1
|
Grant TL, Wood RA, Chapman MD. Indoor Environmental Exposures and Their Relationship to Allergic Diseases. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2963-2970. [PMID: 37652348 PMCID: PMC10927277 DOI: 10.1016/j.jaip.2023.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/23/2023] [Accepted: 08/23/2023] [Indexed: 09/02/2023]
Abstract
Cockroach, dust mite, cat, dog, mouse, and molds are major indoor allergens that have been associated with the development of allergic diseases and disease morbidity in allergen-sensitized individuals. Physical characteristics, such as allergen particle size, hydrophobicity, and charge, can determine an allergen's propensity to become airborne, location of respiratory tract penetration, and ability to elicit IgE responses in genetically predisposed individuals. Standardization and recent advancements in indoor allergen assessment serve to identify sources and distribution of allergens in a patient's home and public environment, inform public policy, and monitor the efficacy of allergen avoidance and therapeutics. Allergen exposure interventions have yielded mixed results with current US and international asthma guidelines differing on recommendations. A pragmatic, patient-centered approach to allergen avoidance includes: (1) tailoring intervention to the patient's sensitization and exposure status, (2) using a rigorous multifaceted intervention strategy to reduce allergen exposure as much as possible, and (3) beginning the intervention as soon as the patient is diagnosed. Further research into the risks/benefits of early allergen exposure, rapid and affordable in-home allergen assessment, and best practices for environmental control measures for asthma is needed.
Collapse
Affiliation(s)
- Torie L Grant
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md.
| | - Robert A Wood
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md
| | | |
Collapse
|
2
|
Querdibitty CD, Williams B, Wetherill MS, Sisson SB, Campbell J, Gowin M, Stephens L, Salvatore AL. Environmental Health-Related Policies and Practices of Oklahoma Licensed Early Care and Education Programs: Implications for Childhood Asthma. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8491. [PMID: 34444242 PMCID: PMC8391589 DOI: 10.3390/ijerph18168491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/02/2021] [Accepted: 08/06/2021] [Indexed: 11/16/2022]
Abstract
Little is known about the environmental health-related policies and practices of early care and education (ECE) programs that contribute to childhood asthma, particularly in Oklahoma where child asthma rates (9.8%) and rates of uncontrolled asthma among children with asthma (60.0%) surpass national rates (8.1% and 50.3%, respectively). We conducted a cross-sectional survey with directors of Oklahoma-licensed ECE programs to assess policies and practices related to asthma control and to evaluate potential differences between Centers and Family Childcare Homes (FCCHs). Surveyed ECEs (n = 476) included Centers (56.7%), FCCHs (40.6%), and other program types (2.7%). Almost half (47.2%) of directors reported never receiving any asthma training. More Center directors were asthma-trained than FCCH directors (61.0% versus 42.0%, p < 0.0001). Most ECEs used asthma triggers, including bleach (88.5%) and air fresheners (73.6%). Centers were more likely to use bleach daily than were FCCHs (75.6% versus 66.8%, p = 0.04). FCCHs used air fresheners more than did Centers (79.0% versus 61.0%, p < 0.0001). The majority of ECEs (74.8%) used pesticides indoors. Centers applied indoor pesticides more frequently (i.e., monthly or more often) than did FCCHs (86.0% versus 58.0%, p < 0.0001). Policy, educational, and technical assistance interventions are needed to reduce asthma triggers and improve asthma control in Oklahoma ECEs.
Collapse
Affiliation(s)
- Cassandra D. Querdibitty
- Department of Health Promotion Sciences, Hudson College of Public Health, University of Oklahoma Health Sciences Center, 801 N.E. 13th Street, Oklahoma City, OK 73104, USA; (C.D.Q.); (M.S.W.); (L.S.)
| | - Bethany Williams
- Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University Health Sciences Spokane, 412 E. Spokane Falls Blvd., Spokane, WA 99202, USA;
- Department of Nutritional Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, 1200 N. Stonewall Ave., Oklahoma City, OK 73114, USA;
| | - Marianna S. Wetherill
- Department of Health Promotion Sciences, Hudson College of Public Health, University of Oklahoma Health Sciences Center, 801 N.E. 13th Street, Oklahoma City, OK 73104, USA; (C.D.Q.); (M.S.W.); (L.S.)
| | - Susan B. Sisson
- Department of Nutritional Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, 1200 N. Stonewall Ave., Oklahoma City, OK 73114, USA;
| | - Janis Campbell
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, 801 N.E. 13th Street, Oklahoma City, OK 73104, USA;
| | - Mary Gowin
- Department of Family & Preventive Medicine, College of Medicine, University of Oklahoma, 900 N.E. 10th Street, Oklahoma City, OK 73104, USA;
| | - Lancer Stephens
- Department of Health Promotion Sciences, Hudson College of Public Health, University of Oklahoma Health Sciences Center, 801 N.E. 13th Street, Oklahoma City, OK 73104, USA; (C.D.Q.); (M.S.W.); (L.S.)
| | - Alicia L. Salvatore
- Department of Health Promotion Sciences, Hudson College of Public Health, University of Oklahoma Health Sciences Center, 801 N.E. 13th Street, Oklahoma City, OK 73104, USA; (C.D.Q.); (M.S.W.); (L.S.)
- Institute for Research on Equity and Community Health (iREACH), ChristianaCare, Avenue North, 4000 Nexus Drive, CEI-300, Wilmington, DE 19803, USA
| |
Collapse
|
3
|
Shahhosseini E, Naddafi K, Nabizadeh R, Shamsipour M, Namvar Z, Tayebi B, Shoormasti RS, Hassanvand MS, Yunesian M. Endotoxin and Der p1 allergen levels in indoor air and settled dust in day-care centers in Tehran, Iran. JOURNAL OF ENVIRONMENTAL HEALTH SCIENCE & ENGINEERING 2019; 17:789-795. [PMID: 32030152 PMCID: PMC6985405 DOI: 10.1007/s40201-019-00395-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 07/31/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Allergens like endotoxin and mite allergen Der p 1 are associated with early wheezing and asthma morbidity. Day-care centers can be an important source of exposure to allergens. The aim of this study was to evaluate children's exposure to endotoxin and mite allergen (Der p 1) associated with total suspended particulate matter (TSP) and settled dust in day-care centers in two phases in years of 2015 and 2016 in Tehran city, Iran. METHODS Endotoxin and mite allergen Der p 1 in TSP and settled dust were measured in 23 day-care centers in Tehran. After collecting dust samples and weighting them, and then their extraction, Endotoxin and Der p 1 allergen were determined using QCL-1000 Endpoint chromogenic LAL Assay and ELISA, respectively. RESULTS The mean concentrations of endotoxin and mite allergen Der p 1 in settled dust were 0.3 EU/mg and 0.2 ng/mg, respectively. The mean concentration of endotoxin and mite allergen Der p 1 in indoor air TSP were 0.8 EU/m3 and 0.4 ng/m3, respectively. A significant negative correlation was found between endotoxin both in settled dust and in TSP with measured relative humidity in winter. Also, moderate correlation was observed between Der p 1 in settled dust and relative humidity in winter; however, the correlation between allergen in TSP and relative humidity was not significant. CONCLUSION Day-care centers can be an important source of endotoxin and Der p 1 allergen, so, implementation of proper interventions in these places can reduce exposure to them.
Collapse
Affiliation(s)
- Elahe Shahhosseini
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Kazem Naddafi
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Nabizadeh
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| | - Mansour Shamsipour
- Department of Research Methodology and Data Analysis, Institute for Environmental Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Namvar
- Department of Environmental Health Engineering, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behnoosh Tayebi
- Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Sadegh Hassanvand
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| | - Masud Yunesian
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
4
|
Abrams EM, Szefler SJ, Becker AB. Time for Allergists to Consider the Role of Mouse Allergy in Non-Inner City Children with Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:1778-1782. [PMID: 30962154 DOI: 10.1016/j.jaip.2019.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 03/04/2019] [Accepted: 03/05/2019] [Indexed: 01/19/2023]
Abstract
Mouse allergen is endemic in the inner cities of the United States, with research predominantly in the Northeastern United States. A recent practice parameter notes the effect of mouse exposure in asthma in inner cities. However, studies are emerging that find a role of mouse allergen in non-inner cities as well. Mouse sensitization is associated with mouse allergen exposure and has been linked with adverse asthma outcomes including increased asthma symptoms, poorer lung function, and increased risk of exacerbations. There are commercially available extracts for testing for mouse sensitization although they are not standardized. Pest management studies have had varying results, but with decreased allergen exposure, there is a trend toward improved asthma outcomes. Physicians should be aware of the potential for rodent exposure and sensitization and consider screening for mouse allergy in asthmatic children, especially if they are located in the inner city, have poorly controlled asthma, or have a history of mouse infestation in their location. Evidence is emerging that this allergen should be considered in non-inner-city asthmatics as well. Finally, advocacy efforts are necessary to ensure that removal of this allergen is accomplished, when possible, in the environments of asthmatic children sensitized to mouse.
Collapse
Affiliation(s)
- Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Stanley J Szefler
- Department of Pediatrics, Section of Pediatric Pulmonary and Sleep Medicine, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colo
| | - Allan B Becker
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
5
|
School exposure and asthma. Ann Allergy Asthma Immunol 2019; 120:482-487. [PMID: 29407419 DOI: 10.1016/j.anai.2018.01.028] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 01/18/2018] [Accepted: 01/22/2018] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To provide a comprehensive overview of common school exposures and the association between school exposures and pediatric asthma morbidity. DATA SOURCES A comprehensive literature review was performed using PubMed. STUDY SELECTIONS Full-length, peer-reviewed studies published in English were considered for review. In vivo, in vitro, and animal studies were excluded. Studies of school exposure to cockroach, mouse, dust mite, dog, cat, molds, pollution, and endotoxin associated with asthma and asthma morbidity were considered. RESULTS The current literature establishes an association between school exposure and pediatric asthma morbidity. There is a need for ongoing research to evaluate the effects of school-based environmental interventions on asthma morbidity. CONCLUSION It is evident that the indoor school environment is a significant reservoir of allergens, molds, pollutants, and endotoxin and that there is an association between school exposure and pediatric asthma morbidity. School-based interventions have the potential for substantial individual, community, and public health benefit. It is important that researchers continue to study the health effects associated with school exposures and assess cost-effectiveness of multifaceted school-based interventions.
Collapse
|
6
|
Grant T, Rule AM, Koehler K, Wood RA, Matsui EC. Sampling Devices for Indoor Allergen Exposure: Pros and Cons. Curr Allergy Asthma Rep 2019; 19:9. [PMID: 30747291 PMCID: PMC10371220 DOI: 10.1007/s11882-019-0833-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW To review current indoor allergen sampling devices, including devices to measure allergen in reservoir and airborne dust, and personal sampling devices, with attention to sampling rationale and major indoor allergen size and characteristics. RECENT FINDINGS While reservoir dust vacuuming samples and airborne dust volumetric air sampling remain popular techniques, recent literature describes sampling using furnace filters and ion-charging devices, both which help to eliminate the need for trained staff; however, variable correlation with reservoir dust and volumetric air sampling has been described. Personal sampling devices include intra-nasal samples and personal volumetric air samples. While these devices may offer better estimates of breathable allergens, they are worn for short periods of time and can be cumbersome. Reservoir dust sampling is inexpensive and is possible for families to perform. Airborne dust sampling can be more expensive and may better quantify cat, dog, and mouse allergen exposure. Personal sampling devices may offer a better representation of breathable air.
Collapse
Affiliation(s)
- Torie Grant
- Division of Pediatric Allergy/Immunology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ana M Rule
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Kirsten Koehler
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Robert A Wood
- Division of Pediatric Allergy/Immunology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elizabeth C Matsui
- Departments of Population Health and Pediatrics, Dell Medical School, The University of Texas at Austin, 1701 Trinity St., Stop Z0500, Austin, TX, 78712, USA.
| |
Collapse
|
7
|
Matsui EC, Perzanowski M, Peng RD, Wise RA, Balcer-Whaley S, Newman M, Cunningham A, Divjan A, Bollinger ME, Zhai S, Chew G, Miller RL, Phipatanakul W. Effect of an Integrated Pest Management Intervention on Asthma Symptoms Among Mouse-Sensitized Children and Adolescents With Asthma: A Randomized Clinical Trial. JAMA 2017; 317:1027-1036. [PMID: 28264080 PMCID: PMC5632564 DOI: 10.1001/jama.2016.21048] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Professionally delivered integrated pest management (IPM) interventions can reduce home mouse allergen concentrations, but whether they reduce asthma morbidity among mouse-sensitized and exposed children and adolescents is unknown. OBJECTIVE To determine the effect of an IPM intervention on asthma morbidity among mouse-sensitized and exposed children and adolescents with asthma. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial conducted in Baltimore, Maryland, and Boston, Massachusetts. Participants were mouse-sensitized and exposed children and adolescents (aged 5-17 years) with asthma randomized to receive professionally delivered IPM plus pest management education or pest management education alone. Enrollment occurred between May 2010 and August 2014; the final follow-up visit occurred on September 25, 2015. INTERVENTIONS Integrated pest management consisted of application of rodenticide, sealing of holes that could serve as entry points for mice, trap placement, targeted cleaning, allergen-proof mattress and pillow encasements, and portable air purifiers. Infestation was assessed every 3 months, and if infestation persisted or recurred, additional treatments were delivered. All participants received pest management education, which consisted of written material and demonstration of the materials needed to set traps and seal holes. MAIN OUTCOMES AND MEASURES The primary outcome was maximal symptom days defined as the highest number of days of symptoms in the previous 2 weeks among 3 types of symptoms (days of slowed activity due to asthma; number of nights of waking with asthma symptoms; and days of coughing, wheezing, or chest tightness) across 6, 9, and 12 months. RESULTS Of 361 children and adolescents who were randomized (mean [SD] age, 9.8 [3.2] years; 38% female; 181 in IPM plus pest management education group and 180 in pest management education alone group), 334 were included in the primary analysis. For the primary outcome, there was no statistically significant between-group difference for maximal symptom days across 6, 9, and 12 months with a median of 2.0 (interquartile range, 0.7-4.7) maximal symptom days in the IPM plus pest management education group and 2.7 (interquartile range, 1.3-5.0) maximal symptom days in the pest management education alone group (P = .16) and a ratio of symptom frequencies of 0.86 (95% CI, 0.69-1.06). CONCLUSIONS AND RELEVANCE Among mouse-sensitized and exposed children and adolescents with asthma, an intensive year-long integrated pest management intervention plus pest management education vs pest management education alone resulted in no significant difference in maximal symptom days from 6 to 12 months. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01251224.
Collapse
Affiliation(s)
- Elizabeth C Matsui
- Division of Pediatric Allergy/Immunology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Matthew Perzanowski
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Roger D Peng
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Robert A Wise
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Susan Balcer-Whaley
- Division of Pediatric Allergy/Immunology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Michelle Newman
- Division of Pediatric Allergy/Immunology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Amparito Cunningham
- Division of Pediatric Allergy/Immunology, Boston Children's Hospital, Harvard University Medical School, Boston, Massachusetts
| | - Adnan Divjan
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Mary E Bollinger
- Division of Pulmonary, Allergy, and Immunology, School of Medicine, University of Maryland, Baltimore
| | - Shuyan Zhai
- Division of Pediatric Allergy/Immunology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Ginger Chew
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Rachel L Miller
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York7Division of Pulmonary, Allergy, and Critical Care Medicine, College of Physicians and Surgeons, Columbia University, New York, New York8Division of Pediatric Allergy, Immunology, and Rheumatology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Wanda Phipatanakul
- Division of Pediatric Allergy/Immunology, Boston Children's Hospital, Harvard University Medical School, Boston, Massachusetts
| |
Collapse
|
8
|
Young CA, Stookey J, Patel AI, Chan C, Evans J, Cohn K, Agana L, Yen IH, Fernandez A, Cabana MD. San Francisco childcare centers' preparedness in the prevention and management of asthma among preschool-aged children. J Asthma 2016; 53:691-8. [PMID: 27164036 PMCID: PMC5814296 DOI: 10.3109/02770903.2015.1135944] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 11/21/2015] [Accepted: 12/21/2015] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Asthma is a common health condition for children in childcare. National recommendations for asthma in childcare exist. However, no studies have investigated the extent to which childcare centers adhere to these recommendations. We aimed to assess childcare center adherence to National Asthma Education and Prevention Program (NAEPP) recommendations for asthma care and preparedness and to identify characteristics associated with increased adherence to national asthma recommendations. METHODS We developed a standardized instrument. Each childcare center received a score of 0 through 7 based on number of recommendations met. We conducted t-tests, chi square tests and linear regression to identify childcare center factors associated with increased asthma preparedness. RESULTS 36 out of 40 eligible childcare centers (90%) participated. These sites served 1570 children primarily between the ages of 2 to 5 years. On average, centers met 3.8 out of 7 (SD = 1.3) recommendations. Staff familiarity caring for children with asthma (p < 0.001) and the center's asthma prevalence (p = 0.01) was positively associated with the center's asthma preparedness. The 3 areas most in need of improvement related to asthma medications, asthma action plans and asthma policies. None of the managers reported being familiar with the NAEPP recommendations. DISCUSSION There is room for improvement in the asthma care and preparedness of childcare centers. The 3 areas in which centers performed poorly (appropriate asthma medication management, use of asthma action plans, and presence of appropriate asthma policies) suggest that closer collaboration between clinicians and childcare centers may be a key to improving asthma management for young children.
Collapse
Affiliation(s)
- Chelsea A. Young
- University of California, San Francisco, Department of Psychiatry, San Francisco, California
| | - Jodi Stookey
- Maternal, Child and Adolescent Health, San Francisco Department of Public Health, San Francisco, California
| | - Anisha I. Patel
- University of California, San Francisco, Department of Pediatrics, San Francisco, California
- Philip R Lee Institute of Health Policy Studies, University of California, San Francisco, California
| | - Curtis Chan
- Maternal, Child and Adolescent Health, San Francisco Department of Public Health, San Francisco, California
| | - Jane Evans
- Maternal, Child and Adolescent Health, San Francisco Department of Public Health, San Francisco, California
| | - Karen Cohn
- Children's Environmental Health, San Francisco Department of Public Health, San Francisco, California
| | - Luz Agana
- Children's Environmental Health, San Francisco Department of Public Health, San Francisco, California
| | - Irene H. Yen
- Internal Medicine, University of California, San Francisco
| | | | - Michael D. Cabana
- University of California, San Francisco, Department of Pediatrics, San Francisco, California
- Philip R Lee Institute of Health Policy Studies, University of California, San Francisco, California
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| |
Collapse
|
9
|
Young CA, Chan C, Stookey J, Patel AI, Evans J, Cohn K, Agana L, Yen IH, Fernandez A, Cabana MD. Development of a Tool to Evaluate Asthma Preparedness and Management in Child-Care Centers. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2015; 28:121-128. [PMID: 26155370 DOI: 10.1089/ped.2014.0471] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 03/29/2015] [Indexed: 11/13/2022]
Abstract
Introduction: Asthma is a common condition affecting many children in child-care centers. The National Asthma Education and Prevention Program offers recommendations about creating an asthma-friendly child-care setting. However, no studies have investigated the extent to which child-care centers adhere to these recommendations. This study describes the development of a novel instrument to determine the ability of child-care centers to meet national recommendations for asthma. Methods: The Preparing for Asthma in Child Care (PACC) Instrument was developed using information from existing recommendations and standards, the peer-reviewed literature, site visits, and expert interviews. The survey questions were pilot-tested at 36 child-care centers throughout San Francisco. Results: The instrument is composed of 43 items across seven domains: smoking exposure, presence of a medical consultant and policies, management of ventilation and triggers, access to medication, presence of asthma action plans, staff training, and encouragement of physical activity. Discussion: The PACC Instrument is an evidence-based and comprehensive tool designed to identify areas to target to improve asthma care for children in child-care centers.
Collapse
Affiliation(s)
- Chelsea A Young
- School of Medicine, University of California , San Francisco, San Francisco, California
| | - Curtis Chan
- Maternal, Child and Adolescent Health Division, San Francisco Department of Public Health , San Francisco, California
| | - Jodi Stookey
- Maternal, Child and Adolescent Health Division, San Francisco Department of Public Health , San Francisco, California
| | - Anisha I Patel
- Department of Pediatrics, University of California , San Francisco, San Francisco, California
| | - Jane Evans
- Maternal, Child and Adolescent Health Division, San Francisco Department of Public Health , San Francisco, California
| | - Karen Cohn
- Children's Environmental Health Division, San Francisco Department of Public Health , San Francisco, California
| | - Luz Agana
- Children's Environmental Health Division, San Francisco Department of Public Health , San Francisco, California
| | - Irene H Yen
- School of Medicine, University of California , San Francisco, San Francisco, California
| | - Alicia Fernandez
- School of Medicine, University of California , San Francisco, San Francisco, California
| | - Michael D Cabana
- Department of Pediatrics, University of California , San Francisco, San Francisco, California. ; Philip R. Lee Institute of Health Policy Studies, University of California , San Francisco, San Francisco, California. ; Department of Epidemiology and Biostatistics, University of California , San Francisco, San Francisco, California
| |
Collapse
|
10
|
Johnston JD, Magnusson BM, Eggett D, Collingwood SC, Bernhardt SA. Comparison of Single-Point and Continuous Sampling Methods for Estimating Residential Indoor Temperature and Humidity. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2015; 12:785-94. [PMID: 26030088 PMCID: PMC4712705 DOI: 10.1080/15459624.2015.1047024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Residential temperature and humidity are associated with multiple health effects. Studies commonly use single-point measures to estimate indoor temperature and humidity exposures, but there is little evidence to support this sampling strategy. This study evaluated the relationship between single-point and continuous monitoring of air temperature, apparent temperature, relative humidity, and absolute humidity over four exposure intervals (5-min, 30-min, 24-hr, and 12-days) in 9 northern Utah homes, from March-June 2012. Three homes were sampled twice, for a total of 12 observation periods. Continuous data-logged sampling was conducted in homes for 2-3 wks, and simultaneous single-point measures (n = 114) were collected using handheld thermo-hygrometers. Time-centered single-point measures were moderately correlated with short-term (30-min) data logger mean air temperature (r = 0.76, β = 0.74), apparent temperature (r = 0.79, β = 0.79), relative humidity (r = 0.70, β = 0.63), and absolute humidity (r = 0.80, β = 0.80). Data logger 12-day means were also moderately correlated with single-point air temperature (r = 0.64, β = 0.43) and apparent temperature (r = 0.64, β = 0.44), but were weakly correlated with single-point relative humidity (r = 0.53, β = 0.35) and absolute humidity (r = 0.52, β = 0.39). Of the single-point RH measures, 59 (51.8%) deviated more than ±5%, 21 (18.4%) deviated more than ±10%, and 6 (5.3%) deviated more than ±15% from data logger 12-day means. Where continuous indoor monitoring is not feasible, single-point sampling strategies should include multiple measures collected at prescribed time points based on local conditions.
Collapse
Affiliation(s)
- James D. Johnston
- Brigham Young University, Department of Health Science, 229L Richards Building, Provo, Utah 84602
| | - Brianna M. Magnusson
- Brigham Young University, Department of Health Science, 229L Richards Building, Provo, Utah 84602
| | - Dennis Eggett
- Brigham Young University, Department of Statistics, 223A TMCB, Provo, Utah 84602
| | - Scott C. Collingwood
- University of Utah, Department of Pediatrics, 295 Chipeta Way, Salt Lake City UT 84108
| | - Scott A. Bernhardt
- Utah State University, Department of Biology, 5305 Old Main Hill, Logan, Utah 84322, (435) 797-3721
| |
Collapse
|
11
|
Matsui EC. Management of rodent exposure and allergy in the pediatric population. Curr Allergy Asthma Rep 2014; 13:681-6. [PMID: 23912589 DOI: 10.1007/s11882-013-0378-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although rodent allergy has long been recognized as an occupational disease, it has only been in the past decade that it has been recognized as a community-based disease that affects children. Most homes in the US have detectable mouse allergen, but the concentrations in inner-city homes are orders of magnitude higher than those found in suburban homes. Home mouse allergen exposure has been linked to sensitization to mouse, and children with asthma who are both sensitized and exposed to high mouse allergen concentrations at home are at greater risk for symptoms, exacerbations and reduced lung function. Rat allergen is found primarily in inner-city homes and has also been linked to asthma morbidity among sensitized children. The objective of this review is to summarize the scientific literature on rodents and their allergens, the effects of exposure to these allergens on allergic respiratory disease, and to make recommendations, based on this evidence base, for the evaluation and management of mouse allergy in the pediatric population.
Collapse
Affiliation(s)
- Elizabeth C Matsui
- The Johns Hopkins Hospital, CMSC 1102, 600 N. Wolfe Street, Baltimore, MD, 21287, USA,
| |
Collapse
|
12
|
Abstract
PURPOSE OF REVIEW To review and interpret recent literature related to the role of environmental control in prevention and treatment of asthma. RECENT FINDINGS Environmental control has a clearly established role in the management of asthma, but its role as a primary prevention tool is not supported by recent clinical trials. Although some of the interventions tested in these trials reduced the risk of asthma, the interventions often included dietary modification and those trials intervening only on environmental exposures were largely negative. Environmental interventions that target multiple asthma triggers, such as a laminar airflow device and relocation to high altitude, continue to demonstrate efficacy in asthma. Several studies highlight the efficacy of portable HEPA purifiers in reduction of indoor particulate matter and improving asthma outcomes. Several recently published practice parameters provide evidence-based recommendations for environmental control practices targeting furry pet, rodent, and cockroach allergens. Emerging work highlights the potential impact of spatial-temporal aspects of exposure and the shape of the dose-response relationships on the indoor allergen exposure-asthma relationship. SUMMARY Environmental interventions likely have no effect on the risk of developing atopic disease, but multifaceted interventions are generally of benefit in the management of asthma, particularly in children.
Collapse
|
13
|
Phipatanakul W, Matsui E, Portnoy J, Williams PB, Barnes C, Kennedy K, Bernstein D, Blessing-Moore J, Cox L, Khan D, Lang D, Nicklas R, Oppenheimer J, Randolph C, Schuller D, Spector S, Tilles SA, Wallace D, Sublett J, Bernstein J, Grimes C, Miller JD, Seltzer J. Environmental assessment and exposure reduction of rodents: a practice parameter. Ann Allergy Asthma Immunol 2012; 109:375-87. [PMID: 23176873 PMCID: PMC3519934 DOI: 10.1016/j.anai.2012.09.019] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 09/26/2012] [Indexed: 11/19/2022]
Affiliation(s)
- Wanda Phipatanakul
- Department of Pediatrics, Division of Allergy and Immunology, Harvard Medical School Children's Hospital, Boston, Massachusetts, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Matsui EC, Ahluwalia SK. The impact of an urban environment on a child's lungs. Expert Rev Respir Med 2011; 5:465-8. [PMID: 21859264 DOI: 10.1586/ers.11.44] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
15
|
Williams AH, Smith JT, Hudgens EE, Rhoney S, Ozkaynak H, Hamilton RG, Gallagher JE. Allergens in household dust and serological indicators of atopy and sensitization in Detroit children with history-based evidence of asthma. J Asthma 2011; 48:674-84. [PMID: 21827376 DOI: 10.3109/02770903.2011.599909] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Home exposure to allergens is an important factor in the development of sensitization and subsequent exacerbations of allergic asthma. We investigated linkages among allergen exposure, immunological measurements, and asthma by examining (1) reservoir dust allergen levels in homes, (2) associations between presence of allergens in homes and sensitization status of resident children, and (3) associations between asthma status and total IgE, atopy (by Phadiatop), and positive allergen-specific tests. METHODS The study protocol was approved by Institutional Review Boards (IRBs) of the University of North Carolina Chapel Hill; Westat, Inc.; and the US Environmental Protection Agency Human Research Protocol Office. Data were collected from questionnaires, serum analyses, and household vacuum dust. Children (n = 205) were predominately African American (AA) (85.4%) and 51.6% were asthmatic. Sera from 185 children and home dust samples (n = 141) were analyzed for total and specific IgE antibodies to allergens from cat and dog dander, cockroach, dust mites, mice, rats, and molds. RESULTS Sixty percent of the homes had detectable levels of three or more dust allergens. The proportions of children with positive allergen-specific IgE tests were dust mite (32%), dog (28%), cat (23%), cockroach (18%), mouse (5%), rat (4%), and molds (24-36%). Children testing positive to a single allergen also had positive responses to other allergens. Those children with positive serum tests for cat, dog, and dust mite lived in homes with detectable levels of cat (51%), dog (90%), and dust mite (Der f 1) (92%) allergens. Correlations between children's specific IgE levels and dust levels were linearly related for dog (p < .04), but not for cat (p = .12) or dust mite (Der f 1) (p = .21). Odds ratios (95% CI) for the associations between asthma and serum-specific IgE were over 1.0 for cat, dog, dust mite (Der f 1), cockroach, and four types of molds. House dust allergen exposure levels, however, exhibited no differences between asthmatic and non-asthmatic homes. CONCLUSIONS Both the co-occurrence of multiple allergens in dust and the high frequency of multiple allergen sensitizations indicate that a broad-based intervention aimed at reducing multiple allergens (pets, pests, and molds) would be more successful than any approach that aimed at reducing one type of allergen.
Collapse
Affiliation(s)
- Ann Houston Williams
- Epidemiology Branch, National Health and Environmental Effects Research Laboratory, United States Environmental Protection Agency, Research Triangle Park, NC 27711, USA.
| | | | | | | | | | | | | |
Collapse
|
16
|
Abstract
Allergy to rodents in the workplace is an important occupational health problem affecting research, pharmaceutical and toxicological sectors and can have a serious impact on employees working in this area. Despite measures to reduce aeroallergen exposures to rodents in the workplace, there are few signs that this occupational health problem is declining. Rodent allergens are well characterized and exposure-response relationships have been demonstrated to be complex. More recently, the importance of rodent allergens outside of the workplace has been demonstrated in several studies of individuals with asthma. This review focuses on rodent allergy both in the workplace and in the home and examines the complex exposure-response relationships between allergen exposure and sensitization and asthma. Risk factors for rodent allergy and mechanisms of tolerance to rodent allergens are discussed.
Collapse
Affiliation(s)
- H Jeal
- Department of Occupational and Environmental Medicine, Imperial College (NHLI), 18 Manresa Road, London, UK
| | | |
Collapse
|
17
|
Simons E, Hwang SA, Fitzgerald EF, Kielb C, Lin S. The impact of school building conditions on student absenteeism in Upstate New York. Am J Public Health 2010; 100:1679-86. [PMID: 20634471 DOI: 10.2105/ajph.2009.165324] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We investigated Upstate New York school building conditions and examined the associations between school absenteeism and building condition problems. METHODS We merged data from the 2005 Building Condition Survey of Upstate New York schools with 2005 New York State Education Department student absenteeism data at the individual school level and evaluated associations between building conditions and absenteeism at or above the 90th percentile. RESULTS After adjustment for confounders, student absenteeism was associated with visible mold (odds ratio [OR]=2.22; 95% confidence interval [CI]=1.34, 3.68), humidity (OR=3.07; 95% CI=1.37, 6.89), poor ventilation (OR=3.10; 95% CI=1.79, 5.37), vermin (OR=2.23; 95% CI=1.32, 3.76), 6 or more individual building condition problems (OR=2.97; 95% CI=1.84, 4.79), and building system or structural problems related to these conditions. Schools in lower socioeconomic districts and schools attended by younger students showed the strongest associations between poor building conditions and absenteeism. CONCLUSIONS We found associations between student absenteeism and adverse school building conditions. Future studies should confirm these findings and prioritize strategies for school condition improvements.
Collapse
Affiliation(s)
- Elinor Simons
- Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, Troy, NY, USA.
| | | | | | | | | |
Collapse
|
18
|
Sheehan WJ, Rangsithienchai PA, Wood RA, Rivard D, Chinratanapisit S, Perzanowski MS, Chew GL, Seltzer JM, Matsui EC, Phipatanakul W. Pest and allergen exposure and abatement in inner-city asthma: a work group report of the American Academy of Allergy, Asthma & Immunology Indoor Allergy/Air Pollution Committee. J Allergy Clin Immunol 2010; 125:575-81. [PMID: 20226293 DOI: 10.1016/j.jaci.2010.01.023] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Revised: 12/29/2009] [Accepted: 01/07/2010] [Indexed: 11/19/2022]
Abstract
Our work group report details the importance of pest allergen exposure in inner-city asthma. We will focus specifically on mouse and cockroach exposure. We will discuss how exposure to these pests is common in the inner city and what conditions exist in urban areas that might lead to increased exposure. We will discuss how exposure is associated with allergen sensitization and asthma morbidity. Finally, we will discuss different methods of intervention and the effectiveness of these tactics.
Collapse
Affiliation(s)
- William J Sheehan
- Division of Immunology, Children's Hospital Boston, Boston, Mass 02115, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Valdivieso R, Iraola V, Estupiñan M, Correa E, Romero MC. Bronchial asthma, sensitisation and exposure to Der p1 and Der f1 in an Andean Ecuadorian school. Allergol Immunopathol (Madr) 2010; 38:100-2. [PMID: 20188454 DOI: 10.1016/j.aller.2009.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2009] [Revised: 07/08/2009] [Accepted: 07/10/2009] [Indexed: 10/19/2022]
|
20
|
Abstract
Mouse allergen has long been recognized as an important cause of occupational allergy and asthma, but only recently has it been implicated in asthma and allergic diseases in community settings. Recent studies have established that mouse allergen is detectable in most US homes, with strikingly high levels in some inner cities. Inner city homes in major northeastern and midwestern US urban centers have levels as much as 100-fold higher than those found in other geographic regions. In addition, about 25% of inner city children with asthma have evidence of IgE sensitization to mouse. Several studies have shown that the combination of sensitization and exposure to higher levels of mouse allergen is associated with substantial asthma morbidity, including hospitalizations. Integrated pest management is efficacious in reducing mouse allergen levels and is recommended for sensitized patients with asthma. However, its impact on clinical outcomes has not yet been proven.
Collapse
|
21
|
Salo PM, Sever ML, Zeldin DC. Indoor allergens in school and day care environments. J Allergy Clin Immunol 2009; 124:185-92, 192.e1-9; quiz 193-4. [PMID: 19577284 DOI: 10.1016/j.jaci.2009.05.012] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2009] [Revised: 05/05/2009] [Accepted: 05/06/2009] [Indexed: 11/17/2022]
Abstract
Most studies that have examined exposure to indoor allergens have focused on home environments. However, allergen exposures can be encountered in environments other than the home. For example, many children spend a large part of their time in schools and day care facilities. Over the past 2 decades, a large number of studies have been conducted in school and day care environments. However, the role of indoor exposures in allergy and asthma development or morbidity in these settings is not well characterized. The purpose of this review is to evaluate the importance of indoor allergen exposures in school and day care settings. We summarize the key findings from recent scientific literature, describe exposure characteristics, discuss the role of these exposures in relation to asthma and allergy symptoms, and provide information on the effectiveness of published interventions.
Collapse
Affiliation(s)
- Päivi M Salo
- National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC 27709, USA
| | | | | |
Collapse
|
22
|
Nalyanya G, Gore JC, Linker HM, Schal C. German cockroach allergen levels in North Carolina schools: comparison of integrated pest management and conventional cockroach control. JOURNAL OF MEDICAL ENTOMOLOGY 2009; 46:420-427. [PMID: 19496408 DOI: 10.1603/033.046.0302] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Cockroach suppression is fundamental to cockroach allergen mitigation in infested homes. The effects of various cockroach control strategies on cockroach populations and allergen concentration have not been examined in schools. This study was conducted to compare the effectiveness of integrated pest management (IPM) and conventional pest control in controlling German cockroach (Blattella germanica L.) infestations and concentrations of the cockroach allergen Bla g 1 in public school buildings. Two school districts included six schools that used conventional pest control and one district included seven schools that used IPM to control pests. Cockroach traps were deployed to assess the level of infestation, settled dust samples were collected in food service areas, classrooms, and other school areas, and the Bla g 1 allergen was quantified by ELISA. Both cockroach counts and Bla g 1 concentrations were dependent on the pest control approach, with highly significant differences between IPM-treated schools and conventionally treated schools in both the cockroach mean trap counts (0 versus 82.6 +/- 17.3 cockroaches/trap/wk, respectively) and in the amount of Bla g 1 in dust samples (2.8 +/- 0.3 versus 30.6 +/- 3.4 U/g dust). Cockroaches and Bla g 1 were primarily associated with food preparation and food service areas and much less with classrooms and offices. Our data extend recent findings from studies in homes, showing that cockroach allergens can be reduced by cockroach elimination alone or by integrating several tactics including education, cleaning, and pest control. IPM is not only effective at controlling cockroaches but also can lead to long-term reductions in cockroach allergen concentrations, resulting in a healthier environment for students and school personnel.
Collapse
Affiliation(s)
- Godfrey Nalyanya
- Department of Entomology, Box 7613, North Carolina State University, Raleigh, NC 27695-7613, USA
| | | | | | | |
Collapse
|
23
|
Mouse allergens in urban elementary schools and homes of children with asthma. Ann Allergy Asthma Immunol 2009; 102:125-30. [PMID: 19230463 DOI: 10.1016/s1081-1206(10)60242-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The association between allergens in schools and childhood asthma has not been well studied, particularly in the United States. OBJECTIVE To investigate allergen exposure in schools compared with homes with a specific focus on children with asthma. METHODS Dust samples were collected from 46 rooms in 4 urban elementary schools (northeastern United States) and from 38 student bedrooms. Samples were analyzed for cat (Fel d 1), dog (Can f 1), cockroach (Bla g 2), dust mites (Der f 1/Der p 1), and mouse urinary protein (MUP). Questionnaires identified students with physician-diagnosed asthma. RESULTS Cat and dog allergens were detectable in most school samples (96% and 78%, respectively), but at low levels. Cockroach allergen was detectable in only 11% of school samples. Mouse allergen was detectable in 89% of school samples, with 68% having MUP levels greater than 0.5 microg/g. In contrast, MUP was detectable in only 26% of bedroom samples. Matched classroom and home samples from 23 asthmatic students showed higher geometric mean MUP levels in the classroom vs the home (6.45 microg/g vs 0.44 microg/g, P < .001). However, there were lower geometric mean dust mite (Der f 1) levels in the classroom vs the home (0.04 microg/g vs 0.66 microg/g, P < .001). CONCLUSIONS There are significantly higher levels of MUP but lower levels of Der f 1 in schools vs homes. It is important to recognize that children with asthma may encounter varying levels of allergens in environments outside the home, such as schools.
Collapse
|