56 results on '"Phipatanakul W"'
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2. Effect of vitamin D supplementation on total and allergen-specific IgE in children with asthma and low vitamin D levels.
- Author
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Rosser FJ, Han YY, Forno E, Bacharier LB, Phipatanakul W, Guilbert TW, Cabana MD, Ross K, Blatter J, Durrani S, Luther J, Wisniewski SR, and Celedón JC
- Subjects
- Animals, Asthma blood, Asthma immunology, Child, Dietary Supplements, Double-Blind Method, Female, Humans, Male, Allergens immunology, Antigens, Dermatophagoides immunology, Arthropod Proteins immunology, Asthma drug therapy, Cysteine Endopeptidases immunology, Immunoglobulin E blood, Vitamin D therapeutic use, Vitamins therapeutic use
- Abstract
Background: Observational studies have yielded inconsistent findings for the relation between vitamin D level and total IgE or allergic sensitization., Objective: To determine whether vitamin D supplementation reduces levels of total IgE and IgE to each of 2 common indoor allergens in children with asthma and low vitamin D levels., Methods: Total IgE, IgE to Dermatophagoides pteronyssinus, and IgE to Blattella germanica were measured at the randomization and exit visits for 174 participants in the Vitamin D Kids Asthma Study, a multicenter, double-blind, randomized placebo-controlled trial of vitamin D
3 supplementation (4000 IU/d) to prevent severe exacerbations in children with persistent asthma and vitamin D levels less than 30 ng/mL. Multivariable linear regression was used for the analysis of the effect of vitamin D supplementation on change in each IgE measure., Results: Participants were followed for an average of 316 days. At the exit visit, more subjects in the vitamin D arm achieved a vitamin D level equal to or more than 30 ng/mL compared with those in the placebo arm (87% vs 30%; P < .001). In a multivariable analysis, vitamin D3 supplementation had no significant effect on change in total IgE, IgE to Dermatophagoides pteronyssinus, or IgE to Blattella germanica between the exit and randomization visits (eg, for log10 total IgE, β = 0.007; 95% CI, -0.061 to 0.074; P = .85)., Conclusions: Vitamin D supplementation, compared with placebo, has no significant effect on serum levels of total IgE, IgE to dust mite, or IgE to cockroach in children with asthma and low vitamin D levels., (Copyright © 2021 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)- Published
- 2022
- Full Text
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3. Allergic Endotypes and Phenotypes of Asthma.
- Author
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Akar-Ghibril N, Casale T, Custovic A, and Phipatanakul W
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- Adolescent, Adult, Animals, Child, Child, Preschool, Cohort Studies, Female, Humans, Male, Middle Aged, Skin Tests, Allergens, Asthma diagnosis, Asthma epidemiology, Phenotype
- Abstract
Allergic asthma is defined as asthma associated with sensitization to aeroallergens, which leads to asthma symptoms and airway inflammation. Allergic asthma is the most common asthma phenotype. The onset of allergic asthma is most often in childhood and is usually accompanied by other comorbidities including atopic dermatitis and allergic rhinitis. It is often persistent although there is a wide variation in disease severity. It is a T
H 2-driven process. Biomarkers have been identified to distinguish patients with allergic asthma, particularly serum IgE levels, tests to indicate sensitization to aeroallergens such as specific IgE or skin prick test positivity, blood and sputum eosinophil levels, fraction of exhaled nitric oxide, and periostin. Treatments for allergic asthma include environmental control measures, allergen immunotherapy, and glucocorticoids. Biologics, targeting the TH 2 pathway, have been shown to be effective in the treatment of allergic asthma., (Copyright © 2019 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)- Published
- 2020
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4. Do Baseline Asthma and Allergic Sensitization Characteristics Predict Responsiveness to Mouse Allergen Reduction?
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Ahmed A, Sadreameli SC, Curtin-Brosnan J, Grant T, Phipatanakul W, Perzanowski M, Balcer-Whaley S, Peng R, Newman M, Cunningham A, Divjan A, Bollinger ME, Wise RA, Miller R, Chew G, and Matsui EC
- Subjects
- Adolescent, Animals, Child, Humans, Male, Mice, Minority Groups, Poverty, Randomized Controlled Trials as Topic, Skin Tests, Allergens, Asthma epidemiology, Hypersensitivity, Immediate
- Abstract
Background: Mouse allergen reduction is associated with improvements in asthma among sensitized and exposed children, but whether clinical characteristics predict responsiveness to allergen reduction is unclear., Objective: To examine the effects of clinical characteristics on relationships between mouse allergen reduction and asthma outcomes., Methods: We performed a secondary analysis of data from a randomized clinical trial of a mouse allergen intervention, examining the effects of atopy, demographic characteristics, lung function, asthma control, and asthma severity on relationships between mouse allergen reduction and asthma outcomes., Results: Participants were predominantly low-income and minority (78% black, 22% Hispanic), and had persistent asthma. Among less atopic participants (<6 positive skin prick test results), each 50% reduction in mouse allergen was associated with fewer symptoms (incidence rate ratio [95% CI]: maximal symptoms: 0.94 [0.92-0.96]). There was little effect of mouse allergen reduction on symptoms among more atopic participants (P > .05). The interactions between atopic status and mouse allergen reduction were statistically significant for all symptom outcomes; however, there was no evidence that atopic status influenced the effect of mouse allergen reduction on exacerbation-related outcomes. Older children (≥9 years) tended to experience greater improvement in some asthma outcomes with reduction in mouse allergen exposure than younger children. There was no evidence that either mouse-specific IgE or lung function influenced the effect of mouse allergen reduction on any asthma outcomes., Conclusions: Although there may be variability in the clinical response to mouse allergen reduction among low-income, minority children with asthma, there were no clinical characteristics that clearly identified a subgroup at which the intervention should be targeted., (Copyright © 2019 American Academy of Allergy, Asthma & Immunology. All rights reserved.)
- Published
- 2020
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5. Reduction in mouse allergen exposure is associated with greater lung function growth.
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Grant T, Phipatanakul W, Perzanowski M, Balcer-Whaley S, Peng RD, Curtin-Brosnan J, Newman M, Cunningham A, Divjan A, Bollinger ME, Wise RA, and Matsui EC
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- Adolescent, Animals, Child, Child, Preschool, Environmental Exposure adverse effects, Environmental Exposure prevention & control, Female, Humans, Hypersensitivity, Immediate etiology, Hypersensitivity, Immediate prevention & control, Male, Mice, Respiratory Function Tests, Allergens adverse effects, Allergens immunology, Asthma etiology, Asthma prevention & control, Patient Education as Topic methods, Pest Control methods
- Abstract
Background: Current childhood asthma therapies have little effect on lung function trajectory., Objective: We sought to determine whether mouse allergen exposure reduction is associated with lung function growth in mouse-sensitized/exposed asthmatic children., Methods: Three hundred fifty mouse-sensitized/exposed asthmatic children (5-17 years old) were enrolled in a 1-year randomized trial of integrated pest management plus education versus education alone. Prebronchodilator/postbronchodilator spirometry was performed at baseline and 6 and 12 months, and bedroom floor mouse allergen levels were measured every 3 months. Mouse allergen reduction was defined as a 75% or greater decrease in mouse allergen levels from baseline. Treatment groups were combined for analyses because there were no differences in outcomes between groups. Changes in lung function over time were modeled, adjusting for age, sex, race, atopy, group, and bronchodilator reversibility and including an interaction term (allergen reduction*time)., Results: The study population was predominantly black (79.4%) and low income (66.3% [<$30,000]). At baseline, the median mouse allergen level was 5.7 μg/g (interquartile range, 1.5-22.8 μg/g), and the mean (SD) prebronchodilator FEV
1 /forced vital capacity ratio was 80.2% (9.0%). Ninety-two (26.3%) participants had 75% or greater reduction in mouse allergen levels. For a 10-year-old black boy, 75% or greater allergen reduction was associated with an increase in prebronchodilator FEV1 of 238 mL/y (95% CI, 177-299 mL/y), whereas less than 75% allergen reduction was associated with an increase in prebronchodilator FEV1 of 131 mL/y (95% CI, 97-166 mL/y). Estimated differences in prebronchodilator and postbronchodilator FEV1 growth were as follows: 107 mL/y (95% CI, 37-177 mL/y; Pint = .003) and 48 mL/y (95% CI, -17 to 113 mL/y; Pint = .15), respectively. Estimated differences in prebronchodilator and postbronchodilator forced expiratory flow at 25% to 75% of vital capacity growth were as follows: 182 mL/y (95% CI, 61-304 mL/y; Pint = .003) and 181 mL/y (95% CI, 48-314 mL/y; Pint = .008), respectively., Conclusion: Mouse allergen reduction is associated with greater increases in prebronchodilator FEV1 and prebronchodilator/postbronchodilator forced expiratory flow at 25% to 75% of vital capacity over 1 year among sensitized/exposed asthmatic children., (Copyright © 2019 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)- Published
- 2020
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6. Association between fungal spore exposure in inner-city schools and asthma morbidity.
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Baxi SN, Sheehan WJ, Sordillo JE, Muilenberg ML, Rogers CA, Gaffin JM, Permaul P, Lai PS, Louisias M, Petty CR, Fu C, Gold DR, and Phipatanakul W
- Subjects
- Air Microbiology, Air Pollution, Indoor, Asthma epidemiology, Child, Child, Preschool, Female, Humans, Male, Prospective Studies, Schools, United States epidemiology, Allergens immunology, Alternaria immunology, Asthma immunology, Environmental Exposure statistics & numerical data, Hypersensitivity epidemiology, Spores, Fungal immunology, Urban Population
- Abstract
Background: Home fungus exposures may be associated with development or worsening of asthma. Little is known about the effects of school/classroom fungus exposures on asthma morbidity in students., Objective: To evaluate the association of school-based fungus exposures on asthma symptoms in both fungus-sensitized and nonsensitized students with asthma., Methods: In this prospective study, 280 children with asthma from 37 inner-city schools were phenotypically characterized at baseline and followed-up for 1 year. Fungal spores were collected by using a Burkard air sampler twice during the school year. Clinical outcomes were evaluated throughout the school year and linked to classroom-specific airborne spore sampling. The primary outcome was days with asthma symptoms per 2-week period., Results: Fungal spores were present in all classroom samples. The geometric mean of the total fungi was 316.9 spores/m
3 and ranged from 15.0 to 59,345.7 spores/m3 . There was variability in total fungus quantity between schools and classrooms within the same school. Mitospores were the most commonly detected fungal grouping. Investigation of the individual mitospores revealed that exposure to Alternaria was significantly associated with asthma symptom days in students sensitized to Alternaria (OR = 3.61, CI = 1.34-9.76, P = .01), but not in children not sensitized to Alternaria (OR = 1.04, CI = 0.72-1.49, P = .85). Students sensitized to Alternaria and exposed to high levels (≥75th percentile exposure) had 3.2 more symptom days per 2-week period as compared with students sensitized but exposed to lower levels., Conclusion: Children with asthma who are sensitized to Alternaria and exposed to this fungus in their classroom may have significantly more days with asthma symptoms than those who were sensitized and not exposed., Clinical Trial Registration: Clinicaltrials.govNCT01756391., (Copyright © 2019 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)- Published
- 2019
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7. Environmental Food Exposure: What Is the Risk of Clinical Reactivity From Cross-Contact and What Is the Risk of Sensitization.
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Sheehan WJ, Taylor SL, Phipatanakul W, and Brough HA
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- Dietary Proteins, Humans, Risk, Allergens, Environmental Exposure, Food, Food Hypersensitivity epidemiology
- Abstract
For food-allergic individuals, the typical exposure to food proteins happens during ingestion; however, individuals may be exposed to foods in other ways. In addition to ingestion reactions, allergic patients may have reactions from cutaneous or mucosal exposures to food proteins, with the classic example being a peanut-allergic child touching a counter with peanut butter and then rubbing their eyes. Similar to hands, saliva can also act as a carrier for food proteins. Finally, there is a wealth of new research regarding the presence of food proteins in the environment, for example, within household floor dust. This review will focus on (1) cross-contact of food proteins and (2) environmental food protein exposures. Cross-contact occurs when one type of food comes into contact with another type of food resulting in the mixture of proteins. For food allergies, cross-contact is important when an allergen is inadvertently transferred to a food/meal that is thought to not contain that specific allergen. We will discuss the current literature regarding the presence of detectable food proteins in different locations, how and if these proteins are transferred or eliminated, and the clinical implications of exposures to food proteins under these different scenarios., (Copyright © 2018 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)
- Published
- 2018
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8. School exposure and asthma.
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Esty B and Phipatanakul W
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- Adolescent, Allergens immunology, Animals, Asthma blood, Asthma etiology, Asthma immunology, Cats, Child, Child, Preschool, Cockroaches chemistry, Cockroaches immunology, Dogs, Endotoxins adverse effects, Endotoxins immunology, Environmental Exposure prevention & control, Fungi chemistry, Fungi immunology, Humans, Immunoglobulin E blood, Mice, Primary Prevention, Pyroglyphidae chemistry, Pyroglyphidae immunology, Students, Air Pollution, Indoor adverse effects, Allergens adverse effects, Asthma prevention & control, Environmental Exposure adverse effects, Schools organization & administration
- Abstract
Objective: To provide a comprehensive overview of common school exposures and the association between school exposures and pediatric asthma morbidity., Data Sources: A comprehensive literature review was performed using PubMed., Study Selections: Full-length, peer-reviewed studies published in English were considered for review. In vivo, in vitro, and animal studies were excluded. Studies of school exposure to cockroach, mouse, dust mite, dog, cat, molds, pollution, and endotoxin associated with asthma and asthma morbidity were considered., Results: The current literature establishes an association between school exposure and pediatric asthma morbidity. There is a need for ongoing research to evaluate the effects of school-based environmental interventions on asthma morbidity., Conclusion: It is evident that the indoor school environment is a significant reservoir of allergens, molds, pollutants, and endotoxin and that there is an association between school exposure and pediatric asthma morbidity. School-based interventions have the potential for substantial individual, community, and public health benefit. It is important that researchers continue to study the health effects associated with school exposures and assess cost-effectiveness of multifaceted school-based interventions., (Copyright © 2018 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)
- Published
- 2018
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9. School Environmental Intervention Programs.
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Permaul P and Phipatanakul W
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- Adolescent, Air Pollution, Indoor adverse effects, Child, Environmental Exposure, Humans, Regional Medical Programs, Schools, Urban Population, Allergens immunology, Asthma prevention & control, Early Intervention, Educational methods, Hypersensitivity therapy, School Health Services
- Abstract
Exposure to indoor allergens and pollutants plays a significant part in the development of asthma and its associated morbidity. Inner-city children with asthma are disproportionately affected by these exposures with increased asthma morbidity. Although years of previous research have linked exposures in the urban home environment with significant childhood asthma disease, many of these allergens are also present in inner-city school environments. Therefore, evaluation of the school environment of patients with asthma is also essential. School-based environmental interventions may offer benefit for this problem and has the potential to help many children with asthma at once in a cost-effective manner. It is important that environmental health researchers continue to assess which interventions are most practical and result in the greatest measurable improvements., (Copyright © 2017 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)
- Published
- 2018
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10. Reduced mouse allergen is associated with epigenetic changes in regulatory genes, but not mouse sensitization, in asthmatic children.
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Miller RL, Zhang H, Jezioro J, De Planell Saguer M, Lovinsky-Desir S, Liu X, Perzanowski M, Divjan A, Phipatanakul W, and Matsui EC
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- Adolescent, Allergens immunology, Animals, Antigens, Dermatophagoides analysis, Antigens, Dermatophagoides immunology, Arthropod Proteins analysis, Arthropod Proteins immunology, Asthma immunology, Child, Child, Preschool, Cockroaches, Cysteine Endopeptidases analysis, Cysteine Endopeptidases immunology, DNA Methylation, Epigenesis, Genetic, Female, Humans, Immunoglobulin E, Interferon-gamma genetics, Male, Mice, Mouth Mucosa metabolism, Promoter Regions, Genetic, Allergens analysis, Asthma genetics, Environmental Exposure prevention & control, Forkhead Transcription Factors genetics
- Abstract
Chronic exposure to mouse allergen may contribute greatly to the inner-city asthma burden. We hypothesized that reducing mouse allergen exposure may modulate the immunopathology underlying symptomatic pediatric allergic asthma, and that this occurs through epigenetic regulation. To test this hypothesis, we studied a cohort of mouse sensitized, persistent asthmatic inner-city children undergoing mouse allergen-targeted integrated pest management (IPM) vs education in a randomized controlled intervention trial. We found that decreasing mouse allergen exposure, but not cockroach, was associated with reduced FOXP3 buccal DNA promoter methylation, but this was unrelated to mouse specific IgE production. This finding suggests that the environmental epigenetic regulation of an immunomodulatory gene may occur following changing allergen exposures in some highly exposed cohorts. Given the clinical and public health importance of inner-city pediatric asthma and the potential impact of environmental interventions, further studies will be needed to corroborate changes in epigenetic regulation following changing exposures over time, and determine their impact on asthma morbidity in susceptible children., (Copyright © 2017 Elsevier Inc. All rights reserved.)
- Published
- 2017
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11. Mouse Sensitization and Exposure Are Associated with Asthma Severity in Urban Children.
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Grant T, Aloe C, Perzanowski M, Phipatanakul W, Bollinger ME, Miller R, and Matsui EC
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- Adolescent, Animals, Child, Child, Preschool, Cockroaches immunology, Female, Humans, Immunoglobulin E blood, Male, Minority Groups, Poverty, Randomized Controlled Trials as Topic, Severity of Illness Index, Skin Tests, Urban Health, Urban Population, Allergens immunology, Asthma drug therapy, Asthma ethnology, Asthma physiopathology, Environmental Exposure adverse effects, Mice immunology
- Abstract
Background: Mouse sensitization and exposure are associated with uncontrolled asthma, but whether they are associated with asthma severity, an intrinsic disease characteristic and long-term outcome predictor, is unclear., Objective: To examine relationships between mouse sensitization and/or exposure and asthma severity in urban children., Methods: A total of 645 children (5-17 years) with uncontrolled asthma underwent mouse sensitization evaluation. Sensitized children had mouse allergen measured in bedroom dust. Relationships between mouse sensitization, allergen levels, and asthma severity measures (treatment step and Composite Asthma Severity Index [CASI]) were examined using regression models adjusted for age, sex, atopy, study site, race, ethnicity, and insurance., Results: The study population was predominantly minority (69.6% black, 20.8% Hispanic), low income (61.8%), and mouse sensitized (54.4%). Mean ± SD treatment step was 3.2 ± 1.6, equivalent to medium-dose inhaled corticosteroid. Mean ± SD CASI was 6.5 ± 3.4, reflecting moderate persistent asthma. Mouse sensitization was associated with higher treatment step (3.5 vs 2.9, mouse-sensitized vs nonsensitized, P < .001), independent of potential confounders (β [95% CI], 0.36 [0.07-0.64]; P = .01). Mouse sensitization was associated independently with CASI (β [95% CI], 0.82 [0.16-1.47]; P = .02). Among mouse-sensitized participants, higher bedroom floor and bed Mus m 1 were independently associated with treatment step (β [95% CI], 0.26 [0.09-0.43]; P = .002 and β [95% CI], 0.22 [0.01-0.43]; P = .04), respectively. Higher bedroom floor Mus m 1 was independently associated with CASI (β [95% CI], 0.43 [0.05-0.81]; P = .03)., Conclusions: Mouse sensitization and exposure are associated with asthma severity, among low-income, minority children. Further studies are needed to determine whether reducing allergen exposure among mouse-sensitized patients with asthma can reduce severity, ultimately altering childhood asthma natural history., (Copyright © 2016 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)
- Published
- 2017
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12. Effect of an Integrated Pest Management Intervention on Asthma Symptoms Among Mouse-Sensitized Children and Adolescents With Asthma: A Randomized Clinical Trial.
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Matsui EC, Perzanowski M, Peng RD, Wise RA, Balcer-Whaley S, Newman M, Cunningham A, Divjan A, Bollinger ME, Zhai S, Chew G, Miller RL, and Phipatanakul W
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- Adolescent, Animals, Baltimore, Bedding and Linens, Boston, Child, Child, Preschool, Dust prevention & control, Environmental Exposure adverse effects, Environmental Exposure analysis, Environmental Exposure prevention & control, Female, Humans, Male, Symptom Assessment methods, Time Factors, Allergens adverse effects, Asthma diagnosis, Asthma prevention & control, Mice, Patient Education as Topic methods, Pest Control methods, Rodenticides
- Abstract
Importance: Professionally delivered integrated pest management (IPM) interventions can reduce home mouse allergen concentrations, but whether they reduce asthma morbidity among mouse-sensitized and exposed children and adolescents is unknown., Objective: To determine the effect of an IPM intervention on asthma morbidity among mouse-sensitized and exposed children and adolescents with asthma., Design, Setting, and Participants: Randomized clinical trial conducted in Baltimore, Maryland, and Boston, Massachusetts. Participants were mouse-sensitized and exposed children and adolescents (aged 5-17 years) with asthma randomized to receive professionally delivered IPM plus pest management education or pest management education alone. Enrollment occurred between May 2010 and August 2014; the final follow-up visit occurred on September 25, 2015., Interventions: Integrated pest management consisted of application of rodenticide, sealing of holes that could serve as entry points for mice, trap placement, targeted cleaning, allergen-proof mattress and pillow encasements, and portable air purifiers. Infestation was assessed every 3 months, and if infestation persisted or recurred, additional treatments were delivered. All participants received pest management education, which consisted of written material and demonstration of the materials needed to set traps and seal holes., Main Outcomes and Measures: The primary outcome was maximal symptom days defined as the highest number of days of symptoms in the previous 2 weeks among 3 types of symptoms (days of slowed activity due to asthma; number of nights of waking with asthma symptoms; and days of coughing, wheezing, or chest tightness) across 6, 9, and 12 months., Results: Of 361 children and adolescents who were randomized (mean [SD] age, 9.8 [3.2] years; 38% female; 181 in IPM plus pest management education group and 180 in pest management education alone group), 334 were included in the primary analysis. For the primary outcome, there was no statistically significant between-group difference for maximal symptom days across 6, 9, and 12 months with a median of 2.0 (interquartile range, 0.7-4.7) maximal symptom days in the IPM plus pest management education group and 2.7 (interquartile range, 1.3-5.0) maximal symptom days in the pest management education alone group (P = .16) and a ratio of symptom frequencies of 0.86 (95% CI, 0.69-1.06)., Conclusions and Relevance: Among mouse-sensitized and exposed children and adolescents with asthma, an intensive year-long integrated pest management intervention plus pest management education vs pest management education alone resulted in no significant difference in maximal symptom days from 6 to 12 months., Trial Registration: clinicaltrials.gov Identifier: NCT01251224.
- Published
- 2017
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13. Association Between Allergen Exposure in Inner-City Schools and Asthma Morbidity Among Students.
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Sheehan WJ, Permaul P, Petty CR, Coull BA, Baxi SN, Gaffin JM, Lai PS, Gold DR, and Phipatanakul W
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- Animals, Asthma physiopathology, Cats, Child, Cockroaches, Dogs, Female, Humans, Male, Mice, Mites, Rats, Respiratory Function Tests, United States, Urban Population, Allergens immunology, Asthma immunology, Environmental Exposure adverse effects, Schools
- Abstract
Importance: Home aeroallergen exposure is associated with increased asthma morbidity in children, yet little is known about the contribution of school aeroallergen exposures to such morbidity., Objective: To evaluate the effect of school-specific aeroallergen exposures on asthma morbidity among students, adjusting for home exposures., Design, Setting, and Participants: The School Inner-City Asthma Study was a prospective cohort study evaluating 284 students aged 4 to 13 years with asthma who were enrolled from 37 inner-city elementary schools in the northeastern United States between March 1, 2008, and August 31, 2013. Enrolled students underwent baseline clinical evaluations before the school year started and were then observed clinically for 1 year. During that same school year, classroom and home dust samples linked to the students were collected and analyzed for common indoor aeroallergens. Associations between school aeroallergen exposure and asthma outcomes during the school year were assessed, adjusting for home exposures., Exposures: Indoor aeroallergens, including rat, mouse, cockroach, cat, dog, and dust mites, measured in dust samples collected from inner-city schools., Main Outcomes and Measures: The primary outcome was maximum days in the past 2 weeks with asthma symptoms. Secondary outcomes included well-established markers of asthma morbidity, including asthma-associated health care use and lung function, measured by forced expiratory volume in 1 second., Results: Among 284 students (median age, 8 years [interquartile range, 6-9 years]; 148 boys and 136 girls), exposure to mouse allergen was detected in 441 (99.5%) of 443 school dust samples, cat allergen in 420 samples (94.8%), and dog allergen in 366 samples (82.6%). Levels of mouse allergen in schools were significantly higher than in students' homes (median settled dust level, 0.90 vs 0.14 µg/g; P < .001). Exposure to higher levels of mouse allergen in school (comparing 75th with 25th percentile) was associated with increased odds of having an asthma symptom day (odds ratio, 1.27; 95% CI, 1.05-1.54; P = .02) and 4.0 percentage points lower predicted forced expiratory volume in 1 second (95% CI, -6.6 to -1.5; P = .002). This effect was independent of allergic sensitization. None of the other indoor aeroallergens were associated with worsening asthma outcomes., Conclusions and Relevance: In this study of inner-city students with asthma, exposure to mouse allergen in schools was associated with increased asthma symptoms and decreased lung function. These findings demonstrate that the school environment is an important contributor to childhood asthma morbidity. Future school-based environmental interventions may be beneficial for this important public health problem.
- Published
- 2017
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14. Indoor allergen exposure and asthma outcomes.
- Author
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Sheehan WJ and Phipatanakul W
- Subjects
- Air Pollutants immunology, Allergens immunology, Asthma immunology, Asthma therapy, Child, Humans, Urban Health, Air Microbiology, Air Pollutants adverse effects, Air Pollution, Indoor adverse effects, Allergens adverse effects, Asthma etiology, Environmental Exposure adverse effects
- Abstract
Purpose of Review: The aim of the present review is to discuss updates on research regarding the relationship between indoor allergen exposure and childhood asthma with a focus on clinical effects, locations of exposure, and novel treatments., Recent Findings: Recent data continue to demonstrate that early life sensitization to indoor allergens is a predictor of asthma development later in life. Furthermore, avoidance of exposure to these allergens continues to be important especially given that the vast majority of children with asthma are sensitized to at least one indoor allergen. New research suggests that mouse allergen, more so than cockroach allergen, may be the most relevant urban allergen. Recent evidence reminds us that children are exposed to clinically important levels of indoor allergens in locations away from their home, such as schools and daycare centers. Exposure to increased levels of indoor mold in childhood has been associated with asthma development and exacerbation of current asthma; however, emerging evidence suggests that early exposure to higher fungal diversity may actually be protective for asthma development. Novel treatments have been developed that target TH2 pathways thus decreasing asthmatic responses to allergens. These therapies show promise for the treatment of severe allergic asthma refractory to avoidance strategies and standard therapies., Summary: Understanding the relationship between indoor allergens and asthma outcomes is a constantly evolving study of timing, location, and amount of exposure., Competing Interests: There are no conflicts of interest.
- Published
- 2016
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15. Clinical Evaluation and Management of Patients with Suspected Fungus Sensitivity.
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Larenas-Linnemann D, Baxi S, Phipatanakul W, and Portnoy JM
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- Humans, Hypersensitivity immunology, Immunoglobulin E immunology, Immunotherapy, Syndrome, Allergens immunology, Fungi immunology, Hypersensitivity diagnosis, Hypersensitivity therapy
- Abstract
Fungus-sensitized patients usually present with symptoms that are similar to symptoms presented by those who are sensitized to other aeroallergens. Therefore, diagnosis and management should follow the same pathways used for patients with allergic conditions in general. The physician should consider that a relationship between fungal exposure and symptoms is not necessarily caused by an IgE-mediated mechanism, even when specific fungal IgE is detected. Until recently, IgE-mediated allergy has been documented only for a limited number of fungi. We propose a series of questions to be used to identify symptoms that occur in situations with high fungal exposure and a limited skin-prick-test panel (Alternaria, Cladosporium, Penicillium, Aspergillus, Candida) that can be amplified only in cases of high suspicion of other fungal exposure (eg, postfloods). We also review in vitro testing for fungi-specific IgE. Treatment includes environmental control, medical management, and, when appropriate, specific immunotherapy. Low-quality evidence exists supporting the use of subcutaneous immunotherapy for Alternaria to treat allergic rhinitis and asthma, and very low quality evidence supports the use of subcutaneous immunotherapy for Cladosporium and sublingual immunotherapy for Alternaria. As is the case for many allergens, evidence for immunotherapy with other fungal extracts is lacking. The so-called toxic mold syndrome is also briefly discussed., (Copyright © 2016 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)
- Published
- 2016
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16. Exposure and Health Effects of Fungi on Humans.
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Baxi SN, Portnoy JM, Larenas-Linnemann D, and Phipatanakul W
- Subjects
- Air Pollution, Indoor adverse effects, Humans, Hypersensitivity etiology, Risk Factors, Air Pollutants adverse effects, Allergens immunology, Environmental Exposure adverse effects, Fungi immunology
- Abstract
Fungi are ubiquitous microorganisms that are present in outdoor and indoor environments. Previous research has found relationships between environmental fungal exposures and human health effects. We reviewed recent articles focused on fungal exposure and dampness as risk factors for respiratory disease development, symptoms, and hypersensitivity. In particular, we reviewed the evidence suggesting that early exposure to dampness or fungi is associated with the development of asthma and increased asthma morbidity. Although outdoor exposure to high concentrations of spores can cause health effects such as asthma attacks in association with thunderstorms, most people appear to be relatively unaffected unless they are sensitized to specific genera. Indoor exposure and dampness, however, appears to be associated with an increased risk of developing asthma in young children and asthma morbidity in individuals who have asthma. These are important issues because they provide a rationale for interventions that might be considered for homes and buildings in which there is increased fungal exposure. In addition to rhinitis and asthma, fungus exposure is associated with a number of other illnesses including allergic bronchopulmonary mycoses, allergic fungal sinusitis, and hypersensitivity pneumonitis. Additional research is necessary to establish causality and evaluate interventions for fungal- and dampness-related health effects., (Copyright © 2016 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)
- Published
- 2016
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17. Recent advances in environmental controls outside the home setting.
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Hauptman M and Phipatanakul W
- Subjects
- Allergens immunology, Animals, Asthma epidemiology, Asthma etiology, Child, Child Day Care Centers, Humans, Schools, Air Pollution, Indoor adverse effects, Allergens adverse effects, Asthma prevention & control, Environmental Exposure adverse effects, Urban Population
- Abstract
Purpose of Review: It has been well studied that aeroallergen, mold, and airborne pollutant exposure in the inner-city home environment is associated with significant childhood asthma morbidity. Although the home environment has been extensively studied, the school environment is less well understood., Recent Findings: In this article, we discuss the relationship between environmental exposures within the school and daycare environment and pediatric asthma morbidity and novel environmental interventions designed to help mitigate pediatric asthma morbidity., Summary: Studies assessing environmental exposures outside the home environment and interventions to mitigate these exposures have the potential to reduce pediatric asthma morbidity. Further study in this area should focus on the complex cost benefit analyses of environmental interventions outside the home setting, while controlling for the home environment.
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- 2016
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18. Association between allergic sensitization and exhaled nitric oxide in children in the School Inner-City Asthma Study.
- Author
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Rao DR, Sordillo JE, Kopel LS, Gaffin JM, Sheehan WJ, Hoffman E, Ozonoff A, Gold DR, and Phipatanakul W
- Subjects
- Breath Tests, Child, Eosinophilia immunology, Humans, Poverty Areas, Schools, Skin Tests, Students, Allergens immunology, Asthma immunology, Exhalation, Nitric Oxide analysis
- Published
- 2015
- Full Text
- View/download PDF
19. Indoor environmental exposures and exacerbation of asthma: an update to the 2000 review by the Institute of Medicine.
- Author
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Kanchongkittiphon W, Mendell MJ, Gaffin JM, Wang G, and Phipatanakul W
- Subjects
- Humans, Risk Factors, Air Pollution, Indoor adverse effects, Allergens adverse effects, Asthma epidemiology, Asthma etiology
- Abstract
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.
- Published
- 2015
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20. Introducing an environmental assessment and intervention program in inner-city schools.
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Huffaker M and Phipatanakul W
- Subjects
- Cities, Humans, Urban Population, Air Pollution, Indoor prevention & control, Allergens, Asthma prevention & control, Environmental Exposure prevention & control, Schools
- Abstract
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.)
- Published
- 2014
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21. Perinatal and early childhood environmental factors influencing allergic asthma immunopathogenesis.
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Gaffin JM, Kanchongkittiphon W, and Phipatanakul W
- Subjects
- Asthma etiology, Child, Child, Preschool, Female, Humans, Infant, Infant, Newborn, Perinatal Care, Pregnancy, Risk, Virus Diseases complications, Air Pollution adverse effects, Allergens adverse effects, Allergens immunology, Asthma epidemiology, Asthma immunology, Environmental Exposure adverse effects, Virus Diseases immunology
- Abstract
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 (NO(2)), ozone (O(3)), 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., (Copyright © 2014 Elsevier B.V. All rights reserved.)
- Published
- 2014
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22. Allergens on desktop surfaces in preschools and elementary schools of urban children with asthma.
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Kanchongkittiphon W, Sheehan WJ, Friedlander J, Chapman MD, King EM, Martirosyan K, Baxi SN, Permaul P, Gaffin JM, Kopel L, Bailey A, Fu C, Petty CR, Gold DR, and Phipatanakul W
- Subjects
- Animals, Cats, Child, Child, Preschool, Dogs, Humans, Mice, Urban Population, Air Pollution, Indoor analysis, Allergens analysis, Dust analysis, Environmental Exposure analysis, Schools
- Abstract
Desktop dust has been studied as a source of food allergen, but not as a source of potential aeroallergen exposure. Thirty-six wiped samples from desktop surfaces were collected from preschools and schools. Samples were analyzed for detectable levels of common aeroallergens including Alternaria, cockroach, dog, dust mite, cat, mouse, and rat allergens by immunoassay. Mouse allergen was the most prevalent, detectable in 97.2% of samples. Cat allergen was detectable in 80.6% of samples, and dog allergen was detectable in 77.8% of samples. Other allergens were not as prevalent. Mouse was the only allergen that was highly correlated with settled floor dust collected from the same rooms (r = 0.721, P < 0.001). This is the first study to detect aeroallergens on desktop surfaces by using moist wipes. Allergens for mouse, cat, and dog were highly detectable in wipes with mouse desktop surface levels correlating with levels in vacuumed floor dust., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
- Published
- 2014
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23. The indoor environment and inner-city childhood asthma.
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Kanchongkittiphon W, Gaffin JM, and Phipatanakul W
- Subjects
- Adolescent, Animals, Child, Child, Preschool, Humans, Mice, PubMed, Air Pollution, Indoor adverse effects, Allergens adverse effects, Asthma epidemiology, Asthma etiology, Asthma physiopathology, Asthma prevention & control, Urban Population
- Abstract
Objective: Exposure to indoor pollutants and allergens has been speculated to cause asthma symptoms and exacerbations and influence the risk of developing asthma. The aim of this article is to review the medical literature regarding the role of the indoor environment on inner-city childhood asthma., Data Sources: A literature search was performed in PubMed. Studies focusing on inner-city indoor allergen, childhood asthma, and environmental controls were included., Results: The prevalence of asthma in children is increasing especially in inner-city area. Exposure to high levels of indoor allergens and pollutants has been related to asthma development. Studies have shown that mouse, cockroach, pets, dust mite, mold, tobacco smoke, endotoxin and nitrogen dioxide are the important exposures. Recent studies have shown that indoor environmental control is beneficial in reducing asthma morbidity and development., Conclusions: Inner-city children are exposed to various indoor allergens and pollutants that may lead to asthma development and exacerbation of existing asthma. Multifaceted environmental controls are beneficial in improving asthma symptom and maybe a viable prevention strategy. Further prospective studies of environmental intervention are needed to further identify effective strategies to improve and prevent asthma symptoms in inner-city children.
- Published
- 2014
24. Environmental assessment and exposure control of dust mites: a practice parameter.
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Portnoy J, Miller JD, Williams PB, Chew GL, Miller JD, Zaitoun F, Phipatanakul W, Kennedy K, Barnes C, Grimes C, Larenas-Linnemann D, Sublett J, Bernstein D, Blessing-Moore J, Khan D, Lang D, Nicklas R, Oppenheimer J, Randolph C, Schuller D, Spector S, Tilles SA, and Wallace D
- Subjects
- Animals, Asthma therapy, Dermatitis, Atopic therapy, Desensitization, Immunologic, Dust analysis, Dust prevention & control, Environmental Exposure analysis, Humans, Practice Patterns, Physicians', Primary Prevention, Rhinitis, Allergic, Perennial therapy, Allergens immunology, Antigens, Dermatophagoides immunology, Environmental Exposure prevention & control, Pyroglyphidae immunology
- Published
- 2013
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25. Predictors of indoor exposure to mouse allergen in inner-city elementary schools.
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Permaul P, Sheehan WJ, Baxi SN, Gaffin JM, Fu C, Petty CR, Gold DR, and Phipatanakul W
- Subjects
- Animals, Asthma epidemiology, Cities epidemiology, Environmental Monitoring, Housing, Humans, Mice, Air Pollution, Indoor analysis, Allergens analysis, Schools
- Published
- 2013
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- View/download PDF
26. Turning up the heat on skin testing for baked egg allergy.
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Bartnikas LM and Phipatanakul W
- Subjects
- Female, Humans, Male, Allergens immunology, Egg Hypersensitivity diagnosis, Egg Hypersensitivity immunology, Eggs adverse effects, Ovomucin immunology, Skin Tests
- Published
- 2013
- Full Text
- View/download PDF
27. Environmental assessment and exposure reduction of rodents: a practice parameter.
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Phipatanakul W, Matsui E, Portnoy J, Williams PB, Barnes C, Kennedy K, Bernstein D, Blessing-Moore J, Cox L, Khan D, Lang D, Nicklas R, Oppenheimer J, Randolph C, Schuller D, Spector S, Tilles SA, Wallace D, Sublett J, Bernstein J, Grimes C, Miller JD, and Seltzer J
- Subjects
- Allergens adverse effects, Animals, Environmental Exposure adverse effects, Humans, Hypersensitivity immunology, Meta-Analysis as Topic, Randomized Controlled Trials as Topic, Allergens immunology, Environmental Exposure prevention & control, Hypersensitivity prevention & control, Pest Control methods, Rodentia immunology
- Published
- 2012
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- View/download PDF
28. Allergens in urban schools and homes of children with asthma.
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Permaul P, Hoffman E, Fu C, Sheehan W, Baxi S, Gaffin J, Lane J, Bailey A, King E, Chapman M, Gold D, and Phipatanakul W
- Subjects
- Animals, Cats, Child, Dogs, Dust analysis, Female, Humans, Male, Mice, Students, United States epidemiology, Allergens analysis, Asthma epidemiology, Environmental Exposure, Housing, Schools, Urban Population
- Abstract
Background: Most studies of indoor allergens have focused on the home environment. However, schools may be an important site of allergen exposure for children with asthma. We compared school allergen exposure to home exposure in a cohort of children with asthma. Correlations between settled dust and airborne allergen levels in classrooms were examined., Methods: Settled dust and airborne samples from 12 inner-city schools were analyzed for indoor allergens using multiplex array technology (MARIA). School samples were linked to students with asthma enrolled in the School Inner-City Asthma Study (SICAS). Settled dust samples from students' bedrooms were analyzed similarly., Results: From schools, 229 settled dust and 197 airborne samples were obtained. From homes, 118 settled dust samples were obtained. Linear mixed regression models of log-transformed variables showed significantly higher settled dust levels of mouse, cat and dog allergens in schools than homes (545% higher for Mus m 1, estimated absolute difference 0.55 μg/g, p < 0.0001; 198% higher for Fel d 1, estimated absolute difference 0.13 μg/g, p = 0.0033; and 144% higher for Can f 1, estimated absolute difference 0.05 μg/g, p = 0.0008). Airborne and settled dust Mus m 1 levels in classrooms were moderately correlated (r = 0.48; p < 0.0001). There were undetectable to very low levels of cockroach and dust mite allergens in both homes and schools., Conclusion: Mouse allergen levels in schools were substantial. In general, cat and dog allergen levels were low, but detectable, and were higher in schools. Aerosolization of mouse allergen in classrooms may be a significant exposure for students. Further studies are needed to evaluate the effect of indoor allergen exposure in schools on asthma morbidity in students with asthma., (© 2012 John Wiley & Sons A/S.)
- Published
- 2012
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29. Endotoxin exposure in inner-city schools and homes of children with asthma.
- Author
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Sheehan WJ, Hoffman EB, Fu C, Baxi SN, Bailey A, King EM, Chapman MD, Lane JP, Gaffin JM, Permaul P, Gold DR, and Phipatanakul W
- Subjects
- Adolescent, Air Pollution, Indoor, Asthma epidemiology, Child, Endotoxins immunology, Female, Housing, Humans, Male, Massachusetts epidemiology, Schools, Seasons, Urban Population, Allergens immunology, Asthma immunology, Dust immunology, Endotoxins analysis
- Abstract
Background: Endotoxins are stimulators of the immune system and, despite their potential to protect against allergy, have been associated with early wheezing and asthma morbidity., Objective: To compare inner-city school endotoxin exposure with home endotoxin exposure in children with asthma., Methods: Students with asthma were recruited from 12 urban elementary schools. Settled and airborne dust samples, linked to enrolled students, were collected from school classrooms, gymnasiums, and cafeterias twice during the academic year. For comparison, settled dust was collected once from the bedrooms of students with asthma., Results: Two hundred twenty-nine school settled dust samples and 118 bedroom settled dust samples were collected and analyzed for endotoxin. The median endotoxin concentration for school samples was 13.4 EU/mg (range, 0.7-360.7 EU/mg) and for home samples was 7.0 EU/mg (range = LLOD-843.0 EU/mg). The median concentration within each individual school varied from 6.6 EU/mg to 24.0 EU/mg. One hundred four students with asthma had matched classroom and bedroom endotoxin exposure measurements performed in the same season and demonstrated significantly higher concentrations of endotoxin in the students' classrooms (mean log value, 1.13 vs 0.99, P = .04). The median of the classrooms was 12.5 EU/mg compared with their bedrooms, with a median of 7.0 EU/mg. Within the school environment, no significant difference was seen between the fall and spring samples (mean log value 1.14 vs 1.09; P = .35)., Conclusion: Inner-city children with asthma were exposed to higher concentrations of endotoxin in their classrooms as compared with their bedrooms. Further studies are needed to evaluate school endotoxin exposure as a factor in asthma morbidity., (Copyright © 2012 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)
- Published
- 2012
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30. Effect of cat and daycare exposures on the risk of asthma in children with atopic dermatitis.
- Author
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Gaffin JM, Spergel JM, Boguniewicz M, Eichenfield LF, Paller AS, Fowler JF Jr, Dinulos JG, Tilles SA, Schneider LC, and Phipatanakul W
- Subjects
- Animals, Cats, Cockroaches immunology, Dogs, Female, Humans, Male, Mice, Pyroglyphidae immunology, Rats, Risk, Allergens immunology, Asthma complications, Asthma epidemiology, Dermatitis, Atopic complications, Environmental Exposure adverse effects
- Abstract
Atopic dermatitis (AD) in young children is often followed by the development of asthma (atopic march). The role of environmental exposures is unclear in this high-risk population. We aimed to determine the predictive relationship between indoor allergen exposures, particularly pets, rodents, and cockroaches, to the development of asthma in a prospective pediatric cohort. Children with AD and a family history of allergy were followed prospectively with questionnaire ascertainment of environmental exposure to cats, dogs, cockroaches, rats, and mice. Asthma was diagnosed by study physicians based on caregiver reports of symptoms continually assessed over the course of the study period. Fifty-five of the 299 children developed asthma by the end of the study. Cat exposure had a strong and independent effect to reduce the risk of developing asthma across all analyses (odds ratio [OR], 0.16; 95% confidence interval [CI], 0.05-0.53). Dog, mouse, rat, and cockroach exposures did not significantly influence the development of asthma. Daycare exposure had the largest risk reduction for the development of asthma (OR, 0.08; 95% CI, 0.03-0.19). Maternal asthma (OR, 2.93; 95% CI, 1.29-6.67), baseline body mass index (OR, 1.23; 95% CI, 1.08-1.42), and specific immunoglobulin E to house-dust mix at 3 years were each independent risk factors for the development of asthma. In children with AD, cat and daycare exposure may reduce the risk of developing early childhood asthma.
- Published
- 2012
- Full Text
- View/download PDF
31. Environmental assessment and exposure control: a practice parameter--furry animals.
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Portnoy J, Kennedy K, Sublett J, Phipatanakul W, Matsui E, Barnes C, Grimes C, Miller JD, Seltzer JM, Williams PB, Bernstein JA, Bernstein DI, Blessing-Moore J, Cox L, Khan DA, Lang DM, Nicklas RA, and Oppenheimer J
- Subjects
- Allergens adverse effects, Animals, Cats, Consensus, Dogs, Evidence-Based Medicine, Expert Testimony, Humans, Hypersensitivity classification, Hypersensitivity diagnosis, Pets classification, Allergens immunology, Environmental Exposure, Hypersensitivity immunology, Pets immunology, Practice Guidelines as Topic
- Published
- 2012
- Full Text
- View/download PDF
32. Impact of environmental controls on childhood asthma.
- Author
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Rao D and Phipatanakul W
- Subjects
- Animals, Asthma etiology, Asthma mortality, Child, Child, Preschool, Female, Filtration methods, Humans, Male, Mice, Air Pollution, Indoor prevention & control, Allergens adverse effects, Asthma prevention & control, Environmental Exposure prevention & control
- Abstract
Exposure to allergens early in life can lead to sensitization and the development of childhood asthma. It is thought that increased exposure with the advent of modern housing is likely contributing to the rise in prevalence of childhood asthma during the past few decades. The progression from allergen exposure to sensitization and asthma development has been noted with respect to dust mites, pets, cockroach, mouse, mold, tobacco smoke, endotoxin, and air pollution, although some have found a protective effect with pet and endotoxin exposure. Recent studies have shown that allergen remediation may be beneficial in reducing asthma morbidity and development, although there is also some evidence to the contrary. Examples of allergen remediation that have been studied include the use of dust mite-impermeable covers, high-efficiency particulate air filtration, integrated pest management, home repairs, ventilation improvement, and pet removal. Several multifaceted, randomized controlled trials have shown that reducing multiple early allergen exposures with environmental controls is associated with a decreased risk of asthma.
- Published
- 2011
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33. Age-specific prevalence of outdoor and indoor aeroallergen sensitization in Boston.
- Author
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Sheehan WJ, Rangsithienchai PA, Baxi SN, Gardynski A, Bharmanee A, Israel E, and Phipatanakul W
- Subjects
- Adolescent, Age Distribution, Air Pollutants adverse effects, Animals, Asthma epidemiology, Asthma immunology, Asthma physiopathology, Boston epidemiology, Cats, Child, Child, Preschool, Cohort Studies, Dogs, Female, Humans, Hypersensitivity immunology, Hypersensitivity physiopathology, Male, Mites immunology, Pollen immunology, Prevalence, Retrospective Studies, Risk Assessment, Skin Tests, Urban Population, Air Pollutants immunology, Air Pollution, Indoor adverse effects, Allergens immunology, Environmental Exposure adverse effects, Hypersensitivity epidemiology, Immunization
- Abstract
Questions exist regarding the appropriate age for referral of an atopic child to an allergist for environmental skin prick testing. This study evaluates age-specific prevalence of sensitization to aeroallergens from infancy through adolescence. A total of 1394 patients were skin tested, with 57.2% being sensitized to at least 1 aeroallergen. In children younger than 2, the authors found that 26.5% were sensitized, including to dogs (15.5%) and cats (9.2%). Additionally, tree sensitization was demonstrated in the youngest age group (7.8% at 0-2 years; 17.1% at 2-4 years), including in 3 infants less than 1 year old. Sensitization rates to dust mites and trees were the highest in all ages above 4 years, with a peak tree sensitization of 56.4% at 10 to 12 years and a peak dust mite sensitization of 56.8% in the >12 group. Overall, the authors observed increasing sensitization rates throughout childhood for indoor and outdoor aeroallergens (P < .001). Aeroallergen sensitization begins at a young age and increases during childhood.
- Published
- 2010
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34. The role of allergen exposure and avoidance in asthma.
- Author
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Baxi SN and Phipatanakul W
- Subjects
- Adolescent, Air Pollutants toxicity, Allergens immunology, Animals, Animals, Domestic, Asthma immunology, Cockroaches, Dermatophagoides farinae, Fungi, Humans, Mice, Pollen, Risk Factors, United States, Allergens toxicity, Asthma etiology, Asthma prevention & control, Environmental Exposure adverse effects, Environmental Exposure prevention & control
- Abstract
Allergy testing and avoidance of allergens plays an important role in asthma control. Increased allergen exposure, in genetically susceptible individuals, can lead to allergic sensitization. Continued allergen exposure can increase the risk of asthma and other allergic diseases. In a patient with persistent asthma, identification of indoor and outdoor allergens and subsequent avoidance can improve symptoms. Often times, a patient will have multiple allergies and the avoidance plan should target all positive allergens. Several studies have shown that successful allergen remediation includes a comprehensive approach including education, cleaning, physical barriers, and maintaining these practices.
- Published
- 2010
35. Pest and allergen exposure and abatement in inner-city asthma: a work group report of the American Academy of Allergy, Asthma & Immunology Indoor Allergy/Air Pollution Committee.
- Author
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Sheehan WJ, Rangsithienchai PA, Wood RA, Rivard D, Chinratanapisit S, Perzanowski MS, Chew GL, Seltzer JM, Matsui EC, and Phipatanakul W
- Subjects
- Animals, Asthma epidemiology, Environmental Exposure, Humans, Hypersensitivity immunology, Urban Health, Urban Population, Air Pollution, Indoor adverse effects, Allergens immunology, Asthma etiology, Cockroaches immunology, Hypersensitivity etiology, Mice immunology
- Abstract
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.
- Published
- 2010
- Full Text
- View/download PDF
36. Air filters and air cleaners: rostrum by the American Academy of Allergy, Asthma & Immunology Indoor Allergen Committee.
- Author
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Sublett JL, Seltzer J, Burkhead R, Williams PB, Wedner HJ, and Phipatanakul W
- Subjects
- Air Conditioning, Animals, Asthma prevention & control, Environmental Exposure, Humans, Particulate Matter adverse effects, Air Pollution, Indoor adverse effects, Air Pollution, Indoor prevention & control, Allergens adverse effects, Filtration methods, Filtration standards, Respiration Disorders prevention & control
- Abstract
The allergist is generally recognized as possessing the greatest expertise in relating airborne contaminants to respiratory health, both atopic and nonatopic. Consequently, allergists are most often asked for their professional opinions regarding the appropriate use of air-cleaning equipment. This rostrum serves as a resource for the allergist and other health care professionals seeking a better understanding of air filtration., (Copyright 2010 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.)
- Published
- 2010
- Full Text
- View/download PDF
37. Mouse allergens in urban elementary schools and homes of children with asthma.
- Author
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Sheehan WJ, Rangsithienchai PA, Muilenberg ML, Rogers CA, Lane JP, Ghaemghami J, Rivard DV, Otsu K, Hoffman EB, Israel E, Gold DR, and Phipatanakul W
- Subjects
- Animals, Antigens, Dermatophagoides analysis, Cats, Child, Cockroaches immunology, Dogs, Dust, Female, Humans, Male, Mice, Proteins analysis, United States, Allergens analysis, Asthma immunology, Housing statistics & numerical data, Schools statistics & numerical data
- Abstract
Background: The association between allergens in schools and childhood asthma has not been well studied, particularly in the United States., Objective: To investigate allergen exposure in schools compared with homes with a specific focus on children with asthma., Methods: Dust samples were collected from 46 rooms in 4 urban elementary schools (northeastern United States) and from 38 student bedrooms. Samples were analyzed for cat (Fel d 1), dog (Can f 1), cockroach (Bla g 2), dust mites (Der f 1/Der p 1), and mouse urinary protein (MUP). Questionnaires identified students with physician-diagnosed asthma., Results: Cat and dog allergens were detectable in most school samples (96% and 78%, respectively), but at low levels. Cockroach allergen was detectable in only 11% of school samples. Mouse allergen was detectable in 89% of school samples, with 68% having MUP levels greater than 0.5 microg/g. In contrast, MUP was detectable in only 26% of bedroom samples. Matched classroom and home samples from 23 asthmatic students showed higher geometric mean MUP levels in the classroom vs the home (6.45 microg/g vs 0.44 microg/g, P < .001). However, there were lower geometric mean dust mite (Der f 1) levels in the classroom vs the home (0.04 microg/g vs 0.66 microg/g, P < .001)., Conclusions: There are significantly higher levels of MUP but lower levels of Der f 1 in schools vs homes. It is important to recognize that children with asthma may encounter varying levels of allergens in environments outside the home, such as schools.
- Published
- 2009
- Full Text
- View/download PDF
38. Mouse allergen exposure, wheeze and atopy in the first seven years of life.
- Author
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Phipatanakul W, Celedón JC, Hoffman EB, Abdulkerim H, Ryan LM, and Gold DR
- Subjects
- Adult, Air Pollution, Indoor, Animals, Child, Child, Preschool, Female, Follow-Up Studies, Humans, Infant, Male, Skin Tests, Surveys and Questionnaires, Allergens immunology, Dermatitis, Atopic immunology, Dust immunology, Mice immunology, Respiratory Sounds immunology
- Abstract
Background: Little is known about mouse allergen exposure in home environments and the development of wheezing, asthma and atopy in childhood., Objective: To examine the relation between mouse allergen exposure and wheezing, atopy, and asthma in the first 7 years of life., Methods: Prospective study of 498 children with parental history of allergy or asthma followed from birth to age 7 years, with longitudinal questionnaire ascertainment of reported mouse exposure and dust sample mouse urinary protein allergen levels measured at age 2-3 months., Results: Parental report of mouse exposure in the first year of life was associated with increased risk of transient wheeze and wheezing in early life. Current report of mouse exposure was also significantly associated with current wheeze throughout the first 7 years of life in the longitudinal analysis (P = 0.03 for overall relation of current mouse to current wheeze). However, early life mouse exposure did not predict asthma, eczema or allergic rhinitis at age 7 years. Exposure to detectable levels of mouse urinary protein in house dust samples collected at age 2-3 months was associated with a twofold increase in the odds of atopy (sensitization to >=1 allergen) at school age (95% confidence interval for odds ratio = 1.1-3.7; P = 0.03 in a multivariate analysis., Conclusions: Among children with parental history of asthma or allergies, current mouse exposure is associated with increased risk of wheeze during the first 7 years of life. Early mouse exposure was associated with early wheeze and atopy later in life.
- Published
- 2008
- Full Text
- View/download PDF
39. Prevalence and titer of IgE antibodies to mouse allergens.
- Author
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Platts-Mills TA, Satinover SM, Naccara L, Litonjua AA, Phipatanakul W, Carter MC, Heymann PW, Woodfolk JA, Peters EJ, and Gold DR
- Subjects
- Adolescent, Adult, Black or African American, Allergens urine, Animals, Child, Child, Preschool, Cohort Studies, Female, Hispanic or Latino, Humans, Male, Middle Aged, Skin Tests, Allergens immunology, Hypersensitivity, Immediate immunology, Immunoglobulin E blood, Mice immunology
- Abstract
Background: Positive skin tests to allergens derived from mouse urine have been reported among patients with asthma. Very few data are available detailing the titer of IgE Ab to mouse allergen and how it varies by location and population., Objective: To evaluate further the prevalence and titer of IgE Ab to mouse-derived allergens and their relevance to total IgE and asthma., Methods: IgE Ab to mouse allergens was measured in 1165 sera from diverse populations including children and adults. The results were compared with IgE Ab to other allergens and total serum IgE., Results: Positive results were found in 79 sera, but only 15 had an IgE Ab titer >or=10 IU/mL. Results for IgE Ab to Mus m 1 showed a close quantitative correlation with IgE Ab to mouse allergen (r = 0.93; P < .001). Cohorts in neither Atlanta nor Virginia contained sera in which IgE Ab to mouse was dominant over other allergens or contributed significantly to total IgE. By contrast, among 319 mothers from minority groups in Boston, 11 sera had >or=10 IU/mL. In these sera, specific IgE Ab to mouse made a significant contribution to the total., Conclusion: Mouse allergen sensitization may contribute significantly to total IgE and allergy in African American and Hispanic populations from some northern cities. Analysis of the significance of an IgE Ab response should include quantitative comparison with other responses and total IgE., Clinical Implications: Significance of rodent infestation and IgE Ab varies dramatically in different populations and areas of the United States.
- Published
- 2007
- Full Text
- View/download PDF
40. Sensitization to mouse allergen and asthma and asthma morbidity among women in Boston.
- Author
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Phipatanakul W, Litonjua AA, Platts-Mills TA, Naccara LM, Celedón JC, Abdulkerim H, Hoffman EB, and Gold DR
- Subjects
- Animals, Asthma ethnology, Female, Humans, Morbidity, Allergens immunology, Asthma etiology, Mice immunology
- Published
- 2007
- Full Text
- View/download PDF
41. Environmental factors and childhood asthma.
- Author
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Phipatanakul W
- Subjects
- Allergens isolation & purification, Animals, Animals, Domestic, Asthma prevention & control, Child, Preschool, Humans, Patient Education as Topic, Pediatrics, Air Pollution, Indoor adverse effects, Allergens adverse effects, Antigens, Dermatophagoides adverse effects, Asthma etiology, Environmental Exposure adverse effects, Fungi
- Abstract
Indoor allergens are potent triggers for acute and chronic pediatric asthma. Environmental control measures of these allergens should be considered first-line treatment measures. Allergen avoidance can produce changes in disease activity and symptoms that can be beneficial before any medical intervention is implemented. In addition to allergen avoidance, studies evaluating other exposures, such as endotoxin and diet, in the pathogenesis of asthma are in progress. Understanding the complex relationships between exposure and allergy/asthma development is vitally important to the development of potentially more effective primary and secondary prevention strategies.
- Published
- 2006
42. Mouse exposure and wheeze in the first year of life.
- Author
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Phipatanakul W, Celedón JC, Sredl DL, Weiss ST, and Gold DR
- Subjects
- Animals, Asthma genetics, Family Characteristics, Genetic Predisposition to Disease, Humans, Infant, Male, Multivariate Analysis, Parents, Polysorbates, Prospective Studies, Respiratory Sounds genetics, Risk Factors, Urban Population, Allergens adverse effects, Environmental Exposure adverse effects, Mice immunology, Respiratory Sounds etiology
- Abstract
Background: Studies have found that exposure to mice is highly prevalent among children with asthma living in urban areas., Objective: To examine the relationship between exposure to mice and wheeze in the first year of life., Methods: We conducted an ongoing prospective birth cohort study of 498 children with a history of allergy or asthma in at least 1 parent living in metropolitan Boston (the Home Allergens and Asthma Study)., Results: In a multivariate analysis, infants whose parents reported exposure to mice in the household had nearly twice the odds of developing any wheeze in the first year of life as children without exposure (odds ratio [OR], 1.83; 95% confidence interval [CI], 1.14-2.95; P = .01). Other variables associated with wheeze in the first year of life included low birth weight (OR, 1.77; 95% CI, 1.06-2.95; P = .03), having at least 1 lower respiratory tract illness (OR, 5.59; 95% CI, 3.46-9.04; P < .001), exposure to high levels of endotoxin at age 2 to 3 months (fourth quartile compared with first quartile: OR, 2.32; 95% CI, 1.19-4.54; P = .01), and exposure to cockroach allergen of 0.05 U/g of dust or more at age 2 to 3 months (OR, 1.83; 95% CI, 1.09-3.08; P = .02)., Conclusion: Among children with a parental history of asthma or allergies, exposure to mice is associated with wheeze in the first year of life, independent of other factors.
- Published
- 2005
- Full Text
- View/download PDF
43. Predictors of indoor exposure to mouse allergen in urban and suburban homes in Boston.
- Author
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Phipatanakul W, Gold DR, Muilenberg M, Sredl DL, Weiss ST, and Celedón JC
- Subjects
- Air Pollution, Indoor, Animals, Boston, Cohort Studies, Female, Humans, Hypersensitivity genetics, Infant, Male, Medical Records, Parents, Prospective Studies, Allergens, Environmental Exposure, Forecasting, Housing, Mice immunology, Suburban Population, Urban Population
- Abstract
Background: Mouse allergen exposure is prevalent among urban children with asthma. Little is known about mouse allergen exposure in children at risk for the development of allergic diseases., Aims of the Study: To assess indoor mouse allergen exposure in early life among children with parental history of asthma or allergies., Methods: Prospective birth cohort study of 498 children with a history of allergy or asthma in at least one parent living in metropolitan Boston., Results: Of the 498 participating children, 357 (71.7%) resided outside the city of Boston and 439 (90.7%) lived in households with incomes > 30,000 dollars. Mouse allergen was detected in 42% of the homes of study participants. In a multivariate analysis adjusting for sex, income, and endotoxin, black race [odds ratio (OR) = 3.0; 95% confidence interval (CI) = 1.3-6.6, P = 0.009], signs of mice in the home at age 2-3 months (OR = 3.0; 95% CI = 1.6-5.6, P = 0.0006), and kitchen cockroach allergen levels > or = 0.05 to < 2 U/g (OR = 1.8; 95% CI = 1.1-3.2, P = 0.02) were associated with detectable mouse allergen in the kitchen. In this model, living in a single detached house was inversely associated with detectable kitchen mouse allergen levels (OR = 0.4; 95% CI = 0.2-0.6, P = 0.0001)., Conclusion: Infants with a parental history of asthma or allergies are commonly exposed to mouse allergen in their homes. Among infants at high risk for atopy, predictors of increased mouse allergen levels included black race, reported mice exposure, and moderate levels of cockroach allergen.
- Published
- 2005
- Full Text
- View/download PDF
44. Effect of environmental intervention on mouse allergen levels in homes of inner-city Boston children with asthma.
- Author
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Phipatanakul W, Cronin B, Wood RA, Eggleston PA, Shih MC, Song L, Tachdjian R, and Oettgen HC
- Subjects
- Adolescent, Air Pollution, Indoor adverse effects, Animals, Asthma physiopathology, Boston epidemiology, Child, Child Welfare, Cockroaches, Female, Forced Expiratory Volume physiology, Humans, Male, Mice, Predictive Value of Tests, Air Pollution, Indoor analysis, Allergens adverse effects, Allergens analysis, Asthma etiology, Environmental Exposure adverse effects, Environmental Exposure analysis
- Abstract
Background: Recent studies have suggested that mouse allergen exposure and sensitization are common in urban children with asthma. The effectiveness of environmental intervention in reducing mouse allergen exposure has not been established., Objective: To evaluate whether environmental intervention of mouse extermination and cleaning results in a reduction in mouse allergen levels., Methods: Eighteen homes of children with positive mouse allergen skin test results and at least mild persistent asthma in urban Boston, MA, with evidence of mouse infestation or exposure were randomized in a 2:1 ratio (12 intervention and 6 control homes). The intervention homes received an integrated pest management intervention, which consisted of filling holes with copper mesh, vacuuming and cleaning, and using low-toxicity pesticides and traps. Dust samples were collected and analyzed for major mouse allergen (Mus m 1) and cockroach allergen (Bla g 1) at baseline and 1, 3, and 5 months after the intervention was started and compared with control homes., Results: Mouse allergen levels were significantly decreased compared with control homes by the end of the intervention period at month 5 in the kitchen and bedroom (kitchen intervention, 78.8% reduction; control, 319% increase; P = .02; bedroom intervention, 77.3% reduction; control, 358% increase; P < .01; and living room intervention, 67.6% reduction; control, 32% reduction; P = .07)., Conclusions: Mouse allergen levels were significantly reduced during a 5-month period using an integrated pest management intervention.
- Published
- 2004
- Full Text
- View/download PDF
45. Environmental indoor allergens.
- Author
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Phipatanakul W
- Subjects
- Air Pollution, Indoor prevention & control, Animals, Antigens, Dermatophagoides analysis, Cats, Cockroaches immunology, Dogs, Fungi immunology, Air Pollution, Indoor analysis, Allergens analysis
- Published
- 2003
- Full Text
- View/download PDF
46. Rodent allergens.
- Author
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Phipatanakul W
- Subjects
- Animals, Hypersensitivity diagnosis, Hypersensitivity therapy, Allergens immunology, Hypersensitivity immunology, Rodentia immunology
- Abstract
Rodent allergens play a significant role in the pathogenesis of asthma and allergic rhinitis, and are potent causes of acute and chronic symptoms. This has long been apparent in occupational settings, particularly in the laboratory, but has been most recently studied and found to be important in home environments. These allergens have been suggested as uniquely important among inner-city children with asthma. Furthermore, rodents have become increasingly popular as pets. With recent awareness of significant exposure in a variety of settings, hypersensitivity to rodents has become increasingly important. This review focuses on the importance of rodent allergens, concentrating on mouse and rat, but including other potentially important rodents such as gerbil, hamster, and rabbit. It also discusses the pathogenesis, diagnosis, prevention, and management of rodent allergy.
- Published
- 2002
- Full Text
- View/download PDF
47. Animal allergens and their control.
- Author
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Phipatanakul W
- Subjects
- Air Pollutants adverse effects, Air Pollution, Indoor adverse effects, Animals, Environmental Exposure adverse effects, Environmental Illness diagnosis, Humans, Air Pollution, Indoor prevention & control, Allergens adverse effects, Environmental Illness etiology, Environmental Illness prevention & control
- Abstract
Animal allergens play a significant role in the pathogenesis of asthma and allergic rhinitis, and are potent causes of acute and chronic symptoms. Although cat and dog allergens are the most important, exposure to a wide variety of other furred animals is not uncommon. Recent reports state that 60% to 70% of households in the western world have at least one pet. Because of this significant exposure, hypersensitivity to animals has become increasingly important. This review focuses on the importance of animal allergens, concentrating on cat and dog allergens, but including others as well. It also discusses the pathogenesis, diagnosis, prevention, and management of animal allergy.
- Published
- 2001
- Full Text
- View/download PDF
48. Mouse allergen. I. The prevalence of mouse allergen in inner-city homes. The National Cooperative Inner-City Asthma Study.
- Author
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Phipatanakul W, Eggleston PA, Wright EC, and Wood RA
- Subjects
- Allergens adverse effects, Animals, Asthma etiology, Asthma immunology, Child, Child, Preschool, Female, Humans, Male, Urban Population statistics & numerical data, Allergens analysis, Housing statistics & numerical data, Mice immunology
- Abstract
Background: Although mouse allergen is a well-defined cause of IgE-mediated hypersensitivity in occupational settings, it has not been well studied in the general population., Objective: We sought to determine the prevalence of mouse allergen in inner-city homes., Methods: A subset of 608 homes from the National Cooperative Inner-City Asthma Study population had dust samples adequate for analysis of mouse allergen. In addition, data regarding the demographics and housing of the subjects were related to the mouse allergen levels., Results: Ninety-five percent of all homes had detectable mouse allergen (Mus m 1) in at least one room, with the highest levels found in kitchens (kitchen: range, 0-618 microg/g; median, 1.60 microg/g; bedroom: range, 0-294 microg/g; median, 0.52 microg/g; television-living room: range, 0-203 microg/g; median, 0. 57 microg/g). By city, 100% of the kitchens in Baltimore had detectable mouse allergen, with the lowest percentage (74%) in Cleveland. Mouse allergen levels correlated among rooms (R = 0.65-0. 75). Forty-nine percent of the homes had reported problems with mice within the last year, and 29% of the homes had evidence of mice in one or more rooms on home inspection and had higher levels of mouse allergen (P =.0001). Higher allergen levels were also associated with evidence of cockroach infestation in any room (P =.006). None of the other subject or housing demographics evaluated were associated with a higher prevalence or level of mouse allergen., Conclusions: We conclude that mouse allergen is widely distributed in inner-city homes and that cockroach infestation is associated with high mouse allergen levels.
- Published
- 2000
- Full Text
- View/download PDF
49. Mouse allergen. II. The relationship of mouse allergen exposure to mouse sensitization and asthma morbidity in inner-city children with asthma.
- Author
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Phipatanakul W, Eggleston PA, Wright EC, and Wood RA
- Subjects
- Animals, Asthma immunology, Child, Child, Preschool, Environmental Exposure analysis, Female, Humans, Hypersensitivity, Immediate immunology, Immunization, Male, Socioeconomic Factors, Urban Health, Allergens analysis, Housing, Mice immunology
- Abstract
Background: Although mouse allergen is known to cause occupational asthma in laboratory workers, its potential significance in home environments has never been studied., Objective: This study was designed to define the prevalence of mouse sensitivity and its relationship to mouse allergen exposure and disease activity in inner-city children with asthma., Methods: A subset of 499 subjects from the National Cooperative Inner-City Asthma Study had dust samples adequate for mouse allergen analysis, as well as valid puncture skin test (PST) results. Data were analyzed to relate mouse allergen exposure and other risk factors to mouse sensitization and asthma morbidity., Results: Eighty-nine (18%) of the 499 children had a positive mouse skin test response. Children whose homes had mouse allergen levels above the median (1.60 microg/g) in the kitchen had a significantly higher rate of mouse sensitization (23% vs 11%, P =. 007). Atopy was also significantly related to mouse sensitization, with 40% of those with more than 4 positive PST responses having mouse sensitivity compared with 4% of those with no other positive PST responses (P <.0001). When atopy and exposure were considered together, 53% of those with more than 4 positive PST responses and allergen levels above the median had a positive PST response to mouse allergen compared with 22% of those with more than 4 positive PST responses and allergen levels below the median (P <.0001). The relationship among mouse allergen exposure, sensitization, and any measures of asthma morbidity was not statistically significant., Conclusions: Mouse allergen may be an important indoor allergen in inner-city children with asthma, with exposure and atopy contributing to mouse sensitization.
- Published
- 2000
- Full Text
- View/download PDF
50. The value of acoustic rhinometry in assessing nasal responses to cat exposure.
- Author
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Phipatanakul W, Kesavanathan J, Eggleston PA, Johnson EF, and Wood RA
- Subjects
- Acoustics, Adult, Aged, Allergens administration & dosage, Animals, Environmental Pollutants administration & dosage, Environmental Pollutants immunology, Humans, Hypersensitivity diagnosis, Manometry methods, Middle Aged, Nasal Cavity immunology, Rhinitis, Allergic, Perennial diagnosis, Rhinitis, Allergic, Perennial immunology, Allergens immunology, Cats immunology, Hypersensitivity immunology, Nasal Provocation Tests methods
- Abstract
Background: Acoustic rhinometry (AR) uses sonar principles to map the anatomy of the nasal cavity and has been used in other studies to assess acute airway responses to allergen exposure., Objective: The purpose of this study was to evaluate the utility of AR in assessing acute airway responses to cat allergen exposure by using a well-characterized cat exposure model., Methods: Thirty subjects with a history of cat-induced rhinitis and a positive skin prick test response to cat allergen underwent an environmental cat challenge. Of these 30 subjects, 10 also had repeat challenges at lower levels of antigen to determine whether there was a dose response. Five subjects with negative skin test responses to cat were recruited as control subjects. During the 1-hour cat exposure, upper and lower respiratory symptoms were scored every 5 minutes, and spirometry and AR were obtained every 15 minutes., Results: Although 29 of 30 subjects had changes in AR measurements, no correlations were detected between upper respiratory symptom scores and any of the changes observed in AR. In comparing the baseline challenges with lower antigen level challenges, upper respiratory symptom scores differed significantly (P = .002), whereas AR responses were nearly identical. Subjects without cat allergy did exhibit less response by AR (P = .05 to .13), but the greatest differences remained in the upper respiratory symptoms scores (P < .0001)., Conclusion: We conclude that although AR does provide an objective measure of nasal response to allergen exposure, it has significant limitations. These are evidenced by the lack of correlation with symptoms, the inability to measure a dose response, and the changes noted even among the control subjects.
- Published
- 1998
- Full Text
- View/download PDF
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