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Objective: Allergic rhinitis (AR) is a disease associated with impaired quality of life and heredity. This study aimed to investigate the association of allergic rhinitis in preschool children with exposure to indoor environment-related factors early in life., Methods: In August 2019, the authors implemented a study among 2020 preschool children in Urumqi City using a case-control design. The study included parental reports for the occurrence of AR in children, parental history of respiratory disease, and indoor environmental correlates of maternal exposure from 1 year prior to pregnancy until the child's age of 0-1 year., Results: Mode of birth (cesarean section) (OR = 1.31, 95% CI = 1.02∼1.67), father with AR (OR = 2.67, 95% CI = 2.08∼3.44), mother with AR (OR = 3.70, 95% CI = 2.88∼4.74), mother with asthma (OR = 3.11, 95% CI = 1.18∼8.20), and mother with newly purchased furniture in the parents' residence during pregnancy (OR = 1.49, 95% CI = 1.03∼2.14) were risk factors for AR in children., Conclusions: The focus of allergic rhinitis should be on children with a family history of AR and asthma and cesarean delivery. Primary prevention efforts for AR in preschool children are avoiding exposure of children to indoor environmental hazardous factors early in life., Competing Interests: Conflicts of interest The authors declare no conflicts of interest., (Copyright © 2023 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.)

Cockroach allergens have a greater impact on asthma morbidity than those from dust mites, cats, and dogs. The American cockroach (Periplaneta americana) and the German cockroach (Blattella germanica) are most frequently responsible for sensitization. The worldwide prevalence of allergic sensitization has been estimated at 2 to 26 % and is influenced by unfavorable socioeconomic conditions. Exposure is generally measured by determining antigen levels in dust or through insect trapping. We developed a real-time quantitative PCR (qPCR) method to provide an objective measurement of B. germanica levels in dwellings. The specificity of the qPCR primers and TaqMan® hydrolysis probe was validated in silico with 18S rRNA sequences. No amplification was observed for other species of cockroaches, with the exception of Blattella nipponica, which is not common indoors. From 2018 to 2021, exposure to B. germanica was detected and quantified in 27 of 389 dwellings in Bourgogne-Franche-Comté (mean = 333.8; median = 9.1 and maximum = 5304 copy number equivalents) and in 236 of 3193 ELFE cohort dwellings in mainland France in 2011 (mean = 15.6; median < 1 and maximum = 1275 copy number equivalents). The distribution of dwellings testing positive for cockroaches (7 %) differed among the 12 regions of France: <1 % in two regions, between 1 and 5 % in eight regions, 16.5 % in two regions and 35 % around Paris. Exposure measurements by the EDC sampling and qPCR methods are effective ways to assess the exposure to cockroaches in dwellings. A knowledge of the level of exposure to cockroaches is particularly important for asthmatic patients, particularly those not allergic to other common antigens., Competing Interests: Declaration of competing interest None., (Copyright © 2022 Elsevier B.V. All rights reserved.)

The increasing prevalence of reported annoyances in the indoor environment threatens public health. This study aimed to investigate the association between perceived annoyances from the home environment and respiratory infections among individuals with and without asthma or chronic obstructive pulmonary disease (COPD). A total of 16,688 individuals from the Danish Health and Morbidity Survey initiated in 2000 were grouped according to their patterns of perceived annoyances. Information on respiratory infections (all causes, bacterial, viral, and those leading to hospital admissions) was obtained from Danish registers up to 19 years after the survey. Poisson regression of incidence rates (IRs) was applied to estimate incidence rate ratios (IRRs). Annoyances significantly increased the IR for respiratory infections of all causes and bacterial respiratory infections in individuals without asthma or COPD, adjusted IRR 1.16 (95% CI: 1.01, 1.34) and 1.15 (95% CI: 1.02, 1.31), respectively. However, no difference was observed for viral respiratory infections nor hospital admissions. Individuals with asthma or COPD and a high level of annoyances had a non-significantly increased IR in all four analyses of respiratory infections. These findings provide support for perceived annoyances as an important risk factor for respiratory infections.

Introduction: As the amount of time people spend indoors increases globally, exposure to indoor air pollutants has become an important public health concern. Asthma is a complex disease caused and/or exacerbated by increased exposure to diverse chemical, physical and biological exposures from multiple indoor and outdoor sources. This review aims to investigate the relationship between increased indoor PM and VOC concentrations (i.e. objectively measured) and the risk of adult asthma in higher-income countries., Methods: Eleven databases were systematically searched on the February 1, 2019 and again on the February 2, 2020. Articles were limited to those published since 1990. Reference lists were independently screened by three reviewers and authors were contacted to identify relevant articles. Backwards and forward citation chasing was used to identify further studies. Data were extracted from included studies meeting our eligibility criteria by three reviewers and assessed for quality using the Newcastle-Ottawa scale designed for case-control and cohort studies., Results: Twelve studies were included in a narrative synthesis. We found insufficient evidence to determine the effect of PM2.5 on asthma in the indoor home environment. However, there was strong evidence to suggest that VOCs, especially aromatic compounds, and aliphatic compounds, were associated with increased asthma symptoms., Discussion & Conclusion: Although no single exposure appears to be responsible for the development of asthma or its associated symptoms, the use of everyday products may be associated with increased asthma symptoms. To prevent poor health outcomes among the general population, health professionals and industry must make a concerted effort to better inform the general population of the importance of appropriate use of and storage of chemicals within the home as well as better health messaging on product labelling., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Phthalic acid esters (PAEs) have a negative impact on human health and are widely distributed in China. As part of the China, Children, Home, Health (CCHH) study, we investigated the associations between childhood asthmatic symptoms and PAEs in settled house dust in Shanghai, China. We found that di-2-ethylhexyl phthalate (DEHP), dibutyl phthalate (DBP), and diisobutyl phthalate (DiBP) were abundant in the indoor environment. A total of 27 % of children suffered from diagnosed asthma. The Mann-Whitney U test and multiple logistic regression were used to obtain the associations between PAEs and childhood asthmatic symptoms. Stratification analysis was performed to reveal the influence of gender on the associations between PAE exposure and target symptoms. Compared with low concentrations of PAEs, high concentrations of high molecular weight PAEs (HMW-PAEs) were significantly associated with childhood diagnosed asthma (adjusted odds ratios (AORs) > 1, P < 0.05). Moreover, significantly negative associations were found between high concentrations of DiBP and current cough (AORs<1, P < 0.05). All significantly positive associations were observed among girls, and most of the associations of dimethyl phthalate (DMP) and diethyl phthalate (DEP) exposure with the studied symptoms among girls were higher than those among boys. Exposure to PAEs may be a risk factor for asthmatic symptoms in children, especially in girls., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objectives: To investigate the associations of household mold and pesticide use with risk of childhood asthma and examine the potential effect modification by child's sex at a national level in the U.S., Methods: Nationally representative data were drawn from the cross-sectional 2017 and 2018 National Surveys of Children's Health. Household mold and pesticide exposures during the past 12 months and physician-diagnosed childhood asthma were assessed by standard questionnaires administered to primary caregivers. Multivariable logistic regression models were used to calculate adjusted odds ratios (aOR) for current asthma, adjusting for child, caregiver, and household covariates. We also examined potential effect modification by child's sex. Sampling weights accounted for the complex survey design., Results: Among 41,423 U.S. children in 2017-2018, the weighted prevalence of current asthma was 10.8% in household mold-exposed children, compared with 7.2% in non-exposed children (P < 0.001). After adjusting for covariates including child's obesity, children with household mold exposure compared to those with no household mold exposure had a 1.41-fold (95% CI: 1.07, 1.87) higher odds of current asthma. Associations between household mold and current asthma were pronounced among boys (aOR 1.57; 95% CI: 1.03-2.38) but not girls (aOR 1.28; 0.90-1.83; P for interaction <0.001). No significant associations were observed between household pesticide use and current asthma, after adjusting for covariates., Conclusions: Our findings suggest that household mold is associated with current asthma among children, independent of other major risk factors including child's obesity status. Our findings may inform strategies targeting mitigation of household mold as an important indoor environment factor to address childhood asthma., (Copyright © 2021 Elsevier GmbH. All rights reserved.)

Background: The links between microbial environmental exposures and asthma are well documented, but no study has combined deep sequencing results from pulmonary and indoor microbiomes of patients with asthma with spirometry, clinical, and endotype parameters., Objective: The goal of this study was to investigate the links between indoor microbial exposures and pulmonary microbial communities and to document the role of microbial exposures on inflammatory and clinical outcomes of patients with severe asthma (SA)., Methods: A total of 55 patients with SA from the national Cohort of Bronchial Obstruction and Asthma cohort were enrolled for analyzing their indoor microbial flora through the use of electrostatic dust collectors (EDCs). Among these patients, 22 were able to produce sputum during "stable" or pulmonary "exacerbation" periods and had complete pairs of EDC and sputum samples, both collected and analyzed. We used amplicon targeted metagenomics to compare microbial communities from EDC and sputum samples of patients according to type 2 (T2)-asthma endotypes., Results: Compared with patients with T2-low SA, patients with T2-high SA exhibited an increase in bacterial α-diversity and a decrease in fungal α-diversity of their indoor microbial florae, the latter being significantly correlated with fraction of exhaled nitric oxide levels. The β-diversity of the EDC mycobiome clustered significantly according to T2 endotypes. Moreover, the proportion of fungal taxa in common between the sputum and EDC samples was significantly higher when patients exhibited acute exacerbation., Conclusion: These results illustrated, for the first time, a potential association between the indoor mycobiome and clinical features of patients with SA, which should renew interest in deciphering the interactions between indoor environment, fungi, and host in asthma., (Copyright © 2020 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Increasing evidence from the home environment indicates that indoor microbiome exposure is associated with asthma development. However, indoor microbiome composition can be highly diverse and dynamic, and thus current studies fail to produce consistent results. Chinese university dormitories are special high-density dwellings with similar building and occupants characteristics, which facilitate to disentangle the complex interactions between microbes, environmental characteristics and asthma. Settled air dust and floor dust was collected from 87 dormitory rooms in Shanxi University. Bacterial communities were characterized by 16 S rRNA amplicon sequencing. Students (n = 357) were surveyed for asthma symptoms and measured for fractional exhaled nitric oxide (FeNO). Asthma was not associated with the overall bacterial richness but associated with specific phylogenetic classes. Taxa richness and abundance in Clostridia, including Ruminococcus, Blautia, Clostridium and Subdoligranulum, were positively associated with asthma (p < 0.05), and these taxa were mainly derived from the human gut. Taxa richness in Alphaproteobacteria and Actinobacteria were marginally protectively associated with asthma, and these taxa were mainly derived from the outdoor environment. Bacterial richness and abundance were not associated with FeNO levels. Building age was associated with overall bacterial community variation in air and floor dust (p < 0.05), but not associated with the asthma-related microorganisms. Our data shows that taxa from different phylogenetic classes and derived habitats have different health effects, indicating the importance of incorporating phylogenetic and ecological concepts in revealing patterns in the microbiome asthma association analysis., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Indoor dampness is thought to affect around 16% of European homes. It is generally accepted that increased exposure to indoor dampness and mould contamination (e.g., spores and hyphae) increases the risk of developing and/or exacerbating asthma. Around 30% of people in the Western world have an allergic disease (e.g., allergy, wheeze and asthma). The role of indoor mould contamination in the risk of allergic diseases in older adults is yet to be fully explored. This is of interest because older people spend more time indoors, as well as facing health issues due to the ageing process, and may be at greater risk of developing and/or exacerbating asthma as a result of indoor dampness. Methods : Face-to-face questionnaires were carried out with 302 participants residing in social housing properties located in South West England. Self-reported demographic, mould contamination (i.e., presence of mould growth and mouldy odour) and health information was linked with the asset management records (e.g., building type, age and levels of maintenance). Multivariate logistic regression was used to calculate the odd ratios and confidence intervals of developing and/or exacerbating asthma, wheeze and allergy with exposure to reported indoor mould contamination. We adjusted for a range of factors that may affect asthma outcomes, which include age, sex, current smoking, presence of pets, education, and building type and age. To assess the role of mould contamination in older adults, we compared younger adults to those aged over 50 years. Results : Doctor-diagnosed adult asthma was reported by 26% of respondents, 34% had current wheeze while 18% had allergies. Asthma was common among subjects exposed to reported visible mould (32%) and reported mouldy odour (42%). Exposure to visible mould growth and mouldy odour were risk factors for asthma, but not for wheeze or allergy. Exposure to mouldy odour increased the risk of asthma in adults over the age of 50 years (odds ratio (OR) 2.4, 95% confidence interval (CI) 1.10-5.34) and the risk was higher for females than for males (OR 3.5, 95% CI 1.37-9.08). These associations were modified by a range of built environment characteristics. Conclusions : We found that older adults living in social (public) housing properties, specifically women, may be at higher risk of asthma when exposed to mouldy odour, which has a number of implications for policy makers and practitioners working in the health and housing sector. Additional measures should be put in place to protect older people living in social housing against indoor damp and mould contamination.

Background: Childhood asthma is prevalent in China. However, there is a lack of evidence on whether household renovation, including the materials used and the periods, are associated with the disease., Objectives: To investigate the associations between household decoration materials and renovation periods, and childhood asthma and its related symptoms., Methods: During 2010-2012, a retrospective cohort study was initiated in seven cities of China, and 40,010 children, aged 3-6 years, were recruited. Data on demographics, health status, and home decoration conditions were collected using a parent-administered questionnaire. Two-level (city-child) logistic regression analyses with adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were performed to show the target associations. Sensitivity analysis was performed by stratifying data for children in the southern and northern cities., Results: Children whose homes underwent renovation or the addition of new furniture within 1 year before pregnancy, during pregnancy, at age 0-1 year, and after age 1 year had significantly (p < 0.05) higher prevalence of childhood asthma and its related symptoms. The use of solid wood floors and wallpaper had significant associations (cement: AOR, 95% CI: 1.59, 1.17-2.17; lime: AOR, 95% CI: 1.31, 1.00-1.71) with an increased risk of lifetime asthma. Household renovation and the addition of new furniture during pregnancy had significant associations with lifetime asthma (renovation: AOR, 95% CI: 1.23, 1.01-1.51); lifetime wheeze (renovation: AOR, 95% CI: 1.21, 1.05-1.39; furniture: AOR, 95% CI: 1.24, 1.14-1.36), current wheeze (renovation: AOR, 95% CI, 1.21 1.05-1.40; furniture: AOR, 95% CI: 1.23, 1.12-1.34), and current dry cough (renovation: AOR, 95% CI: 1.41, 1.23-1.63; furniture: AOR, 95% CI: 1.28, 1.17-1.41). Similar associations were found between the addition of new furniture during early childhood and lifetime asthma and its related symptoms. Except for the association between lifetime wheeze and flooring materials, the studied associations were generally stronger among children from the northern cities., Conclusions: We confirmed that using cellulose based materials in home decoration and renovation, and adding new furniture during early childhood and pregnancy could be risk factors for childhood asthma. The association between household decoration during early childhood and childhood asthma may be stronger in the northern cities of China., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Organophosphates are used in a wide range of materials and consumer products and are ubiquitous in indoor environments. Certain organophosphates have been associated with various adverse health effects. The present paper reports mass fractions of organophosphates in dust samples collected from 500 bedrooms and 151 daycare centers of children living in Odense, Denmark. The identified compounds include: tris(isobutyl) phosphate (TIBP), tri-n-butyl phosphate (TNBP), tris(2-chloroethyl) phosphate (TCEP), tris(2-chloroisopropyl) phosphate (TCIPP), tris(1,3-dichloroisopropyl) phosphate (TDCIPP), tris(2-butoxyethyl) phosphate (TBOEP), triphenylphosphate (TPHP), 2-ethylhexyl-diphenyl phosphate (EHDPP), tris(2-ethylhexyl) phosphate (TEHP) and tris(methylphenyl) phosphate (TMPP). Both the number of organophosphates with median values above the limit of detection and the median values were higher for samples from daycare centers than for samples from homes. Organophosphates with median mass fractions above the limit of detection were: TCEP from homes (6.9 μg g(-1)), and TCEP (16 μg g(-1)), TCIPP (5.6 μg g(-1)), TDCIPP (7.1 μg g(-1)), TBOEP (26 μg g(-1)), TPHP (2.0 μg g(-1)) and EHDPP (2.1 μg g(-1)) from daycare centers. When present, TBOEP was typically the most abundant of the identified OPs. The sum of the organophosphate dust mass fractions measured in this study was roughly in the mid-range of summed mass fractions reported for dust samples collected in other countries. On a global scale, the geographical distribution of organophosphates in indoor dust is quite variable, with higher concentrations in industrialized countries. This trend differs from that for phthalate esters, whose geographic distribution is more homogeneous. Exposure to organophosphates via dust ingestion is relatively low, although there is considerable uncertainly in this assessment., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

The home environment can influence childhood allergies and respiratory health but there is little information on associations between early life exposure at home and new onset and remission of the asthmatic or allergic symptoms in preschool children. A questionnaire survey was performed in a random cluster sample of 4246 preschool children in Urumqi, China. Information on the home environment (perceptions of odors and indicators of pollution sources) and children's health (wheeze, rhinitis and eczema) was collected for the first 2 years of life and the last year (before answering the questionnaire) from one of the parents or another guardian of the child. Associations between the home environment the first 2 years of life and new onset and remission of childhood symptoms were analyzed by multiple logistic regression. Home environment factors reported for the first 2 years of life were consistently positively associated with new onset of symptoms and negatively associated with remission of symptoms. Visible mold (OR 1.46, 95% CI 1.12-1.90), moldy odor (OR 2.15, 95% CI 1.45-3.18), air dryness (OR 1.31, 95% CI 1.08-1.59), stuffy odor (OR 1.25, 95% CI 1.01-1.54) and parental smoking (OR 1.36, 95% CI 1.13-1.65) were associated with new onset of symptoms. These factors were negatively associated with the remission of symptoms. In conclusion, mold contamination at home (moldy odor/visible mold), poor indoor air quality (stuffy odor, air dryness) and exposure to environmental tobacco smoke (ETS) in the first 2 years of life can increase the incidence of asthmatic and allergic symptoms and decrease the remission from these symptoms in preschool children., (Copyright © 2016. Published by Elsevier B.V.)

Background: The microbiome of the home is of great interest because of its possible impact on health. Our goal was to identify some of the factors that determine the richness, evenness and diversity of the home's fungal and bacterial microbiomes., Method: Vacuumed settled dust from homes (n=35) in Cincinnati, OH, were analyzed by pyrosequencing to determine the fungal and bacterial relative sequence occurrence. The correlation coefficients between home environmental characteristics, including age of home, Environmental Relative Moldiness Index (ERMI) values, occupant number, relative humidity and temperature, as well as pets (dog and cat) were evaluated for their influence on fungal and bacterial communities. In addition, linear discriminant analysis (LDA) was used for identifying fungal and bacterial genera and species associated with those housing determinants found to be significant., Results: The fungal richness was found to be positively correlated with age of home (p=0.002), ERMI value (p=0.003), and relative humidity (p=0.015) in the home. However, fungal evenness and diversity were only correlated with the age of home (p=0.001). Diversity and evenness (not richness) of the bacterial microbiome in the homes were associated with dog ownership. Linear discriminant analysis showed total of 39 putative fungal genera/species with significantly higher LDA scores in high ERMI homes and 47 genera/species with significantly higher LDA scores in homes with high relative humidity. When categorized according to the age of the home, a total of 67 fungal genera/species had LDA scores above the significance threshold. Dog ownership appeared to have the most influence on the bacterial microbiome, since a total of 130 bacterial genera/species had significantly higher LDA scores in homes with dogs., Conclusions: Some key determinants of the fungal and bacterial microbiome appear to be excess moisture, age of the home and dog ownership., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Studies in rodents indicate that phthalates can function as adjuvants, increasing the potency of allergens. Meanwhile, epidemiological studies have produced inconsistent findings regarding relationships between phthalate exposures and allergic disease in humans. The present study examined phthalate exposure and allergic sensitization in a large group of 3-5 year old children: 300 random controls and 200 cases with asthma, rhinoconjunctivitis or atopic dermatitis as reported in questionnaires. The children were clinically examined to confirm their health status. Blood samples were analyzed for IgE sensitization to 20 allergens. Adjusted logistic regressions were used to look for associations between phthalate exposure indicators (mass fractions in dust from children's homes and daycares, metabolites in urine, and estimated daily indoor intakes from dust ingestion, inhalation and dermal absorption) and sensitization and allergic disease. No direct associations were found between phthalate exposures and asthma, rhinoconjunctivitis or atopic dermatitis. However, among children with these diseases, there were significant associations between non-dietary exposures to DnBP, BBzP and DEHP in the indoor environment (mass fractions in dust or daily indoor intakes from dust ingestion, inhalation and dermal absorption) and allergic sensitization. Some exposure pathways were more strongly associated with sensitization than others, although the results are not conclusive and require confirmation. A number of the associations depended on accounting for a child's exposure in more than one environment (i.e., daycare facility as well as home). Significant associations were not observed between phthalate metabolites in urine, which reflected exposure from diet as well as indoor pathways, and allergic sensitization., (Copyright © 2015 Elsevier Inc. All rights reserved.)

This study aims to assess potential environmental influences on allergy development in children. Based on a parent-completed questionnaire survey administered in Hong Kong in 2003 in accordance with the International Study of Asthma and Allergies in Childhood protocol, the prevalence and incidence of asthma and rhinoconjunctivitis of 508 preschool children aged 4 to 6 years in Yuen Long District were determined and a range of indoor and outdoor environmental factors were assessed. Exposure to moisture and mold in the first year of life increased the risk of asthma (adjusted odds ratio [aOR] = 2.56; 95% confidence interval [CI] = 1.40-4.68) and rhinoconjunctivitis (aOR = 2.09; 95% CI = 1.15-3.80). Current maternal smoking was also associated with a higher prevalence of asthma (aOR = 2.00; 95% CI = 1.04-3.84). No association was observed between outdoor traffic-related air pollutants and the prevalence of the allergic conditions. Indoor home environments had a stronger influence on allergy development, whereas exposure to traffic-related external environment gave a variable effect, the significance of which would be difficult to be substantiated., (© 2011 APJPH.)

Indoor exposure to the spores and mycelial fragments of fungi that grow on damp building materials can result in increased non-atopic asthma and upper respiratory disease. The mechanism appears to involve exposure to low doses of fungal metabolites. Penicillium corylophilum is surprisingly common in damp buildings in USA, Canada and western Europe. We examined isolates of P. corylophilum geographically distributed across Canada in the first comprehensive study of secondary metabolites of this fungus. The sesquiterpene phomenone, the meroterpenoids citreohybridonol and andrastin A, koninginin A, E and G, three new alpha pyrones and four new isochromans were identified from extracts of culture filtrates. This is the first report of koninginins, meroterpenoids and alpha pyrones from P. corylophilum. These secondary metabolite data support the removal of P. corylophilum from Penicillium section Citrina and suggest that further taxonomic studies are required on this species., (© 2014 by The Mycological Society of America.)

Purpose: Hoarseness and voice problems are one of the chronic conditions experienced by children. The aim of this study was to investigate the prevalence of hoarseness, possible risk factors and effects of the remediation of school buildings to the prevalence of hoarseness among school children. Methods: The material was gathered from all the schools in a large city in the south of Finland and the collection method used was an e-mail survey sent to the parents of the pupils and a simultaneous survey sent to the personnel in the schools. Results: All 51 schools participated, and 5889 pupils returned the questionnaire (39%). The exposure data was obtained from two building experts who knew the repair history of the schools. A subjective estimation of the quality of the indoor air was obtained from teachers and the parents. The overall prevalence of hoarseness among pupils was 6.3%; prevalence being higher in unrepaired school buildings than in schools in a good condition or buildings with a thorough remediation. Hoarseness was associated with asthma and allergies, several respiratory symptoms, and respiratory infections. Exposure to tobacco smoke increased the risk, and consumption of caffeine containing drinks seemed to reduce the risk. Noise, stuffiness of the indoor air and microbial smells correlated strongly with the occurrence of hoarseness in a logistic regression model when controlled for age, gender, asthma, passive smoking, and caffeine consumption. Conclusions: We recommend renovations in school buildings with the aim of providing better acoustics, sufficient ventilation, and a reduction in exposure to moisture damage microbes. [ABSTRACT FROM AUTHOR]

A growing number of studies have shown that the indoor residential environment is associated with respiratory and allergic diseases in children. This study aimed to investigate the prevalence of respiratory and allergic diseases among children in China and its correlation with using air handling equipment, based on the cross-sectional survey results of the China Children Homes Health Project in 2010 and 2019. The binary logistic regression model was used to explore the association between asthma, rhinitis, eczema and pneumonia and the use of air handling equipment in children. The prevalence of children's respiratory and allergic diseases has decreased, and the usage rate of portable air purifiers and split air conditioners has increased in 2019 compared to 2010. The results showed that using a fresh air system with filters was negatively correlated with children's pneumonia (adjusted odds ratio (aOR): 0.767, 95% confidence interval (95% CI): 0.704–0.835). The use of portable air purifiers was positively correlated with most diseases' symptoms in two undertaken surveys. In 2019, the positive correlation between using split air conditioners and asthma-related symptoms decreased compared with 2010, while it was positively correlated with rhinitis, eczema and pneumonia. To avoid children's allergic diseases and reduce respiratory symptoms, parents should choose appropriate air handling equipment. [ABSTRACT FROM AUTHOR]

Background . Ambient air pollution has been associated with exacerbations of chronic obstructive pulmonary disease (COPD) and asthma; however, little is known about indoor environmental factors. Our aim was to study the association between perceived indoor environment and the long-term risk of exacerbations of COPD or asthma. Methods . We followed 2,317 individuals aged ≥16 years with COPD or asthma from the Danish Health and Morbidity Survey from 2000 to 2018. Individuals developing COPD or asthma during the study period were included at the time of incident diagnosis. Individuals were grouped according to their patterns of perceived indoor environment and followed up for exacerbations defined based on information from the Danish National Health Registers. The association between perceived indoor environment and exacerbations was examined using a generalized mixed model with the Poisson distribution of the number of exacerbations and logarithmic transformation of follow-up time as offset. Analyses were adjusted for age, sex, education, household income, smoking, calendar year, construction year, urbanization, home ownership, and resident density. Results . A total of 5,352 exacerbations were recorded in 2,317 individuals during a median of 13.9 years (interquartile range, 7.9–18.2 years). The adjusted incidence rate ratio (IRR) of exacerbations were 1.40 (95% CI 0.85–2.29 and 0.82 (95% CI 0.49–1.38) among individuals with medium and high levels om annoyances, respectively. For annoyances related to temperature and traffic the IRR was 0.88 (95% CI 0.61–1.27) and 1.39 (95% CI 0.88–2.19), respectively. Conclusion . We found no association between indoor environment assessed as annoyances at a single time-point and exacerbations of COPD and asthma.

The relationships between the microbial communities that develop within homes and local outdoor features, household conditions and respiratory health outcomes are not well understood. In this study, high-throughput bacterial 16S and fungal ITS rDNA sequencing were coupled with a quantitative, GIS-based land use approach in a sample of 95 homes in adjacent urban and rural areas to investigate how local land use features surrounding homes relate to the home microbiome. Bacterial richness was higher in homes surrounded by less development while fungal richness was higher in homes surrounded by more development. Home mycobiomes in less developed areas were enriched with crop-associated taxa whereas in more developed areas human-associated bacterial taxa and wood decaying fungal taxa predominated. Not all vegetation had the same effect on the home microbiome and distinct differences were observed between bacterial and fungal communities, and the distance between home and vegetation. Crops and tree coverage were strongly related to indoor mycobiomes due to the abundance of crop-related taxa and wood decaying taxa, respectively. Regarding asthma, the microbiomes in homes with asthmatic children had greater bacterial diversity and lower fungal diversity compared to homes without asthmatic children. In addition, 'protective' taxa were enriched in non-asthmatic homes. The buffer-based approach used for quantitatively categorizing land use and development levels around homes identified specific outdoor environmental factors that affect the indoor microbiomes in urban and rural homes. The study also supports the growing body of scientific evidence that the indoor microbiome can affect health outcomes such as childhood asthma. • Indoor bacterial and fungal microbiomes assessed via HVAC dust. • Investigated effect of local land use on microbiome using GIS-based buffer approach. • Development and vegetation surrounding homes affect indoor microbiome differently. • Greater bacterial and lower fungal diversities in homes with asthmatic children. • 'Protective' taxa enriched in homes without childhood asthma. [ABSTRACT FROM AUTHOR]

BackgroundThe exposure of house occupants to indoor air pollutants has increased in recent decades. Among microbiological contaminants, bacterial and fungal aerosols remain poorly studied and the debate on the impact of these aerosols on respiratory health is still open. This study aimed to assess the diversity of indoor microbial communities in relationship with the health of occupants.MethodsMeasurements were taken from dwellings of 2 cohorts in Brittany (France), one with children without any pathology and the other with children and adults with asthma. Thirty dust samples were analyzed by next generation sequencing with a 16S and 18S targeted metagenomics approach. Analysis of sequencing data was performed using qiime 2, and univariate and multivariate statistical analysis using R software and phyloseq package.ResultsA total of 2,637 prokaryotic (589 at genus level) and 2,153 eukaryotic taxa were identified (856 fungal taxa (39%) and 573 metazoa (26%)). The four main bacterial phyla were identified: Proteobacteria (53%), Firmicutes (27%), Actinobacteria (11%), Bacteroidetes (8%). Among Fungi, only 136 taxa were identified at genus level. Three main fungal phyla were identified: Ascomycota (84%), Basidiomycota (12%) and Mucoromycota (3%). No bacterial nor fungal phyla were significantly associated with asthma versus control group. A significant over representation in control group versus asthma was observed for Christensenellaceae family (p-value = 0.0015, adj. p-value = 0.033). Besides, a trend for over representation in control group was observed with Dermabacteraceae family (p-value = 0.0002, adj. p-value = 0.815).ConclusionsOur findings provide evidence that dust samples harbor a high diversity of human-associated bacteria and fungi. Molecular methods such as next generation sequencing are reliable tools for identifying and tracking the bacterial and fungal diversity in dust samples, a less easy strategy for the detection of eukaryotes at least using18S metagenomics approach. This study showed that the detection of some bacteria might be associated to indoor air of asthmatic patients. Regarding fungi, a higher number of samples and sequencing with more depth could allow reaching significant signatures.

Background: The exposure of house occupants to indoor air pollutants has increased in recent decades. Among microbiological contaminants, bacterial and fungal aerosols remain poorly studied and the debate on the impact of these aerosols on respiratory health is still open. This study aimed to assess the diversity of indoor microbial communities in relationship with the health of occupants. Methods: Measurements were taken from dwellings of 2 cohorts in Brittany (France), one with children without any pathology and the other with children and adults with asthma. Thirty dust samples were analyzed by next generation sequencing with a 16S and 18S targeted metagenomics approach. Analysis of sequencing data was performed using qiime 2, and univariate and multivariate statistical analysis using R software and phyloseq package. Results: A total of 2,637 prokaryotic (589 at genus level) and 2,153 eukaryotic taxa were identified (856 fungal taxa (39%) and 573 metazoa (26%)). The four main bacterial phyla were identified: Proteobacteria (53%), Firmicutes (27%), Actinobacteria (11%), Bacteroidetes (8%). Among Fungi, only 136 taxa were identified at genus level. Three main fungal phyla were identified: Ascomycota (84%), Basidiomycota (12%) and Mucoromycota (3%). No bacterial nor fungal phyla were significantly associated with asthma versus control group. A significant over representation in control group versus asthma was observed for Christensenellaceae family (p -value = 0.0015, adj. p -value = 0.033). Besides, a trend for over representation in control group was observed with Dermabacteraceae family (p -value = 0.0002, adj. p -value = 0.815). Conclusions: Our findings provide evidence that dust samples harbor a high diversity of human-associated bacteria and fungi. Molecular methods such as next generation sequencing are reliable tools for identifying and tracking the bacterial and fungal diversity in dust samples, a less easy strategy for the detection of eukaryotes at least using18S metagenomics approach. This study showed that the detection of some bacteria might be associated to indoor air of asthmatic patients. Regarding fungi, a higher number of samples and sequencing with more depth could allow reaching significant signatures. [ABSTRACT FROM AUTHOR]

Background Exposure to indoor air pollutants at home was found to be associated with respiratory diseases. As lifestyle changes with rapid economic growth in Romania, the aim of our study is to describe the characteristics of Romanian homes and their impact on children's respiratory health. Methods Self-reported information on respiratory symptoms was collected from 280 Romanian elementary school students in 2011, and the symptoms were categorized into allergy, asthma-like, and flu-like symptoms. Home characteristics and demographic information were collected from questionnaires answered by parents. The association between home characteristics and respiratory health was assessed through multivariate logistic regression controlling for school indoor exposure. Results As compared to U.S. households, Romanian homes have a higher percentage of smokers, limited use of indoor climate control, and higher use of iron stoves. Exposure to environmental tobacco smoke was associated with both asthma and allergy symptoms. Additional risk factors identified for allergy symptoms include living in apartments, near pesticide sprayed areas, and the use of incense sticks. The significantly higher risk of flu-like symptoms was associated with mold and dampness issues, the use of air conditioner, gas heater/iron stove in children's bedroom. Conclusion Our findings suggest that an increase in respiratory symptoms among Romanian school-age children can be partly related to their environmental exposure at home. Since most of the identified risk factors are preventable, our results provide critical information and evidence for policymakers, to develop target intervention and education strategies. [ABSTRACT FROM AUTHOR]

As a sub-grantee of a Department of Housing and Urban Development (HUD) Lead Hazard Control and Healthy Homes Program, the University of Nevada, Las Vegas' Department of Environmental and Occupational Health performed lead and Healthy Homes investigations and collected data regarding conditions in the home environment in Henderson, Nevada. The purpose of this research is to characterize housing conditions in southern Nevada, compare data to census data, and to highlight the health outcomes associated with adverse housing conditions. Visual home assessments were conducted in 106 homes in southern Nevada, and specific hazards were characterized using the Healthy Homes Rating System. The results were then compared, when possible, to American Housing Survey (AHS) data for the Las Vegas metropolitan area. Lead, domestic hygiene, carbon monoxide, damp and mold, excess cold and heat, and structural collapse were the most frequently identified hazards, found in at least 101 (90%) of participant households. Median household income of program participants was half (50%) that of the surrounding zip code, which was expected, as classification as 'low-income' by HUD standards was a requirement for participation. Our data indicated that the AHS data may not be representative of very low income housing in southern Nevada and may underreport actual conditions. In-home inspections performed by trained personnel provide a more accurate picture of conditions than the self-report method used by the AHS. In addition, we recommend the development of a standardized Healthy Homes visual assessment tool to allow for the comparison of housing conditions between communities. [ABSTRACT FROM AUTHOR]

In the Swedish Building Energy, Technical Status and Indoor environment study, a total of 1160 adults from 605 single-family houses answered a questionnaire on respiratory health. Building inspectors investigated the homes and measured temperature, air humidity, air exchange rate, and wood moisture content (in attic and crawl space). Moisture load was calculated as the difference between indoor and outdoor absolute humidity. Totally, 7.3% were smokers, 8.7% had doctor' diagnosed asthma, 11.2% current wheeze, and 9.5% current asthma symptoms. Totally, 50.3% had respiratory infections and 26.0% rhinitis. The mean air exchange rate was 0.36/h, and the mean moisture load 1.70 g/m3. Damp foundation ( OR=1.79, 95% CI 1.16-2.78) was positively associated while floor constructions with crawl space ( OR=0.49, 95% CI 0.29-0.84) was negatively associated with wheeze. Concrete slabs with overlying insulation ( OR=2.21, 95% CI 1.24-3.92) and brick façade ( OR=1.71, 95% CI 1.07-2.73) were associated with rhinitis. Moisture load was associated with respiratory infections ( OR=1.21 per 1 g/m3, 95% CI 1.04-1.40) and rhinitis ( OR=1.36 per 1 g/m3, 95% CI 1.02-1.83). Air exchange rate was associated with current asthma symptoms ( OR=0.85 per 0.1/h, 95% CI 0.73-0.99). Living in homes with damp foundation, concrete slabs with overlying insulation, brick façade, low ventilation flow, and high moisture load are risk factors for asthma, rhinitis, and respiratory infections. [ABSTRACT FROM AUTHOR]

Background Exposure to moldy or damp indoor environments is associated with allergic disease in young children, but it is unclear whether the effects persist to adolescence. Our objective was to assess whether exposure to mold or dampness during infancy increases the risk of asthma, rhinitis, or IgE sensitization in children followed from birth to 16 years of age. Methods We collected questionnaire derived reports of mold or dampness indicators and allergic outcomes from 3798 children in a Swedish birth cohort ( BAMSE). Sensitization was assessed from blood samples in 3293 children. Longitudinal associations between prevalent asthma, rhinitis, and IgE sensitization and mold or dampness indicators were assessed using generalized estimating equations. Results Exposure to any mold or dampness indicator was associated with asthma up to 16 years of age ( OR 1.31; 95% CI 1.08-1.59), while exposure to mold odor ( OR 1.29; 95% CI 1.03-1.62) and visible mold ( OR 1.28; 95% CI 1.04-1.58) were associated with rhinitis. Increased risks were observed for nonallergic asthma ( OR 1.80; 95% CI 1.27-2.55) and rhinitis ( OR 1.41; 95% CI 1.03-1.93). No association was observed between mold or dampness indicators and IgE sensitization. Exposure to any mold or dampness indicator was associated with persistent asthma ( OR 1.73; 95% CI 1.20-2.50), but not with early-transient or late-onset asthma. Conclusion Exposure to mold or dampness during infancy increased the risk of asthma and rhinitis up to 16 years of age, particularly for nonallergic disease. Early exposure to mold or dampness appeared particularly associated with persistent asthma through adolescence. [ABSTRACT FROM AUTHOR]

Background: The effect of mold fungi to allergic sensitization is not well-known. We aimed to evaluate the role of molds in the relation between indoor environment and atopy in asthmatics. Materials and Methods: The air samples obtained from 66 stable asthmatics and 35 control subject′s houses were sprayed into Sabouraud dextrose agar. Allergy skin testing were performed in both groups. The temperature and humidity of each house were measured. Results: The incidence of atopy was similar in cases (59.1%) and controls (51.4%). The average amount of mold was 35.9 CFU/m 3 and 34.3 CFU/m 3 , respectively. The number of household residents was positively correlated with the amount of molds. There was no difference in the amount of mold with respect to dosage of inhaler corticosteroids as well as symptom levels in asthmatics. The most frequently encountered allergens were Dermatophagoides farinae/Dermatophagoides pteronyssinus, grass/weeds and molds. Spending childhood in a village was more common among atopics. Conclusion: Living environment during the childhood might affect atopy and asthma. Based on the identification of molds as the second most frequent allergen after mites in our study population, assessment of mold sensitization as well as in forming patients about ways to avoid them seem likely to contribute to the effective management of uncontrolled asthma.

Smoking still represents a huge public health problem. Millions of children suffer the detrimental effects of passive smoking. An increasing number of countries have recently issued laws to regulate smoking in public places. Instead, homes remain a site where children are dangerously exposed to environmental tobacco smoke (ETS). The combination of tobacco smoke pollutants which remain in an indoor environment, the so-called ‘third-hand smoke’ (THS), represent a new concept in the field of tobacco control. THS consists of pollutants that remain on surfaces and in dust after tobacco has been smoked, are re-emitted into the gas-phase, or react with other compounds in the environment to form secondary pollutants. Indoor surfaces can represent a hidden reservoir of THS constituents that could be re-emitted long after the cessation of active smoking. Human exposure to THS pollutants has not yet been thoroughly studied. Infants and children are more prone to the risks related to THS exposure than adults because they typically spend more time indoors and have age-specific behaviours that may expose them to potential health hazards from THS. Further investigations are warranted to study the health effects of THS relevant to different exposure pathways and profiles. It would also be very important to evaluate how THS may affect the lung development through the in utero exposure during the pre-natal life. We aimed at reviewing recent findings published about THS, with special reference to the effects on children’s health.

Building Health Sciences, Inc. (BHS), investigated environmental conditions by many modalities in 71 discreet areas of 12 buildings in a government building complex that had experienced persistent occupant complaints despite correction of deficiencies following a prior survey. An online health survey was completed by 7,637 building occupants (49% response rate), a subset of whom voluntarily wore personal sampling apparatus and underwent medical evaluation. Building environmental measures were within current standards and guidelines, with few outliers. Four environmental factors were consistently associated with group-level building-related health complaints: physical comfort/discomfort, odor, job stress, and glare. Several other factors were frequently commented on by participants, including cleanliness, renovation and construction activities, and noise. Low relative humidity was significantly associated with lower respiratory and “sick building syndrome”-type symptoms. No other environmental conditions (including formaldehyde, PM10[particulate matter with an aerodynamic diameter <10 μm], or mold levels, which were tested by 7 parameters) correlated directly with individual health symptoms. Indicators of atopy or allergy (sinusitis, allergies, and asthma), when present singly, in combinations of 2 conditions, or together, were hierarchically associated with the following: increased absence, increased presenteeism (presence at work but at reduced capacity), and increase in reported symptom-days, including symptoms not related to respiratory disease. We found that in buildings without unusual hazards and with environmental and air quality indicators within the range of acceptable indoor air quality standards, there is an identifiable population of occupants with a high prevalence of asthma and allergic disease who disproportionately report discomfort and lost productivity due to symptoms and that in “normal” buildings these outcome indicators are more closely associated with host factors than with environmental conditions. We concluded from the experience of this study that building-related health complaints should be investigated at the work-area level and not at a building-wide level. An occupant-centric medical evaluation should guide environmental investigations, especially when screening results of building indoor environmental and air quality measurements show that the building and its work areas are within regulatory standards and industry guidelines. [ABSTRACT FROM PUBLISHER]

A recent systematic review and meta-analysis has shown the effect of indoor mildew odour on allergic rhinitis risk, but its relation to other common chronic health outcomes in adults has not been investigated. Therefore, it was aimed to examine the relationship of indoor mildew odour and common health outcomes in adults in a national and population-based setting. Data was retrieved from the United States National Health and Nutrition Examination Surveys, 2005-2006, including the available information on demographics, housing characteristics, self-reported health conditions and urinary concentrations of environmental chemicals. T test, chi-squared test and survey-weighted logistic regression modelling were performed. Of all American adults ( n = 4979), 744 (15.1 %) reported indoor mildew odour or musty smell in their households. People who reported indoor mildew odour or musty smell also reported poorer self-rated health, sleep complaints, chronic bronchitis, asthma attack, itchy rash, sneezing and poor vision. In addition, people who reported indoor mildew odour or musty smell also tended to reside in older housing that were built 20 years earlier. However, there were no significant statistical associations found between indoor mildew odour or musty smell and urinary concentrations of environmental chemicals, which was also found to be associated with old housing. People who lived in older housing with indoor mildew odour or musty smell tended to have chronic health problems. To protect occupants in old housing from chronic illnesses associated with indoor mildew odour, elimination of the odour sources should be explored in future research and therefore public health and housing programs. [Figure not available: see fulltext.] [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

There have been many reports on the adverse impacts of exposures to particulate matter in the air but relatively few of these have been related to exposures to ultrafine particles (UFP) in the indoor environment. To investigate exposures to (UFP) in domestic environments, and the association with childhood respiratory symptoms in Zongshan, China a modified Thoracic Society questionnaire was completed by 359 households with children. Air quality monitoring took place in 37 households using a P-Trak instrument to determine concentration of UFPs in rooms. The mean number of UFP was 4.1 × 104 cm−3. A range of factors was found to be associated with UFP concentration and self-reported childhood respiratory symptoms. In conclusion, the evidence suggests that behavioural and environmental factors contribute to increased UFP concentrations indoors although there was no statistically signification correlation between indoor ultrafine particle concentration and any reported repeated episodes of respiratory symptoms. [ABSTRACT FROM PUBLISHER]

The city of Chongqing has high outdoor temperatures and humidity throughout the year and consequently a high risk of dampness and mold problems in dwellings. As part of the China, Children, Homes, Health (CCHH), associations between home characteristics and children’s asthma, allergies, and related symptoms were investigated in Chongqing, China. A cross-sectional questionnaire survey on home characteristics including dampness and symptoms of asthma and allergies in 5299 children was performed. Data for 4754 children (3–6 years) and their homes were analyzed. Results showed that 35.1% of homes were reported to have “damp bedding”, 14.3% “condensation on window panes (higher than 5 cm)”, 11.6% “mouldy odor”, 9.3% “water leakage”, 8.3% “damp stains” and 5.3% “visible mould”. Wheezing and rhinitis ever were reported for 27.0% and 51.1% children respectively, and rhinitis, wheezing, cough at night and eczema in the last 12 months were reported for 38.1%, 20.5%, 18.9% and 13.2% respectively. Doctor-diagnosed asthma was reported for 8.3% of children, and doctor-diagnosed rhinitis for 6.2%. Dampness in homes was generally strongly associated with asthma and allergies among Chongqing children. The strongest association was found between “visible mould” and doctor-diagnosed rhinitis, and the adjusted Odds Ratio (OR A) was 2.27 (95% CI: 1.48, 3.49). “Damp bedding” was significantly associated with all asthma and allergic symptoms, but doctor-diagnosed asthma and rhinitis. The behavior of “putting bedding to sunshine” could effectively reduce the prevalence of asthma and allergic symptoms, and the risk of bedding affected with damp was reduced significantly when bedding was put to sunshine frequently. [ABSTRACT FROM AUTHOR]

The prevalence and risk factors of sick building syndrome (SBS) symptoms in domestic environments were studied by a questionnaire survey on the home environment. Parents of 5299 3-6 years old children from randomly selected kindergartens in Chongqing, China returned completed questionnaires between December 2010 and April 2011. The prevalence of parents’ SBS symptoms (often (every week) compared with never) were: 11.4% for general symptoms, 7.1% for mucosal symptoms and 4.4% for skin symptoms. Multiple logistic regressions were applied controlling for gender and asthma/allergic rhinitis/eczema. Living near a main road or highway was a strong risk factor for general symptoms (adjusted odds ratio, aOR=2.16, P<0.001), skin symptoms (aOR=2.69, P<0.001), and mucosal symptoms (aOR=1.63, P<0.01). Redecoration was a risk factor for general symptoms (aOR=2.00, P<0.001), skin symptoms (aOR=1.66, P<0.01), and mucosal symptoms (aOR=1.66, P<0.05). New furniture was a risk factor for general symptoms (aOR=2.16, P<0.001) and skin symptoms (aOR=1.67, P<0.01). Dampness related problems (mould spot, damp stain, water damage and condensation) were all risk factors for SBS symptoms, as was the presence of cockroaches, rats, and mosquitoes/flies and use of incense. Protective factors include cleaning the child’s bedroom every day and frequently exposing bedding to sunshine. In conclusion, adults’ SBS symptoms were related to factors of the home environment. [ABSTRACT FROM AUTHOR]

Introduction: The association of respiratory problems with chemical emissions from common indoor materials has been studied but the specific effect of domestic paint has not been widely investigated. The aim of this review is to provide a comprehensive evaluation of experimental, occupational and epidemiological studies that examine the adverse respiratory effects of exposure to domestic paints. Methods: A literature search of PubMed together with consultation with an expert resulted in 997 articles published up to May 2011 of which 3 experimental, 4 occupational and 13 epidemiological studies met selection criteria and were included in the review. Results: The occupational literature suggested that work as a (non-spray) painter increases the risk of asthma, but it provides little insight to the risks of painting in the domestic setting. All epidemiological studies, except one, reported associations with some asthma-like symptoms. In children at least there was evidence that painting was associated with wheezing, but the study designs and the exposure assessment were unsuitable to differentiate between acute and longer terms affects. We found the epidemiological evidence to be weak and certainly insufficient to infer causality. Conclusion: The variable quality of the exposure assignment and heterogeneous study design makes it difficult to draw firm conclusions on whether domestic paint exposures cause or exacerbate asthma in children and/or adults. [ABSTRACT FROM AUTHOR]

We examined the associations between biomarkers of allergy and inflammation, indoor environment in dwellings, and incidence and remission of symptoms included in the sick building syndrome (SBS) and changes in the home environment of 452 adults who were followed from 1992 to 2002 within the Uppsala part of the European Community Respiratory Health Survey (ECRHS). The 10-year incidence (onset) of general, mucosal, and dermal symptoms was 8.5%, 12.7%, and 6.8%, respectively. Dampness or indoor molds at baseline was a predictor of incidence of general (relative risk [RR] = 1.98), mucosal (RR = 2.28), and dermal symptoms (RR = 1.91). Women had higher incidence of general (RR = 1.74) and mucosal symptoms (RR = 1.71). Indoor painting increased the incidence of general symptoms (RR = 1.62). Bronchial responsiveness (BR), eosinophil counts in blood, total IgE and eosinophilic cationic protein (ECP) in serum at baseline were predictors of incidence of SBS. At follow-up, BR, total IgE, and C-reactive protein (CRP ) were associated with increased incidence of SBS. Moreover, subjects with doctor-diagnosed asthma at baseline had a higher incidence of general (RR = 1.65) and mucosal symptoms (RR = 1.97). In conclusion, female gender, dampness or indoor molds, indoor painting, and biomarkers of allergy and inflammation were associated with a higher incidence of SBS symptoms, in particular mucosal symptoms. Practical Implications The focus in Sweden on indoor environment issues over the last few decades has resulted in improvements in dwellings, and reduced tobacco smoking, which could be beneficial for public health. Reducing dampness and molds in the dwelling place is another important way of reducing occurrence of SBS symptoms in the general adult population. The association between the incidence of SBS symptoms and clinical biomarkers of allergy and inflammation suggests a common etiology between inflammatory diseases, including asthma, rhinitis, and SBS. Lastly, good agreement between self-reported and clinically diagnosed atopy indicates that questionnaire data on atopy can be used in epidemiological studies. [ABSTRACT FROM AUTHOR]

Abstract: During 2001 to 2004, a study was conducted to assess the indoor environmental and health impact of installing allergen-reducing interventions in the homes of asthmatic children. Based on the results of a pilot study, to determine an intervention that would provide improved symptom scores and a reduction in house dust mite allergen (Der p 1), mechanical ventilation and heat recovery (MVHR) systems were installed in 16 homes. Environmental and respiratory health assessments were conducted before and after the installation of the MVHR systems. The results indicated that the installation of MVHR systems reduced Der p 1 concentrations in living room carpets and mattresses. There were significant reductions in symptom scores for breathlessness during exercise, wheezing, and coughing during the day and night. Although, there was not a parallel control group for the main study, the lack of change in the pilot study control group (who did not receive an intervention), indicated that the changes in symptom scores were in part to do with the intervention. Larger scale trials are needed to determine the efficacy of MVHR systems in homes to improve indoor air quality and reduce asthma symptoms. [Copyright &y& Elsevier]

Exposure to bacterial endotoxin and fungal β-(1,3)-glucan in the indoor environment can induce respiratory symptoms. Automobiles are an exposure source of allergens but it is not known if, and how much exposure there is to endotoxin and fungal β-(1,3)-glucan. The objective of the study was to determine whether automobiles are a potential source of exposure to these microbial products. Dust was sampled from the passenger seats of 40 automobiles. Specific Limulus amoebocyte kinetic assays were used to measure endotoxin and β-(1,3)-glucan, respectively. Endotoxin and β-(1,3)-glucan was detected in all samples ranging from 19.9-247.0 EU/mg and 1.6-59.8 μg/g, respectively. There were no significant differences in endotoxin levels between automobiles of smokers and non-smokers, but β-(1,3)-glucan levels were about two-fold higher in the automobiles of non-smokers. In conclusion, endotoxin and β-(1,3)-glucan exposure in automobiles at levels found in our study may be of importance for asthmatics. [ABSTRACT FROM AUTHOR]

Background: Most studies on sick building syndrome (SBS) are cross-sectional and have dealt with symptoms among office workers. There are very few longitudinal cohort studies and few studies on SBS in relation to domestic exposures. The aim of this study was to investigate changes in SBS symptoms during the follow-up period and also to investigate changes in different types of indoor exposures at home and relate them to SBS symptoms in a population sample of adults from Sweden. We also wanted to investigate if there was any seasonal or regional variation in associations between exposure and SBS. Methods: A random sample of 1,000 people of the general population in Sweden (1991) was sent a self administered questionnaire. A follow-up questionnaire was sent in 2001. Results: An increased risk for onset of any skin symptoms (risk ratio (RR) 2.32, 1.37-3.93), mucosal symptoms (RR 3.17, 1.69-5.95) or general symptoms (RR 2.18, 1.29-3.70) was found for those who had dampness or moulds in the dwelling during follow-up. In addition people living in damp dwellings had a lower remission of general symptoms and skin symptoms. Conclusions:Dampness in the dwelling is a risk factor for new onset of SBS symptoms. Focus on indoor environment improvements in dwellings can be beneficial both for the inhabitants and the general population. Reducing dampness in buildings is an important factor for reducing SBS symptoms in the general population. [ABSTRACT FROM AUTHOR]

Introduction: Genesis and development of asthma are greatly affected by the indoor environmental quality. During recent years, it is noted an important increase in asthma cases worldwide which is mainly caused by the effects of pollutants in indoor environments. Purpose: In this study, there has been an effort to show the impact of indoor environment on asthma development. Methodology: Reviewing bibliography by information retrieval from the Pubmed and TRIP Database. Conclusion: Indoor air pollution is an interdisciplinary subject. The great number of pollutants, their variety on structure and action, the conditions under which they are developed as well as their different and disparate ways of treatment and control require knowledge from many scientific fields. By assuming new dimensions in world climate changes, increasing sensitization in allergens, using respiratory irritants, such as pesticides and compounds and chemicals of industrial origin, and at the same time the poor home indoor air quality and the family history of asthma lead to new asthma cases worldwide. An important number of asthma cases in a family could be avoided by implementing a better environmental policy inside our homes. Finally, by understanding better the link between environment and asthma as well as by explaining the involved gene action, they will be delivered more effective prevention and treatment programs. [ABSTRACT FROM AUTHOR]

Seasonality of asthma may result from varying exposures. This cross-sectional study was designed to examine the relationship between indoor environmental factors and seasonal childhood asthma. Study subjects were participants from the International Study of Asthma and Allergies in Childhood (ISAAC) in 2004, a population-based surveillance, which included school children aged 6–15 yr in south Taiwan. Cases included 1725 children who experienced asthma symptoms in the past 12 months and the references consisted of 19,646 children who reportedly have no asthma history. By using a moving average and principal component analysis, asthmatic children were grouped into four asthma subtypes: winter, spring, summer/fall, and perennial. Multivariate logistic regression was used to evaluate the effect of indoor environmental factors on seasonality of childhood asthma. For all asthma prevalence, a peak occurred in the winter and a nadir appeared in summer. Contributing factors of asthma for children, regardless of seasonality, included younger age, parental atopy, maternal smoking during pregnancy, breast feeding, and perceived air pollution. After adjusted for salient risk factors, water damage was significantly associated with all subtypes of asthma. Presence of cockroaches was related to the summer/fall asthma (adjusted odds ratio [aOR] = 1.65, 95% confidence interval [CI] = 1.12–2.55). Visible mold on the walls was associated with an increased occurrence of winter and spring asthma (aOR = 1.53, 95% CI = 1.26–1.85 and aOR = 1.34, 95% CI = 1.10–1.62, respectively). Passive smoking was shown to be related to spring and summer/fall asthma. Water damage is a possible risk for childhood asthma year-round. Cockroaches and visible mold on the walls may play essential roles for seasonality of childhood asthma in Taiwan. Plausible mechanisms and allergic effects should be further determined. Elimination of these allergens is necessary to help prevent the development of asthma. [ABSTRACT FROM AUTHOR]

To investigate changes of sick building syndrome (SBS) and different types of indoor exposures at home over an 8-year follow-up period (1989–1997), and onset of SBS symptoms in relation to size of residence town and education level. A random sample (0.1%) of the population in a 3-county region in Sweden, initially aged 20–65 years ( n = 466). In total, 348 (75%) answered the postal follow-up questionnaire. Water leakage during the last year had decreased from 11.2 to 4.8% visible indoor mould had decreased from 4.7 to 1.6%, and any sign of building dampness decreased from 16.1 to 9.5%. The prevalence of current smoking had decreased from 30 to 19%. Smokers at baseline reported more onset of SBS symptoms than non-smokers. Furthermore, remission from mucosal symptoms was less likely in subjects that were tobacco smoker. Subjects with any indoor painting during follow-up period reported more onset of SBS symptoms, and those with intermediate education level had more onset of skin symptoms. Smoking and indoor painting could be predictors of new onset of SBS symptoms. Focus on indoor environment in Sweden the last decades may have resulted in environmental improvements in the dwellings, which can be beneficial both for the inhabitants and for the future public health. [ABSTRACT FROM AUTHOR]

Background. Residents of public housing can experience socioeconomic disadvantages, inadequate access to health care, and particularly substandard indoor air quality due to inadequate building maintenance. Objective. This study investigates demographic, medical management, severity, and household factors associated with asthma-related emergency department visits and hospitalizations. Methods. A total of 103 adult participants with asthma from four Chicago housing developments completed surveys and underwent household inspections. Results. Using stepwise multivariate logistic regression, we identified independent predictors of asthma-related emergency department visits: asthma controller medication use, not keeping an asthma-related doctor's appointment, and frequent nocturnal wheeze episodes. Using stepwise multivariate logistic regression, we identified independent predictors of asthma-related hospitalizations: peeling paint, plaster, or wallpaper, environmental tobacco smoke, written action plan for an asthma-related doctor or emergency department visit, and frequent nocturnal wheeze episodes. Conclusions. In multivariate models, factors related to clinical severity and asthma management were related to both emergency department visits and hospitalizations while household conditions were related only to hospitalizations. Interventions to address both asthma management and household environmental triggers may be needed to reduce asthma morbidity in low-income populations. [ABSTRACT FROM AUTHOR]

Sarcoidosis is a granulomatous disease of unknown etiology with evidence of association with exposure to microbial agents. In June 2006, we investigated a sarcoidosis cluster among office workers in a water-damaged building. In the course of the investigation, we became aware of a high rate of respiratory complaints including asthma and asthma-like symptoms. We conducted case finding for physician-diagnosed sarcoidosis and asthma and administered a health questionnaire survey and pulmonary function tests (PFTs) to consenting occupants. We compared prevalence ratios (PRs) to the Environmental Protection Agency’s Building Assessment Survey and Evaluation study (BASE) and the National Health and Nutrition Examination Survey (NHANES). We identified six sarcoidosis cases. The current building prevalence is 2206 cases/100,000 population, elevated, compared with the US population range of <1–40 cases/100,000. Of current occupants, 77% (105) participated in the health questionnaire survey and 64% (87) in PFTs. Physician-diagnosed asthma was elevated, compared with the US adult population. Adult asthma incidence was 3.3/1000 person-years during the period before building occupancy and 11.5/1000 person-years during the period after building occupancy. Comparisons with US office workers (BASE) yielded elevated PRs for shortness of breath [PR, 9.6; 95% confidence interval (CI), 6.1–15.2], wheeze (PR, 9.1; 95% CI 5.6–14.6), and chest tightness (PR, 5.1; 95% CI 2.8–9.0). PFT results supported reports of respiratory symptoms and diagnoses. Based on our findings building occupants were relocated. Practical Implications The remission of occupational asthma caused by certain known antigens improves with early diagnosis and removal from exposure. As a suspected antigen-mediated disease, sarcoidosis might also benefit if affected persons are isolated from continued exposure. Our investigation identified a high prevalence of new-onset sarcoidosis, and asthma among workers of a water damaged building with a history of indoor environmental quality complaints. Removal of all individuals from such environments until completion of building diagnostics, environmental sampling and complete remediation is a prudent measure when feasible. [ABSTRACT FROM AUTHOR]

Microbial exposure has been indicated as significant in the development of asthma and allergy among children. The aim of the study was to test whether microbial exposure and allergens in the school environment are associated with asthmatic symptoms in pupils. Data on asthmatic symptoms and respiratory infections were collected through a questionnaire survey among 1993 pupils aged 11–15 yr in 10 randomly selected schools in Taiyuan, China. Settled dust in classrooms was analysed using tandem gas chromatography-mass spectrometry for 3-hydroxy fatty acids, marker of lipopolysaccharide (LPS) from endotoxin, muramic acid (MuA), marker of bacteria and ergosterol (Erg) for fungi, quantifying both culturable and non-culturable microbes. A total of 29.8% reported daytime attacks of breathlessness, 8.4% wheeze and 1.2% had doctor’s diagnosed asthma. Generally, MuA was negatively associated with wheeze and daytime attacks of breathlessness, the latter of which was negatively associated with Erg to a weaker extent. Total concentration of LPS was positively associated with daytime attacks of breathlessness, but shorter lengths of LPS, C10, C12 and C14 LPS were negatively associated with either wheezing or daytime attacks of breathlessness. For MuA and C10 and C12 of LPS, the associations were independent of airborne allergens and classroom crowdedness, and even independent of the other two microbial markers for MuA. Microbial exposure indicated by certain chemical markers (e.g. MuA) could be protective for asthmatic symptoms, but for LPS (endotoxin), the picture is more complex, varying by different lengths of fatty acids of LPS. [ABSTRACT FROM AUTHOR]

Abstract: Formaldehyde is a chemical pollutant that is ubiquitous in indoor environments. Exposure to high concentrations in occupational environments has revealed its irritant and allergenic character. However, low levels of exposure in households can likewise have an effect on respiratory health in a non-specific manner, as is equally the case with other pollutants. Augmentation of the response to allergen by formaldehyde has been demonstrated in animals and in children. An effect has also been observed on respiratory symptoms, with the risk of asthma being increased by 39% with domestic exposure to more than 60μgm−3. We have recently been able to show in a study involving mite-sensitized asthmatics that bronchial provocation tests with an allergen are augmented after exposure to 100μgm−3 of formaldehyde for 30min. All data show that exposure in households to a low concentration of formaldehyde is sufficient to induce sensitization but it can also aggravate symptoms of patients with allergic asthma. Considering the published evidence, it is agreed that the concentrations of formaldehyde in products used in households should be known in order to allow improvement in the quality of indoor air. [Copyright &y& Elsevier]

Sweden has had specialized ‘allergen avoidance daycare centers’ (AADC) since 1979. The aim was to compare AADC with ordinary daycare centers (ODC). Through contacts with municipalities and hospitals, 72 AADC were identified. For each AADC, the two nearest ODCs served as controls. A questionnaire was sent to the local directors of the 216 daycare centers (531 sections), 83% responded. A total of 39% of the ODCs had ever had dampness/molds, 12% were near (<500 m) stables/farms, 23% were closer than 50 m to a heavy trafficked road, and 13% were exposed to wood smoke in winter. Only 11% of the AADCs had any child with furred pets at home, while 97% of the ODCs had children with furred pets. Bans on smoking at home and on perfumes were more common at the AADCs ( P = 0.001). Fewer AADCs had PVC floors (OR = 0.53; P = 0.01), dampness/molds (OR = 0.55; P = 0.04), shelves (OR 3.03; P = 0.001), curtains (OR = 1.67; P = 0.047), and flowers (OR = 0.03; P < 0.001), while more had daily floor cleaning (OR = 19.9; P = 0.004), weekly wiping of furniture (OR = 11.0; P = 0.001), and washing of pillows/mattresses (OR = 2.74; P = 0.005) and curtains (OR = 9.07; P = 0.001). In conclusion, allergy avoidance daycare centers differ from other daycare centers, and may have better indoor environments. Practical Implications There is a need to improve the indoor environments of daycare centers, including reduction of building dampness and molds. Allergen avoidance daycare centers (AADC) in Sweden differ from ordinary daycare centers in many respects, with fewer indoor and building factors related to dust, allergens and irritants. This shows that the indoor environments of daycare centers can be improved. Data suggest that AADC may have lower levels of pet allergens, and this is beneficial for children with pet allergy. The effects of these improvements on indoor exposures and health of the children need to be further evaluated. [ABSTRACT FROM AUTHOR]