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Pfaar O, Bergmann K, Bonini S, Compalati E, Domis N, Blay F, Kam P, Devillier P, Durham SR, Ellis AK, Gherasim A, Haya L, Hohlfeld JM, Horak F, Iinuma T, Jacobs RL, Jacobi HH, Jutel M, Kaul S, Kelly S, Klimek L, Larché M, Lemell P, Mahler V, Nolte H, Okamoto Y, Patel P, Rabin RL, Rather C, Sager A, Salapatek AM, Sigsgaard T, Togias A, Willers C, Yang WH, Zieglmayer R, Zuberbier T, Zieglmayer P. Technical standards in allergen exposure chambers worldwide - an EAACI Task Force Report. Allergy 2021; 76:3589-3612. [PMID: 34028057 DOI: 10.1111/all.14957] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/23/2021] [Accepted: 05/07/2021] [Indexed: 12/14/2022]
Abstract
Allergen exposure chambers (AECs) can be used for controlled exposure to allergenic and non-allergenic airborne particles in an enclosed environment, in order to (i) characterize the pathological features of respiratory diseases and (ii) contribute to and accelerate the clinical development of pharmacological treatments and allergen immunotherapy for allergic disease of the respiratory tract (such as allergic rhinitis, allergic rhinoconjunctivitis, and allergic asthma). In the guidelines of the European Medicines Agency for the clinical development of products for allergen immunotherapy (AIT), the role of AECs in determining primary endpoints in dose-finding Phase II trials is emphasized. Although methodologically insulated from the variability of natural pollen exposure, chamber models remain confined to supporting secondary, rather than primary, endpoints in Phase III registration trials. The need for further validation in comparison with field exposure is clearly mandated. On this basis, the European Academy of Allergy and Clinical Immunology (EAACI) initiated a Task Force in 2015 charged to gain a better understanding of how AECs can generate knowledge about respiratory allergies and can contribute to the clinical development of treatments. Researchers working with AECs worldwide were asked to provide technical information in eight sections: (i) dimensions and structure of the AEC, (ii) AEC staff, (iii) airflow, air processing, and operating conditions, (iv) particle dispersal, (v) pollen/particle counting, (vi) safety and non-contamination measures, (vii) procedures for symptom assessments, (viii) tested allergens/substances and validation procedures. On this basis, a minimal set of technical requirements for AECs applied to the field of allergology is proposed.
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Affiliation(s)
- Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery Section of Rhinology and Allergy University Hospital Marburg Philipps‐Universität Marburg Marburg Germany
| | - Karl‐Christian Bergmann
- Charité – Universitätsmedizin Berlin corporate member of Freie Universität Berlin Humboldt‐Universität zu Berlin, and Berlin Institute of Health Department of Dermatology and Allergy Allergy Centre Charité Berlin Germany
| | - Sergio Bonini
- Institute of Translational Medicine Italian National Research Council Rome Italy
| | | | - Nathalie Domis
- ALYATEC Environmental Exposure Chamber Strasbourg France
| | - Frédéric Blay
- ALYATEC Environmental Exposure Chamber Strasbourg France
- Chest Diseases Department Strasbourg University Hospital Strasbourg France
| | | | - Philippe Devillier
- Department of Airway Diseases Pharmacology Research Laboratory‐VIM Suresnes, Exhalomics Platform, Hôpital Foch University Paris‐Saclay Suresnes France
| | | | - Anne K. Ellis
- Departments of Medicine and Biomedical & Molecular Sciences Queen's University Kingston ON Canada
- Allergy Research Unit Kingston General Health Research Institute Kingston ON Canada
| | - Alina Gherasim
- ALYATEC Environmental Exposure Chamber Strasbourg France
| | | | - Jens M. Hohlfeld
- Fraunhofer Institute for Toxicology and Experimental Medicine and Department of Respiratory Medicine Hannover Medical School Member of the German Center for Lung Research Hannover Germany
| | | | | | | | | | - Marek Jutel
- Department of Clinical Immunology Wroclaw Medical University Wroclaw Poland
- All‐MED Medical Research Institute Wrocław Poland
| | | | | | - Ludger Klimek
- Center for Rhinology and Allergology Wiesbaden Germany
- Allergy Center Rhineland‐Palatinate Mainz University Medical Center Mainz Germany
| | - Mark Larché
- Divisions of Clinical Immunology & Allergy, and Respirology Department of Medicine and Firestone Institute for Respiratory Health McMaster University Hamilton ON Canada
| | | | | | | | | | - Piyush Patel
- Cliantha Research Limited Mississauga ON Canada
- Providence Therapeutics Toronto ON Canada
| | - Ronald L. Rabin
- Center for Biologics Evaluation and Research US Food and Drug Administration Silver Spring MD USA
| | | | | | | | - Torben Sigsgaard
- Department of Public Health, Section for Environment Occupation and Health Danish Ramazzini Centre Aarhus University Aarhus Denmark
| | - Alkis Togias
- Division of Allergy, Immunology, and Transplantation (DAIT) National Institute of Allergy and Infectious Diseases NIH Bethesda MD USA
| | | | | | | | - Torsten Zuberbier
- Charité – Universitätsmedizin Berlin corporate member of Freie Universität Berlin Humboldt‐Universität zu Berlin, and Berlin Institute of Health Department of Dermatology and Allergy Allergy Centre Charité Berlin Germany
| | - Petra Zieglmayer
- Vienna Challenge Chamber Vienna Austria
- Karl Landsteiner University Krems Austria
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Laursen KR, Rasmussen BB, Rosati B, Gutzke VH, Østergaard K, Ravn P, Kjaergaard SK, Bilde M, Glasius M, Sigsgaard T. Acute health effects from exposure to indoor ultrafine particles-A randomized controlled crossover study among young mild asthmatics. INDOOR AIR 2021; 31:1993-2007. [PMID: 34235780 DOI: 10.1111/ina.12902] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 06/09/2021] [Accepted: 06/23/2021] [Indexed: 06/13/2023]
Abstract
Particulate matter is linked to adverse health effects, however, little is known about health effects of particles emitted from typical indoor sources. We examined acute health effects of short-term exposure to emissions from cooking and candles among asthmatics. In a randomized controlled double-blinded crossover study, 36 young non-smoking asthmatics attended three exposure sessions lasting 5 h: (a) air mixed with emissions from cooking (fine particle mass concentration): (PM2.5 : 96.1 μg/m3 ), (b) air mixed with emissions from candles (PM2.5 : 89.8 μg/m3 ), and c) clean filtered air (PM2.5 : 5.8 μg/m3 ). Health effects (spirometry, fractional exhaled Nitric Oxide [FeNO], nasal volume and self-reported symptoms) were evaluated before exposure start, then 5 and 24 h after. During exposures volatile organic compounds (VOCs), particle size distributions, number concentrations and optical properties were measured. Generally, no statistically significant changes were observed in spirometry, FeNO, or nasal volume comparing cooking and candle exposures to clean air. In males, nasal volume and FeNO decreased after exposure to cooking and candles, respectively. Participants reported additional and more pronounced symptoms during exposure to cooking and candles compared to clean air. The results indicate that emissions from cooking and candles exert mild inflammation in asthmatic males and decrease comfort among asthmatic males and females.
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Affiliation(s)
| | | | - Bernadette Rosati
- Department of Chemistry, Aarhus University, Aarhus, Denmark
- Faculty of Physics, University of Vienna, Vienna, Austria
| | - Vibeke Heitmann Gutzke
- Environment, Work and Health, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Kirsten Østergaard
- Environment, Work and Health, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Peter Ravn
- Environment, Work and Health, Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Merete Bilde
- Department of Chemistry, Aarhus University, Aarhus, Denmark
| | | | - Torben Sigsgaard
- Environment, Work and Health, Department of Public Health, Aarhus University, Aarhus, Denmark
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Wolkoff P. Indoor air pollutants in office environments: assessment of comfort, health, and performance. Int J Hyg Environ Health 2012; 216:371-94. [PMID: 22954455 DOI: 10.1016/j.ijheh.2012.08.001] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 07/28/2012] [Accepted: 08/05/2012] [Indexed: 02/06/2023]
Abstract
Concentrations of volatile organic compounds (VOCs) in office environments are generally too low to cause sensory irritation in the eyes and airways on the basis of estimated thresholds for sensory irritation. Furthermore, effects in the lungs, e.g. inflammatory effects, have not been substantiated at indoor relevant concentrations. Some VOCs, including formaldehyde, in combination may under certain environmental and occupational conditions result in reported sensory irritation. The odour thresholds of several VOCs are low enough to influence the perceived air quality that result in a number of acute effects from reported sensory irritation in eyes and airways and deterioration of performance. The odour perception (air quality) depends on a number of factors that may influence the odour impact. There is neither clear indication that office dust particles may cause sensory effects, even not particles spiked with glucans, aldehydes or phthalates, nor lung effects; some inflammatory effects may be observed among asthmatics. Ozone-initiated terpene reaction products may be of concern in ozone-enriched environments (≥0.1mg/m(3)) and elevated limonene concentrations, partly due to the production of formaldehyde. Ambient particles may cause cardio-pulmonary effects, especially in susceptible people (e.g. elderly and sick people); even, short-term effects, e.g. from traffic emission and candle smoke may possibly have modulating and delayed effects on the heart, but otherwise adverse effects in the airways and lung functions have not been observed. Secondary organic aerosols generated in indoor ozone-initiated terpene reactions appear not to cause adverse effects in the airways; rather the gaseous products are relevant. Combined exposure to particles and ozone may evoke effects in subgroups of asthmatics. Based on an analysis of thresholds for odour and sensory irritation selected compounds are recommended for measurements to assess the indoor air quality and to minimize reports of irritation symptoms, deteriorated performance, and cardiovascular and pulmonary effects.
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Affiliation(s)
- Peder Wolkoff
- National Research Centre for the Working Environment, Copenhagen, Denmark.
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Riddervold I, Bønløkke J, Mølhave L, Massling A, Jensen B, Grønborg T, Bossi R, Forchhammer L, Kjærgaard S, Sigsgaard T. Wood smoke in a controlled exposure experiment with human volunteers. Inhal Toxicol 2011; 23:277-88. [DOI: 10.3109/08958378.2011.567401] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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