Respiratory and allergic health effects of dampness, mold, and dampness-related agents: a review of the epidemiologic evidence

Prenatal risk factors of indoor environment and incidence of childhood eczema in the Japan Environment and Children's Study

The quality of indoor environment is a risk factor for early childhood eczema and atopic dermatitis; however, its influence during pregnancy on childhood eczema in Japan has not been investigated. In this study, we aimed to determine the indoor environmental factors that are associated with eczema in children up to 3 years of age, using national birth cohort data from the Japan Environment and Children's Study (JECS). Information on indoor environments and eczema symptoms until 3 years of age was collected using self-administered questionnaires to the mothers. A total of 71,883 and 58,639 mother-child pairs at 1.5- and 3-years-old, respectively, were included in the former analyses. To account for prenatal indoor risk factors, 17,568 (1.5-years-old) and 7063 (3-years-old) children without indoor mold and/or ETS exposure were included in the final analysis. A higher mold index, gas heater use, parquet flooring use, and frequent insecticide use showed significantly increased risks for childhood eczema up to 3 years of age. These associations were consistent after stratification analysis among children whose parents did not have a history of allergies. The updated WHO guidelines on indoor air quality should be implemented based on recent findings regarding the effects of prenatal exposure to indoor dampness on health effects of children further in life, including asthma, respiratory effects, eczema, and other immunological effects.

Poor housing quality and the health of newborns and young children

This study uses linked administrative data on live births, hospital stays, and census records for children born in Hungary between 2006 and 2011 to examine the relationship between poor housing quality and the health of newborns and children aged 1-2 years. We show that poor housing quality, defined as lack of access to basic sanitation and exposure to polluting heating, is not a negligible problem even in a high-income EU country like Hungary. This is particularly the case for disadvantaged children, 20-25% of whom live in extremely poor-quality homes. Next, we provide evidence that poor housing quality is strongly associated with lower health at birth and a higher number of days spent in inpatient care at the age of 1-2 years. These results indicate that lack of access to basic sanitation, hygiene, and non-polluting heating and their health impacts cannot be considered as the exclusive problem for low- and middle-income countries. In high-income countries, there is also a need for public policy programs that identify those affected by poor housing quality and offer them potential solutions to reduce the adverse effects on their health.

Volunteerism Addressing Environmental Disparities in Allergy (VAEDIA): The presidential initiative to combat environmental injustice in allergy and immunology-a Work Group Report of the AAAAI VAEDIA task force

Many vulnerable people lose their health or lives each year as a result of unhealthy environmental conditions that perpetuate medical conditions within the scope of allergy and immunology specialists' expertise. While detrimental environmental factors impact all humans globally, the effect is disproportionately more profound in impoverished neighborhoods. Environmental injustice is the inequitable exposure of disadvantaged populations to environmental hazards. Professional medical organizations such as the American Academy of Allergy, Asthma & Immunology (AAAAI) are well positioned to engage and encourage community outreach volunteer programs to combat environmental justice. Here we discuss how environmental injustices and climate change impacts allergic diseases among vulnerable populations. We discuss pathways allergists/immunologists can use to contribute to addressing environmental determinants by providing volunteer clinical service, education, and advocacy. Furthermore, allergists/immunologists can play a role in building trust within these communities, partnering with other patient advocacy nonprofit stakeholders, and engaging with local, state, national, and international nongovernmental organizations, faith-based organizations, and governments. The AAAAI's Volunteerism Addressing Environmental Disparities in Allergy (VAEDIA) is the presidential task force aiming to promote volunteer initiatives by creating platforms for discussion and collaboration and by funding community-based projects to address environmental injustice.

AWMF mold guideline "Medical clinical diagnostics for indoor mold exposure" - Update 2023 AWMF Register No. 161/001

None.

Long-term Impact of Tropical Cyclones on Disease Exacerbation Among Children with Asthma in the Eastern United States, 2000-2018

BACKGROUND

Tropical cyclones are associated with acute increases in mortality and morbidity, but few studies have examined their longer-term health consequences. We assessed whether tropical cyclones are associated with a higher frequency of symptom exacerbation among children with asthma in the following 12 months in eastern United States counties, 2000-2018.

METHODS

We defined exposure to tropical cyclones as a maximum sustained windspeed >21 meters/second at the county center and used coarsened exact matching to match each exposed county to one or more unexposed counties. We used longitudinal, de-identified administrative claims data to estimate the county-level, monthly risk of experiencing at least one asthma exacerbation requiring medical attention among commercially insured children aged 5-17 with prior diagnosis of asthma. We used a difference-in-differences approach implemented via a Poisson fixed effects model to compare the risk of asthma exacerbation in the 12 months before versus after each storm in exposed versus unexposed counties.

RESULTS

Across 43 tropical cyclones impacting the eastern United States, we did not observe evidence of an increase in the risk of symptom exacerbation in the 12 months following the storm (random-effects meta-analytic summary estimate: risk ratio = 1.03 [95% confidence interval = 0.96, 1.10], I2 = 17%). However, certain storms, such as Hurricane Sandy, were associated with a higher risk of symptom exacerbation.

CONCLUSIONS

These findings are consistent with the hypothesis that some tropical cyclones are detrimental to children's respiratory health. However, tropical cyclones were not associated in aggregate with long-term exacerbation of clinically apparent asthma symptoms among a population of children with commercial health insurance.

Unveiling the menace: a thorough review of potential pandemic fungal disease

Fungal diseases have emerged as a significant global health threat, with the potential to cause widespread outbreaks and significant morbidity and mortality. Anticipating future pandemic fungal diseases is essential for effective preparedness and response strategies. This comprehensive literature review aims to provide a comprehensive analysis of the existing research on this topic. Through an extensive examination of scholarly articles, this review identifies potential fungal pathogens that have the potential to become pandemics in the future. It explores the factors contributing to the emergence and spread of these fungal diseases, including climate change, globalization, and antimicrobial resistance. The review also discusses the challenges in diagnosing and treating these diseases, including limited access to diagnostic tools and antifungal therapies. Furthermore, it examines the strategies and interventions that can be employed to mitigate the impact of future pandemic fungal diseases, such as improved surveillance systems, public health education, and research advancements. The findings of this literature review contribute to our understanding of the potential risks posed by fungal diseases and provide valuable insights for public health professionals and policymakers in effectively preparing for and responding to future pandemic outbreaks. Overall, this review emphasizes the importance of proactive measures and collaborative efforts to anticipate and mitigate the impact of future pandemic fungal diseases.

Identification of environmental Actinobacteria in buildings by means of chemotaxonomy, 16S rRNA sequencing, and MALDI-TOF MS

Actinobacteria are abundant in soil and other environmental ecosystems and are also an important part of the human microbiota. Hence, they can also be detected in indoor environments and on building materials, where actinobacterial proliferation on damp materials can indicate moisture damage. The aim of this study was to evaluate the matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) for the identification of 28 environmental strains of Actinobacteria isolated from building materials and indoor and outdoor air samples, mainly collected in the context of moisture damage investigations in buildings in Finland. The 16S rRNA gene sequencing and chemotaxonomic analyses were performed, and results were compared with the MALDI-TOF MS Biotyper identification. Using 16S rRNA gene sequencing, all isolates were identified on the species or genus level and were representatives of Streptomyces, Nocardia, and Pseudonocardia genera. Based on MALDI-TOF MS analysis, initially, 11 isolates were identified as Streptomyces spp. and 1 as Nocardia carnea with a high identification score. After an upgrade in the MALDI-TOF MS in-house database and re-evaluation of mass spectra, 13 additional isolates were identified as Nocardia, Pseudonocardia, and Streptomyces. MALDI-TOF MS has the potential in environmental strain identification; however, the standard database needs to be considerably enriched by environmental Actinobacteria representatives.

IMPORTANCE

The manuscript addresses the challenges in identifying environmental bacteria using matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) Biotyper-based protein profiling. The matter of the studies-actinobacterial strains-has been isolated mostly from building materials that originated from a confirmed moisture-damaged situation. Polyphasic taxonomy, 16S RNA gene sequencing, and MALDI-TOF mass spectrometry were applied for identification purposes. In this experimental paper, a few important facts are highlighted. First, Actinobacteria are abundant in the natural as well as built environment, and their identification on the species and genus levels is difficult and time-consuming. Second, MALDI-TOF MS is an effective tool for identifying bacterial environmental strains, and in parallel, continuous enrichment of the proteomics mass spectral databases is necessary for proper identification. Third, the chemical approach aids in the taxonomical inquiry of Actinobacteria environmental strains.

Residential exposure to mold, dampness, and indoor air pollution and risk of respiratory tract infections: a study among children ages 11 and 12 in the Danish National Birth Cohort

BACKGROUND

The burden of respiratory tract infections (RTIs) is high in childhood. Several residential exposures may affect relative rates.

OBJECTIVES

To determine risk of RTIs in children ages 11 and 12 by residential exposures.

METHODS

We included children in the Danish National Birth Cohort (DNBC) at ages 11 and 12. We estimated incidence risk ratios (IRR) and 95% confidence intervals (CI) for counts of RTIs within the last year by exposure to mold/dampness, gas stove usage, summer and winter candle-burning, fireplace usage, cats and dogs indoors, and farmhouse living. We also estimated IRR and 95% CI for RTIs for predicted scores of four extracted factors ('owned house', 'mold and dampness', 'candles', and 'density') from exploratory factor analyses (EFA).

RESULTS

We included 42 720 children with complete data. Mold/dampness was associated with all RTIs (common cold: IRRadj 1.09[1.07, 1.12]; influenza: IRRadj 1.10 [1.05, 1.15]; tonsillitis: IRRadj 1.19 [1.10, 1.28]; conjunctivitis: IRRadj 1.16 [1.02, 1.32]; and doctor-diagnosed pneumonia: IRRadj 1.05 [0.90, 1.21]), as was the EFA factor 'mold/dampness' for several outcomes. Gas stove usage was associated with conjunctivitis (IRRadj 1.25 [1.05, 1.49]) and with doctor-diagnosed pneumonia (IRRadj 1.14 [0.93, 1.39]). Candle-burning during summer, but not winter, was associated with several RTIs, for tonsillitis in a dose-dependent fashion (increasing weekly frequencies vs. none: [IRRadj 1.06 [0.98, 1.14], IRRadj 1.16 [1.04, 1.30], IRRadj 1.23 [1.06, 1.43], IRRadj 1.29 [1.00, 1.67], and IRRadj 1.41 [1.12, 1.78]).

CONCLUSION

Residential exposures, in particular to mold and dampness and to a lesser degree to indoor combustion sources, are related to the occurrence of RTIs in children.

The impact of indoor pollution on asthma-related outcomes: A systematic review for the EAACI guidelines on environmental science for allergic diseases and asthma

Systematic review using GRADE of the impact of exposure to volatile organic compounds (VOCs), cleaning agents, mould/damp, pesticides on the risk of (i) new-onset asthma (incidence) and (ii) adverse asthma-related outcomes (impact). MEDLINE, EMBASE and Web of Science were searched for indoor pollutant exposure studies reporting on new-onset asthma and critical and important asthma-related outcomes. Ninety four studies were included: 11 for VOCs (7 for incidenceand 4 for impact), 25 for cleaning agents (7 for incidenceand 8 for impact), 48 for damp/mould (26 for incidence and 22 for impact) and 10 for pesticides (8 for incidence and 2 for impact). Exposure to damp/mould increases the risk of new-onset wheeze (moderate certainty evidence). Exposure to cleaning agents may be associated with a higher risk of new-onset asthma and with asthma severity (low level of certainty). Exposure to pesticides and VOCs may increase the risk of new-onset asthma (very low certainty evidence). The impact on asthma-related outcomes of all major indoor pollutants is uncertain. As the level of certainty is low or very low for most of the available evidence on the impact of indoor pollutants on asthma-related outcomes more rigorous research in the field is warranted.

HLA gene variations and mycotoxin toxicity: Four case reports

Mycotoxins are produced by certain molds that can cause many health effects. We present four human cases of prolonged consistent mycotoxins exposure linked to genetic variations in human leukocyte antigen (HLA) alleles. The HLA-DR/DQ isotype alleles are linked to mycotoxins susceptibility due to the lack of proper immune response; individuals with these alleles are poor eliminators of mycotoxins from their system. Four subjects with variations in their HLA-DR alleles were exposed to mycotoxins from living in mold-infested houses and experienced persistent mold-related symptoms long after moving out from the mold-infested houses and only exposed to the levels of molds found in the ambient air. From one of the subjects, two urine samples were collected ~ 18 months apart after the cessation of exposure. Urinary elimination rate was extremely slow for two of the mycotoxins (ochratoxin A [OTA] and mycophenolic acid [MPA]) detected in both samples. In 18 months, decline in OTA level was only ~ 3-fold (estimated t½ of ~ 311 days) and decline in MPA level was ~ 11-fold (estimated t½ of ~ 160 days), which was ~ 10- and ~ 213-fold slower than expected in individuals without HLA-DR alleles, respectively. We estimated that ~ 4.3 and ~ 2.2 years will be required for OTA and MPA to reach < LLQ in urine, respectively. Three other subjects with variations in HLA-DR alleles were members of a family who lived in a mold-infested house for 4 years. They kept experiencing mold-related issues >2 years after moving to a non-mold-infested house. Consistent exposure was confirmed by the presence of several mycotoxins in urine >2 years after the secession of higher than background (from outdoor ambient air) exposure. This was consistent with the extremely slow elimination of mycotoxins from their system. Variations in HLA-DR alleles can, consequently, make even short periods of exposure to chronic exposure scenarios with related adverse health effects. It is, therefore, important to determine genetic predisposition as a reason for prolonged/lingering mold-related symptoms long after the cessation of higher than background exposure. Increased human exposure to mycotoxins is expected from increased mold infestation that is anticipated due to rising CO2, temperature, and humidity from the climate change with possibly increased adverse health effects, especially in individuals with genetic susceptibility to mold toxicity.

Damp Buildings: Associated Fungi and How to Find Them

The number of buildings experiencing humidity problems and fungal growth appears to be increasing as energy-saving measures and changes in construction practices and climate become more common. Determining the cause of the problem and documenting the type and extent of fungal growth are complex processes involving both building physics and indoor mycology. New detection and identification methods have been introduced, and new fungal species have been added to the list of building-related fungi. However, the lack of standardised procedures and general knowledge hampers the effort to resolve the problems and advocate for an effective renovation plan. This review provides a framework for building inspections on current sampling methods and detection techniques for building-related fungi. The review also contains tables with fungal species that have been identified on commonly used building materials in Europe and North America (e.g., gypsum wallboard, oriented strand board (OSB), concrete and mineral wool). The most reported building-associated fungi across all materials are Penicillium chrysogenum and Aspergillus versicolor. Chaetomium globosum is common on all organic materials, whereas Aspergillus niger is common on all inorganic materials.

New generation sequencing: molecular approaches for the detection and monitoring of bioaerosols in an indoor environment: a systematic review

INTRODUCTION

The exposure of occupants to indoor air pollutants has increased in recent decades. The aim of this review is to discuss an overview of new approaches that are used to study fungal aerosols. Thus, this motivation was to compensate the gaps caused by the use of only traditional approaches in the study of fungal exposure.

CONTENT

The search involved various databases such as; Science Direct, PubMed, SAGE, Springer Link, EBCOHOST, MEDLINE, CINAHL, Cochrane library, Web of Science and Wiley Online Library. It was limited to full text research articles that reported the use of non-viable method in assessing bioaerosol, written in English Language, full text publications and published from year 2015-2022.

SUMMARY AND OUTLOOK

A total of 15 articles met the inclusion criteria and was included in this review. The use of next-generation sequencing, which is more commonly referred to as high-throughput sequencing (HTS) or molecular methods in microbial studies is based on the detection of genetic material of organisms present in a given sample. Applying these methods to different environments permitted the identification of the microorganisms present, and a better comprehension of the environmental impacts and ecological roles of microbial communities. Based on the reviewed articles, there is evidence that dust samples harbour a high diversity of human-associated bacteria and fungi. Molecular methods such as next generation sequencing are reliable tools for identifying and tracking the bacterial and fungal diversity in dust samples using 18S metagenomics approach.

Exposure to different residential indoor characteristics during childhood and asthma in adolescence: a latent class analysis of the Danish National Birth Cohort

BACKGROUND

Many residential indoor environments may have an impact on children's respiratory health.

OBJECTIVES

The aims of this study were to identify latent classes of children from the Danish National Birth Cohort (DNBC) who share similar patterns of exposure to indoor home characteristics, and to examine the association between membership in the latent classes and asthma in adolescence.

METHODS

We included data on residential indoor characteristics of offspring from the DNBC whose mothers had responded to the child's 11-year follow-up and who had data on asthma from the 18-year follow-up. Number of classes and associations were estimated using latent class analysis. To account for sample selection, we applied inverse probability weighting.

RESULTS

Our final model included five latent classes. The probability of current asthma at 18 years was highest among individuals in class one with higher clustering on household dampness (9, 95%CI 0.06-0.13). Individuals in class four (with higher clustering on pets ownership and living in a farm) had a lower risk of current asthma at age 18 compared to individuals in class one (with higher clustering on household dampness) (OR 0.53 (95%CI 0.32-0.88), p = .01).

CONCLUSION

Our findings suggest that, in a high-income country such as Denmark, groups of adolescents growing up in homes with mold and moisture during mid-childhood might be at increased risk of current asthma at age 18. Adolescents who grew-up in a farmhouse and who were exposed to pets seem less likely to suffer from asthma by age 18.

Beyond the outdoors: indoor air quality guidelines and standards - challenges, inequalities, and the path forward

In the last few decades, indoor air quality (IAQ) has become a major threat to public health. It is the fifth leading cause of premature death globally. It has been estimated that people spend ∼90 % of their time in an indoor environment. Consequently, IAQ has significant health effects. Although IAQ-related standards and guidelines, policies, and monitoring plans have been developed in a few countries, there remain several global inequalities and challenges. This review paper aims to comprehensively synthesize the current status of widely accepted IAQ guidelines and standards. It analyzes their global implementation and effectiveness to offer insights into challenges and disparities in IAQ policies and practices. However, the complexity of domestic environments and the diversity of international standards impede effective implementation. This manuscript evaluates international, national, and regional IAQ guidelines, emphasizing similarities and differences. In addition, it highlights knowledge gaps and challenges, urging the international scientific community, policymakers, and stakeholders to collaborate to advance IAQ standards and guidelines. The analysis evaluates the efficacy of guidelines, identifies deficiencies, and offers recommendations for the future of domestic air quality standards.

Fungal diversity in homes and asthma morbidity among school-age children in New York City

BACKGROUND

Asthma development has been inversely associated with exposure to fungal diversity. However, the influence of fungi on measures of asthma morbidity is not well understood.

OBJECTIVES

This study aimed to test the hypothesis that fungal diversity is inversely associated with neighborhood asthma prevalence and identify specific fungal species associated with asthma morbidity.

METHODS

Children aged 7-8 years (n = 347) living in higher (11-18%) and lower (3-9%) asthma prevalence neighborhoods were recruited within an asthma case-control study. Fungal communities were analyzed from floor dust using high-throughput DNA sequencing. A subset of asthmatic children (n = 140) was followed to age 10-11 to determine asthma persistence.

RESULTS

Neighborhood asthma prevalence was inversely associated with fungal species richness (P = 0.010) and Shannon diversity (P = 0.059). Associations between neighborhood asthma prevalence and diversity indices were driven by differences in building type and presence of bedroom carpet. Among children with asthma at age 7-8 years, Shannon fungal diversity was inversely associated with frequent asthma symptoms at that age (OR 0.57, P = 0.025) and with asthma persistence to age 10-11 (OR 0.48, P = 0.043). Analyses of individual fungal species did not show significant associations with asthma outcomes when adjusted for false discovery rates.

DISCUSSION

Lower fungal diversity was associated with asthma symptoms in this urban setting. Individual fungal species associated with asthma morbidity were not detected. Further research is warranted into building type, carpeting, and other environmental characteristics which influence fungal exposures in homes.

Exposure to residential mold and dampness and the associations with respiratory tract infections and symptoms thereof in children in high income countries: A systematic review and meta-analyses of epidemiological studies

BACKGROUND

Multiple reviews have been conducted on the associations between residential mold and dampness and respiratory outcomes in children, with few specifically investigating respiratory tract infections (RTIs).

OBJECTIVE

We aimed to review and synthesize the available epidemiological literature on mold and dampness and risk of RTIs and respiratory symptoms compatible with RTIs in children living in high-income countries.

METHOD

We performed a systematic search of literature available from MEDLINE, Embase, and Web of Science for observational studies. We conducted meta-analyses using two-level random effects (RE) and multi-level random effects (ML) models for contrasts of three exposure and three outcome categories, including multiple estimates reported by single studies. We report central estimates for pooled odds ratios (OR) and 95 % confidence intervals (CI).We conducted a risk of bias assessment using the Joanna Briggs Initiative (JBI) checklists for cross-sectional, case-control, and cohort studies. We additionally report on cumulative meta-analyses, leave-one-out analyses of single estimates, subgroup analyses by study quality and study design and inclusion of all effect estimates.

RESULTS

Of the 932 studies initially screened by title and abstract, we included 30 studies with 267 effect estimates that met the inclusion criteria. Most were cross-sectional (n = 22), with fewer cohort (n = 5) and case-control (n = 3) studies. Most of the studies were according to the bias assessment of poor or fair quality (n = 24). The main meta-analyses generally provided similar results regardless of statistical model and central estimates ranged from OR 1.28 (95 % CI; 1.08, 1.53) for dampness and RTIs to OR 1.76 (95 % CI; 1.64, 1.88) for mold and respiratory symptoms. Most analyses were of moderate heterogeneity. Funnel plots did not indicate strong publication bias.

CONCLUSION

Our results are compatible with a weak to moderate effect of residential mold and or dampness on risk of RTIs in children in high-income countries. However, these results are based primarily on cross-sectional studies.

Mechanistic insight into the adjuvant effect of co-exposure to ultrafine carbon black and high humidity on allergic asthma

Respiratory diseases continue to be a major global concern, with allergies and asthma often discussed as critical areas of study. While the role of environmental risk factors, such as non-allergenic pollutants and high humidity, in asthma induction is often mentioned, there is still a lack of thorough research on their co-exposure. This study aims to investigate the adjuvant effect of ultrafine carbon black (30-50 nm) and high humidity (70% relative humidity) on the induction of allergic asthma. A mouse model of asthma was established using ovalbumin, and airway hyperresponsiveness, remodeling, and inflammation were measured as the endpoint effects of asthma. The mediating role of the oxidative stress pathway and the transient receptor potential vanilloid 1 pathway in asthma induction was validated using pathway inhibitors vitamin E and capsaicin, respectively. Co-exposure to ultrafine carbon black and high humidity had a significant impact on metabolic pathways in the lung, including aminoacyl-tRNA biosynthesis, glycerophospholipid metabolism, and ATP-binding cassette transporters. However, administering vitamin E and capsaicin altered the effects of co-exposure on the lung metabolome. These results offer new insights into the health risk assessment of co-exposure to environmental risk factors and provide an important reference point for the prevention and treatment of allergic asthma.

Association Between Second-Hand Smoke Exposure and Respiratory Symptoms Among the General Population of Non-smoker Adults in Saudi Arabia: A Cross-Sectional Study

BACKGROUND

Second-hand smoke (SHS) exposure is associated with respiratory symptoms such as cough, dyspnea, and wheezing. However, data on this association in Saudi Arabia is limited.

OBJECTIVES

The objective of this study is to investigate the prevalence of SHS exposure and its association with respiratory symptoms among non-smoker adults in Saudi Arabia.

METHODS

Data collection was carried out over the course of two months by distributing an online questionnaire among adults living in Saudi Arabia. The survey consisted of questions assessing sociodemographic factors, SHS exposure, and the presence of respiratory symptoms. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 22 (Released 2013; IBM Corp., Armonk, New York, United States). Data was considered significant if p<0.05.

RESULTS

The questionnaire was completed by 1360 participants. Most were females (n=845, 72.1%) and individuals aged 18 to 30 years (n=838, 71.5%). From the analyzed records, 67.3% (n=789) reported SHS exposure. Among them, 40.3% (n=472) reported SHS exposure from household sources, 32.6% (n=382) from work colleagues, and 30.5% (n=357) from friends. The majority (n=306, 76.9%) of those exposed at home reported daily SHS exposure. The main source of home exposure was male family members, particularly the father (n=201, 42.6%). The majority (n=985, 84.0%) of participants reported not having any kind of mold or damage at their place of residence. Individuals with SHS exposure were more likely to report asthma (p=0.043), chest whistling or wheezing (p=0.021), chronic cough (p<0.001), productive cough (p<0.001), and nasal symptoms without a cold (p<0.001). These individuals also demonstrated a higher average symptom score than those not exposed to SHS.  Conclusion: The study reveals that a significant percentage of the Saudi population is exposed to SHS daily, mainly from household sources, especially male family members. A significant association was found between SHS exposure and the presence of respiratory symptoms. Public awareness regarding the prevalence and dangers of SHS exposure is essential in order to alleviate the impact of SHS on the health of the general Saudi population. Additionally, further research is required in this field and demographic group to develop appropriate interventions.

Effects of indoor air quality and home environmental characteristics on allergic diseases among preschool children in the Greater Taipei Area

Indoor air quality and home environmental characteristics are potential factors associated with the onset and exacerbation of allergic diseases. Our study examined the effects of these factors on allergic diseases (i.e., asthma, allergic rhinitis, allergic conjunctivitis, and atopic dermatitis) among preschool children. We recruited a total of 120 preschool children from an ongoing birth cohort study in the Greater Taipei Area. A comprehensive environmental evaluation was conducted at each participant's residence and included measurements of indoor and outdoor air pollutants, fungal spores, endotoxins, and house dust mite allergens. A structured questionnaire was used to collect information on the allergic diseases and home environments of participants. Land-use characteristics and points of interest in the surrounding area of each home were analyzed. Other covariates were obtained from the cohort data. Multiple logistic regressions were used to examine the relationships between allergic diseases and covariates. We observed that all mean indoor air pollutant levels were below Taiwan's indoor air quality standards. After adjustment for covariates, the total number of fungal spores and the ozone, Der f 1, and endotoxin levels were significantly associated with increased risks of allergic diseases. Biological contaminants more significantly affected allergic diseases than other pollutants. Moreover, home environmental characteristics (e.g., living near power facilities and gas stations) were associated with an increased risk of allergic diseases. Regular and proper home sanitation is recommended to prevent the accumulation of indoor pollutants, especially biological contaminants. Living away from potential sources of pollution is also crucial for protecting the health of children.

Mold in Paradise: A Review of Fungi Found in Libraries

Libraries contain a large amount of organic material, frequently stored with inadequate climate control; thus, mold growth represents a considerable threat to library buildings and their contents. In this essay, we review published papers that have isolated microscopic fungi from library books, shelving, walls, and other surfaces, as well as from air samples within library buildings. Our literature search found 54 published studies about mold in libraries, 53 of which identified fungi to genus and/or species. In 28 of the 53 studies, Aspergillus was the single most common genus isolated from libraries. Most of these studies used traditional culture and microscopic methods for identifying the fungi. Mold damage to books and archival holdings causes biodeterioration of valuable educational and cultural resources. Exposure to molds may also be correlated with negative health effects in both patrons and librarians, so there are legitimate concerns about the dangers of contact with high levels of fungal contamination. Microbiologists are frequently called upon to help librarians after flooding and other events that bring water into library settings. This review can help guide microbiologists to choose appropriate protocols for the isolation and identification of mold in libraries and be a resource for librarians who are not usually trained in building science to manage the threat molds can pose to library holdings.

Fungi in Early-Life House Dust Samples and the Development of Asthma: A Birth Cohort Study

Rationale: Fungal exposure has been associated with predisposing and protective effects on the development of childhood asthma. Objectives: To study whether early-life house dust mycobiota composition is associated with the development of asthma. Methods: Mycobiota were determined by amplicon sequencing from 382 dust samples collected from living room floors 2 months after birth in homes of the LUKAS cohort. Asthma status by 10.5 years of age was defined from questionnaires and assigned as ever asthma (n = 68) or current asthma (n = 27). Inhalant atopy was clinically determined at the same age. β-composition was analyzed using PERMANOVA-S, and asthma and atopy analyses were performed using discrete time hazard models and logistic regression, respectively. Results: The house dust mycobiota composition based on Bray-Curtis distance was different in the homes of children who later did or did not develop asthma. The first and the fourth axes scores of principal coordinates analysis based on Bray-Curtis were associated with ever asthma. Of the genera with the strongest correlation with these axes, the relative abundance of Boeremia, Cladosporium, Microdochium, Mycosphaerella, and Pyrenochaetopsis showed protective associations with asthma. None of these associations remained significant after mutual adjustment among the five genera or when mutually adjusted for other microbial cell wall markers and previously identified asthma-protective bacterial indices. Neither fungal α-diversity nor load was associated with asthma in the whole population, but higher fungal richness was a risk factor among children on farms. Higher fungal loads (measured via quantitative polymerase chain reaction) in house dust were associated with the risk of inhalant atopy. Conclusions: The results of our analyses from this well-characterized birth cohort suggest that the early-life house dust mycobiota in Finnish homes, characterized via DNA amplicon sequencing, do not have strong predisposing or protective effects on asthma development.

Co-exposure of environmental contaminants with unfavorable temperature or humidity/moisture: Joint hazards and underlying mechanisms

In the context of global climate change, organisms in their natural habitats usually suffer from unfavorable climatic conditions together with environmental pollution. Temperature and humidity (or moisture) are two central climatic factors, while their relationships with the toxicity of contaminants are not well understood. This review provides a synthesis of existing knowledge on important interactions between contaminant toxicity and climatic conditions of unfavorable temperature, soil moisture, and air humidity. Both high temperature and low moisture can extensively pose severe combined hazards with organic pollutants, heavy metal ions, nanoparticles, or microplastics. There is more information on the combined effects on animalia than on other kingdoms. Prevalent mechanisms underlying their joint effects include the increased bioavailability and bioaccumulation of contaminants, modified biotransformation of contaminants, enhanced induction of oxidative stress, accelerated energy consumption, interference with cell membranes, and depletion of bodily fluids. However, the interactions of contaminants with low temperature or high humidity/moisture, particularly on plants and microorganisms, are relatively vague and need to be further revealed. This work emphasizes that the co-exposure of chemical and physical stressors results in detrimental effects generally greater than those caused by either stressor. It is necessary to take this into consideration in the ecological risk assessment of both environmental contamination and climate change.

Indoor Environmental Exposures and Their Relationship to Allergic Diseases

Cockroach, dust mite, cat, dog, mouse, and molds are major indoor allergens that have been associated with the development of allergic diseases and disease morbidity in allergen-sensitized individuals. Physical characteristics, such as allergen particle size, hydrophobicity, and charge, can determine an allergen's propensity to become airborne, location of respiratory tract penetration, and ability to elicit IgE responses in genetically predisposed individuals. Standardization and recent advancements in indoor allergen assessment serve to identify sources and distribution of allergens in a patient's home and public environment, inform public policy, and monitor the efficacy of allergen avoidance and therapeutics. Allergen exposure interventions have yielded mixed results with current US and international asthma guidelines differing on recommendations. A pragmatic, patient-centered approach to allergen avoidance includes: (1) tailoring intervention to the patient's sensitization and exposure status, (2) using a rigorous multifaceted intervention strategy to reduce allergen exposure as much as possible, and (3) beginning the intervention as soon as the patient is diagnosed. Further research into the risks/benefits of early allergen exposure, rapid and affordable in-home allergen assessment, and best practices for environmental control measures for asthma is needed.

Occupational Contributions to Respiratory Health Disparities

Occupation is an important contributor to disparities in respiratory disease, affecting financial status, health-care access, and exposure to hazardous substances. Although occupation and associated exposures are included in the socioecological models, work exposures remain persistently absent from research on health inequities and their contribution to health. This article focuses on the occupational contribution to disparities in asthma, chronic obstructive pulmonary disease, silicosis, coronavirus disease 2019, and lung cancer. Because occupational exposures are largely preventable through proper workplace controls, the recognition of occupational causes of disease can provide an opportunity for interventions to bring about health equity.

The Impact of Climate Change on Asthma and Allergic-Immunologic Disease

PURPOSE OF REVIEW

This review discusses climate change-related impacts on asthma and allergic-immunologic disease, relevant US public health efforts, and healthcare professional resources.

RECENT FINDINGS

Climate change can impact people with asthma and allergic-immunologic disease through various pathways, including increased exposure to asthma triggers (e.g., aeroallergens, ground-level ozone). Climate change-related disasters (e.g., wildfires, floods) disrupting healthcare access can complicate management of any allergic-immunologic disease. Climate change disproportionately affects some communities, which can exacerbate disparities in climate-sensitive diseases like asthma. Public health efforts include implementing a national strategic framework to help communities track, prevent, and respond to climate change-related health threats. Healthcare professionals can use resources or tools to help patients with asthma and allergic-immunologic disease prevent climate change-related health impacts. Climate change can affect people with asthma and allergic-immunologic disease and exacerbate health disparities. Resources and tools are available to help prevent climate change-related health impacts at the community and individual level.

Occupational asthma related to indoor air pollution in a worker at an indoor air gun shooting range: a case report

Background

Indoor air pollution can cause and exacerbate asthma. We report a previously undescribed case of occupational asthma related to indoor air pollution in a worker at an indoor air gun shooting range and highlight the potential risk of developing occupational asthma in this environment.

Case presentation

A 31-year-old man presented with dyspnea, cough, and sputum and was diagnosed with asthma complicated by pneumonia. Objective evidence of asthma was obtained by performing a methacholine bronchial provocation test. It was suspected that the patient had occupational asthma, which began one month after changing jobs to work within the indoor air gun shooting range. The highest peak expiratory flow (PEF) diurnal variability on working days was 15%, but the highest variation was 24%, with 4 days out of 4 weeks having a variation of over 20% related to workplace exposure. Conversely, the diurnal variability on the rest days was 7%, and no day showed a variation exceeding 20%. The difference in the average PEF between working and rest days was 52 L/min. PEF deterioration during working days and improvement on rest days were noted.

Conclusions

The results obtained from the in-depth analysis of the PEF were adequate to diagnose the patient with occupational asthma. Exposure to indoor air pollution and lead and the patient's atopy and allergic rhinitis may have contributed to the development of occupational asthma.

Sanitary conditions, waste management, safety measures and sources of air pollution associated with shopping malls in Nigeria's largest city

Objectives

Shopping malls are fast becoming one of the most visited public spaces globally. However, information on the possible environmental conditions in relation to health hazards in shopping malls is poorly documented in developing countries. This study assessed the sanitary conditions, waste management, safety measures and sources of air pollution associated with selected shopping malls in Nigeria.Study Design: a descriptive cross-sectional study design was adopted using a comparative approach.

Methods

Three shopping malls (Mall Q, Mall R, and Mall S) in urban areas in Ibadan, Oyo State, Nigeria, were selected using convenience sampling technique. Three major shopping malls were selected using convenience sampling technique. Fifty seven, thirty five, and twenty nine stores were sampled in Mall Q, Mall R, and Mall S respectively. Direct on-site built environment and sanitary conditions of shopping malls were assessed using an observational checklist.

Results

It was observed that all the selected shopping malls had air vents that were free from dust, unbroken walls, and emergency exits, although mold growths were observed on the walls and ceilings of Mall Q and Mall R. Toilet facilities were present and functional across all the shopping malls. Waste management facilities were available across the shopping malls with the absence of overfilled waste bins as regular emptying of the waste bins was a routine. Also, various safety measures and equipment were utilized across all the shopping malls, but safety signals and smoke detectors were absent in Mall R. Furthermore, Mall R and S were 5 m within the proximity of major roads, parking lots and public drainage channels.

Conclusions

These findings reveal a need for improvement in the hygiene and sanitary conditions within shopping malls. Hence, there should be periodic environmental monitoring, and proper housekeeping practices should be encouraged in shopping malls in Nigeria.

Respiratory infections among junior high school students in upper northern Thailand: The role of building dampness and mould, biomass burning and outdoor relative air humidity (RH)

BACKGROUND

Few studies exist on environmental risk factors for respiratory infections in Thai school children.

AIM

To study associations between home and outdoor environment and respiratory infections among school children in Northern Thailand in dry and wet season.

METHODS

A repeated questionnaire survey among the children (N = 1159). Data on ambient temperature and relative air humidity (RH) and PM₁₀ and ozone was collected from nearby monitoring stations. We used logistic regression to calculate odds ratios (OR).

RESULTS

14.1% had current respiratory infections (last 7 days), 32.1% had any respiratory infection last 3 months, and 26.1% had any respiratory infection last 12 months with antibiotic treatment. Students with diagnosed allergy (7.7%) and diagnosed asthma (4.7%) had more often respiratory infections (ORs 1.40-5.40; p < 0.05). Current respiratory infections were more common in dry (18.1%) than in wet season (10.4%) (p < 0.001) and was associated with indoor mould (OR 2.16; p = 0.024) and outdoor RH (OR 1.34 per 10% RH; p = 0.004.) in the total material. In wet season, mould (OR 2.32; p = 0.016), window pane condensation (OR 1.79; p = 0.050), water leakage (OR 1.82; p = 0.018), environmental tobacco smoke (ETS) (OR 2.34; p = 0.003) and outdoor RH (OR 2.70 per 10% RH; p = 0.01) were risk factors for current respiratory infections. In dry season, mould (OR 2.64; p = 0.004) and outdoor RH (OR 1.34 per 10% RH; p = 0.046) were associated with current respiratory infections. Irrespectively of season, biomass burning inside or outside the home was a risk factor for respiratory infections (ORs 1.32-2.34; p < 0.05). Living in a wooden house decreased the risk of respiratory infections (OR 0.56: p = 0.006).

CONCLUSIONS

Dry season, high outdoor RH, household dampness, indoor mould and ETS can increase childhood respiratory infections. Living in a traditional wooden house can reduce respiratory infections, possibly due to better natural ventilation. Smoke from biomass burning can increase childhood respiratory infections in northern Thailand.

Laboratory Test Results in Patients with Workplace Moisture Damage Associated Symptoms—The SAMDAW Study

The mechanisms of health effects of moisture damage (MD) are unclear, but inflammatory responses have been suspected. The usefulness of laboratory and allergy tests among patients in secondary healthcare with symptoms associated with workplace MD were examined. Full blood count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), total serum immunoglobulin E (IgE), fractional exhaled nitric oxide (FeNO), and skin prick testing were assessed and analyzed in relation to multiple chemical sensitivity (MCS) and perceived stress in 99 patients and 48 controls. In analysis, t-tests, Mann-Whitney tests, and chi-squared tests were used. Minor clinically insignificant differences in blood counts were seen in patients and controls, but among patients with asthma an elevated neutrophil count was found in 19% with and only in 2% of patients without asthma (p = 0.003). CRP levels and ESR were low, and the study patients’ FeNO, total IgE, or allergic sensitization were not increased compared to controls. The level of stress was high among 26% of patients and 6% of controls (p = 0.005), and MCS was more common among patients (39% vs. 10%, p < 0.001). Stress or MCS were not significantly associated with laboratory test results. In conclusion, no basic laboratory or allergy test results were characteristic of this patient group, and neither inflammatory processes nor allergic sensitization were found to explain the symptoms among these patients. While the value of basic laboratory tests should not be ignored, the use of allergy tests does not seem necessary when symptoms are indicated to be workplace-related.

Adult asthma associated with roadway density and housing in rural Appalachia: the Mountain Air Project (MAP)

BACKGROUND

Appalachian Kentucky is a rural area with a high prevalence of asthma among adults. The relative contribution of environmental exposures in the etiology of adult asthma in these populations has been understudied.

OBJECTIVE

This manuscript describes the aims, study design, methods, and characteristics of participants for the Mountain Air Project (MAP), and focuses on associations between small area environmental exposures, including roadways and mining operations, and lifetime and current asthma in adults.

METHODS

A cohort of residents, aged 21 and older, in two Kentucky counties, was enrolled in a community-based, cross-sectional study. Stratified cluster sampling was used to select small geographic areas denoted as 14-digit USGS hydrologic units (HUCs). Households were enumerated within selected HUCs. Community health workers collected in-person interviews. The proximity of nearby active and inactive coal mining operations, density of oil and gas operations, and density of roadways were characterized for all HUCs. Poisson regression analyses were used to estimate adjusted prevalence ratios.

RESULTS

From 1,459 eligible households contacted, 1,190 individuals were recruited, and 972 persons completed the interviews. The prevalence of lifetime asthma was 22.8%; current asthma was 16.3%. Adjusting for covariates, roadway density was positively associated with current asthma in the second (aPR = 1.61; 95% CI 1.04-2.48) and third tertiles (aPR = 2.00; 95% CI 1.32-3.03). Increased risk of current asthma was associated with residence in public, multi-unit housing (aPR = 2.01; 95% CI 1.27-3.18) compared to a residence in a single-family home. There were no notable associations between proximity to coal mining and oil and gas operations and asthma prevalence.

CONCLUSIONS

This study suggests that residents in rural areas with higher roadway density and those residing in public housing units may be at increased risk for current asthma after accounting for other known risk factors. Confirming the role of traffic-related particulates in producing high asthma risk among adults in this study contributes to the understanding of the multiple environmental exposures that influence respiratory health in the Appalachia region.

Acute Bronchitis and Bronchiolitis Infection in Children with Asthma and Allergic Rhinitis: A Retrospective Cohort Study Based on 5,027,486 Children in Taiwan

This study evaluated the risks of childhood acute bronchitis and bronchiolitis (CABs) for children with asthma or allergic rhinitis (AR). Using insurance claims data of Taiwan, we identified, from children of ≤12 years old in 2000-2016, cohorts with and without asthma (N = 192,126, each) and cohorts with and without AR (N = 1,062,903, each) matched by sex and age. By the end of 2016, the asthma cohort had the highest bronchitis incidence, AR and non-asthma cohorts followed, and the lowest in the non-AR cohort (525.1, 322.4, 236.0 and 169.9 per 1000 person-years, respectively). The Cox method estimated adjusted hazard ratios (aHRs) of bronchitis were 1.82 (95% confidence interval (CI), 1.80-1.83) for the asthma cohort and 1.68 (95% CI, 1.68-1.69) for the AR cohort, relative to the respective comparisons. The bronchiolitis incidence rates for these cohorts were 42.7, 29.5, 28.5 and 20.1 per 1000 person-years, respectively. The aHRs of bronchiolitis were 1.50 (95% CI, 1.48-1.52) for the asthma cohort and 1.46 (95% CI, 1.45-1.47) for the AR cohort relative to their comparisons. The CABs incidence rates decreased substantially with increasing age, but were relatively similar for boys and girls. In conclusion, children with asthma are more likely to develop CABs than are children with AR.

Volatile organic compounds (VOC) in homes associated with asthma and lung function among adults in Northern Europe

Associations between measured specific VOC reported to be associated with dampness and microbial growth in dwellings and asthma, lung function were investigated in 159 adults (one adult/home) from three North European cities (Reykjavik, Uppsala and Tartu). Spirometry was performed and forced vital capacity (FVC), forced expiratory volume in 1 s (FEV₁) and FEV₁/FVC were measured. Among 159 participants, 58% were females, 24.5% atopics, 25.8% current smokers and 41% reported dampness or mold at home. Dimethyl disulphide (p = 0.004), ethyl isobutyrate (p = 0.021) and ethyl 2-methylbutyrate (p = 0.035) were associated with asthma. Isobutanol (p = 0.043), 3-methyl-1-butanol (p = 0.020), 2-hexanone (p = 0.033), 1-octen-3-ol (p = 0.027), 2-methyl-1-butanol (p = 0.022) and 2-ethyl-1-hexanol (p = 0.045) were associated with lower FEV₁. Isobutanol (p = 0.004), 3-methyl-1-butanol (p = 0.001), 2-heptanone (p = 0.047) and 2-methyl-1-butanol (p = 0.002) were associated with lower FEV₁/FVC. The association between dimethyl disulphide and asthma was more pronounced in females (p for interaction 0.099). The association between 1-butanol and lower FEV₁ was more pronounced in males (p for interaction 0.046). The associations between 3-octanone (p for interaction 0.064), 2-ethyl-1-hexanol (p for interaction 0.049) and lower FEV₁, and between 2-heptanone (p for interaction 0.021), 3-octanone (p for interaction 0.008) and lower FEV₁/FVC were stronger in homes with dampness/mold. Factor analysis identified one VOC factor related to asthma and two VOC factors related to lower lung function. Increased air concentrations of 2-heptanone, ethyl 2-methylbutyrate and ethyl isobutyrate were related to prescence of certain mold species (Aspergillus sp., Cladosporum sp. and Penicillium sp.) or building dampness. Some VOC were associated with type of dwelling, building age and pet keeping. In conclusion, some VOC reported to be associated with dampness and microbial growth can be associated with asthma and lower lung function in adults. Associations between these VOC and respiratory illness can be stronger in homes with dampness/mold. There can be gender differences in respiratory health effects when exposed to indoor VOC.

HEPA filtration intervention in classrooms may improve some students' asthma

OBJECTIVE

The School Inner-City Asthma Intervention Study 2 (SICAS 2) tested interventions to reduce exposures in classrooms of students with asthma. The objective of this post-hoc analysis was limited to evaluating the effect of high-efficiency particulate (HEPA) filtration interventions on mold levels as quantified using the Environmental Relative Moldiness Index (ERMI) and the possible improvement in the students' asthma, as quantified by spirometry testing.

METHODS

Pre-intervention dust samples were collected at the beginning of the school year from classrooms and corresponding homes of students with asthma (n = 150). Follow-up dust samples were collected in the classrooms at the end of the HEPA or Sham intervention. For each dust sample, ERMI values and the Group 1 and Group 2 mold levels (components of the ERMI metric) were quantified. In addition, each student's lung function was evaluated by spirometry testing, specifically the percentage predicted forced expiratory volume at 1 sec (FEV1%), before and at the end of the intervention.

RESULTS

For those students with a higher Group 1 mold level in their pre-intervention classroom than home (n = 94), the FEV1% results for those students was significantly (p < 0.05) inversely correlated with the Group 1 level in their classrooms. After the HEPA intervention, the average Group 1 and ERMI values were significantly lowered, and the average FEV1% test results significantly increased by an average of 4.22% for students in HEPA compared to Sham classrooms.

CONCLUSIONS

HEPA intervention in classrooms reduced Group 1 and ERMI values, which corresponded to improvements in the students' FEV1% test results.

Racial/ethnic inequalities in the indoor home environment among households with people with disabilities

BACKGROUND

The indoor home environment (IHE) is an important determinant of health. However, there is limited information about variation in the IHE by race/ethnicity among the population with disabilities.

OBJECTIVE

This study summarizes the IHE among households with any person with a disability (HWDs) and describes differences by race/ethnicity. The study evaluates whether these racial/ethnic differences are accounted for by demographic, socioeconomic, and geographic characteristics.

METHODS

Using a nationally representative, cross-sectional survey, descriptive and multivariate analyses were conducted to examine racial/ethnic differences across eight inadequate conditions of the IHE and the total number of inadequate conditions of the IHE.

RESULTS

Some IHE conditions are common, such as low indoor air quality. Large racial/ethnic differences in exposure persist, net of controls. Black, Hispanic, and Mixed Race/Ethnicity HWDs have greater exposure to low indoor temperatures, injury hazards, and lead than White HWDs. Black and Hispanic HWDs reside in dwellings with lower indoor air quality and pests/allergens than White HWDs. Mixed Race/Ethnicity HWDs are the only racial/ethnic minority group with greater barriers to water and sanitation than White HWDs. Asian households have comparable exposure to White households for all IHE conditions. Black, Hispanic, and Mixed Race/Ethnicity HWDs have about 23%, 17%, and 15% more inadequate conditions of the IHE than White HWDs, net of controls.

CONCLUSION

There is heterogeneity in exposure to inadequate conditions of the IHE, with Black, Hispanic, and Mixed Race/Ethnicity HWDs at a disadvantage compared to their White counterparts. It is critical to examine racial/ethnic variation when studying health inequalities in the IHE among HWDs.

Adjustment of Matrix Effects in Analysis of 36 Secondary Metabolites of Microbial and Plant Origin in Indoor Floor Dust Using Liquid Chromatography-Tandem Mass Spectrometry

Exposure to microbial agents in water-damaged buildings is a major public health concern. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) has become a primary tool for testing environmental samples for microbial secondary metabolites (SMs); however, matrix effects can lead to inaccurate results in exposure assessment. Applying a universal internal standard (ISTD) and a matrix-matched calibration can adjust for matrix effects, as shown by our previous study. However, there are only few isotope-labeled internal standards for SMs available on the market. In this study, we determined the best-performing ISTDs among ten candidates (nine 13C-labeled isotopes and one unlabeled analogue) for each of 36 SMs. We analyzed school floor dust spiked with the 36 SMs to identify the best-performing ISTDs (initial experiment) and examined reproducibility with the selected ISTDs and the same spiked dust (validation 1). We also tested applicability for the selected ISTDs using spiked dust collected from different schools (validation 2). The three experiments showed that 26, 17, and 19 SMs had recoveries within the range 100 ± 40%. 13C-ochratoxin A and 13C-citrinin were most frequently selected as the best ISTDs for the 36 SMs, followed by deepoxy-deoxynivalenol, 13C-sterigmatocystin, and 13C-deoxynivalenol. Our study shows that using the identified, best-performing analogous ISTDs for those metabolites may improve testing accuracy for indoor dust and help better estimate exposure effects on potential health.

Impact of Air Conditioners on Sick Building Syndrome, Sickness Absenteeism, and Lung Functions

Introduction

Modernization has led to greater usage of Air Conditioners (ACs) in our daily lives. It is observed that the occupants of office buildings with ACs consistently report on average more symptoms than do occupants of office buildings with natural ventilation referred to as Sick Building Syndrome (SBS). The appearance of symptoms reduces work efficiency and increases absenteeism due to sickness (sickness absenteeism). Therefore, the present study was planned to evaluate the impact of usage of ACs on SBS and to find out the association of ACs with sickness absenteeism and lung function tests.

Materials and Methods

This study was conducted on 200 healthy non-smoker adults in the age group of 18 to 45 years who were using ACs for at least 6 to 8 h/day for more than 2 years (group I). And 200 healthy adults, age and gender-matched, with the same work pattern, not using ACs at all served as controls (group II). The basic information on the usage of ACs and the prevalence of discomfort related to neural symptoms, respiratory symptoms, and skin and mucous membrane related to SBS was obtained through a questionnaire.

Results

The building-related symptoms in group I males were more compared to group II males and significantly higher in group I males compared to females. We observed that the appearance of symptoms of SBS led to sickness absenteeism among group I participants. Lung function tests especially FVC, FEV1, PEFR, and MVV were significantly reduced among group I males and females compared to group II males and females.

Conclusion

ACs have a profound effect on the quality of the air we breathe and on human health than just lowering the temperature. There is a higher prevalence of SBS-Respiratory and allergic symptoms in AC users.

Early life exposure to outdoor air pollution and indoor environmental factors on the development of childhood allergy from early symptoms to diseases

BACKGROUND

The prevalence of childhood allergies has increased during past decades leading to serious hospitalization and heavy burden worldwide, yet the key factors responsible for the onset of early symptoms and development of diagnosed diseases are unclear.

OBJECTIVE

To explore the role of early life exposure to ambient air pollution and indoor environmental factors on early allergic symptoms and doctor diagnosed allergic diseases.

METHODS

A retrospective cohort study of 2598 preschool children was conducted at 36 kindergartens in Changsha, China from September of 2011 to February of 2012. A questionnaire was developed to survey each child's early onset of allergic symptoms (wheeze and rhinitis-like symptoms) and doctor diagnosis of allergic diseases (asthma and rhinitis) as well as home environments. Each mother's and child's exposures to ambient air pollutants (PM₁₀, SO₂, and NO₂) and temperature were estimated for in utero and postnatal periods. The associations of early symptoms and diagnosed diseases with outdoor air pollution and indoor environmental variables were examined by logistic regression models.

RESULTS

Childhood early allergic symptoms (33.9%) including wheeze (14.7%) and rhinitis-like symptoms (25.4%) before 2 years old were not associated with outdoor air pollution exposure but was significantly associated with maternal exposure of window condensation at home in pregnancy with ORs (95% CI) of 1.33 (1.11-1.59), 1.30 (1.01-1.67) and 1.27 (1.04-1.55) respectively, and was associated with new furniture during first year after birth with OR (95% CI) of 1.43 (1.02-2.02) for early wheeze. Childhood diagnosed allergic diseases (28.4%) containing asthma (6.7%) and allergic rhinitis (AR) (7.2%) were significantly associated with both outdoor air pollutants (mainly for SO₂ and NO₂) during first 3 years and indoor new furniture, redecoration, and window condensation. We found that sex, age, parental atopy, maternal productive age, environmental tobacco smoke (ETS), antibiotics use, economic stress, early and late introduction of complementary foods, and outdoor air pollution modified the effects of home environmental exposure in early life on early allergic symptoms and diagnosed allergic diseases.

CONCLUSION

Our study indicates that early life exposure to indoor environmental factors plays a key role in early onset of allergic symptoms in children, and further exposure to ambient air pollution and indoor environmental factors contribute to the later development of asthma and allergic rhinitis.

Making sense of the delegitimation experiences of people suffering from indoor air problems in their homes

Purpose

Little is known about the delegitimation experiences of people who associate their health problems with the indoor air quality of their homes (i.e., indoor air sufferers). From other contexts, it is known that people suffering from contested illnesses frequently report delegitimation from authorities and laypersons. Therefore, we analysed delegitimation experiences among indoor air sufferers, focusing on how they explain why others delegitimize them.

Method

Two types of qualitative data—semi-structured interviews with eight people and essays written by 28 people—were subjected to a thematic analysis.

Results

Thematic analysis revealed three themes: 1) lack of understanding; 2) others’ lack of morality; and 3) social discrimination and inequality.

Conclusion

This study demonstrates that indoor air sufferers are vulnerable as individuals and as a group, and suggests that authorities working with people suffering from indoor air problems in homes must pay more attention to sufferers’ ability/willingness to trust people and the system responsible for their care.

Asthma, allergic rhinitis and atopic dermatitis in association with home environment - The RHINE study

We studied home environment exposures in relation to asthma, allergic rhinitis and atopic dermatitis among offspring of participants (parents) in the Respiratory Health in Northern Europe (RHINE) study (age ≤ 30 y). Totally 17,881 offspring from Iceland, Norway, Sweden, Denmark and Estonia were included. Home environment exposures, including dampness and mold, type of dwelling, construction year and indoor painting were registered through a questionnaire answered by parents in the first follow up (RHINE II). The parents reported ten years later with in the frame of RHINE III offspring's birth year and offspring's asthma, allergic rhinitis, atopic dermatitis. They also reported dampness and mold at home from RHINE II to RHINE III. The prevalence of offspring's asthma before 10 y, asthma after 10 y, allergic rhinitis at any age and atopic dermatitis at any age were 9.7 %, 4.3 %, 15.6 % and 17.3 %, respectively. Asthma before 10 y was related to any indoor painting at RHINE II (OR = 1.14, 95%CI (1.02, 1.29)). Asthma after 10 y was associated with dampness/mold at home (OR = 1.33-1.62) and living in the newest buildings (constructed in 1986-2001) (OR = 1.30, 95%CI (1.02, 1.66)). Allergic rhinitis was associated with living in newer buildings (constructed in 1961-2001) (OR = 1.16-1.24). Atopic dermatitis was associated with visible mold (OR = 1.35, 95%CI(1.12, 1.62)), dampness/mold at home (OR = 1.18-1.38), living in apartments (OR = 1.22, 95%CI(1.10, 1.35)) and living in newer buildings (constructed in 1961-2001) (OR = 1.14-1.25). There were dose-response effects of dampness and mold on offspring's asthma after 10 y and atopic dermatitis (20 years exposure vs. 10 years exposure). Older offspring had increased risk of developing asthma after 10 y and atopic dermatitis. In conclusion, home dampness and mold, living in apartments, living in newer buildings and indoor painting were associated with offspring's asthma or allergic diseases. Stronger health effects were found among offspring with prolonged exposure of dampness/mold.

Assessing the health risk of living near composting facilities on lung health, fungal and bacterial disease in cystic fibrosis: a UK CF Registry study

AIM

To explore the health risk of living near permitted composting sites (PCSs) on disease severity in children and adults with cystic fibrosis (CF) across the UK.  METHODS: A semi-individual cross-sectional study was used to examine the risk of disease severity in people with CF (pwCF) within and beyond 4 km of PCSs in the UK in 2016. All pwCF registered in the UK CF Registry were eligible for this study. Linear and Poisson regressions, adjusted for age, gender, genotype, BMI, Pseudomonas aeruginosa and deprivation, were used to quantify associations between distance to a PCS and percent predicted forced expiratory volume in one second (ppFEV₁), pulmonary exacerbations (#IVdays), and fungal and bacterial infections.

RESULTS

The mean age of the 9,361 pwCF (3,931 children and 5,430 adults) studied was 20.1 (SD = 14.1) years; 53.3% were male; and 49.2% were homozygous F508del. Over 10% of pwCF (n = 1,015) lived within 4 km of a PCS. We found no statistically significant difference in ppFEV₁ and #IVdays/year in children. However, in adults, ppFEV₁ was -1.07% lower (95% confidence interval (CI): -2.29%, 0.16%) and #IVdays/year were 1.02 day higher (95%CI: 1.01, 1.04) within 4 km of a PCS. Furthermore, there were statistically significant differences in mean ppFEV₁ in CF adults with Aspergillus fumigatus (58.2.% vs 62.0%, p = 0.005) and Candida spp. (56.9% vs 59.9%, p = 0.029) residing within 4 km of a PCS. No associations were identified for allergic bronchopulmonary aspergillosis, P. aeruginosa or Staphylococcus aureus.

CONCLUSIONS

This novel national study provides evidence that adults with CF living near a PCS may experience small reductions in lung function, an increased risk of pulmonary exacerbations, and more frequent fungal infections. If confirmed by studies using refined exposure assessment methods accounting for bioaerosol dispersion, these results could have important implications for the living environment of pwCF.

Symptoms and oxylipins in plasma before and after exposure to rooms in which individuals have both experienced and not experienced building-related symptoms - an exploratory study

The aim of this study was to investigate if there are differences in symptom ratings and plasma concentrations of oxylipins as a measure of acute inflammation between individuals with building-related symptoms (BRS) and referents during exposure to rooms where people experienced BRS and rooms where they did not experience BRS. Medically examined individuals with BRS and healthy, age and sex matched referents working in the same building were exposed for 60 min. Ratings of symptoms and collection of blood to measure oxylipins in plasma were performed before and after each exposure. Individuals with BRS reported more symptoms (mostly mucosal) than the referents in the problem rooms and there was a tendency towards a difference between the groups in concentration of metabolites from the cyclooxygenase pathway (COX). The mean reported intensity of symptoms among all participants was also found to be positively correlated with both COX and lipoxygenase (LOX-15) oxylipins in problem rooms.

A review of indoor Gaseous organic compounds and human chemical Exposure: Insights from Real-time measurements

Gaseous organic compounds, mainly volatile organic compounds (VOCs), have become a wide concern in various indoor environments where we spend the majority of our daily time. The sources, compositions, variations, and sinks of indoor VOCs are extremely complex, and their potential impacts on human health are less understood. Owing to the deployment of the state-of-the-art real-time mass spectrometry during the last two decades, our understanding of the sources, dynamic changes and chemical transformations of VOCs indoors has been significantly improved. This review aims to summarize the key findings from mass spectrometry measurements in recent indoor studies including residence, classroom, office, sports center, etc. The sources and sinks, compositions and distributions of indoor VOCs, and the factors (e.g., human activities, air exchange rate, temperature and humidity) driving the changes in indoor VOCs are discussed. The physical and chemical processes of gas-particle partitioning and secondary oxidation processes of VOCs, and their impacts on human health are summarized. Finally, the recommendations for future research directions on indoor VOCs measurements and indoor chemistry are proposed.

Determinants of bacterial and fungal microbiota in Finnish home dust: Impact of environmental biodiversity, pets, and occupants

The indoors is where many humans spend most of their time, and are strongly exposed to indoor microbiota, which may have multifaceted effects on health. Therefore, a comprehensive understanding of the determinants of indoor microbiota is necessary. We collected dust samples from 295 homes of families with young children in the Helsinki region of Finland and analyzed the bacterial and fungal composition based on the 16S rRNA and ITS DNA sequences. Microbial profiles were combined with extensive survey data on family structure, daily life, and physical characteristics of the home, as well as additional external environmental information, such as land use, and vegetational biodiversity near the home. Using permutational multivariate analysis of variance we explained 18% of the variation of the relative abundance between samples within bacterial composition, and 17% of the fungal composition with the explanatory variables. The fungal community was dominated by the phyla Basidiomycota, and Ascomycota; the bacterial phyla Proteobacteria, Firmicutes, Cyanobacteria, and Actinobacteria were dominant. The presence of dogs, multiple children, and firewood were significantly associated with both the fungal and bacterial composition. Additionally, fungal communities were associated with land use, biodiversity in the area, and the type of building, while bacterial communities were associated with the human inhabitants and cleaning practices. A distinction emerged between members of Ascomycota and Basidiomycota, Ascomycota being more abundant in homes with greater surrounding natural environment, and potential contact with the environment. The results suggest that the fungal composition is strongly dependent on the transport of outdoor environmental fungi into homes, while bacteria are largely derived from the inhabitants.

Effect of preconceptional, prenatal and postnatal exposure to home environmental factors on childhood pneumonia: A key role in early life exposure

BACKGROUND

Increasing evidence have associated pneumonia with early exposure to ambient air pollution. However, the role of indoor environmental factors exposure in early life on childhood pneumonia remains unclear.

OBJECTIVE

To examine the association between indoor environmental factors exposure during different timing windows and childhood pneumonia, and to identify the key indoor factor(s) in different critical window(s).

METHODS

A retrospective cohort study of 8689 pre-schoolers was performed in Changsha, China during 2019-2020. Our questionnaire survey was designed to collect information on pre-schooler's outcome and residential environmental exposure containing indoor pollution and allergens during 1 year before pregnancy, pregnancy, first year, and past year. The associations were further estimated stratified by personal exposure level of outdoor NO₂, CO, temperature (T) and different covariates. Associations were assessed by multiple logistic regression model in terms of odds ratio (OR) of 95% confidence interval (CI).

RESULTS

Pre-schooler's pneumonia was significantly related with exposure of new furniture, redecoration, mold/damp stains, and mold or damp clothing or bedding exposure during the four periods, with the strongest associations observed during 1 year before pregnancy based on multi-window model, with ORs (95% CI) of 1.27 (1.12-1.44), 1.26 (1.09-1.46), 1.34 (1.14-1.57), and 1.28 (1.05-1.56) respectively. Environmental tobacco smoke (ETS) including both parental and grandparental smoking were significantly related with increased risk of pre-schooler's pneumonia, and ETS played a more important role in early life, with ORs (95% CI) of 1.17 (1.01-1.36) and 1.19 (1.02-1.39) in pregnancy and first year. Indoor plants particularly nonflowering plants significantly elevated pneumonia risk but only in past year, with ORs (95% CI) of 1.17 (1.05-1.30) and 1.14 (1.03-1.26). Higher pneumonia risk was observed for renovation exposure in pre-birth compared to post-birth, while mold/dampness exerted an accumulative effect with the highest risk for exposure during both pre- and post-birth. Living near traffic road and exposure to high level of traffic-related air pollution and high temperature significantly increased pneumonia risk. Sensitivity analysis found that some sub-groups were more susceptible to pneumonia risk of home environment exposure.

CONCLUSION

Early life exposure to indoor environmental factors plays an important role in pneumonia development, supporting the hypothesis of "Preconceptional and Fetal Origin of Childhood Pneumonia" and "Developmental Origins of Health and Pneumonia".

Child Tobacco Smoke Exposure, Indoor Home Characteristics, and Housing Stability among a National Sample of U.S. Children

(1) Objectives: To examine the associations of child tobacco smoke exposure (TSE) with home quality and housing instability. (2) Methods. A secondary analysis of 32,066 U.S. 0-11-year-old children from the 2018-2019 National Survey of Children's Health was conducted. Child home TSE status was defined as: no TSE: child lived with no smokers; thirdhand smoke (THS) exposure only: child lived with a smoker(s) who did not smoke indoors; and secondhand smoke (SHS) and THS exposure: child lived with a smoker(s) who smoked indoors. Home quality was assessed by the presence of mold or pesticide use and housing instability was assessed by home ownership, frequency of moves, and number of household members. We conducted weighted multivariable logistic regression and linear regression models while adjusting for important child covariates. (3) Results: In total, 12.3% had home THS exposure only and 1.6% had home SHS and THS exposure. Compared to children with no home TSE, children with home SHS and THS exposure were 2.60 times more likely (95%CI = 1.73, 3.92) to have mold inside their homes; 1.57 times more likely (95%CI = 1.09, 2.26) to live in homes where pesticides were used ≥1 time during the past 12-months; and more likely to have more frequent moves (β = 1.06, 95%CI = 0.62, 1.50). (4) Conclusions: Children with home TSE have higher rates of mold, pesticide use, frequent moves, and household members compared to children with no home TSE. Children with TSE should also be screened for home quality and housing instability and provided with appropriate interventions and resources.

Emissions of Fungal Volatile Organic Compounds in Residential Environments and Temporal Emission Patterns: Implications for Sampling Methods

Currently, little is known about the occurrences of fungi-derived microbial volatile organic compounds (mVOCs) in various indoor materials and their detection in residential environments, despite mVOCs being linked to several acute health effects. We identified various mVOCs emitted from fungi grown on PVC wallpaper, silicone rubber, and malt extract agar. We also investigated mVOCs temporal emission and whether fungi-derived VOCs concentration can be used to estimate fungal concentration in the air using active and passive air sampling methods. Among the three fungal growth media included in this study, silicone rubber produced the most variety of mVOCs: 106 compounds (from Aspergillus niger), 35 compounds (from Alternaria alternata), and 85 compounds (from Penicillium chrysogenum). We also found the emission patterns of eight chemical classes (i.e., aromatics, ethers, aliphatics, alcohols, ketones, aldehydes, chlorides, and nitrides) from the three different fungi. From the results of our field experiments in 11 residential environments, passive air samplers led to higher correlations coefficients (0.08 to 0.86) between mVOCs' air concentrations and airborne fungal concentrations, compared with active air samplers, which showed negative correlation coefficients (-0.99 to -0.02) for most compounds. This study elucidated the occurrence and temporal emission patterns of fungal VOCs in residential environments.

Early-life residential exposure to moisture damage is associated with persistent wheezing in a Finnish birth cohort

BACKGROUND AND AIMS

Moisture damage increases the risk for respiratory disorders in childhood. Our aim was to determine whether early age residential exposure to inspector-observed moisture damage or mold is associated with different wheezing phenotypes later in childhood.

METHODS

Building inspections were performed by civil engineers, in a standardized manner, in the children's homes-mostly single family and row houses (N = 344)-in the first year of life. The children were followed up with repeated questionnaires until the age of 6 years and wheezing phenotypes-never/infrequent, transient, intermediate, late onset, and persistent-were defined using latent class analyses. The multinomial logistic regression model was used for statistical analysis.

RESULTS

A total of 63% (n = 218) had infrequent or no wheeze, 23% (n = 80) had transient and 9.6% (n = 21) had a persistent wheeze. Due to the low prevalence, results for intermediate (3.8%, n = 13) and late-onset wheeze (3.5%, n = 12) were not further evaluated. Most consistent associations were observed with the persistent wheeze phenotype with an adjusted odds ratio (95% confidence intervals) 2.04 (0.67-6.18) for minor moisture damage with or without mold spots (present in 23.8% of homes) and 3.68 (1.04-13.05) for major damage or any moisture damage with visible mold in a child's main living areas (present in 13.4% of homes). Early-age moisture damage or mold in the kitchen was associated with transient wheezing.

CONCLUSION

At an early age, residential exposure to moisture damage or mold, can be dose-dependently associated especially with persistent wheezing phenotype later in childhood.