Comparison of biocontaminant levels associated with hard vs. carpet floors in nonproblem schools: results of a year long study

Risk factors of non-typhoidal Salmonella gastroenteritis in hospitalised young children: a case-control study

OBJECTIVE

To explore risk factors associated with non-typhoidal Salmonella gastroenteritis in young children in Hong Kong.

DESIGN

A case-control study.

SETTING

Paediatrics wards at three public hospitals in Hong Kong.

PARTICIPANTS

Cases were children aged above 30 days to below 5 years hospitalised for gastroenteritis at three public hospitals in Hong Kong with culture confirmed non-typhoidal Salmonella infection. Controls were age-matched (±2 months) children admitted for a reason other than gastroenteritis.

MAIN OUTCOMES MEASURES

A face-to-face interview by using standardised questionnaire on exposures 3 days prior to illness. Adjusted OR (aORs) and 95% CIs were calculated using multivariable logistic regression.

RESULTS

A total of 102 cases and 204 age-matched controls were included in the analysis. Multivariable logistic regression revealed that having food purchased from places other than a supermarket, that is, from wet market/restaurant/farm (aOR, 2.64; 95% CI, 1.03 to 6.77; p=0.044) was a significant risk factor for non-typhoidal Salmonella infection. Having a household member with gastroenteritis symptoms (aOR, 2.03; 95% CI, 0.94 to 4.39; p=0.072) was of borderline significance and playing at a children's indoor playroom was a protective factor (aOR, 0.28; 95% CI, 0.09 to 0.85; p=0.024).

CONCLUSIONS

Consumption of food purchased from places other than a supermarket was the identified determinant factor for non-typhoidal Salmonella gastroenteritis in Hong Kong. Parents/caregivers should be alerted to this risk when choosing foods for their young children. The protective effect of playing in an indoor playroom could be confounded by socioeconomic factors and further investigation is required to better understand its potential implication. There was some support for person-to-person transmission and good family hygiene needs to be emphasised.

Hospital flooring safety and health: knowledge gaps and suggestions

Fall incidents are a leading safety concern in the hospital industry. Whereas roughening the floor surface can reduce fall risks, there remains unanswered controversies between achieving and maintaining hygienic cleaning efficiencies and adequately addressing conditions of flooring safety. Thus, the current study critically overviews the status of research and accepted practices on hospital flooring safety and healthy controls. Salient literature was identified by searching keywords and phrases within the databases of PubMed, Web of Science, MEDLINE, Scopus and ScienceDirect to find answers for the major questions on hospital floorings. A comprehensive review analysis identified that underlying causes of hospital fall incidents and flooring-attributable infectious illnesses mainly comprised floor types and materials, cleaning chemicals, materials and methods, maintenance and slip-resistance properties. Findings from this study suggest several major actions to advance hospital flooring safety and health research and practice.

The level of allergens in dust samples collected from selected schools in Shiraz, Iran and its asthma-risk implications

BACKGROUND

Both home and school are important places where children are exposed to various indoor allergens. This study aimed to identify the profile of indoor allergens in schools and its impact on asthma development.

METHODS

A total of 104 classrooms from 52 schools were selected for dust collection during the fall of 2017. The levels of indoor allergens including dust mite (Der f1, Der p1), cat (Fel d1), cockroach (Bla g1) and mouse (Mus m1) were measured by enzyme linked immunosorbent assay (ELISA). The diagnosis of asthma was made in all students of the selected classes by the allergist. The collected data were analyzed using SPSS version 21.0.

RESULTS

Out of 2816 students in the selected classes, 180 students were involved with asthma. Students were mostly exposed to Bla g1 (83.1%), followed by Der f1 (51.5%), Mus m 1 (45.5%), Der p1 (8.9%) and Fel d1 (7.9%) in the dust collected from 101 classrooms. Although levels of all studied allergens in the settled dust of the classrooms were low, there was a relationship between Fel d1 in the classroom dust and development of asthma.

CONCLUSION

This study showed considerable levels of cockroach allergens in schools. Exposure to cat allergen in our schools played an important role in asthma development; further school-based investigations require evaluating the role of classroom allergen on asthma development.

Household Dust: Loadings and PM10-Bound Plasticizers and Polycyclic Aromatic Hydrocarbons

Residential dust is recognized as a major source of environmental contaminants, including polycyclic aromatic hydrocarbons (PAHs) and plasticizers, such as phthalic acid esters (PAEs). A sampling campaign was carried out to characterize the dust fraction of particulate matter with an aerodynamic diameter smaller than 10 µm (PM10), using an in situ resuspension chamber in three rooms (kitchen, living room, and bedroom) of four Spanish houses. Two samples per room were collected with, at least, a one-week interval. The PM10 samples were analyzed for their carbonaceous content by a thermo-optical technique and, after solvent extraction, for 20 PAHs, 8 PAEs and one non-phthalate plasticizer (DEHA) by gas chromatography-mass spectrometry. In general, higher dust loads were observed for parquet flooring as compared with tile. The highest dust loads were obtained for rugs. Total carbon accounted for 9.3 to 51 wt% of the PM10 mass. Plasticizer mass fractions varied from 5 µg g−1 to 17 mg g−1 PM10, whereas lower contributions were registered for PAHs (0.98 to 116 µg g−1). The plasticizer and PAH daily intakes for children and adults via dust ingestion were estimated to be three to four orders of magnitude higher than those via inhalation and dermal contact. The thoracic fraction of household dust was estimated to contribute to an excess of 7.2 to 14 per million people new cancer cases, which exceeds the acceptable risk of one per million.

Floor finish selection in health-care facilities: a systematic literature review

Purpose

The purpose of this paper is to identify, analyze and discuss floor finishes used in health-care facilities and their selection criteria in the form of advantages and disadvantages. The authors also identify the top three health-care floor finishes and selection criteria based on the literature review results. Although flooring materials have a considerable impact on the life-cycle cost and indoor environment of health-care facilities, what criteria may be used for such flooring choices is not thoroughly studied.

Design/methodology/approach

The authors performed a systematic review of the literature on certain flooring systems currently used in health-care facilities and the criteria applied for their selection. Peer-reviewed studies and articles published after Year 2000 consistent with the research design were included.

Findings

Sixteen different selection criteria that influence the choice of floor finishes in health-care facilities were determined and discussed. The results show that the top three-floor finish materials preferred in health-care facilities are sheet vinyl, rubber and carpet, and the top three selection criteria for floor finishes are indoor air quality, patient safety and infection control.

Originality/value

The results of this study will assist building owners, architects and interior designers with implementing an informed design decision-making process, particularly in relation to floor finish selection. The findings will also provide guidance to floor finish manufacturers to improve their products based on facility managers’ preferences.

Environmental factors influencing fungal growth on gypsum boards and their structural biodeterioration: A university campus case study

The new era in the design of modern healthy buildings necessitates multidisciplinary research efforts that link principles of engineering and material sciences with those of building biology, in order to better comprehend and apply underlying interactions among design criteria. As part of this effort, there have been an array of studies in relation to the effects of building characteristics on indoor microbiota and their propensity to cause health issues. Despite the abundance of scientific inquiries, limited studies have been dedicated to concomitantly link these effects to the deterioration of 'structural integrity' in the building materials. This study focuses on the observed biodeteriorative capabilities of indoor fungi upon the ubiquitous gypsum board material as a function of building age and room functionality within a university campus. We observed that the fungal growth significantly affected the physical (weight loss) and mechanical (tensile strength) properties of moisture-exposed gypsum board samples; in some cases, tensile strength and weight decreased by more than 80%. Such intertwined associations between the biodeterioration of building material properties due to viable indoor fungi, and as a function of building characteristics, would suggest a critical need towards multi-criteria design and optimization of next-generation healthy buildings. Next to structural integrity measures, with a better understanding of what factors and environmental conditions trigger fungal growth in built environment materials, we can also optimize the design of indoor living spaces, cleaning strategies, as well as emergency management measures during probable events such as flooding or water damage.

Floor dust bacteria and fungi and their coexistence with PAHs in Jordanian indoor environments

Floor dust samples were collected from Jordanian indoor environments (eight dwellings and an educational building) in Amman. Quantitative PCR (qPCR) analyses of selected fungal and bacterial groups were performed. The bacterial and fungal concentrations were also correlated with PAHs concentrations, which were previously measured in the same samples by using GC-MS. The bacterial and fungal concentrations varied significantly among and within the tested indoor environments. Based on the collected samples in the entrance area of the dwellings, the largest variation was found in Gram-negative bacteria and total fungi concentration. The lowest bacterial and fungal concentrations were found in the dwelling that was least occupied and the most recently built. At the educational building, the Gram-positive bacteria concentrations were lower than those observed in the dwellings. Unlike for bacteria, we observed significant negative correlation with some polycyclic aromatic hydrocarbons (PAHs). This calls for further studies investigating biodegradation of PAHs in house dust and presence of potentially health hazardous PAH metabolites. Since biocontamination in floor dust has been given relatively little to no attention in the MENA region we recommend that more extensive measurements be conducted in the future with chemical and biological analysis of floor dust contaminants and their exposure indoors.

Comparison of survivability of Staphylococcus aureus and spores of Aspergillus niger on commonly used floor materials

BACKGROUND

The survivability of Staphylococcus aureus and spores of Aspergillus niger was compared on 5 common floor materials.

METHODS

Floor materials were inoculated with a known concentration of S aureus and spores of A niger on day 0. Their survivability was measured on days, 2, 7, 14, and 28 by bulk rinsate method and enumerated using culture-based method.

RESULTS

The difference in change of S aureus levels was statistically significant for all tested days (P < .001) for all floor materials. Vinyl composition tile (VCT) and porcelain tile (PT) had statistically similar survivability and differed statistically from carpets. On both VCT and PT, positive growth for S aureus occurred by day 2 (1-1.7 log₁₀), declined slightly (0.1 to -0.2 log₁₀) by day 7, and remained positive until day 28. However, S aureus was undetected by day 7 on both carpets. A niger spores were undetected on residential broadloom carpet and rubber-backed commercial carpet after day 2 but survived on VCT, PT, and wood until day 28.

CONCLUSIONS

Floor materials with hard and smooth surfaces, such as VCT and PT, can allow survival of S aureus and A niger for up to 4 weeks. It may imply that floor materials can play a major role in preserving microbial contaminants in the built environment.

Indoor fungi: companions and contaminants

This review discusses the role of fungi and fungal products in indoor environments, especially as agents of human exposure. Fungi are present everywhere, and knowledge for indoor environments is extensive on their occurrence and ecology, concentrations, and determinants. Problems of dampness and mold have dominated the discussion on indoor fungi. However, the role of fungi in human health is still not well understood. In this review, we take a look back to integrate what cultivation-based research has taught us alongside more recent work with cultivation-independent techniques. We attempt to summarize what is known today and to point out where more data is needed for risk assessment associated with indoor fungal exposures. New data have demonstrated qualitative and quantitative richness of fungal material inside and outside buildings. Research on mycotoxins shows that just as microbes are everywhere in our indoor environments, so too are their metabolic products. Assessment of fungal exposures is notoriously challenging due to the numerous factors that contribute to the variation of fungal concentrations in indoor environments. We also may have to acknowledge and incorporate into our understanding the complexity of interactions between multiple biological agents in assessing their effects on human health and well-being.

Endotoxin levels in settled airborne dust in European schools: the HITEA school study

Indoor exposure to microbial agents is known to influence respiratory health. Besides home exposure, exposure in schools can affect respiratory health. In this study, we measured endotoxin in settled dust in primary schools in three European countries from three different geographical regions with different climates. Our aim was to characterize endotoxin levels in primary schools and evaluate associations with potential determinants. Endotoxin levels were repeatedly assessed in 23 schools in Spain (n = 7), the Netherlands (n = 10), and Finland (n = 6) using electrostatic dustfall collectors. In total, 645 measurements were taken in 237 classrooms. Endotoxin levels differed significantly between countries; Dutch schools had the highest levels, while Finnish schools showed the lowest levels. In each country, differences in endotoxin levels were observed between schools and over the sampling periods. Estimates improved after adjustment for sampling period. Factors affecting endotoxin levels in a school differed per country. In general, endotoxin levels were higher in lower grades and in classrooms with higher occupancy. School endotoxin levels may contribute significantly to total endotoxin exposure in children and teachers. As the correlation between the repeated measurements is reasonable, single endotoxin measurements form a reasonable basis for estimating annual endotoxin levels in schools.

Allergens and β-glucans in dutch homes and schools: characterizing airborne levels

Background

Indoor air quality has an effect on respiratory health. Children are more vulnerable to a decreased indoor air quality as their lungs are still developing. We measured levels of allergens and β-(1,3)-glucans in 19 school buildings and determined whether measured levels could be reproduced. School levels were compared to those in 169 homes and the effect of building characteristics on both home and school exposure was explored.

Methods

Electrostatic Dust fall Collectors were placed in school buildings for 8 weeks and in homes for 2 weeks to collect settled airborne dust. Cat, dog, and mouse allergen levels, domestic mite antigen levels and β-(1,3)-glucans were measured in the extracts from the collectors. Results were corrected for sampling duration. Using questionnaire data, relations between measured levels and building and classroom characteristics were explored.

Results

In schools, exposure levels were highest in classrooms and were influenced by the socioeconomic status of the children, the season measurements were performed, moisture status of the building and pet ownership. Repeated measurements in different seasons and over the years showed significantly different levels. Home exposure was influenced by socioeconomic status, occupancy and pet ownership. Domestic mite antigen was found in higher levels in extracts from homes compared to schools while pet allergen levels were 13 times higher in schools compared to homes without pets. For mouse allergen overall levels of exposure were low but still two times higher in schools compared to homes. Levels of β-(1,3)-glucans were also approximately two times higher in schools than in homes.

Conclusion

Exposure levels of several allergens and β-(1,3)-glucans in schools differ over time and are higher than in homes. For children, exposure levels measured at school could contribute to their total exposure as especially animal allergen levels can be much higher in schools compared to homes.

Identification and levels of airborne fungi in Portuguese primary schools

Several studies found associations between exposure to airborne fungi and allergy, infection, or irritation. This study aimed to characterize airborne fungi populations present in public primary schools in Porto, Portugal, during winter through quantification and identification procedures. Fungal concentration levels and identification were obtained in a total of 73 classrooms. The AirIdeal portable air sampler was used in combination with chloramphenicol malt extract agar. Results showed a wide range of indoor fungi levels, with indoor concentrations higher than outdoors. The most prevalent fungi found indoors were Penicillium sp. (>70%) and Cladosporium sp. As evidence indicates that indoor fungal exposures plays a role in asthma clinical status, these results may contribute to (1) promoting and implementing public health prevention programs and (2) formulating recommendations aimed at providing healthier school environments.

Endotoxins in indoor air and settled dust in primary schools in a subtropical climate

Endotoxins can significantly affect the air quality in school environments. However, there is currently no reliable method for the measurement of endotoxins, and there is a lack of reference values for endotoxin concentrations to aid in the interpretation of measurement results in school settings. We benchmarked the "baseline" range of endotoxin concentration in indoor air, together with endotoxin load in floor dust, and evaluated the correlation between endotoxin levels in indoor air and settled dust, as well as the effects of temperature and humidity on these levels in subtropical school settings. Bayesian hierarchical modeling indicated that the concentration in indoor air and the load in floor dust were generally (<95th percentile) <13 EU/m(3) and <24,570 EU/m(2), respectively. Exceeding these levels would indicate abnormal sources of endotoxins in the school environment and the need for further investigation. Metaregression indicated no relationship between endotoxin concentration and load, which points to the necessity for measuring endotoxin levels in both the air and settled dust. Temperature increases were associated with lower concentrations in indoor air and higher loads in floor dust. Higher levels of humidity may be associated with lower airborne endotoxin concentrations.

Indoor residence times of semivolatile organic compounds: model estimation and field evaluation

Indoor residence times of semivolatile organic compounds (SVOCs) are a major and mostly unavailable input for residential exposure assessment. We calculated residence times for a suite of SVOCs using a fugacity model applied to residential environments. Residence times depend on both the mass distribution of the compound between the "mobile phase" (air and dust particles settled on the carpet) and the "non-mobile phase" (carpet fibers and pad) and the removal rates resulting from air exchange and cleaning. We estimated dust removal rates from cleaning processes using an indoor-particle mass-balance model. Chemical properties determine both the mass distribution and relative importance of the two removal pathways, resulting in different residence times among compounds. We conducted a field study after chlorpyrifos was phased out for indoor use in the United States in 2001 to determine the decreases in chlorpyrifos air concentrations over a one-year period. A measured average decrease of 18% in chlorpyrifos air concentrations indicates the residence time of chlorpyrifos is expected to be 6.9 years and compares well with model predictions. The estimates from this study provide the opportunity to make more reliable estimates of SVOCs exposure in the indoor residential environment.

Airborne allergens, endotoxins, and particulate matter in elementary schools, results from Germany (LUPE 2)

Allergic disorders are the most common childhood-related chronic diseases in developed countries. It is essential to assess the exposure, especially in schools, where children spend a large portion of their time. We aimed to investigate allergen and endotoxin levels in the air of schools and to observe seasonal variations of these factors. We evaluated airborne concentrations of house dust mites allergens (Der p 1, Der f 1), cat allergen (Fel d 1), and endotoxin in PM10 in 14 classrooms during the school days in the region of Munich, each over 20 consecutive days and in 1 classroom over the course of a year (at 83 days); we also tested outdoor air close to the schools. Endotoxin levels were quantified using two different analytical methods. In addition, indoor air climate parameters were measured. The median daily indoor CO2 and PM10 concentrations in the classrooms ranged from 423 to 3,135 ppm (median: 1,211 ppm) and 9 to 390 μg/m(3) (median: 127 μg/m(3)), respectively. Fel d 1 in the PM10 samples was the most frequently detected allergen, with levels from 0.02 to 1.15 ng/m(3) in a total of 301 samples (median: 0.19 ng/m(3), 95th percentile: 0.57 ng/m(3)). Der p 1 and Der f 1 were detected in only 51% and 19% of the samples, with 95th percentiles at 0.5 and 0.3 ng/m(3). Endotoxin levels in the PM10 and inhalable dust samples ranged from 0.5 to 84.1 EU/m(3) (median: 15.3 EU/m(3); 95th percentile: 58.2 EU/m(3)) and from 0.03 to 115 EU/m(3) (median: 8.4 EU/m(3); 95th percentile: 27.9 EU/m(3)). Fel d 1 and endotoxin were found in higher levels in the winter months. The results of the two different indoor sampling techniques for endotoxin were statistically significantly correlated. The results of airborne allergens indicate a generally low exposure level in classrooms. With regard to endotoxin, our study showed higher levels in schools compared with residences.

Air pollution, lung function, and physical symptoms in communities near concentrated Swine feeding operations

BACKGROUND

Concentrated animal feeding operations emit air pollutants that may affect health. We examined associations of reported hog odor and of monitored air pollutants with physical symptoms and lung function in people living within 1.5 miles of hog operations.

METHODS

Between September 2003 and September 2005, we measured hydrogen sulfide (H2S), endotoxin, and particulate matter (PM10, PM2.5, and PM2.5-10) for approximately 2-week periods in each of 16 eastern North Carolina communities. During the same time periods, 101 adults sat outside their homes twice a day for 10 minutes, reported hog odor and physical symptoms, and measured their lung function. Conditional fixed-effects logistic and linear regression models were used to derive estimates of associations.

RESULTS

The log odds (±1 standard error) of acute eye irritation following 10 minutes outdoors increased by 0.53 (±0.06) for every unit increase in odor, by 0.15 (±0.06) per 1 ppb of H2S, and by 0.36 (±0.11) per 10 μg/m of PM10. Odor and H2S were also associated with irritation and respiratory symptoms in the previous 12 hours. The log odds of difficulty breathing increased by 0.50 (±0.15) per unit of odor. A 10 μg/m increase in mean 12-hour PM2.5 was associated with increased log odds of wheezing (0.84 ± 0.29) and declines in forced expiratory volume in 1 second (-0.04 ± 0.02 L). A 10 EU/mg increase in endotoxin was associated with increased log odds of sore throat (0.10 ± 0.05), chest tightness (0.09 ± 0.04), and nausea (0.10 ± 0.05).

CONCLUSIONS

Pollutants measured near hog operations are related to acute physical symptoms in a longitudinal study using analyses that preclude confounding by time-invariant characteristics of individuals.

Indoor allergens in Minnesota schools and child care centers

Elevated concentrations of allergens in the indoor environment may cause allergic sensitization and symptoms. Occupant exposure to indoor allergens in educational facilities should and can be controlled. This study (1) assessed the presence of indoor allergens in Minnesota schools and child care centers, (2) characterized the distribution of allergens in different materials, and (3) evaluated the effect of building and maintenance interventions on allergen concentrations. Settled dust samples were collected from carpet, vinyl tile floors, and upholstered furniture in six schools and seven child care centers before and after interventions. Interventions included changes to cleaning, ventilation, entry mats, furnishings, flooring, and classroom items. The amount of total dust, culturable fungi, and indoor allergens--cockroach, dust mite, cat, and dog--were quantified in the dust samples. Cockroach and dust mite allergens were generally low and below the detection limit, but one dust mite allergen was detected in some areas. Cat and dog allergens were frequently detected at elevated levels, with half the samples above the provisional sensitization risk thresholds and a few samples above the symptom thresholds. Allergen concentrations were highest in upholstered furniture, followed by carpeting and then vinyl floor tile. Cat and dog allergens were lower after the interventions. Cat and dog allergens, but not dust mite and cockroach allergens, seem to be ubiquitous in child care and elementary schools of the U.S. Midwest. These allergens may contribute to sensitization in atopic individuals and occasionally cause symptoms in sensitized allergic individuals. Fleecy materials that are not adequately cleaned, such as upholstered furniture, appear to be the most significant allergen reservoirs. Modest environmental interventions can be implemented by building staff, which should result in lower allergen concentrations.

Indoor allergens in school and day care environments

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.

A comparative study of asthma, pollen, cat and dog allergy among pupils and allergen levels in schools in Taiyuan city, China, and Uppsala, Sweden

We compared the school environment, asthma and allergy in 10 schools in Taiyuan, China, with eight schools in Uppsala, Sweden. In total 2193 pupils (mean age 13 years) participated. Chinese pupils had more respiratory symptoms, particularly daytime breathlessness after exercise (29.8% vs. 7.1%; P < 0.001), while cat allergy (1.2% vs. 6.6%; P < 0.001) and dog allergy (1.3% vs. 4.0%; P < 0.01) was less common. Cumulative incidence of asthma (1.8% vs. 9.5%; P < 0.001) and doctor's diagnosed asthma (1.2% vs. 9.0%; P < 0.001) were less common in China, indicating an under-diagnosis of asthma. Chinese classrooms were colder (mean 14.7 vs. 21.4 degrees C), more humid (mean 42% vs. 31% RH) and had higher CO2-levels (mean 2211 vs. 761 ppm). Levels of cat (Fel d1), dog (Can f1) allergens were low in settled dust from China (< 200 ng/g dust), but high in airborne dust on Petri-dishes (GM 16.8 ng/m2/day for Fel d1 and 17.7 for Can f1). The Swedish settled dust contained cat, dog and horse allergens in high levels (median 1300 ng/g, 1650 ng/g, 1250 U/g dust, respectively). In conclusion, there were large differences in the school environment, and in respiratory symptom and allergy. Allergen measurements in settled dust only may largely underestimate the classroom exposure. Practical Implications There is a need to improve the school environment, both in China and Sweden. The Swedish schools contained high levels of cat, dog and horse allergens and more amounts of open shelves and textiles that can accumulate dust and allergens. The air measurements indicated that Chinese schools may contain significant amounts of cat and dog allergen, and analysis of settled dust only may not reflect the true allergen exposure. Since the Chinese schools had no mechanical ventilation, they could not fulfill the ventilation standard in winter, and hence there is a need for improving the ventilation. The great discrepancy between respiratory symptoms and reports on asthma, and the high prevalence of attacks of breathlessness without wheeze, may have implication for future questionnaire studies on asthma in China.

The effect of home characteristics on dust antigen concentrations and loads in homes

On-site home visits, consisting of a home inspection, dust sampling, and questionnaires were conducted in 777 homes belonging to an ongoing birth cohort study in Cincinnati, Ohio. Various home characteristics were investigated, and antigen levels (concentrations [microg/g] and loadings [microg/m(2)]; IU for cockroach allergen) in floor dust samples collected in child's primary activity room were analyzed by ELISA. Monoclonal antibodies were used for the analysis of cat, house dust mite, and cockroach allergens, and polyclonal antibodies for Alternaria and dog antigens. The relationship between the antigen levels and home characteristics was investigated through a generalized multiple regression model. More than half of the homes experienced mold/water damage. Cats and dogs were present in 19.7% and 31.1% of homes, respectively. More than 90% of homes had either carpet or area rug covering their floors. Among 777 homes, 87-92% of homes had measurable amount of Alternaria, cat, and dog allergen/antigen in house dust, whereas only 38% and 14% of homes had measurable levels of house dust mite and cockroach, respectively. Alternaria antigen level in house dust was not associated with visual mold/water damage, which was suspected to be one of the sources for this antigen in homes. Instead, the antigen level was high in samples taken in fall and in homes having dogs implicating that Alternaria antigen appears to be transported from outdoors to indoors. A high level was also measured in homes using a dehumidifier (these homes have experienced excessive humidity) and in-home venting of clothes dryer, which might be associated with microclimate affecting mold growth and spore release. The allergen/antigen level (both concentration and loading) of cat, dog and cockroach was significantly associated with the number of cats and dogs, or the appearance of cockroaches, respectively. High level of house dust mite allergen was measured in bedrooms and in homes using dehumidifier and no central forced air heating system. Having indoor plants was shown to reduce allergen levels. Carpeted floor was found to hold larger amount of antigens than non-carpeted floor. Antigen loading demonstrated more consistent and larger numbers of associations with home characteristics compared to antigen concentration. This study encompassed a wide range of home characteristics and various antigen types. Our findings provide information on home characteristics that can be used for allergen avoidance and in planning future exposure assessment studies.

Importance of the personal endotoxin cloud in school-age children with asthma

BACKGROUND

A number of studies have observed associations between the amount of endotoxin in urban dust and chronic asthma severity, but a direct relationship between personal exposure to household endotoxin and acute asthma worsening has not yet been defined.

OBJECTIVE

We sought to investigate the relationship between day-to-day changes in personal endotoxin exposure and asthma severity.

METHODS

In the winter and spring of 1999 through 2000, endotoxin exposures were monitored in asthmatic schoolchildren by using portable, as opposed to stationary, monitors designed to measure inhalable and respirable particulate matter less than or equal to 2.5 and 10 microm in diameter. Children were followed with daily measurements of FEV(1) and asthma symptoms.

RESULTS

Over a 24-hour period, median daily personal endotoxin exposures ranged from 0.08 EU/m(3) (measured at a particulate matter size range </=2.5 microm in diameter) to 0.37 EU/m(3) (measured at a particulate matter size range </=10 microm in diameter). Personal exposures were significantly (P < .001) higher than endotoxin measurements from either indoor or outdoor stationary monitors. Moreover, individual exposures did not correlate with stationary measurements, suggesting that exposures derived from sources in close proximity to the children's personal activities might be better correlated with disease severity. Increases in personal endotoxin exposures were associated with decreased FEV(1) values and increased symptoms.

CONCLUSIONS

These findings demonstrate the importance of using personal monitoring to both measure and correlate endotoxin exposure with asthma severity.

Indoor allergens in settled school dust: a review of findings and significant factors

The school environment can be an important site of exposure to cat, dog, dust mite, and cockroach allergens, which have been detected in the settled dust of many schools. The sizable body of research that has been published in recent years warrants careful examination. This review article informs clinicians, researchers, and other parties about the potential for exposure in the school environment, factors that affect allergen concentrations, and areas of future research. While average concentrations in schools were usually under risk levels for symptoms or sensitization, many studies reported at least one location where the concentrations exceeded these levels. Maintenance, mechanical, and administrative factors were related to allergen levels in schools. From a clinical perspective, the school environment in industrialized nations has a lower potential for exposure than the home environment, but schools are significant for allergic individuals whose home environment has been addressed to the extent feasible. From a public health perspective, the school environment should be considered as a target for primary and secondary prevention. It can be more practical and amenable to intervene on a single school than the hundreds of homes in a community. Future research should continue to evaluate which interventions are most practical and result in the greatest measurable improvements. In addition, research should further examine the relationship between allergen exposure in schools and health effects, in order to develop an accurate exposure assessment model and risk levels that are specific to the school environment.