Dust from carpeted and smooth floors. VI. Allergens in homes compared with those in schools in Norway

Detection of Food Allergens in School and Home Environments of Elementary Students

BACKGROUND

Little is known about environmental food allergen exposure on school surfaces.

OBJECTIVE

To compare the distribution of major food allergens in floor dust and table wipe samples from elementary schools and dust samples from students' homes.

METHODS

In this substudy of the School Inner-City Asthma Study-II, 103 table wipe samples and 98 floor dust samples from cafeterias and classrooms in 18 elementary schools were analyzed for milk, peanut, cashew, hazelnut, and egg using a multiplex array. Home kitchen floor and bed dust samples from 90 students were also analyzed.

RESULTS

Food allergens were detectable in schools, but at significantly lower levels than in homes (P < .001). In schools, milk and peanut were detected in all table wipe samples; milk and egg were detected in all floor dust samples. Cafeteria table wipe samples contained significantly higher levels of milk, peanut, hazelnut, and egg, compared with classrooms. Cafeteria floor dust samples contained higher levels milk than classrooms. Peanut-restrictive policies did not consistently reduce environmental peanut exposure in schools. Peanut allergen was lower in dust from homes of students with peanut allergy (n = 5) compared with those without peanut allergy (n = 85) (P < .001). Reassuringly, peanut allergen in the schools of peanut-allergic students was not significantly different than in their homes.

CONCLUSION

Food allergens were readily detectable on tables and floors in elementary schools, but at levels lower than in students' homes. For peanut-allergic students, the levels of detectable peanut in their schools were not higher than their homes. The low levels of detectable food allergens in school environments are unlikely to result in severe allergic reactions.

The relevance of a digestibility evaluation in the allergenicity risk assessment of novel proteins. Opinion of a joint initiative of COST action ImpARAS and COST action INFOGEST

The current allergenicity assessment of novel proteins is based on the EFSA GMO guidance. Recently, EFSA launched a new guidance document on allergenicity assessment of GM plants (2017). This document describes, amongst other topics, the new scientific and regulatory developments on in vitro protein digestibility tests. The EFSA GMO Panel stated that for in vitro protein digestibility tests, additional investigations are needed before any additional recommendation in the form of guidance can be provided. To this end, an interim phase is considered necessary to evaluate the revisions to the in vitro gastrointestinal digestion test, proposed by EFSA. This prompted the establishment of a joint workshop through two COST Action networks: COST Action ImpARAS and COST Acton INFOGEST. In 2017, a workshop was organised to discuss the relevance of digestion in allergenicity risk assessment and how to potentially improve the current methods and readouts. The outcome of the workshop is that there is no rationale for a clear readout that is predictive for allergenicity and we suggest to omit the digestion test from the allergenicity assessment strategy for now, and put an effort into filling the knowledge gaps as summarized in this paper first.

Do Carpets Impair Indoor Air Quality and Cause Adverse Health Outcomes: A Review

Several earlier studies have shown the presence of more dust and allergens in carpets compared with non-carpeted floors. At the same time, adverse effects of carpeted floors on perceived indoor air quality as well as worsening of symptoms in individuals with asthma and allergies were reported. Avoiding extensive carpet use in offices, schools, kindergartens and bedrooms has therefore been recommended by several health authorities. More recently, carpet producers have argued that former assessments were obsolete and that modern rugs are unproblematic, even for those with asthma and allergies. To investigate whether the recommendation to be cautious with the use of carpets is still valid, or whether there are new data supporting that carpet flooring do not present a problem for indoor air quality and health, we have reviewed the literature on this matter. We have not found updated peer reviewed evidence that carpeted floor is unproblematic for the indoor environment. On the contrary, also more recent data support that carpets may act as a repository for pollutants which may become resuspended upon activity in the carpeted area. Also, the use of carpets is still linked to perception of reduced indoor air quality as well as adverse health effects as previously reported. To our knowledge, there are no publications that report on deposition of pollutants and adverse health outcomes associated with modern rugs. However, due to the three-dimensional structure of carpets, any carpet will to some extent act like a sink. Thus, continued caution should still be exercised when considering the use of wall-to-wall carpeted floors in schools, kindergartens and offices, as well as in children’s bedrooms unless special needs indicate that carpets are preferable.

Prevention of food allergy

The past few decades have witnessed an increase in the prevalence of IgE-mediated food allergy (FA). For prevention strategies to be effective, we need to understand the causative factors underpinning this rise. Genetic factors are clearly important in the development of FA, but given the dramatic increase in prevalence over a short period of human evolution, it is unlikely that FA arises through germline genetic changes alone. A plausible hypothesis is that 1 or more environmental exposures, or lack thereof, induce epigenetic changes that result in interruption of the default immunologic state of tolerance. Strategies for the prevention of FA might include primary prevention, which seeks to prevent the onset of IgE sensitization; secondary prevention, which seeks to interrupt the development of FA in IgE-sensitized children; and tertiary prevention, which seeks to reduce the expression of end-organ allergic disease in children with established FA. This review emphasizes the prevention of IgE-mediated FA through dietary manipulation, among other strategies; in particular, we focus on recent interventional studies in this field.

Cat (Fel d 1) and dog (Can f 1) allergen levels in cars, dwellings and schools

Pets are an important source of indoor allergens. The aim of the study was to compare cat and dog allergen levels in cars, schools and homes. The study was carried out in 17 cars, 14 classrooms and 19 dwellings located in the highly industrialized and urbanized region of Poland. Dust and air samples were analyzed for Fel d 1 and Can f 1 using a double monoclonal ELISA assay. The highest amounts of cat and dog allergens (Fel d 1: 1169 μg/g; Can f 1: 277 μg/g) were found in dwellings with pets. Allergen concentrations were correlated with the number of animals kept at home. Although concentrations on automobile seats were lower, Fel d 1 levels exceeded 8 μg/g in 23.5 % of cars and high levels of Can f 1 (>10 μg/g) were found in 17.6 % of cars. The study revealed that cars of pet owners may be reservoirs of cat and dog allergens even when animals are not transported in them. In schools, concentrations of pet allergens did not reach high levels, but the moderate levels of Fel d 1 (≥1-8 μg/g) and Can f 1 (≥2-10 μg/g) were detected in 42.9 and 7.1 % of the investigated classrooms. Concentrations of cat and dog allergen in schools were higher than in homes without pets. While airborne Fel d 1 and Can f 1 levels were found low, residential allergen concentrations in settled dust and air were correlated. The study results suggest that classrooms and cars of pet owners may be important sites of exposure to cat and dog allergens, though the highest concentrations of Fel d 1 and Can f 1 are found in homes of pet owners.

Indoor air quality and sources in schools and related health effects

Good indoor air quality in schools is important to provide a safe, healthy, productive, and comfortable environment for students, teachers, and other school staff. However, existing studies demonstrated that various air pollutants are found in classrooms, sometimes at elevated concentrations. Data also indicated that poor air quality may impact children's health, in particular respiratory health, attendance, and academic performance. Nevertheless, it should be noted that there are other adverse health effects that are less documented. Few data exist for teachers and other adults that work in schools. Allergic individuals seem to be at a higher risk for adverse respiratory health consequences. Air quality improvement represents an important measure for prevention of adverse health consequences in children and adults in schools.

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.

Early consumption of peanuts in infancy is associated with a low prevalence of peanut allergy

BACKGROUND

Despite guidelines recommending avoidance of peanuts during infancy in the United Kingdom (UK), Australia, and, until recently, North America, peanut allergy (PA) continues to increase in these countries.

OBJECTIVE

We sought to determine the prevalence of PA among Israeli and UK Jewish children and evaluate the relationship of PA to infant and maternal peanut consumption.

METHODS

A clinically validated questionnaire determined the prevalence of PA among Jewish schoolchildren (5171 in the UK and 5615 in Israel). A second validated questionnaire assessed peanut consumption and weaning in Jewish infants (77 in the UK and 99 in Israel).

RESULTS

The prevalence of PA in the UK was 1.85%, and the prevalence in Israel was 0.17% (P < .001). Despite accounting for atopy, the adjusted risk ratio for PA between countries was 9.8 (95% CI, 3.1-30.5) in primary school children. Peanut is introduced earlier and is eaten more frequently and in larger quantities in Israel than in the UK. The median monthly consumption of peanut in Israeli infants aged 8 to 14 months is 7.1 g of peanut protein, and it is 0 g in the UK (P < .001). The median number of times peanut is eaten per month was 8 in Israel and 0 in the UK (P < .0001).

CONCLUSIONS

We demonstrate that Jewish children in the UK have a prevalence of PA that is 10-fold higher than that of Jewish children in Israel. This difference is not accounted for by differences in atopy, social class, genetic background, or peanut allergenicity. Israeli infants consume peanut in high quantities in the first year of life, whereas UK infants avoid peanuts. These findings raise the question of whether early introduction of peanut during infancy, rather than avoidance, will prevent the development of PA.

Particle resuspension during the use of vacuum cleaners on residential carpet

Vacuuming is generally considered to be an important activity with respect to the cleanliness of indoor environments but may lead to short-term resuspension of particulate matter and elevated particle mass in indoor air. Because resuspended particles often contain toxicants, such as lead and pesticides, or consist of biological agents that can trigger allergic reactions, it is important to understand the role of vacuuming on short-term variations in indoor particulate matter concentrations. The inhalation of particles during vacuuming events may affect adversely those whose occupation requires them to clean a wide range of indoor environments, from homes to schools and offices, as well as those who occupy those environments. In response, a series of 46 experiments was completed to determine time-variant concentrations of both PM(10) and PM(2.5) during various vacuuming activities in 12 separate apartments. Experiments involved the use of two different non-HEPA vacuum cleaners and were completed with a vacuum cleaner activated (switched on) as well as deactivated (switched off). The latter was intended to provide insight on the potential for resuspension of particles by the mechanical agitation of vacuum cleaner movement across carpet. Separate experiments were completed also using "mock" vacuuming simulations, that is, walking on the carpet in a manner consistent with using a vacuum cleaner. Results are presented as incremental particulate matter concentration increases, relative to background (prevacuum) concentrations, and peak-to-background particle concentration ratios. Results indicate significant resuspension of PM(10) mass during vacuum cleaning, with a mean time-averaged PM(10) increase of greater than 17 mu g/m(3) above background. Resuspension of PM(2.5) mass was determined to be small, that is, PM(10) mass was dominated by particles greater than 2.5 mu m. The frequency of vacuuming (between a 10-day standard frequency and several experiments at > 24 days between vacuuming) had little influence on resuspended particle mass. Resuspension by mechanical agitation (rolling of vacuum cleaner across carpet) with the vacuum cleaner switched off was determined to be substantial, with a mean time-averaged (during vacuuming) PM(10) increase of 35 mu g/m(3) relative to background. Peak-to-background PM(10) concentrations exceeded 6 for some experiments and averaged between approximately 3 and 4 for experiments when the vacuum cleaner was switched on.

Skin sensitization in school children in northern and southern Norway

It has been suggested that environmental exposures and living conditions can explain some of the worldwide variation in atopic disorders. Norway has large environmental contrasts within the country. We compared skin prick sensitization rates among school children living in the southern subarctic and in the northern arctic part of Norway. Approximately one quarter of the children were sensitized, mostly against pollen and animal dander, while mite and mould sensitization seemed to be a minor problem. Sensitization rates and profiles were similar in the north and south despite differences in living conditions and environmental exposures.

Allergens and endotoxin in settled dust from day-care centers and schools in Oslo, Norway

Allergy to indoor allergens can cause frequent and severe health problems in children. Because little is known about the content of allergens in the indoor environments in Norway, we wanted to assess the levels of cat, dog and mite allergens in schools and day-care centers in Oslo. Allergen levels in dust samples from 155 classrooms and 81 day-care units were measured using commercially available enzyme-linked immunosorbent assay (ELISA) kits. Additionally, we measured the levels of endotoxin in 31 day-care units, using the limulus amebocyte lysate test. Most of the dust samples contained detectable amounts of cat and dog allergens. In mattress and floor dust (day-care centers), and curtain and floor dust (schools) the median Fel d 1 levels were 0.17, 0.002, 0.02 and 0.079 microg/m2, while the median Can f 1 levels were 1.7, 0.03, 0.1 and 0.69 microg/m2, respectively. Levels of cat and dog allergens in school floor dust were associated with the number of pupils with animals at home. In contrast, <1% of the samples had measurable levels of the mite allergen Der p 1. Moreover, the levels of endotoxin tended to be higher in dust from floors (1.4 ng/m2) compared with that from mattresses (0.9 ng/m2).

PRACTICAL IMPLICATIONS

To reduce allergen exposure, allergic individuals should be placed in the classes/rooms with the fewest pet owners. Moreover, mattresses in day-care centers are major reservoirs of cat and dog allergens and should be cleaned frequently.

The effect of outdoor air and indoor human activity on mass concentrations of PM(10), PM(2.5), and PM(1) in a classroom

The 12-h mass concentration of PM(10), PM(2.5), and PM(1) was measured in a lecturing room by means of three co-located Harvard impactors. The filters were changed at 8 AM and at 8 PM to cover the periods of presence and absence of students. Concentrations were assessed by gravimetry. Ambient PM(10) data were available for corresponding 12-h intervals from the nearest state air-quality-monitoring network station. The data were pooled into four periods according to the presence and absence of students-Monday-Thursday day (workday daytime), Monday-Thursday night (workday night), Friday-Sunday day (weekend daytime), and Friday-Sunday night (weekend night). Average indoor workday daytime concentrations were 42.3, 21.9 and 13.7 microgm(-3), workday night were 20.9, 19.1 and 15.2 microgm(-3), weekend daytime were 21.9, 18.1 and 11.4 microgm(-3), and weekend night were 24.5, 21.3, and 15.6 microgm(-3) for PM(10), PM(2.5), and PM(1), respectively. The highest 12-h mean, median, and maximum (42.3, 43.0, and 76.2 microgm(-3), respectively) indoor concentrations were recorded on workdays during the daytime for PM(10). The statistically significant (r=0.68,P<0.0009) correlation between the number of students per hour per day and the indoor coarse fraction calculated as PM(10--2.5) during daytime on workdays indicates that the presence of people is an important source of coarse particles indoor. On workdays, the daytime PM(10) indoor/outdoor ratio was positively associated (r=0.93) with an increasing indoor coarse fraction (PM(10--2.5)), also indicating that an important portion of indoor PM(10) had its source inside the classroom. With the exception of the calculated coarse fraction (PM(10--2.5)), all of the measured indoor particulate matter fractions were significantly highly correlated with outdoor PM(10) and negatively correlated with wind velocity, showing that outdoor levels of particles influence their indoor concentrations.

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.

Biology, ecology, and prevalence of dust mites

The house dust mites D. farinae, D. pteronyssinus, and E. maynei are sources of multiple potent allergens in the indoor environment. They are common inhabitants in homes worldwide. Many biologically significant studies have revealed how well adapted these mites are to the microhabitats in homes. Ambient RH is a key factor in determining where these mites are found. Many aspects of the biology of house dust mites are not understood. A greater understanding of the biology of dust mites may reveal new strategies for controlling dust mites and their allergens in homes.

Dust mite allergens: ecology and distribution

The most important allergy-causing mites found in homes worldwide are the house dust mites Dermatophagoides farinae, D. pteronyssinus, Euroglyphus maynei, and the storage mite Blomia tropicalis. Most homes contain multiple species. The most prevalent mite species and allergen in homes differ geographically, between homes within a geographical region, and among areas within a home. Therefore, it is important to know which mite species are present in a geographical area when performing diagnostic testing and prescribing immunotherapy. The key factor that influences mite survival and prevalence is relative humidity. Mites are present in homes in humid geographical areas and are rare or absent in drier climates unless humidity is artificially raised. Generally speaking, dust mite allergen levels are low in public buildings and transportation compared to levels in homes.

Relationship among house-dust mites, Der 1, Fel d 1, and Can f 1 on clothing and automobile seats with respect to densities in houses

BACKGROUND

Locations where there are no dust mites or pets present may contain allergens that pose a risk factor for sensitizing and inducing rhinitis and asthma.

OBJECTIVE

The purpose of this study was to investigate the relationship among the prevalence of mites and mite, dog, and cat allergens in homes, on clothing, and on automobile seats.

METHODS

Over a 2-year period (July 1998 to July 2000), dust mite and mite, dog, and cat allergen densities were determined in homes, associated automobiles, and on the clothing of the drivers. During this period 87 homes were sampled one to five times each.

RESULTS

Low levels of live and dead mites were present in most dust samples obtained from automobile seats and in 16% from clothing. Seventy-two and 50% of the home samples had >2 microg and >10 microg Der l/g of dust, respectively, whereas 23% of automobiles seat samples had >2 microg Der l/g of dust with a mean of 1.3 microg/g. Mite and Der 1 densities were not different for homes with or without pets. However, homes with pets had significantly more Fel d 1 or Can f 1 allergen than homes without pets. Homes without cats and dogs had an average of 93 and 29 microg/g of Fel d 1 and Can f 1, respectively, which was well above threshold levels for sensitization and induction of allergic reactions. Although most clothing had detectable levels of pet allergen, the levels of these allergens were low.

CONCLUSIONS

Der 1 densities in some automobiles were sufficiently high (>2 microg/g of dust) to be risk factors for sensitization and allergic reactions. However, most automobile seats had levels of dog and cat allergen that were well above the threshold levels considered to be risk factors for both sensitization and symptoms, regardless of the presence of a pet in the home. The presence of live and dead mites and mite, cat, and dog allergens in automobiles and on clothing suggests that both are vehicles in the dispersal of mites and mite and pet allergen.

Environmental allergens and irritants in schools: a focus on asthma

As part of the Partners in School Asthma Management Program, environmental data were collected from 385 rooms in 60 elementary schools in southeast Texas, using an Environmental Observation Checklist and a Q-TRAK Indoor Air Quality Monitor. Dust samples for allergen analysis were collected from floors, carpets, and area rugs in 80 classrooms in a subset of 20 schools. CO2 levels > 1,000 ppm were found in 86% of rooms; 69% had indoor humidity above recommended levels. Der p I dust mite allergen levels > 2,000 ng/g were present in 20% of rooms, but only 2.5% of rooms had Der f I mite allergen levels exceeding recommended tolerances. Detectable levels of cockroach allergen (Bla g II) were found in all schools (median 5.5 ng/g), with 10% of rooms over the recommended threshold. Almost two-thirds of classrooms had mold spore counts > 10,000 col/g (median, 14,400 col/g; range, 2,000-52,000 col/g).

Sensitization and exposure to pet allergens in asthmatics versus non-asthmatics with allergic rhinitis

In sensitized subjects with allergic rhinitis (AR) or asthma, allergen exposure provokes symptoms. Among non-asthmatics with AR, an association between allergen sensitization, pollen season and lower airway inflammation has been demonstrated. Our aims were to compare AR and asthma with regard to patterns of allergen sensitization, the degree of airway hyperresponsiveness (AHR) and levels of exhaled nitric oxide (ENO). Finally, we wanted to relate our findings to previous or current exposure to household pets. Four hundred and thirty-one adolescents with different clinical phenotypes were randomly selected from a large-scale epidemiological survey. They were investigated with allergy screening, measurements of ENO and a methacholine bronchoprovocation test. Sensitization to pet allergens (cat, dog and horse) was associated with increased AHR and ENO both in asthmatics and non-asthmatics with AR. The risk of being sensitized to cat allergens was significantly reduced in those who had kept cats vs. those who had never kept them. Keeping dogs or horses did not influence the risk of being sensitized to the respective allergens. Only in steroid-naive, non-smoking asthmatics, a trend towards increased ENO in those sensitized and exposed to cat or dog allergens was seen. Although sensitization towards pet allergens was associated with inflammation in the lower airways irrespective of clinical phenotype, keeping pets did not increase the risk of being sensitized to pet allergens.

New ventilation systems at select schools in Sweden--effects on asthma and exposure

The air-exchange rate is often low in schools. The authors studied the possible impact of improving school ventilation on health and exposure of pupils. Questionnaire data on allergies, asthma, and asthmatic symptoms were obtained in 1993 and 1995 for 1,476 primary- and secondary-school pupils in 39 randomly selected schools. Various exposure factors were measured in 1993 and 1995 in approximately 100 classrooms. In 12% of the classrooms, new ventilation systems were installed between 1993 and 1995; the subsequent air-exchange rate increased and the relative humidity and concentration of several airborne pollutants were reduced compared with classrooms in nonimproved buildings. The reporting of at least one asthmatic symptom and the reporting of more asthmatic symptoms in 1995 than in 1993 were less common among the 143 pupils who attended schools with new ventilation systems.

Mite-allergen levels in Norwegian homes

The scarce data published on mite sensitization and mite-allergen levels in Norway indicate that the mites may not be of the same importance in allergic disease in Norway as in countries such as the UK and the rest of Europe. The problem also involves the low allergen levels and small amounts of dust collected for allergen determination, and when the level is to be expressed as mg/g, the lower detection limit will often vary from sample to sample, giving within the same investigation results such as <0.2 microg/g, <0.5 microg/g, and even <2.0 microg/g. The use of allergen levels expressed instead per area (microg/m2) at least results in a uniform lower detection limit, making statistical analysis easier.

Environmental assessment of Dermatophagoides mite-allergen levels in Sweden should include Der m 1

The major allergen of Dermatophagoides microceras, Der m 1, as well as the allergens of D. pteronyssinus and D. farinae, Der p 1 and Der f 1, were analyzed in the homes of 111 asthmatic children in three climatic regions in Sweden. The numbers and species of mites were determined by microscopy, and circulating IgE antibodies against mites were measured. Der f 1 was the predominant house-dust-mite (HDM) allergen, Der p 1 the least often found, and Der m 1 represented 31% of the allergen load. However, in the Linköping area, Der m 1 was the major HDM allergen (58%). Mite counts and allergen levels correlated well. Current exposure to HDM allergens at home was associated with the serum IgE antibody response to HDM in the children with no threshold level. Of the children with IgE antibodies against HDM, 67% reacted to all three mites. Mite sensitization rates were marginally increased (7%) by the addition of IgE analysis of D. microceras to the routine analysis of IgE antibodies against D. pteronyssinus and D. farinae. Thus, Der m 1 may be an important HDM allergen and should be considered when HDM exposure data are assessed in areas with a climate like that of Sweden.

Increasing risk of asthma without other atopic diseases in school children: a repeated cross-sectional study after 13 years

Some children develop asthma and other atopic diseases, others asthma without atopic diseases. To better understand secular trends, we estimated the relative increase in asthma in children with (atopy related asthma) and without (non-atopy related asthma) other atopic diseases (eczema or hay fever) in two samples of school children born, 1965-1975 (n = 1674) and 1978-1988 (n = 2188). By analysing the samples as historical cohorts, age-specific prevalence rates were estimated and incidence rates were calculated (number of new cases by 1000 person years under risk). Cox regression was used to estimate the relative risk (RR) of asthma by year of birth. The point prevalence of asthma was 1.9% (95% CI: 1.4-2.4) in the 1965-1975 cohort and 4.6% (95% CI: 3.8-5.4) in the 1978-1988 cohort for three-year old children, and remained fairly constant throughout childhood. The age-specific prevalence of non-atopy related asthma increased relatively more from 1965-1975 to 1978-1988 compared to atopy related asthma. The age-specific incidence rates of asthma showed that the RRs comparing the two cohorts tended at all ages to be highest for non-atopy related asthma. The relative risks of non-atopy related asthma by gender and birth cohort, showed that the effect of cohort was higher for non-atopy related asthma, aRR: 4.0 (95 % CI: 2.5-6.5), than for atopy-related asthma aRR: 2.0 (95% CI: 1.3-3.2). Children without other atopic diseases have a higher relative risk of being diagnosed with asthma than children with other atopic diseases across all ages comparing two samples of school children born 1965-1975 and 1978-1988.

Childhood asthma and exposure to indoor allergens: low mite levels are associated with sensitivity

The prevalence and level of sensitivity to indoor allergens were studied in relation to current exposure at home in 124 children with perennial asthma living in three climatic zones of Sweden. The house dust mite (HDM) allergen levels were higher in the South than in the North (p < 0.001), while cat and dog allergen levels tended to be higher in the North than the South (n.s.). Thirty-four percent of the children were sensitive to the HDM Dermatophagoides pteronyssinus, as determined by IgE antibodies in vitro, 27% were sensitive to D. farinae, 57% to cat and 55% to dog. Sensitivity to HDM was significantly more prevalent in Southern, than in Central and Northern Sweden (p = 0.001) where the children were more often sensitive to pets (cat p = 0.005, dog p = 0.002). A significant association between the concentration of Der p I and Der fI in the house dust and both the prevalence of sensitivity to HDM and the IgE antibody levels against mites was found even at concentrations well below the commonly suggested risk level for sensitisation of 2 micrograms/g dust. No relationship was found between pet allergen concentration in the home dust and sensitivity to pets, possibly because of exposure outside home, e.g. in schools and meeting places for leisure activities. Similarly, there was no consistent association between the level of mite or pet allergen exposure at home and asthma severity as judged by symptom and medication score. The study indicates that there is no threshold value for sensitisation to mite allergens in asthmatic children, and therefore, dust allergen levels at home should be kept as low as possible in homes of children at risk for asthma.

Viable fungi in indoor air in homes and schools in the Sør-Varanger community during winter

The present study investigated the content of fungal aerospores in homes and schools of house-dust-mite (HDM)-sensitized and control children in a subarctic area. During winter, airborne microfungi were collected from the homes and schools of 19 HDM-sensitized children and 19 nonatopic controls, all living in the community of Sør-Varanger, northern Norway. The samples were cultivated and microfungal growth was identified microscopically. Indoor humidity, temperature, and carbon dioxide (CO2) concentrations were measured. Housing conditions and sociodemographic and symptom data were obtained by a questionnaire. Penicillium was the most common microfungus in both homes and schools, followed by various yeasts, Aspergillus, Cladosporium, and Mucor. The number of infected homes was equal in the HDM-sensitized group and the control group, but aerospore counts were higher in the HDM-sensitized group than in the control group. The lowest aerospore counts were found in the schools. High aerospore counts also appeared to be related to high indoor humidity. The keeping of pets and damp indoor conditions were more frequent in homes of HDM-sensitized children than in the control group, whereas parental smoking and carpeting occurred with equal frequency in both groups. This indicates that no allergy sanitation measures had been undertaken, especially in the homes of the HDM-sensitized children.

Indoor environmental risk factors in young asthmatics: a case-control study

One hundred and ninety three children with asthma and 318 controls aged 1-4 years were evaluated for atopic heredity and exposure to possible indoor risk factors for asthma-for example exposure to furred pets, tobacco smoke, and home dampness. A subgroup of cases were classified as cat and/or dog allergic on the basis of skin prick tests. Heredity for asthma was a significant risk factor (odds ratio (OR) 3.0, confidence interval (CI) 2.1 to 4.6). Environmental tobacco smoke was associated with an excess risk for asthma (OR 1.7, CI 1.1 to 2.3) and signs of home dampness tended to increase this risk (OR 1.3, CI 0.9 to 2.0). High dose exposure to cat and/or dog resulted in an increased risk only in asthma cases sensitised to cat and/or dog (OR 2.7, CI 1.0 to 7.3). A combination of high dose exposure to cat and/or dog, environmental tobacco smoke and damp housing was associated with an OR of 8.0 (CI 1.9 to 34.1). Raised indoor humidity has been shown to reflect low air exchange, which may also lead to increased doses of inhaled aeroallergens and tobacco smoke, and contribute to the interaction between the three risk factors.

Indoor allergen levels in day nurseries

BACKGROUND

Because allergic sensitization seems to occur especially during infancy, we decided to evaluate such an exposure in day nurseries.

METHODS

Thirty day nurseries in Marseilles, which were selected at random, were visited during 2 weeks in April 1993. Routine cleaning includes daily cleaning of smooth floors, weekly laundering of sheets, and monthly cleaning of soft toys. Mattresses are encased in synthetic covers. Dust samples were collected from four settings: infants' mattresses and pillows, smooth floors, and soft toys. Levels of mite, cockroach, cat, and dog allergens were analyzed with a monoclonal antibody-based ELISA.

RESULTS

Mite allergen levels were lower than the proposed threshold level for sensitization (2 micrograms/gm of dust) on 94% of mattresses and soft toys and on 100% of floors and pillows. Cat allergen levels in mattresses ranged from less than 0.1 to 4.5 micrograms/gm dust. On floors, cat allergen levels ranged from less than 0.1 to 2.4 micrograms/gm dust. Only 10% of pillows and soft toys had levels greater than 2 micrograms/gm of dust. Fel d I levels were significantly higher (p < 0.03) in mattresses from nurseries with curtains and were correlated with the percentage of children with a cat at home. In almost all day nurseries, cockroach allergen (Bla g I and Bla g II) levels were very low. Only three samples from mattresses had dog allergen levels greater than 2 micrograms of Can f I allergen per gram of dust. On floors the level was always lower than 2 micrograms/gm.

CONCLUSIONS

These data clearly show that indoor allergen levels are much lower in day nurseries than in most houses. Most samples contain allergen levels below threshold levels for sensitization. Thus children of atopic parents are less likely to become sensitized to indoor allergens in day nurseries than in their own homes. In addition, this study emphasizes the efficacy of avoidance measures such as use of synthetic protective mattress covers, frequent washing of sheets and soft toys, and avoidance of carpets and curtains.