Article

The role of the indoor environment: Residential determinants of allergy, asthma and pulmonary function in children from a US-Mexico border community

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Abstract

The El Paso Children's Health Study examined environmental risk factors for allergy and asthma among fourth and fifth grade schoolchildren living in a major United States-Mexico border city. Complete questionnaire information was available for 5210 children, while adequate pulmonary function data were available for a subset of 1874. Herein we studied indoor environmental health risk factors for allergy and asthma. Several indoor environmental risk factors were associated with allergy and asthma. In particular, we found that ant and spider pest problems, pet dogs, fireplace heat, central air conditioning, humidifier use, and cooking with gas stoves were positively associated with both allergy and asthma prevalence. With regards to asthma severity, our analysis indicated that exposure to pet dogs increased monotonically with increasing asthma severity while the lack of any heat source and gas stove use for cooking decreased monotonically with increasing asthma severity. Lung function also decreased among children who lived in homes with reported cockroach pest problem in the past year without concurrent use of pesticides. These effects on pulmonary function were present even after excluding children with a current physician's diagnosis of asthma. Clinicians and public health professionals may need to look closely at the contribution of these indoor risk factors on pulmonary health and quality of life among susceptible populations.

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... Raw RRs were also calculated for 4 studies from the distribution of the exposed/not exposed and cases and non-cases (Daigler et al., 1991;Honicky et al., 1985;Levesque et al., 2001;Svendsen et al., 2018). We did not distinguish between studies reporting incidence or prevalence, as this information was missing in almost all studies. ...
... Asthma. The pooled RR, from random-effects meta-analytical models, for the risk of asthma for subjects exposed versus those not exposed to indoor wood burning was 0.90 (95% CI 0.77, 1.05), based on 13 studies (Daigler et al., 1991;Svendsen et al., 2018;Dekker et al., 1991;Infante-Rivard, 1993;Maier et al., 1997;Martel et al., 2009;McConnell et al., 2002;Nguyen et al., 2010;Spengler et al., 1994;Van Miert et al., n.d.;Volkmer et al., 1995;Ware et al., 2014;Zhou et al., 2013), with significant heterogeneity among the studies (Fig. 2). Influence analysis omitting one study in turn did not change the overall result (data not shown). ...
Article
Epidemiological studies have shown a positive association between exposure to outdoor and indoor solid fuel combustion and adverse health effects. We reviewed the epidemiological evidence from Europe, North America, Australia and New Zealand on the association between outdoor and indoor exposure to solid fuel combustion and respiratory outcomes in children. We performed a systematic review and meta-analysis. Pooled relative risks (RRs) and 95% confidence intervals (CI) were calculated using random-effects models. We identified 74 articles. Due to limited evidence on other exposures and outcomes, we performed meta-analyses on the association between indoor wood burning exposure and respiratory outcomes. The RR for the highest vs the lowest category of indoor wood exposure was 0.90 (95% CI 0.77–1.05) considering asthma as an outcome. The corresponding pooled RRs for lower respiratory infection (LRI) and upper respiratory infection (URI) were 1.11 (95% CI 0.88, 1.41) and 1.11 (95% CI 0.85, 1.44) respectively. No association was found between indoor wood burning exposure and risk of wheeze and cough. Inconsistent and limited results were found considering the relationship between indoor wood burning exposure and other respiratory outcomes (rhinitis and hay fever, influenza) as well as indoor coal burning exposure and respiratory outcomes in children. Results from epidemiological studies that evaluated the relationship between the exposure to outdoor emissions derived from indoor combustion of solid fuels are too limited to allow firm conclusions. We found no association between indoor wood burning exposure and risk of asthma. A slight, but not significant, increased risk of LRI and URI was identified, although the available evidence is limited. Epidemiological studies evaluating the relationship between indoor coal burning exposure and respiratory outcomes, as well as, studies considering exposure to outdoor solid fuels, are too limited to draw any firm conclusions.
... e IAQ is influenced by a mixture of pollutants from indoor (i.e., cooking, airborne suspended particles, and smoking) and outdoor (i.e., vehicular traffic and industrial) activities, as well as the building-related factors (ventilation and emissions from building materials) [3]. Biological particles, such as bacteria, fungi, and pollen, and cockroach allergens, are also associated with causing asthma or exacerbating the condition [3,[6][7][8]. Chemicals affecting IAQ contain carbon monoxide (CO), ozone (O 3 ), radon, volatile organic compounds (VOCs), and ultrafine particulate matter (PM 2.5 ). Among them, exposure to PM 2.5 has become a major concern in public health. ...
... e most significant PM 2.5 mean difference between pre-and postintervention among 13 participants was in the bedroom (-2.13 μg/m 3 ), where the air purifier was installed and children spent the longest time at home. e mean PM 2.5 levels in HHs 4,6,8,9,12, and 13 showed consistently significant improvements in all locations within the house. e PM 2.5 levels in HHs 2 and 3 were shown to decrease significantly only in the kitchen. ...
Article
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Few studies have investigated household interventions to enhance indoor air quality (IAQ) and health outcomes in relatively low-income communities. This study aims to examine the impact of the combined intervention with asthma education and air purifier on IAQ and health outcomes in the US-Mexico border area. An intervention study conducted in McAllen, Texas, between June and November 2019 included 16 households having children with asthma. The particulate matter (PM2.5) levels were monitored in the bedroom, kitchen, and living room to measure the IAQ for 7 days before and after the intervention, respectively. Multiple surveys were applied to evaluate changes in children's health outcomes. The mean PM2.5 levels in each place were significantly improved. Overall, they significantly decreased by 1.91 μg/m3 on average (p
... • Indoor environment: Several indoor environmental risk factors were linked to allergies and asthma. Clinicians and public health workers may need to focus on indoor health risks [68]. • Geographic history: A correlation between urban/rural status and the prevalence of food allergies was identified in [16], therefore gathering history of residency may be important for determining and predicting allergies. ...
Chapter
Allergy is an immune system reaction to foreign materials. Some reactions would occur after an allergen is injected, touched, inhaled, or eaten. Allergic responses influence the human quality of life by affecting nose, ears, eyes, and throat. Allergies are increasing public health concerns and healthcare costs. To reduce these threats, The Internet of Things (IoT) and Artificial Intelligence (AI) have substantially improved allergy risk prediction. While these technologies can anticipate some allergies, Digital Twins (DT) help diagnose, predict, model, and treat allergies more precisely. To the best of our knowledge, there is no study on DT in allergies. In this chapter, we adapt the general allergy ecosystem based on [11] and extract substantial components of DT for allergy diseases. To demonstrate the concept's potential, anaphylaxis shocks are examined as a case study. It attempts to harness DT in the detection, forecasting, diagnosis, and treatment of Anaphylaxis shocks by simulating the broad range of organs in people at high risk for these shocks.
... 68,70,71 This study highlighted the importance of unique exposures in home environments in urban children with asthma and stemmed a line of investigation in this area, confirming the importance of sensitization and exposure to cockroach in contributing to more hospitalizations and unscheduled medical visits for asthma 72 and decline in lung function. 73 Of importance, sensitization to cockroach has been reported in as high as 60-80% of asthmatic children living in urban areas, while respective rates in suburban population was 21%. 70,74 Nevertheless, data from certain populations challenge the importance of sensitization/exposure to cockroach as opposed to mouse allergen. ...
Article
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Allergen exposure may exacerbate asthma symptoms in sensitized patients. Allergen reduction or avoidance measures have been widely utilized; however, there is ongoing controversy on the effectiveness of specific allergen control measures in the management of children with asthma. Often, allergen avoidance strategies are not recommended by guidelines because they can be complex or burdensome, although individual patients may benefit. Here we explore the potential for intervention against exposure to the major allergens implicated in asthma (ie, house dust mites, indoor molds, rodents, cockroaches, furry pets, and outdoor molds and pollens), and subsequent effects on asthma symptoms. We critically assess the available evidence regarding the clinical benefits of specific environmental control measures for each allergen. Finally, we underscore the need for standardized and multifaceted approaches in research and real-life settings, which would result in the identification of more personalized and beneficial prevention strategies.
... Asthma is considered one of the most significant causes of mortality and morbidity, which is accompanied by an uncontrolled spasmatic narrowing of the bronchus and bronchioles as a result of bronchitis and bronchial myocytic contraction (1) . Allergy is considered an immune-mediated hypersensitivity reaction associated with expression of specific immunoglobulins mainly IgE caused by identification of antigens of specific allergen (2) . ...
Article
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Background: Bronchial asthma is one of the relevant diseases of the respiratory tract, the asthma is one of the forms of respiratory allergy. The change in environment and aeroallergens are the main etiology of asthma. Allergy of asthma is thought to affect the bronchial region of the respiratory airway. Objective: The current study aimed to compare the total IgE elevation and skin prick test (SPT) positivity to evaluate the IgE and SPT ability to assess the asthmatic severity. Subjects and Methods: This retrospective case study was carried out on 3450 cases at the outpatient clinic and Chest Department at Zagazig University and did skin prick test and IgE in authorized centers were collected from 2015-2019. The cases were already diagnosed asthmatic according to Global Initiative for Asthma (GINA) (9) guidelines and were divided according to severity into mild, moderate, and severe according to GINA guidelines. Results: IgE has been tested for different aeroallergens and has strong significant elevation with (P< 0.001) in Alternaria, cat hair, cotton, birch, and helminths aeroallergen. Most of the cases with elevated IgE had moderate asthma severity followed by mild severity cases then severe cases. Conclusion: Comparing the results of SPT and IgE, the SPT test is more accurate, reliable, and easy in detecting the aeroallergen sensitivity.
... Asthma is considered one of the most significant causes of mortality and morbidity, which is accompanied by an uncontrolled spasmatic narrowing of the bronchus and bronchioles as a result of bronchitis and bronchial myocytic contraction (1) . Allergy is considered an immune-mediated hypersensitivity reaction associated with expression of specific immunoglobulins mainly IgE caused by identification of antigens of specific allergen (2) . ...
... However, inadequate system installation and poorly maintained air ducts and filters diminish the air quality [15]. Biological particles such as bacteria, fungi, and viruses correlated with respiratory health conditions can float in the air and linger longer in poorly ventilated indoor spaces [16][17][18]. ...
Article
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Indoor air quality (IAQ) has a substantial impact on public health. Since the beginning of the COVID-19 pandemic, more employees have worked remotely from home to minimize in-person contacts. This pilot study aims to measure the difference in workplace IAQ before and during the pandemic and its impact on employees’ health. The levels of fine particulate matter (PM2.5) and total volatile organic chemicals (tVOC) were measured in the employees’ offices before the COVID-19 pandemic and at homes while working from home during the pandemic using Foobot air monitors. The frequencies of six sick building syndrome (SBS) symptoms were evaluated at each period of monitoring. The result showed PM2.5 levels in households while working from home were significantly higher than in offices while working at the office for all participants (p < 0.05). The PM2.5 levels in all households exceeded the health-based annual mean standard (12 µg/m3 ), whereas 90% of offices were in compliance. The tVOC levels were all below the standard (500 µg/m3 ). We also found a higher frequency of SBS symptoms were observed while working from home as the IAQ was worse at home. This study suggested that working from home might have a detrimental health impact due to poor IAQ and providing interventions to remote employees should be considered.
... However, inadequate system installation and poorly maintained air ducts and filters diminish the air quality [15]. Biological particles such as bacteria, fungi, and viruses correlated with respiratory health conditions can float in the air and linger longer in poorly ventilated indoor spaces [16][17][18]. ...
Article
Full-text available
Indoor air quality (IAQ) has a substantial impact on public health. Since the beginning of the COVID-19 pandemic, more employees have worked remotely from home to minimize in-person contacts. This pilot study aims to measure the difference in workplace IAQ before and during the pandemic and its impact on employees’ health. The levels of fine particulate matter (PM2.5) and total volatile organic chemicals (tVOC) were measured in the employees’ offices before the COVID-19 pandemic and at homes while working from home during the pandemic using Foobot air monitors. The frequencies of six sick building syndrome (SBS) symptoms were evaluated at each period of monitoring. The result showed PM2.5 levels in households while working from home were significantly higher than in offices while working at the office for all participants (p < 0.05). The PM2.5 levels in all households exceeded the health-based annual mean standard (12 µg/m3 ), whereas 90% of offices were in compliance. The tVOC levels were all below the standard (500 µg/m3 ). We also found a higher frequency of SBS symptoms were observed while working from home as the IAQ was worse at home. This study suggested that working from home might have a detrimental health impact due to poor IAQ and providing interventions to remote employees should be considered.
... Children's residence located close to cultivated land sprayed with pesticides was another risk factor in top five important predictors selected from the allergy-like symptoms in the RF model. Numerous studies have shown that exposure to some pesticide was associated with allergy-like symptoms (Buralli et al., 2020;Raherison et al., 2019;Svendsen et al., 2018). Moreover, a meta-analysis by Buralli et al. (2020), showed that 79% of previous studies included in their analysis, found a positive association between pesticide exposure and children's respiratory and allergic symptoms (Buralli et al., 2020). ...
Article
Background Few studies have simultaneously assessed the health impact of school and home environmental factors on children, since handling multiple highly correlated environmental variables is challenging. In this study, we examined indoor home and school environments in relation to health outcomes using machine learning methods and logistic regression. Methods We used the data collected by the SINPHONIE (Schools Indoor Pollution and Health: Observatory Network in Europe) project in Romania, a multicenter European research study that collected comprehensive information on school and home environments, health symptoms in children, smoking, and school policies. The health outcomes were categorized as: any health symptoms, asthma, allergy and flu-like symptoms. Both logistic regression and random forest (RF) methods were used to predict the four categories of health outcomes, and the methods prediction performance was compared. Results The RF method we employed for analysis showed that common risk factors for the investigated categories of health outcomes, included: environmental tobacco smoke (ETS), dampness in the indoor school environment, male gender, air freshener use, residence located in proximity of traffic (< 200 m), stressful schoolwork, and classroom noise (contributions ranged from 7.91% to 23.12%). Specificity, accuracy and area under the curve (AUC) values for most outcomes were higher when using RF compared to logistic regression, while sensitivity was similar in both methods. Conclusion: This study suggests that ETS, dampness in the indoor school environment, use of air fresheners, living in proximity to traffic (< 200 m) and noise are common environmental risk factors for the investigated health outcomes. RF pointed out better predictive values, sensitivity and accuracy compared to logistic regression.
... A study in inner-city children with asthma found that those sensitized and exposed to cockroach had significantly more hospitalizations and unscheduled medical visits for asthma [34]. A recent study found that cockroach exposure was significantly associated with decreased lung function [35]. ...
Article
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Purpose of review: Sensitization and exposure to triggers in the indoor environment, including aeroallergens, indoor air pollution, and environmental tobacco smoke, have a significant role in asthma development and morbidity. This review discusses indoor environmental exposures and their effect on children with asthma as well as environmental interventions and their role in improving asthma morbidity. Recent findings: Recent research has emphasized the role of aeroallergen sensitization and exposure in asthma morbidity and the importance of the school indoor environment. There is an established association between indoor exposures and asthma development and morbidity. Recent evidence has highlighted the importance of the indoor environment in childhood asthma, particularly the role of the school indoor environment. While home environmental interventions have had mixed results, interventions in the school environment have the potential to significantly impact the health of children, and ongoing research is needed to determine their effectiveness.
... House dust mites are animals of the araknoidea class (Leas et al., 2018;Rofieq, 2012). Stools and debris from house dust mites can cause allergy (Judarwanto, 2016;Svendsen, Gonzales, & Commodore, 2018). Home dust mite allergies can be reduced by environmental controls (Reisacher, 2011;Sativa, 2017) however, parents' knowledge of environmental control is considered to be lacking. ...
Article
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Introduction: Allergies can cause complications such as inadequate nutrition, impaired sleep quality, and inhibition of child growth and development. There were about 15% children who suffered from dust allergies in 2017 in Indonesia. Parents lacking of knowledge about environmental control can increase the prevalence of allergic relapse in children. Counselling is a method of health education that aims to improve knowledge, and practice. The purpose of this study was to investigate whether counselling has any influence on allergic related knowledge and environmental control measures skills. Methods: The design of study was a pre-experiment design. There were 14 respondents in this study who were recruited at a university hospital based on inclusion criteria with consecutive sampling. The independent variable was counselling, the dependent variable were knowledge and environmental control measures. Data were collected using both a questionnaire was developed from the AAAAI and a check list was used to determine parents' skills on environmental controls. Data were analysed using Wilcoxon Sign Rank Test with significance level of α
... Health has become a greater border concern as many U.S. residents come to Mexico to attain alcohol and drugs (Cherpitel et al. 2015). Pulmonary issues such as asthma and allergies have been investigated in El Paso regarding indoor residential environments (Svendsen et al. 2018). Similar investigations regarding hazardous air pollutants have also occurred in Hildago County, Texas . ...
Article
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This paper explores quality of life (QoL) in the US–Mexico Border region by revisiting The Border Observatory Project (BOP). The BOP collected and analyzed survey-response data derived from four pairs of border sister cities (Mexicali, Baja and Calexico, California; San Luis Rio Colorado, Sonora and San Luis/Somerton, Arizona; Juarez, Chihuahua and El Paso, Texas; Tijuana, Baja and San Diego, California) over time. This paper adds to the literature on QoL by identifying the social and QoL indicators particularly pertinent to U.S.–Mexico border cities and significant differences between cities. The BOP and recent literature on U.S.-Mexico border QoL and social indicators are described and leveraged to propose a border-rooted bi-national, multi-community, and multi-indicator social indicators framework for use in future QoL and social indicator studies regarding border cities. The commentary and proposed framework in this paper help inform future research, policy, and practice concerning residents and migrants found in border communities.
... The PM0.1 have the ability to enter the human respiratory system [19], [20]. PMs relates to a nasal cavity and lung problems such as influenza-like illness and asthma [21]- [23]. ...
... However, as emphasized earlier, indoor exposures have a strong plausibility in driving the human early life gut microbiome diversity. Indoor exposures characterized in the El Paso Children's Health Study enumerate many components of the built environment-pests, pets, cooking and heating gases-that strongly associate with allergy and asthma93 . The timing of exposure to various features of built environment also impacts allergic outcomes as seen in the Cohort for Childhood Origin of Asthma and Allergic Disease where Lee et al. (2018) identify prenatal, and not postnatal, mold abundances-not diversity-as predictors of atopic dermatitis 94 . ...
Article
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Imbalance, or dysbiosis, of the gut microbiome of infants has been linked to an increased risk of asthma and allergic diseases. Most studies to date have provided a wealth of data showing correlations between early‐life risk factors for disease and changes in the structure of the gut microbiome that disrupt normal immunoregulation. These studies have typically focused on one specific risk factor, such as mode of delivery or early‐life antibiotic use. Such ‘micro‐level’ exposures have a considerable impact on affected individuals but not necessarily the whole population. In this Review we place these mechanisms under a larger lens that takes into account the influence of upstream ‘macro‐level’ environmental factors such as air pollution and the built environment. While these exposures likely have a smaller impact on the microbiome at an individual level, their ubiquitous nature confers them with a large influence at the population level. We focus on features of the indoor and outdoor human‐made environment, their microbiomes and the research challenges inherent in integrating the built environment microbiomes with the early‐life gut microbiome. We argue that an exposome perspective integrating internal and external microbiomes with macro‐level environmental factors can provide a more comprehensive framework to define how environmental exposures can shape the gut microbiome and influence the development of allergic disease. This article is protected by copyright. All rights reserved.
... Estimations state that the incidence of cockroach induced allergies ranges from 17-41% in the US population, including both children and adults, and mainly affects urban and low-income families. It was also observed that 85% of the homes in city centers contain cockroach allergens and 60-80% of the children with asthma who live in these centers are sensitized to these allergens (COHN, 2006;SVENDSEN, 2018). ...
... This results in substantial emissions, with high levels of indoor pollution. Biomass exposure to wood for cooking or heating the home thus poses a significant risk for current asthma, due to high level of respirable particulate matter, further confirming findings from other studies.22,[26][27][28][29][30] Many wood smoke constituents cause both acute and ...
Article
Background Asthma prevalence in African children is high. Factors driving the prevalence or disease severity are poorly understood. This study aims to investigate environmental factors associated with asthma and severity in African children. Methods Population based cross‐sectional study of children aged 13–14 years from 10 African centers who participated in ISAAC III. Self‐reported environmental exposures included engaging in physical exercise, television watching, various biomass and ETS exposure, consumption of paracetamol, large family sizes and having pets in the home. Univariable and multivariable analyses were done adjusting for center variations. Prevalences, odds ratio and 95% confidence intervals (CI) were calculated. Results There were 258 267 children recruited among the 13‐14‐year‐old participants. Of these, 28,391 respondents from 232 schools completed both the written questionnaire (WQ) and environmental questionnaire (EQ). The prevalence of asthma and severe asthma were 12.8% (CI 12.4‐13.2), and 8.7% (CI 8.4‐8.0) respectively. Factors strongly associated with asthma were maternal smoking (OR = 1.41; 95%CI: 1.23‐1.64), open fire heating (OR = 1.28; 95%CI: 1.08‐1.51) electric heating (OR = 1.13; 95%CI: 1.01‐1.28), physical exercise (OR = 1.29; 95%CI: 1.11‐1.50), monthly paracetamol use (OR 1.23; 95%CI 1.13‐1.33), having an elder sibling (OR = 0.87; 95%CI 0.77‐0.98). Factors associated with severe asthma were maternal smoking (OR = 1.61; 95%CI: 1.38‐1.89), cat pet (OR = 1.14; 95%CI: 1.04‐1.25), frequent physical exercise (OR = 1.42; 95%CI: 1.23‐1.64) and monthly paracetamol use (OR = 1.20; 95%CI 1.07, 1.34). Conclusion Several environmental exposures were associated with asthma and severe disease.
... With their similarities in etiology, location, pathogenesis, and pathophysiology, both AR and allergy asthma should be treated together (6). Seasonal perennial allergens, such as grass, trees, pollen, house dust (HD), mold, and animal fur, can often cause allergic asthma in children (7,8). In allergic patients, respiratory allergies often lead to systemic allergies. ...
Article
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Objective: To explore the effects of Astragalus oral solution (AOS) on allergic asthma in children by investigating relative contents of CD4⁺CD25highCD127low Treg cells. Methods: The contents of Astragaloside A in AOS were detected by using HPLC. Eighty children with allergic asthma were recruited from February 2016 to June 2017, and randomly assigned into the control group (received placebo, 0.1% quinine chloride in deionized water, daily) and the AOS group (received 10 mL AOS daily). After 6-month treatment, therapeutic results were compared between the two groups. Serum levels of IL-10 and TGF-beta, Th1 cytokines (IL-2 and IFN-γ), and Th2 cytokines (IL-4 and IL-6) were measured by using ELISA kits. Relative contents of CD4⁺CD25highCD127low Treg cells were determined by using flow cytometry. Results: Astragaloside A was the main ingredient of AOS with 0.216 ± 0.027 mg/mL from six-batch samples. After 6-month therapy, the AOS group showed improved forced expiratory volume in 1 s (FEV1) and the Pediatric Asthma Quality of Life Questionnaire (PAQLQ) scores compared with the control group (P < 0.05). Serum level of IL-10 was higher and the levels of TGF-beta, Th1 cytokines (IL-2 and IFN-γ), and Th2 cytokines (IL-4 and IL-6) were lower in the AOS group than in the control group (P < 0.05). AOS treatment increased the percentage of gated CD4⁺ T cells, CD4⁺CD25⁺ T cells, CD4⁺CD25high Treg cells, CD4⁺CD25⁺FoxP3⁺ Treg cells and CD4⁺CD25highCD127low Treg cells when compared with the control group (P < 0.05). Conclusions: Astragaloside A was the main component of AOS, and AOS ameliorated allergic asthma in children by regulating relative contents of CD4⁺CD25highCD127low Treg cells.
Article
Objective: To investigate the indoor environmental risk factors to provide measures for the prevention and control of otitis in preschool children. Method: In this cross-sectional study, a questionnaire survey was administered to preschool children aged 2-7 years from 60 kindergartens in six districts of Urumqi City in August 2019. Multiple regression was run to predict influence factors for otitis media in preschool children. Result: A total of 8153 valid questionnaires were collected. After adjusting for age, the prevalence of otitis among preschool children in Urumqi was 13.1%. Multivariate logistic regression showed that previous antibiotic treatment, treatment with one to two antibiotics before 1 year of age, presence of walls with aqueous or latex paint, use of carpet floor bedding in rooms, newly decorated homes of mothers before pregnancy, purchase of new furniture for homes of children at 0-1 year of age, and presence of flowering plants in the residence of children at 0-1 years of age were all identified as risk factors for the development of otitis in children. Conclusion: Parents should also pay attention to indoor living environments, and reduce indoor renovation in the homes of children during their growth and development, which can positively improve children's indoor living environment, thus effectively preventing otitis in preschool children.
Article
Background There is rapidly growing evidence indicating that extreme temperature is a crucial trigger and potential activator of asthma; however, the effects of extreme temperature on asthma are inconsistently reported and the its potential mechanisms remain undefined. Objectives This review aims to estimate the impacts of extreme heat, extreme cold, and temperature variations on asthma by systematically summarizing the existing studies from epidemiological evidence to biological plausibility. Methods We conducted a systematic search in PubMed, Embase, and Web of Science from inception to June 30, 2022, and we retrieved articles of epidemiology and biological studies which assessed associations between extreme temperatures and asthma. This protocol was registered with PROSPERO (CRD42021273613). Results From 12,435 identified records, 111 eligible studies were included in the qualitative synthesis, and 37 articles were included in the meta-analysis (20 for extreme heat, 16 for extreme cold, and 15 for temperature variations). For epidemiological evidence, we found that the synergistic effects of extreme temperatures, indoor/outdoor environments, and individual vulnerabilities are important triggers for asthma attacks, especially when there is extreme heat or cold. Meta-analysis further confirmed the associations, and the pooled relative risks for asthma attacks in extreme heat and extreme cold were 1.05 (95%CI: 1.01–1.09) and 1.18 (95%CI: 1.10–1.26), respectively. Additionally, this review discussed the potential inflammatory mechanisms behind the associations between extreme temperatures and asthma exacerbation, and highlighted the regulatory role of immunological pathways and transient receptor potential ion channels in asthma triggered by extreme temperatures. Conclusions We concluded that both extreme heat and cold could significantly increase the risk of asthma. Additionally, we proposed a potential mechanistic framework, which is important for understanding the disease pathogenesis that uncovers the complex mechanisms of asthma triggered by extreme temperatures and protects the sensitive individuals from impacts of extreme weather events and climate change.
Article
Exposure and sensitization to environmental factors play a fundamental role in asthma development and is strongly associated with asthma morbidity. While hereditary factors are critical determinants of asthma, exposures to environmental factors are implicated in the phenotypic expression of asthma and have been strongly associated in the risk of its development. Significant interest has thus been geared toward potentially modifiable environmental exposures which may lead to the development of asthma. Allergen exposure, in particular indoor allergens, plays a significant role in the pathogenesis of asthma, and remediation is a primary component of asthma management. In the home, multifaceted and multitargeted environmental control strategies have been shown to reduce home exposures and improve asthma outcomes. In addition to the home environment, assessment of the school, daycare, and workplace environments of patients with asthma is necessary to ensure appropriate environmental control measures in conjunction with medical care. This article will discuss the role of the environment on asthma, review targeted environmental therapy, and examine environmental control measures to suppress environmental exposures in the home and school setting.
Article
Objective: In recent decades, many indoor allergens have been identified, including dust mite, cat, dog, mouse, cockroach and indoor molds, which have important health effects particularly in sensitized asthmatics. This review aims to update our understanding regarding the extent of these exposures in the indoor environment, review strategies for reducing their levels in the environment, and highlight innovative recent trials targeting these exposures and their impact on pediatric asthma morbidity. Data Sources: Recent practice parameter updates on indoor allergen exposures, seminal studies, and recent peer-reviewed journal articles are referenced. Study Selections: This review cites recent cohort studies of well-characterized pediatric asthmatic patients as well as innovative randomized controlled trials evaluating exposure to environmental allergens, interventions to limit these exposures, and their outcomes. Results: Links between indoor aeroallergen exposures and health outcomes have been well established. However, only some allergen reduction interventions have been successful in improving health outcomes. Conclusion: There are many complicating factors involved in allergic exposures and health outcomes. The interplay between patient genetic factors, indoor allergic triggers, airborne irritants/pollutants and microbial exposures complicate the study of indoor allergen exposures and their impact on asthma morbidity.
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Background: Asthma is a chronic inflammatory disorder characterized by airway obstruction and hyper-responsiveness. Studies suggest that household fuel exposure and housing characteristics are associated with air way related allergy. But there remains to be a considerable uncertainty about whether that reflects an association with asthma. This study endeavored to bridge the gap by identifying factors associated with asthma, with special reference to household fuel exposure and housing characteristics in selected public hospitals in Addis Ababa, Ethiopia. Methods: We conducted a hospital-based matched case-control study. A total of 483 study participants were selected from two Ethiopian referral hospitals using a sequential sampling technique, with 161 cases and 322 controls. Standard questionnaire from the European Community Respiratory Health Survey II (ECRHS II) and the American Thoracic Society Division of Lung Disease (ATS-DLD-78) were used to collect household related data. Conditional logistic regression model was applied to identify the determinants of asthma. Both crude and adjusted odds ratios with 95% confidence interval (CI) were used to identify predictors of asthma. Results: The response rate for both cases and controls was 99.17%. The odds of developing asthma was about four times higher among those who used agricultural residues for cooking (AOR: 3.81, 95% CI: 1.05, 13.79)., about five times higher among those who used wood for cooking (AOR: 4.95, 95% CI: 2.1, 11.69), nearly five times higher among those who had family history of asthma (AOR: 4.72, 95% CI: 1.54, 14.45), just over six times higher among those who smoke tobacco (AOR: 6.16, 95% CI: 1.31, 29.09) and over ten times higher among those who do not practice door opening, while cooking (AOR: 10.25, 95% CI: 3.97, 26.49). Conclusion: Family history of asthma, tobacco smoking, use of solid fuels including, woods and agricultural residues were associated with development of asthma. To reduce the risk of asthma, people should practice door opening, while cooking, and must avoid using wood and agricultural residues for cooking and should also refrain from tobacco smoking.
Article
Objectives Few studies have comprehensively assessed multiple environmental exposures affecting children's health. This study applied machine-learning methods to evaluate how indoor environmental conditions at home and school contribute to asthma and allergy-related symptoms. Methods We randomly selected 10 public schools representing different socioeconomic status in New York State (2017–2019) and distributed questionnaires to students to collect health status and home-and school-environmental exposures. Indoor air quality was measured at school, and ambient particle exposures (PM2.5 and components) were measured using real-time personal monitors for 48 h. We used random forest model for identifying most important risk factors for asthma and allergy-related symptoms, and decision tree for visualizing the inter-relationships among the multiple risk factors with the health outcomes. Results The top contributing factors identified for asthma were family rhinitis history (relative importance: 10.40%), plant pollen trigger (5.48%); bedroom carpet (3.58%); environmental tobacco smoke (ETS) trigger symptom (2.98%); and ETS exposure (2.56%). For allergy-related symptoms, plant pollen trigger (10.88%), higher paternal education (7.33%), bedroom carpet (5.28%), family rhinitis history (4.78%), and higher maternal education (4.25%) were the strongest contributing factors. Conversely, primary heating with hot water radiator was negatively (−6.86%) associated with asthma symptoms. Younger children (<9 years old) with family history rhinitis and having carpet in bedroom, were the prominent combined risk factors for asthma. Children jointly exposed to pollen, solvents, and carpeting in their home tended to have greater risks of allergy-related symptoms, even without family history of rhinitis. Conclusion Family rhinitis history, bedroom carpet, and pollen triggers were the most important risk factors for both asthma and allergy-related symptoms. Our new findings included that hot-water radiator was related to reduced asthma symptoms, and the combination of young age, rhinitis history, and bedroom carpeting was related to increased asthma symptoms. Further studies are needed to confirm our findings.
Article
The question addressed by the study: Are long-term Household Air Pollutions (HAPs) associated with asthma and lung function decline in middle-aged adults, and whether these associations were modified by GST gene variants, ventilation and atopy. Materials and methods: Prospective data on HAPs (heating, cooking, mould, smoking) and asthma were collected in the Tasmanian Longitudinal Health Study (TAHS) at mean ages 43 and 53 years (n=3314). Subsamples had data on lung function (n=897) and GST gene polymorphisms (n=928). Latent class analysis was used to characterise longitudinal patterns of exposure. Regression models assessed associations and interactions. Results: We identified seven longitudinal HAP profiles. Of these, 3 were associated with persistent asthma, greater lung function decline and %reversibility by age 53 years, compared to "least exposed" profile, for who used reverse cycle air conditioning, electric cooking and without smoking. "All gas"(OR:2.64, 95%CI 1.22-5.70), "wood heating/smoking" (2.71, 1.21-6.05) and "wood heating/gas cooking" (2.60, 1.11-6.11) were associated with persistent asthma, greater lung function decline and %reversibility. Participants with GSTP1 Ile/Ile genotypes were at a higher risk of asthma or greater lung function decline when exposed compared to other genotypes. Exhaust fan use and opening windows frequently could reduce the adverse effects of HAP produced by combustion heating and cooking on current asthma presumably through increasing ventilation. Answer to the question: Exposures to wood heating, gas cooking and heating, and tobacco smoke over 10 years increased the risks of persistent asthma, lung function decline and %reversibility, with evidence of interaction by GST genes and ventilation.
Article
Background: Previous studies have suggested that exposures to indoor air-polluting factors during pregnancy and early life can influence childhood allergy development. These exposures have been investigated in singularity, however the effect of simultaneous exposure to multiple factors remains unclear. Objective: We aimed to evaluate the effect of prenatal and early life exposure to 7 air-polluting factors on allergic sensitization at 2 years of age. Methods: Mother-child pairs (n=108) enrolled in the Kingston Allergy Birth Cohort (KABC) were followed from birth to 2 years of age. Exposure to air fresheners, candles, mould, cats, dogs, carpet and environmental tobacco smoke (ETS) during the prenatal, 6 month, 1 year, and 2 year timepoints were obtained. A skin prick test (SPT) was performed on both the mother and the 2 year old child. Results: Exposure to candles during the prenatal window, cats during the 6 month window, and ETS at 2 years significantly increased the odds ratio (OR) of a positive SPT (candles OR 5.096 1.69-13.86, p=0.006; cat OR 4.267 1.096-15.68, p=0.048; and ETS OR 3.78 1.189-11.18, p=0.04). Children with a positive SPT had significantly more exposures than SPT negative children (prenatal p=0.005, 1 year p=0.03, and 2 year p=0.008). As total number of exposures increased the percentage of SPT positive children increased (prenatal p=0.005, 1 year p=0.031, 2 year p=0.013). Conclusion: We have provided evidence supporting the role of the indoor environment on atopic disease development. The combined effect of multiple exposures may be more influential to allergy development than one single exposure.
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This article examines the lived experiences of 17 renters residing in Clark County, Nevada. Using a phenomenological study design, we used semistructured interviews to investigate how renters navigate living in substandard housing. The qualitative analysis revealed four main themes: (a) housing serves as a mediator with one's sense of well-being and good health, (b) housing insecurity and displacement occur through various pathways, (c) housing quality can lead to a sense of powerlessness over where one lives, and (d) social networks are key in low-opportunity neighborhoods. The findings support numerous studies that connect housing quality and insecurity to health and well-being, but the findings also highlight the mediating factors to limited housing choices such as the landlord and tenant relationship. Studies of this nature are essential in identifying the various pathways by which housing inequities and disparities can occur, particularly among low-income communities.
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The living lab approach to building science research provides the ability to accurately monitor occupants and their environment and use the resulting data to evaluate the impact that various components of the built environment have on human comfort, health, and well-being. A hypothesized benefit of the living lab approach is the ability to simulate the real indoor environment in an experimentally controlled setting over relatively long periods of time, overcoming a significant hurdle encountered in many chamber-type experimental designs that rarely reflect typical indoor environments. Here, we present indoor environmental quality measurements from a network of sensors as well as building system design and operational data demonstrating the ability of a living lab to realistically simulate a wide range of environmental conditions in an office setting by varying air temperature, lighting, façade control, and sound masking in a series of three human subject experiments. The temporal variability of thermal and lighting conditions was assessed on an hourly basis and demonstrated the significant impact of façade design and control on desk-level measurements of both factors. Additional factors, such as desk layout and building system design (e.g., luminaires, speaker system), also contributed significantly to spatial variability in air temperature, lighting, and sound masking exposures, and this variability was reduced in latter experiments by optimizing desk layout and building system design. While ecologically valid experimental conditions are possible with a living lab, a compromise between realism and consistency in participant experience must often be found by, for example, using an atypical desk layout to reduce spatial variability in natural light exposure. Based on the experiences from these three studies, experimental design and environmental monitoring considerations for future office-based living lab experiments are explored.
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Context: Despite considerable evidence that the economic and other benefits of asthma home visits far exceed their cost, few health care payers reimburse or provide coverage for these services. Objective: To evaluate the cost and savings of the asthma intervention of a state-funded healthy homes program. Design: Pre- versus postintervention comparisons of asthma outcomes for visits conducted during 2008-2012. Setting: The New York State Healthy Neighborhoods Program operates in select communities with a higher burden of housing-related illness and associated risk factors. Participants: One thousand households with 550 children and 731 adults with active asthma; 791 households with 448 children and 551 adults with asthma events in the previous year. Intervention: The program provides home environmental assessments and low-cost interventions to address asthma trigger-promoting conditions and asthma self-management. Conditions are reassessed 3 to 6 months after the initial visit. Main outcome measures: Program costs and estimated benefits from changes in asthma medication use, visits to the doctor for asthma, emergency department visits, and hospitalizations over a 12-month follow-up period. Results: For the asthma event group, the per person savings for all medical encounters and medications filled was $1083 per in-home asthma visit, and the average cost of the visit was $302, for a benefit to program cost ratio of 3.58 and net benefit of $781 per asthma visit. For the active asthma group, per person savings was $613 per asthma visit, with a benefit to program cost ratio of 2.03 and net benefit of $311. Conclusion: Low-intensity, home-based, environmental interventions for people with asthma decrease the cost of health care utilization. Greater reductions are realized when services are targeted toward people with more poorly controlled asthma. While low-intensity approaches may produce more modest benefits, they may also be more feasible to implement on a large scale. Health care payers, and public payers in particular, should consider expanding coverage, at least for patients with poorly controlled asthma or who may be at risk for poor asthma control, to include services that address triggers in the home environment.
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Severe exacerbations negatively impact the quality of life and education of children with asthma, while also causing substantial healthcare costs. Preventing severe asthma exacerbations requires identifying patients at high risk, in order to develop personalized care protocols to prevent such exacerbations. In this review, we assess and discuss recently published data on risk factors and predictive tools for severe asthma exacerbations in childhood. Although few genome-wide association studies have focused on severe asthma exacerbations, one such study recently identified cadherin-related family member 3 (CDHR3, implicated on integrity of the airway epithelium), as a susceptibility gene for recurrent severe asthma exacerbations in young children. Viral infections cause the majority of severe asthma exacerbations in childhood, with particularly detrimental effects in atopic subjects. Other known or potential risk factors for severe asthma exacerbations include second-hand tobacco smoke (SHS), allergens, air pollution, obesity, vitamin D insufficiency, chronic psychosocial stress, and non-adherence to prescribed treatment. In spite of progress in our understanding of the pathophysiology of asthma, we lack reliable instruments or biomarkers to predict severe asthma exacerbations. To date, having had a recent severe asthma exacerbation remains the single best predictor of subsequent exacerbations in children, suggesting individual susceptibility. Thus, children who had a recent severe asthma exacerbation should be closely monitored, particularly before viral infections are likely to occur (as when school begins), so that their controller medications can be adjusted according to their asthma control. Moreover, SHS avoidance and adherence to controllers such as ICS deserve particular emphasis on high-risk children.
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Background: Growing evidence suggests that pesticide use may contribute to respiratory symptoms. Objective: To evaluate the association of currently used pesticides with allergic and non-allergic wheeze among male farmers. Methods: Using the 2005-2010 interview data of the Agricultural Health Study, a prospective study of farmers in North Carolina and Iowa, we evaluated the association between allergic and non-allergic wheeze and self-reported use of 78 specific pesticides, reported by ≥ 1% of the 22,134 men interviewed. We used polytomous regression models adjusted for age, BMI, state, smoking, and current asthma, as well as for days applying pesticides and days driving diesel tractors. We defined allergic wheeze as reporting both wheeze and doctor-diagnosed hay fever (n=1,310, 6%) and non-allergic wheeze as reporting wheeze but not hay fever (n=3,939, 18%); men without wheeze were the referent. Results: In models evaluating current use of specific pesticides, 19 pesticides were significantly associated (p<0.05) with allergic wheeze (18 positive, 1 negative) and 21 pesticides with non-allergic wheeze (19 positive, 2 negative); 11 pesticides with both. Seven pesticides (herbicides: 2,4-D and simazine; insecticides: carbaryl, dimethoate, disulfoton, and zeta-cypermethrin; and fungicide pyraclostrobin) had significantly different associations for allergic and non-allergic wheeze. In exposure-response models with up to five exposure categories, we saw evidence of an exposure-response relationship for several pesticides including the commonly used herbicides 2,4-D and glyphosate, the insecticides permethrin and carbaryl and the rodenticide warfarin. Conclusions: These results for farmers implicate several pesticides that are commonly used in agricultural and residential settings with adverse respiratory effects.
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Background: Studies have revealed the efficacy of home-based environmental interventions on reduction of asthma symptoms as a strategy for managing asthma in children. A focus on education and behavior change alone is generally too limited to reduce exposure to asthma triggers that exist because of adverse housing conditions. Objective: To demonstrate that housing conditions as a focus of a health intervention should be considered more widely as an effective means of addressing serious health problems such as asthma. Methods: Residences of 41 families of children identified with some of the highest rates of asthma-related hospital visits were assessed for the presence of asthma triggers. Results: The intervention had a positive effect on lessening the effect of the child's asthma on the family's lives and activities. Reductions in frequency of negative effects of children's asthma on sleeping, job or work around the house, and family activity plans, fewer worries or concerns about children getting enough sleep and performing normal daily activities, and fewer adverse effects of children's asthma medications were reported. Reduced use of asthma medication, medication applications, and health visits were noted. Households with return visits had 50% lower hospital bills for childhood asthma treatment. Conclusion: Home environment conditions that lead to or exacerbate asthma may be reduced or eliminated by making minor repairs and introducing reasonable cleaning regimens that address sources of asthma triggers. This can produce greater awareness on the part of families about the presence of asthma triggers and motivate future action to address the conditions associated with these triggers.
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Asthma is the most commonly reported chronic condition of childhood in developed countries, with 6.5 million children affected in the USA. A disparate burden of childhood asthma is seen among socioeconomically disadvantaged youth, often concentrated in urban areas with high poverty rates. Host factors that predispose a child to asthma include atopy, male gender, parental history of asthma, and also race, ethnicity, and genetic and epigenetic susceptibilities. Environmental factors, such as improved hygiene, ambient air pollution, and early life exposures to microbes and aeroallergens, also influence the development of asthma. With greater than 90 % of time spent indoors, home exposures (such as cockroach, rodent, and indoor air pollution) are highly relevant for urban asthma. Morbidity reduction may require focused public health initiatives for environmental intervention in high priority risk groups and the addition of immune modulatory agents in children with poorly controlled disease.
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Concerns about energy consumption and climate change make residential evaporative coolers a popular alternative to central air conditioning in arid and semi-arid climates. However, evaporative coolers have been shown to significantly increase indoor relative humidity and dust mite allergen levels in some studies, while showing no association in other studies. Improved measurement of temporal fluctuations in indoor relative humidity may help identify factors that promote mite growth in homes in dry climates. Dust samples and continuous indoor relative humidity measurements were collected from homes with central air conditioning and homes with evaporative coolers in Utah. Samples were collected over two seasons, winter/spring (Jan-Apr) and summer (July-Sept), 2014. Dust samples were analyzed for Der p 1 and Der f 1 using a two-site monoclonal antibody-based enzyme-linked immunosorbent assay (ELISA) analysis. Housing characteristics including age of home, occupant density, and age of mattresses, furniture, and carpeting were also measured. Positive Der p 1 or Der f 1 samples were found in 25.0% of the homes and there was no difference in mean allergen levels by type of air conditioning. Indoor relative humidity was significantly higher in homes with evaporative coolers compared to those with central air conditioning during the summer. Homes with evaporative coolers also spent significantly more time during summer above 55.0% and 65.0% relative humidity compared to central air homes, but not above 75.0%. Findings from this study suggest that increased humidity from evaporative coolers may not be sufficient to exceed the critical equilibrium humidity or maintain humidity excursions for sufficient duration in relatively larger single-family homes in semi-arid climates to support mite growth and reproduction.
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Cockroach sensitization is an important risk factor for the development of asthma. However, its underlying immune mechanisms and the genetic etiology for differences in allergic responses remain unclear. Cockroach allergens identification and their expression as biologically active recombinant proteins has provided a basis for studying the mechanisms regarding cockroach allergens induced allergic sensitization and asthma. Glycans in allergens may play a crucial role in the immunogenicity of allergic diseases. Protease-activated receptor (PAR)-2, Toll-like receptor (TLR), and C-type lectin receptors have been suggested to be important for the penetration of cockroach allergens through epithelial cells to mediate allergen uptake, dendritic cell maturation, antigen presenting cell (APC) function in T cell polarization, and cytokine production. Environmental pollutants, which often co-exist with the allergen, could synergistically elicit allergic inflammation, and aryl hydrocarbon receptor (AhR) activation and signaling may serve as a link between these two elements. Genetic factors may also play an important role in conferring the susceptibility to cockroach sensitization. Several genes have been associated with cockroach sensitization and asthma-related phenotypes. In this review, we will discuss the epidemiological evidence for cockroach allergen-induced asthma, cockroach allergens, the mechanisms regarding cockroach allergens induced innate immune responses, and the genetic basis for cockroach sensitization. This article is protected by copyright. All rights reserved.
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Asthma is the most common chronic disease among children. It cannot be prevented but can be controlled. Industrialized countries experience high lifetime asthma prevalence that has increased over recent decades. Asthma has a complex interplay of genetic and environmental triggers. Studies have revealed complex interactions of lung structure and function genes with environmental exposures such as environmental tobacco smoke and vitamin D. Home environmental strategies can reduce asthma morbidity in children but should be tailored to specific allergens. Coupled with education and severity-specific asthma therapy, tailored interventions may be the most effective strategy to manage childhood asthma. Copyright © 2015 Elsevier Inc. All rights reserved.
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Background: Although pesticide use is widespread, the possible effect of early-life exposure to organophosphate (OP) on pediatric respiratory health is not well described. Objectives: We investigated the relationship between early-life exposure to OPs and respiratory outcomes. Methods: Participants included 359 mothers and children from the CHAMACOS birth cohort. Dialkyl phosphate (DAP) metabolites of OP pesticides, specifically diethyl (DE) and dimethyl (DM) phosphate metabolites, were measured in urine from mothers twice during pregnancy (mean = 13 and 26 weeks gestation) and from children five times during childhood (0.5–5 years). Childhood DAP concentrations were estimated by the area under curve (AUC). Mothers reported their child’s respiratory symptoms at 5 and 7 years of age. We used generalized estimating equations (GEE) to examine associations of prenatal and childhood DAP concentrations with repeated measures of respiratory symptoms and exercise-induced coughing at 5 and 7 years of age, adjusting for child’s sex and age, maternal smoking during pregnancy, secondhand tobacco smoke, season of birth, PM2.5, breastfeeding, mold and cockroaches in home, and distance from highway. Results: Higher prenatal DAP concentrations, particularly DE, were nonsignificantly associated with respiratory symptoms in the previous 12 months at 5 or 7 years of age [adjusted odds ratio (aOR) per 10-fold increase = 1.44; 95% CI: 0.98, 2.12]. This association was strongest with total DAP and DE from the second half of pregnancy (aOR per 10-fold increase = 1.77; 95% CI: 1.06, 2.95; and 1.61; 95% CI: 1.08, 2.39, respectively). Childhood DAP, DE, and DM concentrations were associated with respiratory symptoms and exercise-induced coughing in the previous 12 months at 5 or 7 years of age (total DAPs: aOR per 10-fold increase = 2.53; 95% CI: 1.32, 4.86; and aOR = 5.40; 95% CI: 2.10, 13.91, respectively). Conclusions: Early-life exposure to OP pesticides was associated with respiratory symptoms consistent with possible asthma in childhood. Citation: Raanan R, Harley KG, Balmes JR, Bradman A, Lipsett M, Eskenazi B. 2015. Early-life exposure to organophosphate pesticides and pediatric respiratory symptoms in the CHAMACOS cohort. Environ Health Perspect 123:179–185; http://dx.doi.org/10.1289/ehp.1408235
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Chronic obstructive respiratory disorders such as asthma and chronic obstructive pulmonary disease often originate early in life. In addition to a genetic predisposition, prenatal and early-life environmental exposures have a persistent impact on respiratory health. Acting during a critical phase of lung development, these factors may change lung structure and metabolism, and may induce maladaptive responses to harmful agents, which will affect the whole lifespan. Some environmental factors, such as exposure to cigarette smoke, type of childbirth and diet, may be modifiable, but it is more difficult to influence other factors, such as preterm birth and early exposure to viruses or allergens. Here, we bring together recent literature to analyse the critical aspects involved in the early stages of lung development, going back to prenatal and perinatal events, and we discuss the mechanisms by which noxious factors encountered early on may have a lifelong impact on respiratory health. We briefly comment on the need for early disease biomarkers and on the possible role of “-omic” technologies in identifying risk profiles predictive of chronic respiratory conditions. Such profiles could guide the ideation of effective preventive strategies and/or targeted early lifestyle or therapeutic interventions.
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Background: Previous research has found relationships between specific indoor environmental exposures and exacerbation of asthma. Objectives: In this review we provide an updated summary of knowledge from the scientific literature on indoor exposures and exacerbation of asthma. Methods: Peer-reviewed articles published from 2000 to 2013 on indoor exposures and exacerbation of asthma were identified through PubMed, from reference lists, and from authors' files. Articles that focused on modifiable indoor exposures in relation to frequency or severity of exacerbation of asthma were selected for review. Research findings were reviewed and summarized with consideration of the strength of the evidence. Results: Sixty-nine eligible articles were included. Major changed conclusions include a causal relationship with exacerbation for indoor dampness or dampness-related agents (in children); associations with exacerbation for dampness or dampness-related agents (in adults), endotoxin, and environmental tobacco smoke (in preschool children); and limited or suggestive evidence for association with exacerbation for indoor culturable Penicillium or total fungi, nitrogen dioxide, rodents (nonoccupational), feather/down pillows (protective relative to synthetic bedding), and (regardless of specific sensitization) dust mite, cockroach, dog, and dampness-related agents. Discussion: This review, incorporating evidence reported since 2000, increases the strength of evidence linking many indoor factors to the exacerbation of asthma. Conclusions should be considered provisional until all available evidence is examined more thoroughly. Conclusion: Multiple indoor exposures, especially dampness-related agents, merit increased attention to prevent exacerbation of asthma, possibly even in nonsensitized individuals. Additional research to establish causality and evaluate interventions is needed for these and other indoor exposures.
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Gas stoves emit pollutants that are respiratory irritants. U.S. children under age 6 who live in homes where gas stoves are used for cooking or heating have an increased risk of asthma, wheeze and reduced lung function. Yet few studies have examined whether using ventilation when operating gas stoves is associated with a decrease in the prevalence of respiratory illnesses in this population. The Third National Health and Nutrition Examination Survey was used to identify U.S. children aged 2–16 years with information on respiratory outcomes (asthma, wheeze, and bronchitis) who lived in homes where gas stoves were used in the previous 12 months and whose parents provided information on ventilation. Logistic regression models evaluated the association between prevalent respiratory outcomes and ventilation in homes that used gas stoves for cooking and/or heating. Linear regression models assessed the association between spirometry measurements and ventilation use in children aged 8–16 years. The adjusted odds of asthma (Odds Ratio [OR] = 0.64; 95% confidence intervals [CI]: 0.43, 0.97), wheeze (OR = 0.60, 95% CI: 0.42, 0.86), and bronchitis (OR = 0.60, 95% CI: 0.37, 0.95) were lower among children whose parents reported using ventilation compared to children whose parents reported not using ventilation when operating gas stoves. One-second forced expiratory volume (FEV1) and FEV1/FVC ratio was also higher in girls who lived in households that used gas stoves with ventilation compared to households that used gas stoves without ventilation. In homes that used gas stoves, children whose parents reported using ventilation when operating their stove had higher lung function and lower odds of asthma, wheeze, and bronchitis compared to homes that never used ventilation or did not have ventilation available after adjusting for other risk factors. Additional research on the efficacy of ventilation as an intervention for ameliorating respiratory symptoms in children with asthma is warranted.
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Background: The prevalence of asthma has increased dramatically over the past several decades. While hereditary factors are highly important, the rapid rise outstrips the pace of genomic variation. Great emphasis has been placed on potential modifiable early life exposures leading to childhood asthma. Methods: We reviewed the recent medical literature for important studies discussing the role of the perinatal and early childhood exposures and the inception of childhood asthma. Results and discussion: Early life exposure to allergens (house dust mite (HDM), furred pets, cockroach, rodent and mold), air pollution (nitrogen dioxide (NO2), ozone (O3), volatile organic compounds (VOCs), and particulate matter (PM)) and viral respiratory tract infections (Respiratory syncytial virus (RSV) and human rhinovirus (hRV)) has been implicated in the development of asthma in high risk children. Conversely, exposure to microbial diversity in the perinatal period may diminish the development of atopy and asthma symptoms.
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There is evidence for adverse effects of outdoor air pollution on lung function of children. Quantitative summaries of the effects of air pollution on lung function, however, are lacking due to large differences among studies. To study the association between residential exposure to air pollution and lung function in five European birth cohorts with a standardized exposure assessment following a common protocol. As part of the European Study of Cohorts for Air Pollution Effects (ESCAPE) we analyzed data from birth cohort studies situated in Germany, Sweden, The Netherlands, and the United Kingdom that measured lung function at 6-8 years of age (N=5,921). Annual average exposure to air pollution [nitrogen oxides (NO2, NOx), mass concentrations of particulate matter with diameters < 2.5, < 10, and 2.5-10 µm (PM2.5, PM10, and PMcoarse), and PM2.5 absorbance] at the birth address and current address was estimated by land-use regression models. Associations of lung function with estimated air pollution levels and traffic indicators were estimated for each cohort using linear regression analysis, and then combined by random effects meta-analysis. Estimated levels of NO2, NOx, PM2.5 absorbance, and PM2.5 at the current address, but not at the birth address, were associated with small decreases in lung function. For example, changes in forced expiratory volume in 1 second (FEV1) ranged from -0.86% (95% CI: -1.48, -0.24%) for a 20-µg/m(3) increase in NOx, to -1.77% (95% CI: -3.34, -0.18%) for a 5-µg/m(3) increase in PM2.5. Exposure to air pollution may result in reduced lung function in school children.
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Background Bronchial asthma is one of the most prevalent diseases in Arab children. Environmental pollution has been suggested to be considered causative of asthma, nasal symptoms and bronchitis in both children and adult. The objectives of this study were to evaluate the association between serum polycyclic aromatic hydrocarbons (PAHs) levels, asthma and allergic outcomes among Saudi children aged up to 15 yrs. We hypothesized that increased serum PAHs are associated with allergy, asthma, or respiratory symptoms. Methods A total of 195 Saudi children (98 asthma pediatric patients and 97 healthy controls) were randomly selected from the Riyadh Cohort Study for inclusion. The diagnosis of Asthma was based on established pediatric diagnosis and medications taken. Results Asthma related markers showed highly significant differences between children with and without asthma. Thus IgE, resistin and IL-4 were significantly increased (p 0.004, 0.001 and 0.003, respectively) in children with asthma compared with non-asthma control subjects. GMCSF, IFN-γ, IL-5, IL-8 and IL-10, on the other hand, were significantly decreased in children with asthma (p 0.003, 0.03, 0.001, 0.004 and 0.03, respectively). Strong associations between serum PAHs levels and biomarkers of childhood asthma were detected in Arabic children. Data confirmed the role of naphthalene, 4H-cyclobenta[def]phenanthrene, 1,2-benzanthracene, chrysene and benzo(e)acephenanthrylene in childhood asthma; levels of these PAHs were correlated with asthma related biomarkers including IgE, resistin, GMCSF and IFN-γ as well as IL-4, IL-5, IL-8 and IL-10 cytokines. Conclusions This data highlight the pivotal role of specific PAHs in childhood asthma.
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Investigators examined 5,654 children enrolled in the El Paso, Texas, public school district by questionnaire in 2001. Exposure measurements were first collected in the late fall of 1999. School-level and residence-level exposures to traffic-related air pollutants were estimated using a land use regression model. For 1,529 children with spirometry, overall geographic information system (GIS)-modeled residential levels of traffic-related ambient air pollution (calibrated to a 10-ppb increment in nitrogen dioxide levels) were associated with a 2.4% decrement in forced vital capacity (95% confidence interval (CI): -4.0, -0.7) after adjustment for demographic, anthropomorphic, and socioeconomic factors and spirometer/technician effects. After adjustment for these potential covariates, overall GIS-modeled residential levels of traffic-related ambient air pollution (calibrated to a 10-ppb increment in nitrogen dioxide levels) were associated with pulmonary function levels below 85% of those predicted for both forced vital capacity (odds ratio (OR) = 3.10, 95% CI: 1.65, 5.78) and forced expiratory volume in 1 second (OR = 2.35, 95% CI: 1.38, 4.01). For children attending schools at elevations above 1,170 m, a 10-ppb increment in modeled nitrogen dioxide levels was associated with current asthma (OR = 1.56, 95% CI: 1.08, 2.50) after adjustment for demographic, socioeconomic, and parental factors and random school effects. These results are consistent with previous studies in Europe and California that found adverse health outcomes in children associated with modeled traffic-related air pollutants.
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Objective: To characterize the association between residential pesticide application and acute and chronic respiratory symptoms in children, focusing on the location of the pesticide application in and around the home and the type of pesticide applicator (professional vs nonprofessional). Methods: We used 1999 to 2004 National Health and Nutrition Examination Survey results to investigate this association in children younger than 18 years (N = 14,065). Results: Overall, pesticide use in the home was not associated with wheezing (odds ratio [OR], 1.15; 95% confidence interval [CI], 0.91 to 1.47). Nevertheless, pesticide use in the kitchen or dining rooms was significantly associated with increased odds of wheezing (OR, 1.39; 95% CI, 1.08 to 1.78) and dry cough (OR, 2.38; 95% CI, 1.40 to 4.06) after controlling for covariates. Conclusions: These findings suggest that residential use of pesticides and the location of pesticide application are associated with increased respiratory complaints in children.
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Associations between exposure to cats and dogs and respiratory and allergic outcomes in children have been reported in affluent countries, but little is known about such associations in less-affluent countries. The International Study of Asthma and Allergies in Childhood, phase 3 was carried out in children aged 6-7 years and adolescents aged 13-14 years across the world. Questions about cats and dogs in the home were included in an additional questionnaire. Using logistic regression, we investigated the association between such exposures and symptoms of asthma, rhinoconjunctivitis, and eczema. Adjustments were made for sex, region of the world, language, gross national income per capita, and 10 other covariates. Among children (6-7 years of age), cat exposure in the first year of life was associated with current symptoms of asthma, wheeze, rhinoconjunctivitis, and eczema, especially in less-affluent countries. Among adolescents (13-14 years of age), we found a positive association between exposure to cats or dogs and symptom prevalence in more-affluent and less-affluent countries. The global multivariate odds ratios for children with complete covariate data were 1.17 (95% confidence interval = 1.08-1.29) for current symptoms of asthma, 1.13 (1.05-1.23) for rhinoconjunctivitis, and 1.38 (1.26-1.52) for eczema. Smaller odds ratios were found for exposure to only dogs. Exposure to only cats was associated with eczema. Early-life exposure to cats is a risk factor for symptoms of asthma, rhinoconjunctivitis, and eczema in 6- to 7-year-old children, especially in less-affluent countries. Current exposure to cats and dogs combined, and only to dogs, is a risk factor for symptom reporting by 13- to 14-year-old adolescents worldwide.
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Endocrine disruptors are substances commonly encountered in every setting and condition in the modern world. It is virtually impossible to avoid the contact with these chemical compounds in our daily life. Molecules defined as endocrine disruptors constitute an extremely heterogeneous group and include synthetic chemicals used as industrial solvents/lubricants and their by-products. Natural chemicals found in human and animal food (phytoestrogens) also act as endocrine disruptors. Different from adults, children are not exposed only to chemical toxins in the environment but may also be exposed during their intrauterine life. Hundreds of toxic substances, which include neuro-immune and endocrine toxic chemical components that may influence the critical steps of hormonal, neurological and immunological development, may affect the fetus via the placental cord and these substances may be excreted in the meconium. Children and especially newborns are more sensitive to environmental toxins compared to adults. Metabolic pathways are immature, especially in the first months of life. The ability of the newborn to metabolize, detoxify and eliminate many toxins is different from that of the adults. Although exposures occur during fetal or neonatal period, their effects may sometimes be observed in later years. Further studies are needed to clarify the effects of these substances on the endocrine system and to provide evidence for preventive measures. Conflict of interest:None declared.
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The incidence of allergic respiratory diseases and bronchial asthma appears to be increasing worldwide, and people living in urban areas more frequently experience these conditions than those living in rural areas. One of the several causes of the rise in morbidity associated with allergic respiratory diseases is the increased presence of outdoor air pollutants resulting from more intense energy consumption and exhaust emissions from cars and other vehicles. Urban air pollution is now a serious public health hazard. Laboratory studies confirm epidemiologic evidence that air pollution adversely affects lung function in asthmatics. Damage to airway mucous membranes and impaired mucociliary clearance caused by air pollution may facilitate access of inhaled allergens to the cells of the immune system, thus promoting sensitization of the airway. Consequently, a more severe immunoglobulin (Ig) E-mediated response to aeroallergens and airway inflammation could account for increasing prevalence of allergic respiratory diseases in polluted urban areas. The most abundant components of urban air pollution in urban areas with high levels of vehicle traffic are airborne particulate matter, nitrogen dioxide, and ozone. In addition, the earth's temperature is increasing, mainly as a result of anthropogenic factors (e.g., fossil fuel combustion and greenhouse gas emissions from energy supply, transport, industry, and agriculture), and climate change alters the concentration and distribution of air pollutants and interferes with the seasonal presence of allergenic pollens in the atmosphere by prolonging these periods.
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We evaluated the impact of migration to the USA-Mexico border city of El Paso, Texas (USA), parental language preference, and Hispanic ethnicity on childhood asthma to differentiate between its social and environmental determinants. Allergy and asthma prevalence was surveyed among 9797 fourth and fifth grade children enrolled in the El Paso Independent School District. Parents completed a respiratory health questionnaire, in either English or Spanish, and a sub-sample of children received spirometry testing at their school. Here we report asthma and allergy outcomes across ethnicity and El Paso residency duration. Asthma and allergy prevalence increased with longer duration of El Paso residency independent of ethnicity and preferred language. Compared with immigrants who arrived in El Paso after entering first grade (18%), lifelong El Paso residents (68%) had more prevalent allergy (OR, 1.72; 95% CI, 1.32 - 2.24), prevalent asthma (OR, 1.75; 95% CI, 1.24 - 2.46), and current asthma (OR, 2.01; 95% CI, 1.37 - 2.95). Spirometric measurements (FEV1/FVC and FEF25-75) also declined with increasing duration of El Paso residency (0.16% and 0.35% annual reduction, respectively). These findings suggest that a community-wide environmental exposure in El Paso, delayed pulmonary development, or increased health of immigrants may be associated with allergy and asthma development in children raised there.
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Reactive oxidants such as nitrogen dioxide (NO(2)) injure the pulmonary epithelium, causing airway damage and inflammation. We previously demonstrated that nuclear factor-κ B (NF-κB) activation within airway epithelial cells occurs in response to NO(2) inhalation, and is critical for lipopolysaccharide-induced or antigen-induced inflammatory responses. Here, we investigated whether manipulation of NF-κB activity in lung epithelium affected severe lung injuries induced by NO(2) inhalation. Wild-type C57BL/6J, CC10-IκBα(SR) transgenic mice with repressed airway epithelial NF-κB function, or transgenic mice expressing a doxycycline-inducible, constitutively active I κ B kinase β (CC10-rTet-(CA)IKKβ) with augmented NF-κB function in airway epithelium, were exposed to toxic levels of 25 ppm or 50 ppm NO(2) for 6 hours a day for 1 or 3 days. In wild-type mice, NO(2) caused the activation of NF-κB in airway epithelium after 6 hours, and after 3 days resulted in severe acute lung injury, characterized by neutrophilia, peribronchiolar lesions, and increased protein, lactate dehydrogenase, and inflammatory cytokines. Compared with wild-type mice, neutrophilic inflammation and elastase activity, lung injury, and several proinflammatory cytokines were significantly suppressed in CC10-IκBα(SR) mice exposed to 25 or 50 ppm NO(2). Paradoxically, CC10-rTet-(CA)IKKβ mice that received doxycycline showed no further increase in NO(2)-induced lung injury compared with wild-type mice exposed to NO(2), instead displaying significant reductions in histologic parameters of lung injury, despite elevations in several proinflammatory cytokines. These intriguing findings demonstrate distinct functions of airway epithelial NF-κB activities in oxidant-induced severe acute lung injury, and suggest that although airway epithelial NF-κB activities modulate NO(2)-induced pulmonary inflammation, additional NF-κB-regulated functions confer partial protection from lung injury.
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Objectives The National Asthma Survey—New York State (NYS), a telephone survey of NYS residents, was conducted in 2002–2003 to further understand the burden of asthma among adults and children and to identify health, socioeconomic, behavioral, and environmental factors associated with asthma. Methods A total of 1,412 households with at least one member with current asthma and 2,290 control households answered questions about their home environment (e.g., presence of asthma triggers and practices that promote or reduce common asthma triggers). Results For children younger than 18 years of age, we found statistically significant positive associations between current asthma and the presence of mold (adjusted odds ratio [AOR] = 2.1, 95% confidence interval [CI] 1.3, 3.3), air cleaners (AOR=1.5, 95% CI 1.1, 2.1), dehumidifiers (AOR=2.0, 95% CI 1.4, 2.7), and humidifiers (AOR=1.6, 95% CI 1.1, 2.3). For adults, there were statistically significant positive associations with the presence of mold (AOR=2.5, 95% CI 1.8, 3.4), air cleaners (AOR=2.2, 95% CI 1.7, 2.8), and humidifiers (AOR=1.4, 95% CI 1.1, 1.8). There were no statistically significant associations with the presence of cockroaches, pets, or tobacco smoke, while use of a wood-burning stove or fireplace was significantly more prevalent in control homes. Conclusions Asthma guidelines emphasize the importance of reducing triggers in the home as part of a multifaceted approach to asthma control. Despite these guidelines, many asthma triggers (specifically, mold) were as prevalent or more so in the homes of New Yorkers with asthma as compared with control households. Public health interventions in NYS should focus on educating households about potential asthma triggers and their sources and teach methods to prevent, reduce, or eliminate them.
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Background: Home-based interventions to improve indoor air quality have demonstrated benefits for asthma morbidity, yet little is known about the effect of environmental interventions in the school setting. Objective: We piloted the feasibility and effectiveness of a classroom-based air cleaner intervention to reduce particulate pollutants in classrooms of children with asthma. Methods: In this pilot randomized controlled trial, we assessed the effect of air cleaners on indoor air particulate pollutant concentrations in 18 classrooms (9 control, 9 intervention) in 3 urban elementary schools. We enrolled 25 asthmatic children (13 control, 12 intervention) aged 6-10 years old. Classroom air pollutant measurements and spirometry were completed once prior to and twice after randomization. Asthma symptoms were surveyed every 3 months. Results: Baseline classroom levels of fine particulate matter (PM2.5) and black carbon (BC) were 6.3 μg/m3 and 0.41 μg/m3, respectively. When comparing the intervention to the control group, classroom PM2.5 levels were reduced by 49% and 42%, and BC levels were reduced by 58% and 55% in the first and second follow-up periods, respectively (p < 0.05 for all comparisons). When comparing the children randomized to intervention and control classrooms, there was a modest improvement in peak flow, but no significant changes in forced expiratory volume in 1 second (FEV1) and asthma symptoms. Conclusion: In this pilot study, a classroom-based air cleaner intervention led to significant reductions in PM2.5 and BC. Future large-scale studies should comprehensively evaluate the effect of school-based environmental interventions on pediatric asthma morbidity.
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Before the first description of hay fever in 1870, there was very little awareness of allergic disease, which is actually similar to the situation in prehygiene villages in Africa today. The best explanation for the appearance and subsequent increase in hay fever at that time is the combination of hygiene and increased pollen secondary to changes in agriculture. However, it is important to remember that the major changes in hygiene in Northern Europe and the United States were complete by 1920. Asthma in children did not start to increase until 1960, but by 1990, it had clearly increased to epidemic numbers in all countries where children had adopted an indoor lifestyle. There are many features of the move indoors that could have played a role; these include increased sensitization to indoor allergens, diet, and decreased physical activity, as well as the effects of prolonged periods of shallow breathing. Since 1990, there has been a remarkable increase in food allergy, which has now reached epidemic numbers. Peanut has played a major role in the food epidemic, and there is increasing evidence that sensitization to peanut can occur through the skin. This suggests the possibility that changes in lifestyle in the last 20 years could have influenced the permeability of the skin. Overall, the important conclusion is that sequential changes in lifestyle have led to increases in different forms of allergic disease. Equally, it is clear that the consequences of hygiene, indoor entertainment, and changes in diet or physical activity have never been predicted. Copyright © 2015 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
Article
BACKGROUND The relation between home dampness and respiratory symptoms among adults is well confirmed, but data on specific allergic diseases and respiratory infections is more limited. Individual factors that may enhance susceptibility to the effects of home dampness are mainly unknown. METHODS The association between home dampness and current physician diagnosed asthma, allergic rhinitis, allergic conjunctivitis, atopic dermatitis, common colds, and bacterial respiratory infections was studied in a questionnaire survey of 10 667 Finnish first year university students aged 18–25 years. The dampness categories analysed were visible mould and visible mould or damp stains or water damage during the last year. In multivariate analyses adjustment was made for parental education, active and passive smoking, type and place of residence, pets, and wall to wall carpets. The interaction effect of atopic heredity and dampness was investigated. RESULTS Visible mould or damp stains or water damage was reported by 15.0% of the respondents. In multivariate models there was a positive association between home dampness and current asthma, allergic rhinitis, and atopic dermatitis, as well as common colds ⩾4 times per year and other respiratory infections, but not between home dampness and allergic conjunctivitis. The strongest association was found between exposure to visible mould and asthma (OR 2.21, 95% CI 1.48 to 3.28) and common colds (OR 1.49, 95% CI 1.18 to 1.87). The risk of current asthma in damp homes was highest among subjects with atopic heredity. CONCLUSIONS The risk of current asthma, allergic rhinitis, and atopic dermatitis was higher in damp homes. Of the respiratory infections, the risk of common colds was most clearly increased.
Article
Home-based environmental interventions have demonstrated clinical benefit for children with asthma. Although much is known about school-based exposures, few studies have comprehensively examined the role the school environment plays in asthma and how effectively changing the environment might reduce morbidity when adjusting for exposures in the home. This review summarizes the importance and common challenges of school-based environmental assessment and intervention studies linked to health effects. We focus on the key components of study development and the challenges and benefits to implementation. Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
Article
The Forum of International Respiratory Societies has released a report entitled Respiratory Disease in the World: Realities of Today-Opportunities for Tomorrow. The report identifies five conditions that primarily contribute to the global burden of respiratory disease (asthma, chronic obstructive pulmonary disease, acute respiratory infections, tuberculosis, and lung cancer), and offers an action plan to prevent and treat those diseases. It describes the staggering magnitude of the global burden of lung disease: hundreds of millions of people suffer and four million people die prematurely from respiratory diseases each year. The situation is not hopeless, because most major respiratory illnesses are avoidable. Much of the disease burden can be mitigated by reducing exposure to indoor and outdoor air pollution, restraining tobacco use, and relieving urban overcrowding. Implementation of the strategies described in the Forum of International Respiratory Societies respiratory diseases report would have a profound effect on respiratory health, reduce economic costs, and enhance health equality in the world.
Article
Background Allergic sensitization is an important risk factor for the development of atopic disease. The National Health and Nutrition Examination Survey (NHANES) 2005-2006 provides the most comprehensive information on IgE-mediated sensitization in the general US population. Objective We investigated clustering, sociodemographic, and regional patterns of allergic sensitization and examined risk factors associated with IgE-mediated sensitization. Methods Data for this cross-sectional analysis were obtained from NHANES 2005-2006. Participants aged 1 year or older (n = 9440) were tested for serum specific IgEs (sIgEs) to inhalant and food allergens; participants 6 years or older were tested for 19 sIgEs, and children aged 1 to 5 years were tested for 9 sIgEs. Serum samples were analyzed by using the ImmunoCAP System. Information on demographics and participants' characteristics was collected by means of questionnaire. Results Of the study population aged 6 years and older, 44.6% had detectable sIgEs, whereas 36.2% of children aged 1 to 5 years were sensitized to 1 or more allergens. Allergen-specific IgEs clustered into 7 groups that might have largely reflected biological cross-reactivity. Although sensitization to individual allergens and allergen types showed regional variation, the overall prevalence of sensitization did not differ across census regions, except in early childhood. In multivariate modeling young age, male sex, non-Hispanic black race/ethnicity, geographic location (census region), and reported pet avoidance measures were most consistently associated with IgE-mediated sensitization. Conclusions The overall prevalence of allergic sensitization does not vary across US census regions, except in early life, although allergen-specific sensitization differs based on sociodemographic and regional factors. Biological cross-reactivity might be an important but not the sole contributor to the clustering of allergen-specific IgEs.
Article
Airborne particulate matter (PM) components from fossil fuel combustion can induce oxidative stress initiated by reactive oxygen species (ROS). Reported associations between worsening asthma and PM2.5 mass could be related to PM oxidative potential to induce airway oxidative stress and inflammation (hallmarks of asthma pathology). We followed 45 schoolchildren with persistent asthma in their southern California homes daily over 10 days with offline fractional exhaled nitric oxide (FENO), a biomarker of airway inflammation. Ambient exposures included daily average PM2.5, PM2.5 elemental and organic carbon (EC, OC), NO2, O3, and endotoxin. We assessed PM2.5 oxidative potential using both an abiotic and an in vitro bioassay on aqueous extracts of daily particle filters: (1) dithiothreitol (DTT) assay (abiotic), representing chemically produced ROS; and (2) ROS generated intracellularly in a rat alveolar macrophage model using the fluorescent probe 2'7'-dicholorohidroflourescin diacetate. We analyzed relations of FENO to air pollutants in mixed linear regression models. FENO was significantly positively associated with lag 1-day and 2-day averages of traffic-related markers (EC, OC, and NO2), DTT and macrophage ROS, but not PM2.5 mass. DTT associations were nearly twice as strong as other exposures per interquartile range: median FENO increased 8.7-9.9% per 0.43 nmole/min/m(3) DTT. Findings suggest that future research in oxidative stress-related illnesses such as asthma and PM exposure would benefit from assessments of PM oxidative potential and composition.Journal of Exposure Science and Environmental Epidemiology advance online publication, 15 May 2013; doi:10.1038/jes.2013.25.
Article
Racial disparities are present in many facets of health and disease. Allergy and asthma are no exceptions. Secondary results from cross-sectional and cohort studies have provided information on the scope of racial disparities in allergic sensitization in the United States. African American/Black individuals tend to be sensitized more frequently than White individuals. Little is known about rates in other race groups. Genetics are unlikely to be the sole or major cause of the observed differences. Home dust allergen and endotoxin levels cannot explain the differences. Studies that have been designed to specifically address the sources of these racial disparities are needed. A "Multilevel Framework" that considers the roles of the individual, family and community presents an excellent approach to guide design of future studies of the causes of these disparities. Understanding the causes of the disparities could lead to interventions that would improve the health of all individuals.
Article
Particulate matter (PM) exposures have been linked with poor respiratory health outcomes, especially among susceptible populations such as asthmatic children. Smoke from biomass combustion for residential home heating is an important source of PM in many rural or peri-urban areas in the United States. To assess the efficacy of residential interventions that reduce indoor PM exposure from wood stoves and to quantify the corresponding improvements in quality of life and health outcomes for asthmatic children. The asthma randomized trial of indoor wood smoke (ARTIS) study is an in-home intervention study of susceptible children exposed to biomass combustion smoke. Children, ages 7 to 17, with persistent asthma and living in homes that heat with wood stoves were recruited for this three arm randomized placebo-controlled trial. Two household-level intervention strategies, wood stove replacement and air filters, were compared to a sham air filter placebo. Improvement in quality of life of asthmatic children was the primary outcome. Secondary asthma-related health outcomes included peak expiratory flow (PEF) and forced expiratory volume in first second (FEV(1)), biomarkers in exhaled breath condensate, and frequency of asthma symptoms, medication usage, and healthcare utilization. Exposure outcomes included indoor and outdoor PM(2.5) mass, particle counts of several size fractions, and carbon monoxide. To our knowledge, this was the first randomized trial in the US to utilize interventions targeting residential wood stoves to assess the impact on indoor PM and health outcomes in a susceptible population.
Article
The propensity of various types of home humidifiers to support and disseminate microbial contaminants into indoor air was tested. Reservoir water and air discharged from humidifiers seeded in the laboratory or naturally contaminated in the home were analyzed by standard microbiological methods. Clinically insignificant as well as overt or potentially pathogenic microorganisms were found to colonize the reservoirs of all types of humidifiers, but only cool mist and ultrasonic units readily aerosolized bacteria and endotoxin. Only cool mist units emitted hydrophobic fungal spores. Cool mist units discharged the greatest number of water particles in the inhalabk size range (4–16 μm) while ultrasonic units were more likely to emit respirable-sized water particles (< 0.2–4 μm). Overt pathogens isolated from humidifiers in homes included Legionella and a pathogenic Acanthamoeba. Aerosolizing humidifiers should thus be avoided if frequent, thorough cleaning of the units is not practical.
Article
The risk of asthma associated with pets and other indoor exposures has been examined in both cross-sectional and prospective studies of younger children. However, there has been little investigation of the effect of the indoor environment on incident asthma in adolescents. Risk factors for the development of asthma were examined in a cohort of 3535 Southern California school children with no history of asthma at 1993 entry into the study, who were followed for up to 5 years. Newly diagnosed cases of asthma were identified by yearly interview report. A total of 265 children reported a new diagnosis of asthma during the follow-up period; 163 of these had reported no history of wheeze at baseline. The risk associated with indoor exposures assessed by questionnaire at entry into the study was examined using Cox proportional hazards models. In children with no history of wheezing, an increased risk of developing asthma was associated with a humidifier (relative risk [RR] = 1.7; 95% confidence interval [CI] = 1.2-2.4), any pet (RR = 1.6; 95% CI = 1.0-2.5), or specifically a dog (RR = 1.4; 95% CI = 1.0-2.0) in the home. An estimated 32% of new asthma cases could be attributed to pets. We conclude that furry pets are a common and potentially remediable risk factor for new onset asthma in adolescents. Our results suggest that a humidifier in the home may contribute to the onset of asthma in this age group.
Article
Children with asthma exposed to secondhand smoke (SHS) might be at higher risk for severe exacerbations, but biomarkers of susceptibility to SHS exposure have not been previously reported. We sought to assess the usefulness of urinary leukotriene E(4) (uLTE₄) levels in the prediction of increased risk of severe asthma exacerbations requiring emergency department (ED) or urgent care (UC) visits. Forty-four schoolchildren with moderate-to-severe asthma receiving inhaled corticosteroids were followed for 5 months with repeated measurements of uLTE₄ and monitoring of ED and UC visits. SHS exposure status was determined by using prestudy questionnaires and repeated measurements of urinary cotinine during the study. Nine (45%) of 20 children with SHS exposure experienced a severe exacerbation requiring an ED or UC visit compared with 3 (12.5%) of 24 children without significant SHS exposure (relative risk, 3.6; 95% CI, 1.1-11.5; P = .02). The uLTE₄ level was a significant predictor of exacerbation risk in children exposed to SHS (area under the curve, 0.85; P = .003). Other predictors, such as nighttime symptom frequency, prebronchodilator and postbronchodilator lung function, and exhaled nitric oxide levels, were not related to exacerbations in this group. uLTE₄ levels at or greater than 106 pg/mg achieved 67% (6/9) sensitivity and 100% (11/11) specificity for predicting children with SHS exposure who required an ED or UC visit. Children exposed to SHS are at increased risk for severe asthma exacerbations, despite use of inhaled corticosteroids. uLTE₄ levels identify children exposed to SHS at high risk for asthma exacerbations.
Article
Asthma exacerbations are commonly triggered by exposure to allergens and irritants within the home. The purpose of this review was to evaluate evidence that interventions that target reducing these triggers through home visits may be beneficial in improving asthma outcomes. The interventions involve home visits by trained personnel to conduct two or more components that address asthma triggers in the home. Intervention components focus on reducing exposures to a range of asthma triggers (allergens and irritants) through environmental assessment, education, and remediation. Using methods previously developed for the Guide to Community Preventive Services, a systematic review was conducted to evaluate the evidence on effectiveness of home-based, multi-trigger, multicomponent interventions with an environmental focus to improve asthma-related morbidity outcomes. The literature search identified over 10,800 citations. Of these, 23 studies met intervention and quality criteria for inclusion in the final analysis. In the 20 studies targeting children and adolescents, the number of days with asthma symptoms (symptom-days) was reduced by 0.8 days per 2 weeks, which is equivalent to 21.0 symptom-days per year (range of values: reduction of 0.6 to 2.3 days per year); school days missed were reduced by 12.3 days per year (range of values: reduction of 3.4 to 31.2 days per year); and the number of asthma acute care visits were reduced by 0.57 visits per year (interquartile interval: reduction of 0.33 to 1.71 visits per year). Only three studies reported outcomes among adults with asthma, finding inconsistent results. Home-based, multi-trigger, multicomponent interventions with an environmental focus are effective in improving overall quality of life and productivity in children and adolescents with asthma. The effectiveness of these interventions in adults is inconclusive due to the small number of studies and inconsistent results. Additional studies are needed to (1) evaluate the effectiveness of these interventions in adults and (2) determine the individual contributions of the various intervention components.
Article
We report a 31-year-old farmer whose work consists in handling cereal and vegetables, who consulted our clinic because of asthma symptoms after inhalation of dust during manipulation of the deposited material, usually inside the warehouse. Skin prick tests and specific immunoglobulin E (IgE) determinations were negative with common aeroallergens. The patient noted the presence of many spiders in the warehouse, which were identified as the cellar spider Holocnemus pluchei and the common house spider, Tegenaria domestica. Extracts of spider bodies brought in by the patient were obtained and used to perform in vivo and in vitro studies. Molecular characterization of IgE-binding bands was performed by mass spectrometry. We obtained positive prick tests to the extracts of the bodies of both spiders. Immunoblotting displayed different bands in both spider extracts, in a range of 20-70 kDa. All were hemocyanins, except for a 17-kDa protein of Holocnemus identified as an arginine kinase (AK). Bronchial challenge was positive with the extract of the cellar spider and with the AK, but was negative with the domestic house spider. We present the first case of respiratory allergy due to sensitization to AK from a common spider, confirmed by bronchial provocation tests.
Article
Our work group report details the importance of pest allergen exposure in inner-city asthma. We will focus specifically on mouse and cockroach exposure. We will discuss how exposure to these pests is common in the inner city and what conditions exist in urban areas that might lead to increased exposure. We will discuss how exposure is associated with allergen sensitization and asthma morbidity. Finally, we will discuss different methods of intervention and the effectiveness of these tactics. (J Allergy Clin Irnmunol 2010;125:575-81.)
Article
During the last decades more than 100 000 new chemicals have been introduced to the environment. Many of these new chemicals and many common consumer products that include these have been shown to be toxic in animal studies and an increasing body of evidence suggests that they are also impacting human health. Among the suspect chemicals, the endocrine disrupting chemicals (EDCs) are of particular concern. One such chemical group is the phthalates, used in soft poly vinyl chloride (PVC) material and in a huge number of consumer products. During the same period of time that the prevalence of these modern chemicals has increased, there has been a remarkable increase in several chronic illnesses, including asthma and allergy in children. In this article we outline the scientific knowledge on phthalate exposure for asthma and airway diseases in children by examining epidemiological and experimental peer review data for potential explanatory mechanisms. Epidemiological data point to a possible correlation between phthalate exposure and asthma and airway diseases in children. Experimental studies present support for an adjuvant effect on basic mechanisms in allergic sensitization by several phthalates. Despite variations in the experimental design and reported result in the individual studies, a majority of published reports have identified adjuvant effects on Th2 differentiation, production of Th2 cytokines and enhanced levels of Th2 promoted immunoglobulins (mainly IgG1 but also IgE) in mice. A limited amount of data do also suggest phthalate-induced enhancement of mast cell degranulation and eosinophilic infiltration which are important parts in the early inflammation phase. Thus, some of the early key mechanisms in the pathology of allergic asthma could possibly be targeted by phthalate exposure. But the important questions of clinical relevance of real life exposure and identification of molecular targets that can explain interactions largely remain to be answered.
Article
Asthma continues to disproportionately affect minority and low-income groups, with African American and Latino children who live in low-socioeconomic-status urban environments experiencing higher asthma morbidity and mortality than white children. This uneven burden in asthma morbidity has been ever increasing despite medical advancement. Many factors have contributed to these disparities in the areas of health care inequities, which result in inadequate treatment; poor housing, which leads to increased exposure to asthma allergens; and social and psychosocial stressors, which are often unappreciated. Interventions to reduce individual areas of disparities have had varying successes. Because asthma is a complex disease that affects millions of persons, multifaceted comprehensive interventions that combine all evidence-based successful strategies are essential to finally closing the gap in asthma morbidity.
Article
Asthma prevalence has markedly increased over the past 30 years. Although atopy and exposure to environmental allergens are known to exacerbate asthma, recent literature supports a causal role of indoor allergens in disease development. High-risk birth cohorts continue to point to atopy as the main risk factor for developing asthma. Exposure to perennial allergens has also been linked to the development of asthma, though with less consistency. Intervention at the level of allergen exposure and allergic immune response is promising. The current model of atopic asthma, the predominant phenotype, incorporates genetic and environmental factors in the development of disease. Although genetic factors are less malleable, the environmental component lends itself to analysis and modification.For many, the development of asthma starts with allergen exposure leading to atopic sensitization and subsequent disease. Several studies support the progression from exposure to sensitization with the potential of extremely high levels of exposure leading to tolerance. Likewise, the progression from atopy to asthma is well documented,especially in genetically predisposed children. Recent intervention trials confirm these findings and begin to show promise for the prevention of asthma by interrupting the allergen exposure==>allergen sensitization==>atopic asthma pathway.
Article
We conducted a multicenter prospective study to assess the effects of occupational exposure to ethylenebisdithiocarbamate fungicides and/or other pesticides on self-reported asthma and asthmatic symptoms. This multicenter study was conducted among 248 workers exposed to pesticides and 231 non-exposed workers from five field studies. The five field studies were carried out in The Netherlands, Italy, Finland, and two studies in Bulgaria. Subjects constituting this cohort completed a self-administered questionnaire at baseline (before the start of exposure). Ethylenethiourea in urine was determined to assess exposure to ethylenebisdithiocarbamates. In multivariate analyses adjusted for all potential confounders (age, education, residence, smoking, gender, and field study), we found inverse associations, all not statistically significant, between occupational exposure to pesticides and asthma diagnosis (OR 0.41; 95% CI 0.15-1.11), complains of chest tightness (OR 0.60; 95% CI 0.36-1.02), wheeze (OR 0.56; 95% CI 0.32-0.98), asthma attack (OR 0.52; 95% CI 0.12-2.25), and asthma medication (OR 0.79; 95% CI 0.25-2.53). Furthermore, we reported null associations for multivariate analysis using ethylenethiourea as determinant for exposure. Although exposure to pesticides remains a potential health risk, our results do not suggest an association between exposure to ethylenebisdithiocarbamates and/or other pesticides used in our study on asthma and asthmatic symptoms.
Article
Bronchial asthma with cockroach hypersensitivity is prevalent among urban asthmatic populations. To elucidate characteristics of cockroach asthma, we analyzed 592 consecutive urban Chicago asthmatic patients retrospectively. Allergy skin testing (AST) with common inhalants, serum total IgE, and cockroach-specific IgE (IgE-CR) antibodies were measured. Some cockroach asthmatics were studied further for bronchial reactivity in vivo and histamine releasability (HR) in vitro against cockroach allergen (CRa), and diagnostic accuracy for asthma was analyzed. Clinical characteristics were evaluated and compared with those of ragweed asthmatics and asthmatics in general. Two hundred eighty-three (196 women, 87 men) were reactive to CRa by AST. The average age and duration of cockroach asthma were 30.4 and 15.1 years, respectively. Steroid dependency of the cockroach asthma was higher (32%) than those of general asthmatics (P less than .05) and ragweed asthma (P less than .05). IgE level was elevated (geometric mean 413.2 IU/mL), higher than that of general asthmatics (P less than .001), and 87% showed IgE level higher than 100 IU/mL. IgE-CR and BPT-CR were positive in 61% (175 tested) and in 87% (166 tested), respectively. Sensitivity and specificity of skin test were 99% and 40%, while those of IgE-CR were 91% and 58%, respectively. IgE-CR increased probability of cockroach asthma from 87% to 91%. BPT with CRa was correlated well with the HR of leukocytes (P less than .0001). Thus, cockroach asthma is a severe allergic asthma and can be diagnosed accurately by skin test plus BPT or skin test plus HR.
Article
The effect of indoor nitrogen dioxide on the cumulative incidence of respiratory symptoms and pulmonary function level was studied in a cohort of 1,567 white children aged 7-11 years examined in six US cities from 1983 through 1988. Week-long measurements of nitrogen dioxide were obtained at three indoor locations over 2 consecutive weeks in both the winter and the summer months. The household annual average nitrogen dioxide concentration was modeled as a continuous variable and as four ordered categories. Multiple logistic regression analysis of symptom reports from a questionnaire administered after indoor monitoring showed that a 15-ppb increase in the household annual nitrogen dioxide mean was associated with an increased cumulative incidence of lower respiratory symptoms (odds ratio (OR) = 1.4, 95% confidence interval (95% Cl) 1.1-1.7). The response variable indicated the report of one or more of the following symptoms: attacks of shortness of breath with wheeze, chronic wheeze, chronic cough, chronic phlegm, or bronchitis. Girls showed a stronger association (OR = 1.7, 95% Cl 1.3-2.2) than did boys (OR = 1.2, 95% Cl 0.9-1.5). An analysis of pulmonary function measurements showed no consistent effect of nitrogen dioxide. These results are consistent with earlier reports based on categorical indicators of household nitrogen dioxide sources and provide a more specific association with nitrogen dioxide as measured in children's homes.
Article
To investigate the influence of indoor air quality on respiratory health, a questionnaire-based study of 17,962 Canadian schoolchildren in kindergarten through grade 2 was carried out in 1988. The present report focuses on associations between several indoor environmental factors and childhood asthma. Increased reports of physician-diagnosed asthma were significantly associated (p less than 0.001) with exposure to environmental tobacco smoke (OR = 1.4), living in a damp home (OR = 1.5), the use of gas for cooking (OR = 2.0) and the use of a humidifier (OR = 1.7). Wheezing without a diagnosis of asthma also was associated (p less than 0.01) with environmental tobacco smoke (OR = 1.4, home dampness (OR = 1.6) and humidifier use (OR = 1.4), but not with gas cooking. Thus, several modifiable risk factors for respiratory illness may exist in Canadian homes. Further research is required to determine the nature of these cross-sectional observations.
Article
The occurrence of symptoms of respiratory illness among preschool children living in homes heated by wood-burning stoves was examined by conducting an historical prospective study (n = 62) with an internal control group (matched for age, sex, and town of residence). Exposures of subjects were not significantly different (P greater than .05) with respect to parental smoking, urea-formaldehyde foam insulation, and use of humidifiers. The control group made significantly greater use of gas stoves for cooking whereas the study group made greater use of electric stoves for cooking and of air filters (P less than .05). Only one home used a kerosene space heater. During the winter of 1982, moderate and severe symptoms in all categories were significantly greater for the study group compared with the control group (P less than .001). These differences could not be accounted for by medical histories (eg, allergies, asthma), demographic or socioeconomic characteristics, or by exposure to sources of indoor air pollution other than wood-burning stoves. Present findings suggest that indoor heating with wood-burning stoves may be a significant etiologic factor in the occurrence of symptoms of respiratory illness in young children.