Four methods of sampling for dust mite allergen: differences in 'dust'

Effects of Air Purifiers on Patients with Allergic Rhinitis: a Multicenter, Randomized, Double-Blind, and Placebo-Controlled Study

PURPOSE

Exposure to particulate matter (PM) is a well-known risk factor in the triggering and exacerbation of allergic airway disease. Indoor environments, where people spend most of their time, are of utmost importance. To assess the effects of air purifiers [equipped with high-efficiency particulate air (HEPA) filters] on allergic rhinitis (AR) in adult patients, we performed a multicenter, randomized, double-blind, and placebo-controlled study.

MATERIALS AND METHODS

Patients with house dust mite (HDM)-induced AR were randomly assigned to either active or mockup (placebo) air-purification groups. Two air purifiers (placed in living room and bedroom) were operated for 6 weeks in each home environment. The primary study endpoint was to achieve improvement in AR symptoms and medication scores. Secondary endpoints were to achieve improvement in the quality of life (QoL) and visual analog scale (VAS) scores, as well as in the indoor (bedroom and living room) concentrations of PM_2.5 and PM₁₀.

RESULTS

After 6 weeks of air purifier use, medication scores improved significantly in the active (vs. placebo) group, although subjective measures (symptoms, VAS, and QoL scores) did not differ. Bedroom PM_2.5 concentrations initially exceeded living room or outdoor levels, but declined (by up to 51.8%) following active purifier operation. Concentrations of PM_2.5 in living room and PM₁₀ in bedroom and living room were also significantly reduced through active purification.

CONCLUSION

The use of air purifiers with HEPA filters significantly reduced medication requirements for patients with HDM-induced AR and significantly lowered indoor PM_2.5 concentrations, regardless of room placement. Active intervention to reduce household air pollutants may help improve allergic airway disease (clinicaltrials.gov NCT03313453).

Sampling Devices for Indoor Allergen Exposure: Pros and Cons

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.

Field Performance of a Novel Passive Bioaerosol Sampler using Polarized Ferroelectric Polymer Films

Passive bioaerosol samplers can improve environmental and health protection by enhancing the practicality and cost-effectiveness of air sampling. Here, we present the outdoor field testing of a novel, passive bioaerosol sampler, the Rutgers Electrostatic Passive Sampler (REPS), based on the use of polarized, ferroelectric polymer film (poly(vinylidene fluoride)). Four 10-day-long field campaigns were conducted to compare total (culturable + non-culturable) and culturable bioaerosol collection efficiencies of REPS to passive samplers (PTFE settling filters and agar settling plates). These collection efficiencies were calculated relative to performance of an active, reference Button Sampler. Compared to passive PTFE filters, which exclusively rely on gravitational particle deposition, REPS collected a 7-fold higher total microorganism quantity. Relative to the Button Sampler, REPS collected 25% of the total number of bacteria and fungi and 65% of the culturable bacteria. Furthermore, REPS achieved this performance without any air movers, pumps, batteries or external power. Since the Button Samplers operated at 4 L/min, REPS was calibrated to have equivalent sampling rates of 2.6 L/min and 1.0 L/min for culturable bacteria and total microorganisms, respectively. These results suggest that REPS can passively collect airborne microorganisms, including culturable bacteria, with high efficiency over long-term sampling durations. REPS can provide better preservation of bacterial culturability because it has no active airflow, which desiccates microbes in active samplers. Since there are limited options available for long-term, unattended bioaerosol sampling, REPS can complement currently available bioaerosol sampling technologies for numerous environmental health applications, such as exposure assessment for epidemiology and monitoring aeroallergen trends.

Effective allergen avoidance for reducing exposure to house dust mite allergens and improving disease management in adult atopic asthmatics

OBJECTIVE

We investigated the best strategy for adult asthmatics to avoid exposure to Dermatophagoides group (Der-1) allergens.

METHODS

Adult atopic asthmatics (n = 111) followed a 32-item checklist for avoiding Der-1 allergen exposure. Twenty-five patients were excluded through incomplete sampling; 50 remaining patients encased their pillows/futons/mattresses in microfine-fiber covers, 13 used vacuum cleaners with dust-mite-collection nozzles, and 23 acted as non-intervention controls. During August-October 2010 and August-October 2011, dust samples were collected in Petri dishes placed in bedrooms for 2 weeks and from mattresses/futons by using adhesive tape on one morning. A Der-1 level decrease was defined as a mean 2011 Der-1 level of <1 as a ratio of the 2010 level on tape or Petri dish samples. We analyzed the associations between Der-1 level change (by ELISA) and % weekly variability in peak expiratory flow (PEF) or fraction of exhaled nitric oxide (FeNO) after intervention.

RESULTS

Der-1 levels decreased significantly in the covers group but not the vacuuming group. FeNO levels and PEF variability were unchanged in both groups. In patients whose Petri dish or tape samples showed decreased Der-1 levels, the % PEF variability was lower in 2011 than in 2010, but FeNO levels were unchanged. Three interventions (vacuuming all family members' mattress/futon surfaces at least weekly or after exposure of the futons to sunlight, and floor wiping before vacuuming), plus using covers, were the most effective management strategy in reducing Der-1 levels.

CONCLUSIONS

This environmental and bedding maintenance program may help manage adult atopic asthma.

Measurement of aeroallergens from furnace filters

BACKGROUND

Exposure assessment is an important component of allergic disease diagnosis and management. Analysis for allergen content in vacuumed dust has been used traditionally.

OBJECTIVE

To study allergen levels of dust taken from high-efficiency furnace filters in Midwestern homes.

METHODS

Furnace filters used were FQT12 1-inch disposable filters with high-efficiency media placed in homes enrolled in the Kansas City Safe and Healthy Homes Project. Dust was removed from the filters by vacuuming. Fungal culture was used to obtain counts of viable spores. Aeroallergens Fel d1, Can f1, Mus m1, Der f1, Der p1, and Bla g2 and antigenic material from Alternaria, Aspergillus, Cladosporium, and Penicillium species were measured using commercially available immunoassay materials.

RESULTS

Sixty filters were recovered from 56 homes after an average 135 days in situ. Mean weight of dust recovered was 2.43 g and correlated well with the time the filter was in place. Viable spore counts ranged to 4.8 × 10(7) per gram of dust. Mean fungal antigenic material ranged to 42 μg per gram for Cladosporium species. Mean aeroallergen material ranged to 7 μg per gram for Fel d1. Aeroallergen measurements were above the level of detection in 100% of houses for Fel d1 and 89% of houses for Bla g2. Levels of Fel d1 and Can f1 were strongly positively correlated.

CONCLUSION

Allergens from 5 common aeroallergen species and antigenic material from 4 common fungal taxa can be measured in dust taken from high-efficiency furnace filters.

A side-by-side comparison of three allergen sampling methods in settled house dust

Understanding allergen exposure and potential relationships with asthma requires allergen sampling methods, but methods have yet to be standardized. We compared allergen measurements from dust collected from 200 households with asthmatics and conducted a side-by-side vacuum sampling of settled dust in each home's kitchen, living room and subject's bedroom by three methods (EMM, HVS4 and AIHA). Each sample was analyzed for dust mite, cockroach, mouse, rat, cat and dog allergens. The number of samples with sufficient dust mass for allergen analysis was significantly higher for Eureka Mighty Mite (EMM) and high volume small surface sampler (HVS4) compared with American Industrial Hygiene Association (AIHA) in all rooms and surfaces tested (all P<0.05). The allergen concentration (weight of allergen divided by total weight of dust sampled) measured by the EMM and HVS4 methods was higher than that measured by the AIHA. Allergen loadings (weight of allergen divided by surface area sampled) were significantly higher for HVS4 than for AIHA and EMM. Cockroach and rat allergens were rarely detected via any method. The EMM method is most likely to collect sufficient dust from surfaces in the home and is relatively practical and easy. The AIHA and HVS4 methods suffer from insufficient dust collection and/or difficulty in use.

A comparison of subject room dust with home vacuum dust for evaluation of dust-borne aeroallergens

BACKGROUND

Assessment of indoor allergen is valuable in exposure research and evaluation of allergic individuals. Collection methods range from grab vacuum samples to filtration devices located in the breathing range of an individual. For practical purposes, many research studies use analysis of collected house dust to evaluate allergen reservoirs.

OBJECTIVE

To test the hypothesis that house dust collected from the family vacuum is equivalent to house dust collected by a technician following standard protocol.

METHODS

Homes from a healthy homes demonstration project (n = 41) were sampled using a specific Department of Housing and Urban Development-suggested protocol in the bedroom of the child with asthma and a simple grab procedure from the family vacuum. Samples were evaluated for the presence of 5 allergens, Bla g2, Can f1, Der f1, and Der p1 combined as total mite, Fel d1, and Mus m1. Samples were also evaluated for total antigenic protein from 4 fungal taxa, including Alternaria, Aspergillus, Cladosporium, and Penicillium.

RESULTS

All of the allergens and antigens tested showed good correlation between the 2 collection methods. Fungal antigens ranged up to 92,651 nanograms per gram of dust for Aspergillus, and allergens ranged up to 17,928 nanograms per gram of dust for Can f1. The best correlation was for Cladosporium (r = 0.91), and the weakest was for dust mite (r = 0.34).

CONCLUSION

Allergens and antigens tested from samples collected by protocol and by grab sampling from the home vacuum were highly positively correlated. Grab samples taken from the family vacuum may be a good surrogate for evaluating home allergen exposure.

Domestic exposure to aeroallergens in Hong Kong families with asthmatic children

Indoor aeroallergen exposures increased asthma symptoms in Caucasians, but their determinants and relationship to asthma and allergy in Asians are unclear. This study investigated exposures to cat, cockroach, and Blomia tropicalis allergens in 115 Hong Kong families with asthmatic children. Patients underwent exhaled nitric oxide and spirometric measurements. Home visits were made within 2 weeks during which parents completed a standardized questionnaire. Fel d 1, Bla g 2, and Blo t 5 in dust samples collected from patients' mattresses, bedroom floors, and living room floors were measured by immunoassays. These aeroallergens were only detectable in some homes (38-55% for Fel d 1; 9-21% for Bla g 2, and 7-14% for Blo t 5). The presence of cat and/or dog was a strong determinant for Fel d 1 in all indoor sites. The timing and frequency of bedding change was associated with Bla g 2 levels, whereas the timing of bedroom floor cleaning was a consistent factor for Blo t 5 levels. Asthmatic children in families with high allergen exposure were more likely to have ≥4 wheezing attacks in preceding 12 months and exercise-induced wheezing than those with normal allergen exposure (P = 0.051 and 0.030, respectively). Mattress levels of all three allergens were also associated with severity of several allergy symptoms (P = 0.025-0.005). None of these aeroallergens correlated with exhaled nitric oxide and spirometric parameters. This study identifies determinants for cat, cockroach, and B. tropicalis levels in Hong Kong families with asthmatic children. These exposures are associated with severity of allergy symptoms.

Feather bedding and childhood asthma associated with house dust mite sensitisation: a randomised controlled trial

INTRODUCTION

Observational studies report inverse associations between the use of feather upper bedding (pillow and/or quilt) and asthma symptoms but there is no randomised controlled trial (RCT) evidence assessing the role of feather upper bedding as a secondary prevention measure.

OBJECTIVE

To determine whether, among children not using feather upper bedding, a new feather pillow and feather quilt reduces asthma severity among house dust mite (HDM) sensitised children with asthma over a 1-year period compared with standard dust mite avoidance advice, and giving children a new mite-occlusive mattress cover.

DESIGN

RCT.

SETTING

The Calvary Hospital in the Australian Capital Territory and the Children's Hospital at Westmead, Sydney, New South Wales.

PATIENTS

197 children with HDM sensitisation and moderate to severe asthma. Intervention New upper bedding duck feather pillow and quilt and a mite-occlusive mattress cover (feather) versus standard care and a mite-occlusive mattress cover (standard).

MAIN OUTCOME MEASURES

The proportion of children reporting four or more episodes of wheeze in the past year; an episode of speech-limiting wheeze; or one or more episodes of sleep disturbance caused by wheezing; and spirometry with challenge testing. Statistical analysis included multiple logistic and linear regression.

RESULTS

No differences between groups were found for primary end points--frequent wheeze (OR 1.51, 95% CI 0.83 to 2.76, p=0.17), speech-limiting wheeze (OR 0.70, 95% CI 0.32 to 1.48, p=0.35), sleep disturbed because of wheezing (OR 1.17, 95% CI 0.64 to 2.13, p=0.61) or for any secondary end points. Secondary analyses indicated the intervention reduced the risk of sleep being disturbed because of wheezing and severe wheeze to a greater extent for children who slept supine.

CONCLUSION

No differences in respiratory symptoms or lung function were observed 1 year after children with moderate-severe asthma and HDM sensitisation were given a mite-occlusive mattress cover and then received either feather upper bedding (pillow and quilt) or standard bedding care.

Microbial content of house dust samples determined with qPCR

This study was designed to produce information about microbial concentrations using qPCR and their variation in different seasons and home environments with analyses of two types of house dust samples. Also the correlations between the two types of samples and the reproducibility of the parallel subsamples were studied. Two types of vacuumed house dust samples, rug dust and vacuum cleaner bag dust, were collected in 5 normal urban homes in four different seasons (N=20+20). From all dust samples, five parallel subsamples were subjected to qPCR analyses of 17 microbial species or assay groups of microbes. The highest fungal concentrations were found for the Penicillium/Aspergillus/Paecilomyces variotii group, and for the species Aspergillus penicillioides, Aureobasidium pullulans, Cladosporium cladosporioides and Cladosporium herbarum. These species/groups were present in almost all samples. The two types of dust samples gave similar results for most microbial species or groups analyzed, but in general, concentrations were slightly higher in rug dust than in dust from vacuum cleaner bag. Microbial concentrations varied significantly between different seasons and hence the similarity of samples within home was mainly low. The concentrations varied significantly also between different home environments. The reproducibility of the parallel subsamples was good or moderate for most of the analyzed species or assay groups. However, further studies are needed to fully understand the factors causing variation in these methods. Nevertheless, in order to show actual differences in fungal concentrations between urban homes with no known microbial sources, all dust samples to be compared should be taken during the same season.

Evaluation of a low-cost electrostatic dust fall collector for indoor air endotoxin exposure assessment

Exposure to endotoxin in home environments has become a key issue in asthma and allergy research. Most studies have analyzed floor or mattress dust endotoxin, but its validity as a proxy for airborne exposure is unknown, while active airborne dust sampling is not feasible in large-scale population studies because of logistic and financial limitations. We therefore developed and evaluated a simple passive airborne dust collection method for airborne endotoxin exposure assessment. We explored an electrostatic dust fall collector (EDC), consisting of a 42- by 29.6-cm-sized folder with four electrostatic cloths exposed to the air. The EDC was tested during two 14-day periods in seven nonfarm and nine farm homes and in farm stables. In parallel, active airborne dust sampling was performed with Harvard impactors and floor dust collected by vacuuming, using nylon sampling socks. The endotoxin levels could be measured in all EDC cloth extracts. The levels (in EU/m(2)) between EDCs used simultaneously or in different sampling periods in the same home correlated strongly (r > 0.8). EDC endotoxin also correlated moderately to strongly (r = 0.6 to 0.8) with the endotoxin measured by active airborne dust sampling and living room floor dust sampling and-in farm homes-with the endotoxin captured by the EDC in stables. In contrast, endotoxin levels measured by floor dust sampling showed only a poor correlation with the levels measured by active airborne dust sampling. We therefore conclude that measuring endotoxin levels with the EDC is a valid measure of average airborne endotoxin exposure, while reproducibility over time is at least equivalent to that of reservoir dust analyses.

In vivo-to-in silico iterations to investigate aeroallergen-host interactions

BACKGROUND

Allergic asthma is a complex process arising out of the interaction between the immune system and aeroallergens. Yet, the relationship between aeroallergen exposure, allergic sensitization and disease remains unclear. This knowledge is essential to gain further insight into the origin and evolution of allergic diseases. The objective of this research is to develop a computational view of the interaction between aeroallergens and the host by investigating the impact of dose and length of aeroallergen exposure on allergic sensitization and allergic disease outcomes, mainly airway inflammation and to a lesser extent lung dysfunction and airway remodeling.

METHODS AND PRINCIPAL FINDINGS

BALB/C mice were exposed intranasally to a range of concentrations of the most pervasive aeroallergen worldwide, house dust mite (HDM), for up to a quarter of their lifespan (20 weeks). Actual biological data delineating the kinetics, nature and extent of responses for local (airway inflammation) and systemic (HDM-specific immunoglobulins) events were obtained. Mathematical equations for each outcome were developed, evaluated, refined through several iterations involving in vivo experimentation, and validated. The models accurately predicted the original biological data and simulated an extensive array of previously unknown responses, eliciting two- and three-dimensional models. Our data demonstrate the non-linearity of the relationship between aeroallergen exposure and either allergic sensitization or airway inflammation, identify thresholds, behaviours and maximal responsiveness for each outcome, and examine inter-variable relationships.

CONCLUSIONS

This research provides a novel way to visualize allergic responses in vivo and establishes a basic experimental platform upon which additional variables and perturbations can be incorporated into the system.

House dust collection efficiency of the high volume small surface sampler on worn carpets

The High Volume Small Surface Sampler (HVS3) is a dust-sampling vacuum that allows for set airflow and back pressure during sampling, increasing precision. Total dust collection efficiency of the HVS3 has been evaluated only on new carpets-not worn carpets. We performed a factorial study to assess the impact of carpet wear, dust deposition level, carpet type, and relative humidity during sampling on HVS3 collection efficiency. House dust was aerosolized in a 1-m3 exposure chamber and allowed to settle on test carpets and reference filters. Dust was embedded into the carpets and later extracted with the HVS3 under controlled environmental conditions according to established protocols. Overall collection efficiency was high, 88.3%. Collection efficiency was significantly higher at low relative humidity levels (30%) relative to high (75%) (p = < 0.0001), though differentially between cut-pile and closed-loop carpets. Collection efficiency of carpets with high wear was significantly lower than those with midlevel wear (p = 0.01). These results demonstrate that the design of the HVS3 partially corrects for differences in dust load and carpet type. However, collection efficiency of the HVS3 is affected by high levels of carpet wear and ambient humidity during sampling.

Proficiency testing of allergen measurements in residential dust

BACKGROUND

Analyses of household dust for allergens are more common with increased efforts to reduce and control asthma. Currently, no laboratory accreditation or quality assurance program specific to household dust allergen analyses exists. Moreover, there is an absence of peer-reviewed data on within-laboratory and between-laboratory variability that is achievable for these analyses.

OBJECTIVES

The purpose of this study was to characterize the levels of intralaboratory and interlaboratory variability in analyses of allergen concentrations in residential dust and to investigate the utility of quality control samples for monitoring laboratory performance.

METHODS

Aliquots from homogeneous batches of dust and dust extracts were provided to 8 commercial, academic, and municipal laboratories to be analyzed for as many as 6 allergens (Der p 1, Der f 1, Fel d 1, Can f 1, Bla g 1, Mus m 1) by using ELISA techniques.

RESULTS

Coefficients of variation on the estimated geometric means from the analytical results ranged between 61% and 93%. In most cases, between-laboratory variability was the dominant component of total variability. In spite of this between-laboratory variability, reasonable agreement was observed between the means of allergen levels in the reference laboratory characterizations and the estimated geometric means from the model fitting of results across participating laboratories.

CONCLUSION

The results from this study indicate that, in most cases, participating laboratories could measure the concentrations of allergens by using ELISA procedures with a level of accuracy and precision that may be acceptable in many situations.