Symptoms, complaints, ocular and nasal physiological signs in university staff in relation to indoor environment - temperature and gender interactions

Self-reported voice disorders of teachers and indoor air quality in schools: a cross-sectional study in Finland

OBJECTIVE

We aimed to study the association between self-reported voice disorders among teachers and indoor air quality in school buildings.

METHODS

We performed a questionnaire study of 538 Finnish teachers working in 67 school buildings utilizing both perceived and technical evaluations; the agreement between these two assessments was also studied. The technical assessment was provided by technical experts.

RESULTS

Teachers with voice disorders reported significantly more complaints from indoor air than those without voice disorders. The results also indicated a possible connection between the technical assessment and voice disorders. After adjustment for sex, stress and asthma, the prevalence of voice disorders was 47% higher in teachers working in renovated buildings compared to those working in the non-problem buildings (aRR1.47; CI 95% 1.11-1.95). The prevalence of voice disorders was 28% higher among teachers working in buildings with problems compared to those working in non-problem buildings (aRR 1.28; 95% CI 0.99-1.64).

DISCUSSION

In our study, poor perceived indoor air was significantly associated with self-reported voice disorders in teachers and there was an agreement between the perceived and technical assessments. Our results also indicated a possible connection between the technical assessment and voice disorders. Our results imply the need for longitudinal research with technical assessment to study the effect of renovation on voice disorders.

A Systematic Review of Associations between Energy Use, Fuel Poverty, Energy Efficiency Improvements and Health

Energy use in buildings can influence the indoor environment. Studies on green buildings, energy saving measures, energy use, fuel poverty, and ventilation have been reviewed, following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The database PubMed was searched for articles published up to 1 October 2020. In total, 68 relevant peer-reviewed epidemiological or exposure studies on radon, biological agents, and chemicals were included. The main aim was to assess current knowledge on how energy saving measures and energy use can influence health. The included studies concluded that buildings classified as green buildings can improve health. More efficient heating and increased thermal insulation can improve health in homes experiencing fuel poverty. However, energy-saving measures in airtight buildings and thermal insulation without installation of mechanical ventilation can impair health. Energy efficiency retrofits can increase indoor radon which can cause lung cancer. Installation of a mechanical ventilation systems can solve many of the negative effects linked to airtight buildings and energy efficiency retrofits. However, higher ventilation flow can increase the indoor exposure to outdoor air pollutants in areas with high levels of outdoor air pollution. Finally, future research needs concerning energy aspects of buildings and health were identified.

Indoor air quality and sick building syndrome in a university setting: a case study in Greece

The perceived Indoor Air Quality (IAQ), the prevalence of Sick Building Syndrome (SBS) symptoms and its contributing risk factors were assessed in a university during the period of the economic crisis in Greece. Data was collected from 613 employees via questionnaires. Hierarchical linear regression analysis was performed. The most prevalent perceived IAQ complaints were 'Dust and dirt' (63.2%), 'Room temperature too low' (24.9%) and 'Varying room temperature' (24.4%). The most frequently reported SBS symptom was 'Fatigue' (34.1%). The prevalence of General, Mucosal and Dermal symptoms was 40.8%, 19.8% and 8.1%, respectively. Several contributing risk factors were identified, such as IAQ Discomfort Scale, atopy, sleep problems, female, exposure to biological and chemical agents, PC-use, Psychosocial Work Scale and job satisfaction. Poor perceived IAQ and high prevalence of SBS symptoms were reported from the university staff in a temperate climate country. SBS seemed to be multifactorial.

Humidification of indoor air for preventing or reducing dryness symptoms or upper respiratory infections in educational settings and at the workplace

BACKGROUND

Indoor exposure to dry air during heating periods has been associated with dryness and irritation symptoms of the upper respiratory airways and the skin. The irritated or damaged mucous membrane poses an important entry port for pathogens causing respiratory infections.

OBJECTIVES

To determine the effectiveness of interventions that increase indoor air humidity in order to reduce or prevent dryness symptoms of the eyes, the skin and the upper respiratory tract (URT) or URT infections, at work and in educational settings.

SEARCH METHODS

The last search for all databases was done in December 2020. We searched Ovid MEDLINE, Embase, CENTRAL (Cochrane Library), PsycINFO, Web of Science, Scopus and in the field of occupational safety and health: NIOSHTIC-2, HSELINE, CISDOC and the In-house database of the Division of Occupational and Environmental Medicine, University of Zurich. We also contacted experts, screened reference lists of included trials, relevant reviews and consulted the WHO International Clinical Trials Registry Platform (ICTRP).

SELECTION CRITERIA

We included controlled studies with a parallel group or cross-over design, quasi-randomised studies, controlled before-and-after and interrupted time-series studies on the effects of indoor air humidification in reducing or preventing dryness symptoms and upper respiratory tract infections as primary outcomes at workplace and in the educational setting. As secondary outcomes we considered perceived air quality, other adverse events, sick leave, task performance, productivity and attendance and costs of the intervention.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened titles, abstracts and full texts for eligibility, extracted data and assessed the risks of bias of included studies. We synthesised the evidence for the primary outcomes 'dry eye', 'dry nose', 'dry skin', for the secondary outcome 'absenteeism', as well as for 'perception of stuffiness' as the harm-related measure. We assessed the certainty of evidence using the GRADE system.

MAIN RESULTS

We included 13 studies with at least 4551 participants, and extracted the data of 12 studies with at least 4447 participants. Seven studies targeted the occupational setting, with three studies comprising office workers and four hospital staff. Three of them were clustered cross-over studies with 846 participants (one cRCT), one parallel-group controlled trial (2395 participants) and three controlled before-and-after studies with 181 participants. Five studies, all CTs, with at least 1025 participants, addressing the educational setting, were reported between 1963 and 1975, and in 2018. In total, at least 3933 (88%) participants were included in the data analyses. Due to the lack of information, the results of the risk of bias assessment remained mainly unclear and the assessable risks of bias of included studies were considered as predominantly high. Primary outcomes in occupational setting:  We found that indoor air humidification at the workplace may have little to no effect on dryness symptoms of the eye and nose (URT). The only cRCT showed a significant decrease in dry eye symptoms among working adults (odds ratio (OR) 0.54, 95% confidence interval (CI) 0.37 to 0.79) with a low certainty of the evidence. The only cluster non-randomised cross-over study showed a non-significant positive effect of humidification on dryness nose symptoms (OR 0.87, 95% CI 0.53 to 1.42) with a low certainty of evidence. We found that indoor air humidification at the workplace may have little and non-significant effect on dryness skin symptoms. The pooled results of two cluster non-RCTs showed a non-significant alleviation of skin dryness following indoor air humidification (OR 0.66, 95% CI 0.33 to 1.32) with a low certainty of evidence. Similarly, the pooled results of two before-after studies yielded no statistically significant result (OR 0.69, 95% CI 0.33 to 1.47) with very low certainty of evidence No studies reported on the outcome of upper respiratory tract infections. No studies conducted in educational settings investigated our primary outcomes. Secondary outcomes in occupational setting: Perceived stuffiness of the air was increased during the humidification in the two cross-over studies (OR 2.18, 95% CI 1.47 to 3.23); (OR 1.70, 95% CI 1.10 to 2.61) with low certainty of evidence. Secondary outcomes in educational setting: Based on different measures and settings of absenteeism, four of the six controlled studies found a reduction in absenteeism following indoor air humidification (OR 0.54, 95% CI 0.45 to 0.65; OR 0.38, 95% CI 0.15 to 0.96; proportion 4.63% versus 5.08%).

AUTHORS' CONCLUSIONS

Indoor air humidification at the workplace may have little to no effect on dryness symptoms of the eyes, the skin and the URT. Studies investigating illness-related absenteeism from work or school could only be summarised narratively, due to different outcome measures assessed. The evidence suggests that increasing humidification may reduce the absenteeism, but the evidence is very uncertain. Future RCTs involving larger sample sizes, assessing dryness symptoms more technically or rigorously defining absenteeism and controlling for potential confounders are therefore needed to determine whether increasing indoor air humidity can reduce or prevent dryness symptoms of the eyes, the skin, the URT or URT infections at work and in educational settings over time.

Does dampness and mold in schools affect health? Results of a meta-analysis

This paper provides meta-analyses of the published findings relating the respiratory health of occupants of schools with visible dampness, water damage, visible mold, and/or mold odor. Random effects models were used to develop central estimates and confidence limits for the associations of respiratory health effects with school dampness and mold. Eleven studies, all with cross-sectional designs, were included in the meta-analyses; however, analyses for some health outcomes were based on as few as four studies. Analyses were performed using data from adults and children combined, using only data from children, and using data from adults and children after excluding two studies. The central estimates of odds ratios from the meta-analyses were consistently above unity. The evidence of adverse health effects was strongest for cough and wheeze, which had confidence limits excluding unity in some or all analyses. The odds ratios of 1.32 for cough and 1.68 for wheeze suggest moderate increases in health risk. Studies not included in the meta-analyses provide additional evidence that dampness and mold in schools are associated with adverse health outcomes. These meta-analyses and the published literature not included in the meta-analyses suggest that dampness and mold in schools are associated with adverse respiratory health effects.

Clinical and allergological analysis of ocular manifestations of sick building syndrome

PURPOSE

The disease concept of sick building syndrome (SBS) is still unclear. Ocular mucous membrane irritation is one of the major symptoms of SBS. However, the immunological aspects of the ocular complications of SBS are not yet clarified. The clinical and allergological aspects of SBS cases with ocular disorders with special reference to allergic conjunctival diseases (ACD) were analyzed, especially with respect to local immunological features.

METHODS

Twelve cases of SBS with ocular findings and 49 cases of ACD (allergic conjunctivitis [AC], atopic keratoconjunctivitis [AKC], and vernal keratoconjunctivitis [VKC]) for comparison were evaluated. The clinical findings in SBS and ACD were scored, and tear film breakup time (BUT) was measured. Cytokine (interferon-γ [IFN-γ], interleukin [IL]-2, IL-4, IL-5, IL-6, IL-8, and IL-13) concentrations in tears were analyzed by cytometric bead arrays. Eosinophil count in peripheral blood, total IgE in serum, and multiple allergen simultaneous test (MAST) for antigen-specific IgE were also measured.

RESULTS

In SBS, conjunctival lesions were observed in all cases, and corneal abnormalities were found in two-thirds of the cases. Limbal lesions were observed in 2 pediatric cases. Mean serum total IgE level in SBS was significantly higher than that in AC; however, it was significantly lower than that in AKC and VKC. Eosinophil count in peripheral blood and number of positive allergens in MAST were significantly lower in SBS than in AKC and VKC. Significant elevation of tear IL-4 was observed in SBS and ACD. However, in contrast to ACD, elevation of other cytokines in tears was not observed in SBS. Mean tear BUT in SBS was in the normal range.

CONCLUSION

From these results, SBS is thought to be partially induced by an allergic response. However, clinical dissociation of the ocular clinical findings and local immunological features in tear cytokines may suggest that SBS belongs to a different entity from ACD.

Ocular symptoms and tear film break up time (BUT) among junior high school students in Penang, Malaysia - Associations with fungal DNA in school dust

BACKGROUND

There are few studies on ocular effects of indoor mould exposure in schools, especially in the tropics OBJECTIVE: To study associations between eye symptoms and tear film break up time (BUT) in students and demographic data and fungal DNA in schools.

METHODS

A school environment study was performed among randomly selected students in eight randomly selected secondary schools in Penang, Malaysia. Information on eye symptoms and demographic data was collected by a standardised questionnaire. BUT was measured by two methods, self-reported BUT (SBUT) and by the non-invasive Tearscope (NIBUT). Dust was collected by vacuuming in 32 classrooms and analysed for five fungal DNA sequences. Geometric mean (GM) for total fungal DNA was 7.31*10⁴ target copies per gram dust and for Aspergillus/Penicillium DNA 3.34*10⁴ target copies per gram dust. Linear mixed models and 3-level multiple logistic regression were applied adjusting for demographic factors.

RESULTS

A total of 368 students (58%) participated and 17.4% reported weekly eye symptoms the last 3 months. The median SBUT and TBUT were 15 and 12s, respectively. Students wearing glasses (OR 2.41, p=0.01) and with a history of atopy (OR=2.67; p=0.008) had more eye symptoms. Girls had less eye symptoms than boys (OR=0.34; p=0.006) Indoor carbon dioxide in the classrooms was low (range 380-720ppm), temperature was 25-30°C and relative air humidity 70-88%. Total fungal DNA in vacuumed dust was associated with shorter SBUT (4s shorter per 10⁵ target copies per gram dust; p=0.04) and NIBUT (4s shorter per 10⁵ target copies per gram dust; p<0.001). Aspergillus/Penicillium DNA was associated with shorter NIBUT (5s shorter per 10⁵ target copies per gram dust; p=0.01).

CONCLUSION

Fungal contamination in schools in a tropical country can be a risk factor for impaired tear film stability among students.

Exploration of the effects of classroom humidity levels on teachers' respiratory symptoms

PURPOSE

Previous studies indicate that teachers have higher asthma prevalence than other non-industrial worker groups. Schools frequently have trouble maintaining indoor relative humidity (RH) within the optimum range (30-50 %) for reducing allergens and irritants. However, the potential relationship between classroom humidity and teachers' health has not been explored. Thus, we examined the relationship between classroom humidity levels and respiratory symptoms among North Carolina teachers.

METHODS

Teachers (n = 122) recorded daily symptoms, while data-logging hygrometers recorded classroom RH levels in ten North Carolina schools. We examined effects of indoor humidity on occurrence of symptoms using modified Poisson regression models for correlated binary data.

RESULTS

The risk of asthma-like symptoms among teachers with classroom RH >50 % for 5 days was 1.27 (95 % Confidence Interval (CI) 0.81, 2.00) times the risk among the referent (teachers with classroom RH 30-50 %). The risk of cold/allergy symptoms among teachers with classroom RH >50 % for 5 days was 1.06 (95 % CI 0.82, 1.37) times the risk among the referent. Low RH (<30 %) for 5 days was associated with increased risk of asthma-like [risk ratio (RR) = 1.26 (95 % CI 0.73, 2.17)] and cold/allergy symptoms [RR = 1.11 (95 % CI 0.90, 1.37)].

CONCLUSIONS

Our findings suggest that prolonged exposure to high or low classroom RH was associated with modest (but not statistically significant) increases in the risk of respiratory symptoms among teachers.

Crucial Role for Outdoor Chemistry in Ultrafine Particle Formation in Modern Office Buildings

In the developed world, we spend most of our time indoors, where we receive the majority of our exposure to air pollution. This paper reports model simulations of PM2.5 and ozone concentrations in identical landscape offices in three European cities: Athens, Helsinki, and Milan. We compare concentrations during an intense heatwave in August 2003 with a meteorologically more typical August in 2009. During the heatwave, average indoor ozone concentrations during office hours were 44, 19, and 41 ppb in Athens, Helsinki, and Milan respectively, enhanced by 7, 4, and 17 ppb respectively relative to 2009. Total predicted PM2.5 concentrations were 13.5, 3.6, and 17.2 μg m(-3) in Athens, Helsinki, and Milan respectively, enhanced by 0.5, 0.4, and 6.7 μg m(-3) respectively relative to 2009: the three cities were affected to differing extents by the heatwave. A significant portion of the indoor PM2.5 derived from gas-phase chemistry outdoors, producing 2.5, 0.8, and 4.8 μg m(-3) of the total concentrations in Athens, Helsinki, and Milan, respectively. Despite filtering office inlet supplies to remove outdoor particles, gas-phase precursors for particles can still enter offices, where conditions are ripe for new particles to form, particularly where biogenic emissions are important outdoors. This result has important implications for indoor air quality, particularly given the current trend for green walls on buildings, which will provide a potential source of biogenic emissions near to air inlet systems.

Fungal pollution of indoor environments and its management

Indoor environments play important roles in human health. The health hazards posed by polluted indoor environments include allergy, infections and toxicity. Life style changes have resulted in a shift from open air environments to air tight, energy efficient, environments, in which people spend a substantial portion of their time. Most indoor air pollution comes from the hazardous non biological agents and biological agents. Fungi are ubiquitous in distribution and are a serious threat to public health in indoor environments. In this communication, we have reviewed the current status on biotic indoor air pollution, role of fungi as biological contaminants and their impact on human health.

Fungal pollution of indoor environments and its management

Indoor environments play important roles in human health. The health hazards posed by polluted indoor environments include allergy, infections and toxicity. Life style changes have resulted in a shift from open air environments to air tight, energy efficient, environments, in which people spend a substantial portion of their time. Most indoor air pollution comes from the hazardous non biological agents and biological agents. Fungi are ubiquitous in distribution and are a serious threat to public health in indoor environments. In this communication, we have reviewed the current status on biotic indoor air pollution, role of fungi as biological contaminants and their impact on human health.

Carbon dioxide (CO2) demand-controlled ventilation in university computer classrooms and possible effects on headache, fatigue and perceived indoor environment: an intervention study

PURPOSE

To study the effects of a CO(2) demand-controlled ventilation system (variable flow) in computer classrooms on perceived air quality and sick building syndrome.

METHODS

University students (27% women) participated in a blinded study. Two classrooms had variable flow (mean 5.56 ac/h); two others had constant ventilation flow (mean 5.07 ac/h). After one week, ventilation conditions were shifted. The students reported symptoms/perceptions during the last hour on rating scales. Temperature, air humidity, CO(2), PM10 and number concentration of particles were measured simultaneously. Cat (Fel d 1), dog (Can f 1), horse (Equ cx) and house dust mites (Der f 1 and Der p 1) allergens were measured in dust. Those participating twice in the same classroom (N = 61) were analysed longitudinally.

RESULTS

Mean CO(2) was 784 ppm (9% of time >1,000 ppm) with variable flow and 809 ppm with constant flow conditions (25% of time >1,000 ppm). Mean temperature (22.6 °C), PM10 (18 μg/m(3)) and number concentration (1,860 pt/cm(3)) were unchanged. The median levels of cat, dog, horse and Der f 1 allergens were 10,400 ng/g, 4,900 ng/g, 13,700 U/ng and 260 ng/g dust, respectively. There were slightly less headache (p = 0.003), tiredness (p = 0.007) and improved perceived air quality (p = 0.02) with variable flow.

CONCLUSIONS

Use of a CO(2)-controlled ventilation system, reducing elevated levels of CO(2), may slightly reduce headache and tiredness and improve perceived air quality. The high levels of pet allergens, due to track in of allergens from the home and possible accumulation due to electrostatic forces, illustrate a need for improved cleaning.

A longitudinal study of aldehydes and volatile organic compounds associated with subjective symptoms related to sick building syndrome in new dwellings in Japan

To determine whether indoor chemicals act as possible environmental risk factors responsible for sick building syndrome (SBS)-related symptoms in new houses (<6 years old) in Japan, we studied 871 people living in 260 single-family houses in 2004 and 2005. We measured the indoor concentrations of aldehydes and volatile organic compounds and longitudinal changes in the living rooms over two consecutive years. Participants answered standardized questionnaires on SBS symptoms and lifestyle habits. Approximately 14% and 12% of subjects were identified as having SBS in the first and second year, respectively. According to analysis adjusted for sex, age, smoking, and allergic diseases, increases in aldehydes and aliphatic hydrocarbons contributed to the occurrence of SBS. Elevated levels of indoor aldehydes and aliphatic hydrocarbons increased the possible risk of SBS in residents living in new houses, indicating that source controls against indoor chemicals are needed to counter SBS.

Eczema increases susceptibility to PM10 in office indoor environments

The objective was to compare impact of indoor office environment on employees with eczema with those without eczema. Exposure was measured at 56 sites and modelled for 173 work places. Tear film stability, lysozyme in nasal lavage, immunoglobulin E (IgE), and Phadiatop were assessed, and symptoms and perceptions collected by questionnaires. Multiple regression analyses were applied, adjusted for age, gender, strain, current smoking, and respiratory infections. Those with eczema perceived temperature too high but not associated with measured temperature. They had increased lysozyme in nasal lavage associated with increased air temperature difference between 6 and 10 AM, more general and mucosal symptoms, and "dry or flushed facial skin" associated with airborne particulate matter less than 10 microns in diameter (PM(10)). Impact of PM(10) was most pronounced among those with eczema previous 30 days. Having eczema might be an important predictor for subjective and objective responses to indoor environment.

Airborne bacteria concentrations and related factors at university laboratories, hospital diagnostic laboratories and a biowaste site

Aims

To evaluate concentrations of airborne bacteria in university laboratories, hospital diagnostic laboratories, and a biowaste site in Seoul, Korea. To measure total airborne bacteria (TAB), the authors assessed sampling site, type of ventilation system, weather and detection of Gram-negative bacteria (GNB), indoors and outdoors.

Method

An Andersen one-stage sampler (Quick Take 30; SKC Inc) was used to sample air at a flow rate of 28.3 l/min for 5 min on nutrient medium in Petri dishes located on the impactor. A total of 236 samples (TAB, 109 indoor and nine outdoor; GNB, 109 indoor and nine outdoor) were collected three times in each spot from the 11 facilities to compare airborne bacteria concentrations.

Results

TAB concentrations ranged from undetectable to 3451 CFU/m3 (mean 384 CFU/m3), and GNB concentrations from undetectable to 394 CFU/m3 (mean 17 CFU/m3). TAB concentrations were high in window-ventilated facilities and facilities in which GNB were detected; concentrations were also high when it was rainy (all p values <0.05). TAB concentrations correlated significantly with GNB (r=0.548, p<0.01), number of bacteria species (r=0.351, p<0.01) and temperature (r=0.297, p<0.01). The presence of heating, ventilating, and air conditioning (HVAC), the number of TAB species and the detection of GNB affect TAB concentrations in laboratories.

Conclusions

It is recommended that special attention be given to regular control of indoor environments to improve the air quality of university and hospital laboratories.

Indoor air quality in university environments

This study evaluates the airborne microflora in research laboratories of the University of Chieti (Italy). A quali-quantitative evaluation of the index microbial air contamination was performed using the settle plate method. The microbial air contamination was evaluated during 6 months in three university buildings (A, B, and C). Nutrient agar plates were exposed, monthly, for 1 h at the morning and the afternoon to evaluate the colony forming units per plate per hour. Together with the quantitative analysis, the most frequent bacterial and fungal colonies isolated were also characterized. Moreover, in each sampling, the number of the occupants in each room was recorded to evaluate a possible relationship with the microbial pollution. The microbial concentration was always within the limit values defined for these environments. Buildings A and C displayed a seasonal fluctuation of airborne microflora with the increase in microbial concentration in the warmer season (April to June) in respect to the colder period (October to December). The most common microorganisms detected in the indoor air of the examined buildings were Gram-positive bacteria, belonged to the genera Staphylococcus, Bacillus, and Actinomyces. Data presented here underline the useful monitoring of the research university laboratories also emphasizing the effectiveness of the settle plate method.

Atopy, symptoms and indoor environmental perceptions, tear film stability, nasal patency and lavage biomarkers in university staff

OBJECTIVE

Study associations between airway symptoms, complaints on environmental perceptions, atopy definitions and biomarkers including tear film stability (BUT), nasal patency and nasal lavage (NAL). Personal predictors (gender, age, smoking, infections) for the biomarkers as well as associations between the biomarkers were also assessed.

METHODS

A cross-sectional study of 173 employees in four university buildings, response rate 86%. Tear film break up time (BUT) was measured by a non-invasive method (NIBUT) and self-reported (SBUT). NAL-analysis included eosinophilic cationic protein (ECP), myeloperoxidase (MPO), lysozyme and albumin. Total serum IgE, and specific IgE using Phadiatop was measured. Data on subjective symptoms, environmental perceptions and background data were collected by use of a questionnaire. Multiple regression analyses were applied.

RESULTS

Mean age was 43 years, 21% had weekly ocular, 21% nasal, and 17% laryngeal symptoms. Women had more complaints on environmental perceptions, shorter BUT and less nasal patency. Neither atopy (Phadiatop) nor Total IgE or allergy in the family, but asthma and hay fever was associated with mucosal symptoms or perceptions. Subjects with positive Phadiatop had higher levels of all NAL-biomarkers. Those with ocular symptoms had shorter BUT. Nasal symptoms were related to respiratory infections and laryngeal symptoms to NAL-lysozyme. Perceiving dry air was associated with lower BUT and reduced nasal volume difference before and after decongestion. Older subjects had greater nasal patency, and less atopy. All NAL-biomarkers were positively correlated. Higher lysozyme level was associated with less nasal patency and greater nasal decongestion.

CONCLUSIONS

BUT and NAL-lysozyme was associated with ocular, nasal, laryngeal symptoms and indoor environmental perceptions. Ever having had asthma and ever having had hay fever were predictors for symptoms and perceived air quality, respectively. Phadiatop, Total IgE, familiar allergy and ever eczema were not associated to symptoms or perceived environments. Age, gender and Phadiatop were main predictors for ocular and nasal biomarkers.