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Effects of air purifier on change of atopic dermatitis and indoor air quality
Abstract
High level of indoor air pollutant may cause aggravation of atopic diseases (AD) along with various allergic respiratory diseases especially to people who spend most of their lives indoors. The aim of this study is to evaluate the effect of air purifier on the reduction of relevant hazards in indoors and the improvement of AD. A total of 24 families, consisting of 18 AD families and 6 normal control families, were enrolled in this study. We examined air quality and AD severity before the installation of air purifiers and after twenty four weeks. The assessment of air quality includes particles (PM2.5 and PM10), gaseous contaminants (CO, CO2, VOCs, formaldehyde, NO2) and density of offloating microorganisms. Severity of AD was assessed by SCORing Atopic Dermatitis (SCORAD) index and transepidermal water loss (TEWL). At the end of study, particular air pollutants and VOCs of gaseous air pollutants decreased in both groups (p<0.01). In AD group, SCORAD index decreased from 23.45±4.34 to 15.42±6.53 (-18.5%) and TEWL decreased from 33.78±5.16 to 26.89±5.66 (-18.7%) (p<0.01, p<0.01, respectively). However, the value of total IgE and eosinophil did not show significant changes in both groups compared with baseline. These results suggested that air purifier may improve severity of AD by reducing air pollutants like fine particles and VOCs. Our preliminary study could provide a basis for using air purifer to prevent aggravation of AD.
Formaldehyde (FA) and other volatile organic compounds (VOCs) are considered among the main causes of atopic aggravation. Their main sources include wallpapers, paints, adhesives, and flooring materials.
To assess the effects of environmentally friendly wallpaper and flooring material on indoor air quality and atopic dermatitis severity.
Thirty patients with atopic dermatitis were enrolled in this study. To improve air quality, the wallpaper and flooring in the homes of the subjects were replaced with plant- or silica-based materials. The indoor air concentration of FA and the total VOCs (TVOCs) were measured before remodeling and 2, 6, and 10 weeks thereafter. Pruritus and the severity of atopic eczema were evaluated by using a questionnaire and the eczema area and severity index (EASI) score before and at 4, 8, and 12 weeks after remodeling. The subjects were instructed to continue their therapy for atopic dermatitis.
The houses of 24 subjects were remodeled; all subjects completed the study. The concentration of FA in ambient air significantly decreased within 2 weeks after remodeling. The TVOC level showed a decrease at week 2 but increased again at weeks 6 and 10. The reduction of pruritus and EASI score was statistically significant in patients whose baseline EASI score was >3.
Replacing the wallpaper and flooring of houses with environmentally friendly material reduced FA in ambient air and improved pruritus and the severity of atopic eczema. The improvement of pruritus and eczema was statistically significant in patients whose baseline EASI score was >3.
Atopic dermatitis (AD) is one of the most common chronic childhood skin diseases affecting up to 17% of children in the United States. The point prevalence of AD has increased based on validated questionnaires in the most recent update of the International Study of Asthma and Allergies in Childhood. However, the increases are primarily in developing countries, whereas the rates have stabilized in countries with higher incomes. AD starts in early childhood with 65% of children affected by 18 months of age. Furthermore, less than half of the patients with AD have complete resolution by 7 years of age and only 60% have resolution by adulthood, indicating the chronic nature of AD. AD is a major risk factor for the development of asthma, with an increased odds ratio in children with AD in several longitudinal studies compared with children without AD, and about 30% of patients with AD develop asthma. Patients with atopic sensitization along with eczema are at a higher risk for progressing in the atopic march to asthma. The main risk factors for progression and persistence of asthma are early onset and severity of AD.
Some studies have suggested that the prevalence of atopic eczema may vary between geographical regions. This descriptive study investigates the regional and subregional geography of reported and examined eczema prevalence at the age of 7, 11 and 16 years in Britain using data from the 1958 birth cohort study (n = 828). Estimates of the relative risk of reported eczema associated with residence in each region of the country were calculated and the regional distribution of reported and examined eczema prevalence was compared. The reported prevalence of eczema was mapped at the smaller county level. Comparisons were made with the county-level distribution of asthma and hay fever prevalence. The study showed a marked and statistically significant variation in eczema prevalence across the regions in Britain which was present for examined as well as reported eczema. The highest risk was associated with four regions: North Midlands; Eastern; London and the South-East; and Southern. This regional pattern was not altered significantly after adjustment for social class and family size. The geographical distribution of eczema prevalence was largely maintained when analysed at the county level. Few similarities were found between the county-level distribution of eczema prevalence and that for asthma and hay fever. Explanations for this strong regional variation now need to be sought in terms of environmental and life-style associations.
Indoor allergens represent an important precipitating factor for both asthma and atopic eczema dermatitis syndromes (AEDS). There is also accumulating evidence that sensitization to those allergens is associated with the onset of atopic disorders. Patients with AEDS present aeroallergen-specific T-cell responses associated with worsening of symptoms when exposed to specific aeroallergens. Furthermore, application of indoor allergens to the skin of patient with AEDS induces a local eczematous response in one-third of these patients. Exposure to high concentrations of mite allergens in early infancy have been demonstrated to be a risk factor for developing atopic dermatitis during the first 3 years of life. Moreover, a clear dose-response relationship has been documented between mite exposure and disease activity. Primary prevention of AEDS by avoiding indoor allergen exposure has been proved to be effective only when allergenic foods have also been avoided. Mite allergen avoidance in infants with AEDS and food allergy may however, prevent mite sensitization and the onset of asthma. Indoor allergen avoidance has been demonstrated to be effective in the majority of studies performed in patients with established AEDS. Negative results may be explained either by individual susceptibility variation, by long duration of disease with the consequent irreversible pathological changes in the target tissue or by exposure to allergens outside the house. Education of the patients and public consciousness of the problems are crucial for the efficacy of indoor allergen avoidance in allergic diseases.