the illness. Failure to consider all major allergen contacts, including foods and chemicals, can lead to inadequate therapy. Similarly, failure to understand total allergic and oxidant load and the effects of chemical toxicity can lead to inappropriate or ineffective treatment. Clinically, food allergies occur in two different types: immediate, anaphylactic, fixed reactions and delayed, chronic, cyclic reactions. Different test methods have been developed for the two types. Fixed food allergies can be safely and efficiently detected by in vitro specific IgE or histamine release tests. Cyclic food allergies are best detected by either oral food challenges or by the IPDFT test. Choosing the best test for a particular patient requires a clear understanding of the two food allergy types and how their clinical presentations differ. Other tests for food allergies are compared and contrasted with these primary tests. Chemical sensitivity also occurs in two different clinical types: allergic, and toxic. True allergy to chemical haptens, either type I, IgE-mediated, or type IV, delayed hypersensitivity, occurs with significant frequency but is often unsuspected. Chemical toxicity can be caused by the aftereffects of an acute exposure or as a result of chronic, low-level exposure, but is even more frequently unsuspected and will not be diagnosed without a high index of suspicion. Both types of chemical sensitivity need to be addressed in any patients who have either a high allergen or chemical exposure load [105]. Either in vitro or in vivo tests can be used for chemical allergy detection; the advantages of each are outlined. Chemical toxicity screening tests are available and useful but do not detect all possible toxicants. Definitive toxic chemical tests usually require specialized laboratory facilities and expert consultation, for which possible sources are specified. The most important point in testing for food or chemical sensitivity is to be aware that food or chemical sensitivity can be contributing to a specific patient's clinical problems. Only then can appropriate investigations be undertaken to understand and then, perhaps, to intervene successfully in that illness.

Effect of ultraviolet germicidal lights installed in office ventilation systems on workers' health and wellbeing: double-blind multiple crossover trial

BACKGROUND

Workers in modern office buildings frequently have unexplained work-related symptoms or combinations of symptoms. We assessed whether ultraviolet germicidal irradiation (UVGI) of drip pans and cooling coils within ventilation systems of office buildings would reduce microbial contamination, and thus occupants' work-related symptoms.

METHODS

We undertook a double blind, multiple crossover trial of 771 participants. In office buildings in Montreal, Canada, UVGI was alternately off for 12 weeks, then turned on for 4 weeks. We did this three times with UVGI on and three times with it off, for 48 consecutive weeks. Primary outcomes of self-reported work-related symptoms, and secondary outcomes of endotoxin and viable microbial concentrations in air and on surfaces, and other environmental covariates were measured six times.

FINDINGS

Operation of UVGI resulted in 99% (95% CI 67-100) reduction of microbial and endotoxin concentrations on irradiated surfaces within the ventilation systems. 771 participants appeared to remain masked, and reported no adverse effects. On the basis of within-person estimates, use of UVGI was associated with significantly fewer work-related symptoms overall (adjusted odds ratio 0.8 [95% CI 0.7-0.99]), as well as respiratory (0.6 [0.4-0.9]) and mucosal (0.7 [0.6-0.9]) symptoms than was non-use. Reduction of work-related mucosal symptoms was greatest among atopic workers (0.6 [0.5-0.8]), and never-smokers (0.7 [0.5-0.9]). With UVGI on, never-smokers also had large reduction of work-related respiratory (0.4 [0.2-0.9]), and musculoskeletal symptoms (0.5 [0.3-0.9]).

INTERPRETATION

Installation of UGVI in most North American offices could resolve work-related symptoms in about 4 million employees, caused by microbial contamination of heating, ventilation, and air-conditioning systems. The cost of UVGI installation could in the long run prove cost-effective compared with the yearly losses from absence because of building-related illness.

Indoor mold, toxigenic fungi, and Stachybotrys chartarum: infectious disease perspective

Damp buildings often have a moldy smell or obvious mold growth; some molds are human pathogens. This has caused concern regarding health effects of moldy indoor environments and has resulted in many studies of moisture- and mold-damaged buildings. Recently, there have been reports of severe illness as a result of indoor mold exposure, particularly due to Stachybotrys chartarum. While many authors describe a direct relationship between fungal contamination and illness, close examination of the literature reveals a confusing picture. Here, we review the evidence regarding indoor mold exposure and mycotoxicosis, with an emphasis on S. chartarum. We also examine possible end-organ effects, including pulmonary, immunologic, neurologic, and oncologic disorders. We discuss the Cleveland infant idiopathic pulmonary hemorrhage reports in detail, since they provided important impetus for concerns about Stachybotrys. Some valid concerns exist regarding the relationship between indoor mold exposure and human disease. Review of the literature reveals certain fungus-disease associations in humans, including ergotism (Claviceps species), alimentary toxic aleukia (Fusarium), and liver disease (Aspergillys). While many papers suggest a similar relationship between Stachybotrys and human disease, the studies nearly uniformly suffer from significant methodological flaws, making their findings inconclusive. As a result, we have not found well-substantiated supportive evidence of serious illness due to Stachybotrys exposure in the contemporary environment. To address issues of indoor mold-related illness, there is an urgent need for studies using objective markers of illness, relevant animal models, proper epidemiologic techniques, and examination of confounding factors.

Particle deposition indoors: a review

Particle deposition indoors has received increasing attention recently because of increasing concern about the effects of particle exposure on human health. Deposition is a positive phenomenon from the perspective of human health, as deposited particles cannot be inhaled unless resuspended. There are studies showing strong correlation between the prevalence of biological-origin airborne particles and the prevalence of some specific sick building syndrome (Menzies et al., 1998; Teeuw et al., 1994). In the literature, the amount of research effort put on particle deposition indoors which is directly related to human health and microcontamination control is far less than the amount of research on deposition in small diameter tube/channel. This is a summary of the full-length version which will appear on the home page. The full-length paper aims to provide an up-to-date revision for both experiment and modeling on particle deposition indoors. This paper summarizes the experimental studies for particle deposition indoors for non-industrial environments. In section 2, 'Background', an overview of the different mechanisms of particle deposition, focusing on indoor environments is addressed. In section 3, 'Experimental Study Review', a survey of aerosol deposition experiments in small experimental chambers and real houses (or large-scale chambers) is presented. Detailed experimental measurements are addressed for the real house studies. The experimental techniques of particle generation, particle labeling and detection methods are discussed. Although the present paper focuses on experimental studies, it would be more complete to include some discussions on the modeling of the term particle eddy diffusivity and it is reviewed in section 4, 'Modeling Review'.

Upper respiratory symptoms associated with aging of the ventilation system in artificially ventilated offices in São Paulo, Brazil

BACKGROUND

The increase of work-related respiratory complaints in artificially ventilated buildings has multiple causes, and the role of allergen exposure and symptoms is still controversial.

STUDY OBJECTIVES

To analyze the risk factors and the association of work-related symptoms with allergen exposure and different conditions of the same air conditioning system in São Paulo, Brazil.

DESIGN

Workers were classified according to characteristics of the air conditioning system: the first group (group 1) with ventilation machinery and ducts with > 20 years of use, the second group (group 2) with ventilation machinery with > 20 years of use and ventilation ducts with < 2 years of use, and the third group (group 3) with ventilation machinery and ducts with < 2 years of use. Logistic regression was performed to check the associations between air conditioning groups, allergen exposure (fungi, mites, animal dander, and cockroach), and symptoms.

RESULTS

There was a higher prevalence of building-related worsening of respiratory symptoms (p = 0.004; odds ratio [OR], 8.53) and symptoms of rhinoconjunctivitis (p = 0.01; OR, 8.49) in group 1. There was a lower relative humidity (p = 0.05) and nonsignificant lower temperature in group 1, when compared to the other groups. The viable mold spores totals were higher outdoors than in the indoor samples (n = 45, p = 0.017). There were higher levels of Der p 1 in group 2 (p = 0.032). All allergen levels were considered low.

CONCLUSION

There was a strong association of building-related upper-airway symptoms with places having ventilation systems with > 20 years of use.

Studies of sick building syndrome. IV. Mycotoxicosis

There has been increasing public attention to the potential health risks of mold exposure, particularly in wet buildings. A variety of molds has been isolated from both damaged homes and businesses, including agents that secrete toxigenic materials. One area that is attracting particular notice is the relative toxigenic potential of mycotoxins. Although exposure to molds can produce significant mucosal irritation, there are very few data to suggest long-term ill effects. More importantly, there is no evidence in humans that mold exposure leads to nonmucosal pathology. In fact, many of the data on toxigenic molds are derived from animal toxicity studies, and these are based primarily, on ingestion. Although every attempt should be made to improve the quality of indoor air, including avoidance of molds, the human illnesses attributed to fungal exposure are, with the exception of invasive infections and mold allergy, relatively rare. In this review we discuss selected aspects of the microbiology of mycotoxin-producing molds and their potential role in human immunopathology with respect to wet building environments.

Assessment and control of fungal allergens

Fungal sensitivity is a significant cause of allergic disease. Understanding the role fungi play in allergic disease, and how to best control exposure among those with allergy, can have important clinical ramifications.

Germicidal ultraviolet irradiation in air conditioning systems: effect on office worker health and wellbeing: a pilot study

OBJECTIVES

The indoor environment of modern office buildings represents a new ecosystem that has been created totally by humans. Bacteria and fungi may contaminate this indoor environment, including the ventilation systems themselves, which in turn may result in adverse health effects. The objectives of this study were to test whether installation and operation of germicidal ultraviolet (GUV) lights in central ventilation systems would be feasible, without adverse effects, undetected by building occupants, and effective in eliminating microbial contamination.

METHODS

GUV lights were installed in the ventilation systems serving three floors of an office building, and were turned on and off during a total of four alternating 3 week blocks. Workers reported their environmental satisfaction, symptoms, as well as sickness absence, without knowledge of whether GUV lights were on or off. The indoor environment was measured in detail including airborne and surface bacteria and fungi.

RESULTS

Airborne bacteria and fungi were not significantly different whether GUV lights were on or off, but were virtually eliminated from the surfaces of the ventilation system after 3 weeks of operation of GUV light. Of the other environmental variables measured, only total airborne particulates were significantly different under the two experimental conditions--higher with GUV lights on than off. Of 113 eligible workers, 104 (87%) participated; their environmental satisfaction ratings were not different whether GUV lights were on or off. Headache, difficulty concentrating, and eye irritation occurred less often with GUV lights on whereas skin rash or irritation was more common. Overall, the average number of work related symptoms reported was 1.1 with GUV lights off compared with 0.9 with GUV lights on.

CONCLUSION

Installation and operation of GUV lights in central heating, ventilation and air conditioning systems of office buildings is feasible, cannot be detected by workers, and does not seem to result in any adverse effects.