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Mosnaim G, Carrasquel M, Wolfson AR, Peters J, Lang D, Rathkopf M. Social Determinants of Health and COVID-19. J Allergy Clin Immunol Pract 2023; 11:3347-3355. [PMID: 37507069 DOI: 10.1016/j.jaip.2023.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 06/22/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected disadvantaged populations. Many of the factors related to the disproportionate impact on underserved communities are related to social determinants of health, defined by the World Health Organization as the nonmedical factors that influence health outcomes. They include the wider set of forces and systems shaping the conditions of daily life. This work explores the interrelationships between social determinants of health and access to care, health care professional and supply shortages, social and environmental factors, health behaviors, vaccine uptake, and treatment options on COVID-19 health outcomes. Increased awareness of inequities, learning from failures, and leveraging new opportunities to partner with key stakeholders in underserved communities create empowerment and preparedness to face new challenges.
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Affiliation(s)
- Giselle Mosnaim
- Division of Allergy and Immunology, Department of Medicine, NorthShore University HealthSystem, Evanston, Illinois.
| | - Michelle Carrasquel
- Division of Allergy and Immunology, Department of Medicine, NorthShore University HealthSystem, Evanston, Illinois
| | - Anna R Wolfson
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Jonny Peters
- Division of Allergy and Clinical Immunology at Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - David Lang
- Division of Allergy and Clinical Immunology, Department of Medicine, Cleveland Clinic., Milwaukee, Wis
| | - Melinda Rathkopf
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga
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Pham DL, Le KM, Truong DDK, Le HTT, Trinh THK. Environmental allergen reduction in asthma management: an overview. Front Allergy 2023; 4:1229238. [PMID: 37868650 PMCID: PMC10587592 DOI: 10.3389/falgy.2023.1229238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/12/2023] [Indexed: 10/24/2023] Open
Abstract
Asthma is a prevalent non-communicable disease that affects both children and adults. Many patients with severe, uncontrolled asthma could not achieve total control despite using anti-asthmatic drugs. There is increasing evidence that allergy to environmental allergens, including both indoor and outdoor allergens, is associated with asthma symptoms and severe asthma. Frequently reported sensitized allergens were dust mites, cockroaches, grass pollens, molds, pets, and rodents in allergic asthma patients, although the patterns of widespread allergens differed from each country. Allergen avoidance is the cornerstone of asthma management, especially in sensitized subjects. This review summarizes environmental allergen avoidance and clarifies their effects on asthma control. Despite contrasting results about the impact of allergen exposure reduction on asthma control, several studies supported the beneficial effects of reducing asthma-related symptoms or risk of exacerbations as a nondrug therapy. Identifying environmental allergens is helpful for asthma patients, and further studies on clinically effective avoidance methods are required.
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Affiliation(s)
- Duy Le Pham
- Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- University Medical Center Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Kieu-Minh Le
- Center for Molecular Biomedicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Diem D. K. Truong
- Center for Molecular Biomedicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Huyen T. T. Le
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Tu H. K. Trinh
- Center for Molecular Biomedicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
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Dileep A, Warren C, Bilaver LA, Stephen E, Andy-Nweye AB, Fox S, Jiang J, Newmark PJ, Chura A, Abdikarim I, Nimmagadda SR, Sharma HP, Tobin MC, Assa'ad AH, Gupta RS, Mahdavinia M. Assessing Disparities in the Prevalence of Atopic Comorbidities Among Food-Allergic Children. J Allergy Clin Immunol Pract 2023; 11:1169-1176. [PMID: 36720389 PMCID: PMC10085831 DOI: 10.1016/j.jaip.2023.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/23/2022] [Accepted: 01/17/2023] [Indexed: 01/30/2023]
Abstract
BACKGROUND Previous studies have reported that Black children with food allergy (FA) have higher risk of atopic comorbidities than White children. OBJECTIVE Our study sought to understand if disparities in the prevalence of atopic comorbidities among children with FA are driven by individual and community-level socioeconomic status (SES). METHODS We analyzed data from a prospective, multicenter cohort investigating the natural history of pediatric atopy: the Food Allergy Outcomes Related to White and African American Racial Differences (FORWARD) study. A validated, multicomponent area deprivation index (ADI) percentile score was tabulated by the census block group for each subject's home address. The association of ADI with atopic comorbidities in FA was assessed via multivariable regression analysis. RESULTS Of the 700 children in this study, the mean ADI was 37.7 (95% confidence interval: 35.6-39.7). The mean ADI was higher in children with asthma (43.3) compared with those without asthma (31.8), which remained significant after adjusting for race (P < .0001). Children with allergic rhinitis (AR) had a higher mean ADI (39.1) compared with those without (33.4) (P = .008). ADI was associated with secondhand smoking, parents' education, and household income. Black children had a higher risk for asthma after adjusting for ADI and SES-related factors. CONCLUSION The independent association of ADI with asthma and AR, regardless of race, suggests a role of neighborhood-level socioeconomic deprivation in the development of these conditions among children with FA. Black children with FA remained at higher risk for asthma after adjusting for SES-related variables, which can indicate an independent risk for asthma in these children.
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Affiliation(s)
- Anandu Dileep
- Division of Allergy and Immunology, Rush University Medical Center, Chicago, Ill
| | - Christopher Warren
- Division of Allergy and Immunology, Northwestern University Feinberg School of Medicine, Chicago, Ill; Division of Allergy and Immunology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill
| | - Lucy A Bilaver
- Division of Allergy and Immunology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Ellen Stephen
- Division of Allergy and Immunology, Rush University Medical Center, Chicago, Ill
| | - Aame B Andy-Nweye
- Division of Allergy and Immunology, Rush University Medical Center, Chicago, Ill
| | - Susan Fox
- Division of Allergy and Immunology, Rush University Medical Center, Chicago, Ill
| | - Jialing Jiang
- Division of Allergy and Immunology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Pamela J Newmark
- Division of Allergy and Immunology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Annika Chura
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Iman Abdikarim
- Division of Allergy and Immunology, Children's National Health Systems, Washington DC
| | - Sai R Nimmagadda
- Division of Allergy and Immunology, Northwestern University Feinberg School of Medicine, Chicago, Ill; Division of Allergy and Immunology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill
| | - Hemant P Sharma
- Division of Allergy and Immunology, Children's National Health Systems, Washington DC
| | - Mary C Tobin
- Division of Allergy and Immunology, Rush University Medical Center, Chicago, Ill
| | - Amal H Assa'ad
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Ruchi S Gupta
- Division of Allergy and Immunology, Northwestern University Feinberg School of Medicine, Chicago, Ill; Division of Allergy and Immunology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill
| | - Mahboobeh Mahdavinia
- Division of Allergy and Immunology, Rush University Medical Center, Chicago, Ill.
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Thanik E, Harada K, Garland E, Bixby M, Bhatia J, Lopez R, Galvez S, Dayanov E, Vemuri K, Bush D, DeFelice NB. Impact of COVID-19 on pediatric asthma-related healthcare utilization in New York City: a community-based study. BMC Pediatr 2023; 23:41. [PMID: 36691011 PMCID: PMC9868511 DOI: 10.1186/s12887-023-03845-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 01/10/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND COVID-19 disproportionately affects families of low socioeconomic status and may worsen health disparities that existed prior to the pandemic. Asthma is a common chronic disease in children exacerbated by environmental exposures. METHODS A cross-sectional survey was conducted to understand the impact of the initial stage of the pandemic on environmental and social conditions, along with access to care for children with asthma in New York City (NYC). Participants were recruited from a community-based organization in East Harlem and a nearby academic Pediatric Pulmonary clinic and categorized as having either public or private insurance (n = 51). RESULTS Factors significantly associated with public compared to private insurance respectively were: increased reports of indoor asthma triggers (cockroach 76% vs 23%; mold 40% vs 12%), reduced income (72% vs 27%), and housing insecurity (32% vs 0%). Participants with public insurance were more likely to experience conditions less conducive to social distancing compared to respondents with private insurance, such as remaining in NYC (92% vs 38%) and using public transportation (44% vs 4%); families with private insurance also had greater access to remote work (81% vs 8%). Families with public insurance were significantly more likely to test positive for SARS-CoV-2 (48% vs 15%) but less likely to have gotten tested (76% vs 100%). Families with public insurance also reported greater challenges accessing office medical care and less access to telehealth, although not statistically significant (44% vs 19%; 68% vs 85%, respectively). CONCLUSIONS Findings highlight disproportionate burdens of the pandemic, and how these disparities affect children with asthma in urban environments.
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Affiliation(s)
- Erin Thanik
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1057, New York, NY, 10029, USA.
| | - Kaoru Harada
- Department of Medicine, Division of Clinical Immunology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Elizabeth Garland
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1057, New York, NY, 10029, USA
| | - Moira Bixby
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1057, New York, NY, 10029, USA
| | - Jasmine Bhatia
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1057, New York, NY, 10029, USA
| | - Ray Lopez
- LSA Family Health Service, New York, NY, USA
| | | | - Elan Dayanov
- Graduate Program in Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Krishna Vemuri
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1057, New York, NY, 10029, USA
| | - Douglas Bush
- Department of Pediatrics, Division of Pulmonary, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nicholas B DeFelice
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1057, New York, NY, 10029, USA
- Department of Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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5
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Banzon TM, Phipatanakul W. Environmental Interventions for Asthma. Semin Respir Crit Care Med 2022; 43:720-738. [PMID: 35803266 DOI: 10.1055/s-0042-1749453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Exposure and sensitization to environmental factors play a fundamental role in asthma development and is strongly associated with asthma morbidity. While hereditary factors are critical determinants of asthma, exposures to environmental factors are implicated in the phenotypic expression of asthma and have been strongly associated in the risk of its development. Significant interest has thus been geared toward potentially modifiable environmental exposures which may lead to the development of asthma. Allergen exposure, in particular indoor allergens, plays a significant role in the pathogenesis of asthma, and remediation is a primary component of asthma management. In the home, multifaceted and multitargeted environmental control strategies have been shown to reduce home exposures and improve asthma outcomes. In addition to the home environment, assessment of the school, daycare, and workplace environments of patients with asthma is necessary to ensure appropriate environmental control measures in conjunction with medical care. This article will discuss the role of the environment on asthma, review targeted environmental therapy, and examine environmental control measures to suppress environmental exposures in the home and school setting.
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Affiliation(s)
- Tina M Banzon
- Deparmtent of Allergy and Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Wanda Phipatanakul
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.,Division of Immunology, Clinical Research Center, Boston Children's Hospital, Asthma, Allergy and Immunology, Boston, Massachusetts
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Abstract
OBJECTIVE To describe asthma control and household environmental exposures among adults and children with asthma in Puerto Rico. METHODS A cross-sectional analysis was conducted using data from the 2014-2016 Behavioral Risk Factor Surveillance System Asthma Call-back Survey on 931 adults and 177 children with current asthma in Puerto Rico. These data were analyzed to assess the prevalence of uncontrolled asthma in Puerto Rico and potential associations with household environmental exposure to cockroaches, smoke, and mold. Asthma control was classified using daytime and nighttime symptoms, activity limitation, and short-acting beta agonist use. Prevalence and prevalence ratios were calculated, adjusting for sample weighting. RESULTS An estimated 53% of adults with asthma and 29% of children with asthma in Puerto Rico have uncontrolled asthma. Among adults with asthma, in the past 30 days, 29% had seen or smelled mold and 50% had seen cockroaches; in the past week, 12% reported having someone smoke in their home. Adults with uncontrolled asthma were 1.4 times more likely to have observed mold in their homes than were those with controlled asthma when adjusting for age, sex, education, and income (prevalence ratio [95% confidence interval]: 1.4 [1.1, 1.8]). Children with uncontrolled asthma were also more likely to have mold observed in their home than were children with controlled asthma (adjusted PR [95% CI]: 3.0 [1.3, 7.1]). CONCLUSIONS Uncontrolled asthma is common among adults and children with asthma in Puerto Rico. These results suggest potential differences in household mold exposure by asthma control status.
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Affiliation(s)
- Kristen N. Cowan
- Asthma and Community Health Branch, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Chamblee, GA ,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Xiaoting Qin
- Asthma and Community Health Branch, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Chamblee, GA
| | - Krystel Ruiz Serrano
- Division of Prevention and Control of Chronic Disease, Health Promotion Secretariat of the Puerto Rico Health Department, San Juan, Puerto Rico
| | - Kanta Sircar
- Asthma and Community Health Branch, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Chamblee, GA
| | - Audrey F. Pennington
- Asthma and Community Health Branch, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Chamblee, GA
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Kalayci O, Miligkos M, Pozo Beltrán CF, El-Sayed ZA, Gómez RM, Hossny E, Le Souef P, Nieto A, Phipatanakul W, Pitrez PM, Xepapadaki P, Jiu-Yao W, Papadopoulos NG. The role of environmental allergen control in the management of asthma. World Allergy Organ J 2022; 15:100634. [PMID: 35341023 PMCID: PMC8917313 DOI: 10.1016/j.waojou.2022.100634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 01/08/2022] [Accepted: 02/01/2022] [Indexed: 11/26/2022] Open
Abstract
Allergen exposure may exacerbate asthma symptoms in sensitized patients. Allergen reduction or avoidance measures have been widely utilized; however, there is ongoing controversy on the effectiveness of specific allergen control measures in the management of children with asthma. Often, allergen avoidance strategies are not recommended by guidelines because they can be complex or burdensome, although individual patients may benefit. Here we explore the potential for intervention against exposure to the major allergens implicated in asthma (ie, house dust mites, indoor molds, rodents, cockroaches, furry pets, and outdoor molds and pollens), and subsequent effects on asthma symptoms. We critically assess the available evidence regarding the clinical benefits of specific environmental control measures for each allergen. Finally, we underscore the need for standardized and multifaceted approaches in research and real-life settings, which would result in the identification of more personalized and beneficial prevention strategies.
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8
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Tackett AP, Farrow M, Kopel SJ, Coutinho MT, Koinis-Mitchell D, McQuaid EL. Racial/ethnic differences in pediatric asthma management: the importance of asthma knowledge, symptom assessment, and family-provider collaboration. J Asthma 2021; 58:1395-1406. [PMID: 32546119 PMCID: PMC7775333 DOI: 10.1080/02770903.2020.1784191] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 05/29/2020] [Accepted: 06/14/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Asthma disproportionately impacts youth from marginalized minority backgrounds. Aspects of core asthma management (asthma management and medication beliefs) were examined among a cohort of diverse families. METHODS Caregiver-youth dyads (N = 92; Mage= 13.8 years; non-Hispanic/Latinx White (NLW) = 40%; Black/African-American = 25%; Hispanic/Latinx= 35%) completed a medication beliefs questionnaire (Medication Necessity, Medication Concerns) and a semi-structured interview (Family Asthma Management System Scale (FAMSS)). FAMSS subscales (Asthma Knowledge, Symptom Assessment, Family Response to Symptoms, Child Response to Symptoms, Environmental Control, Medication Adherence, Family-Provider Collaboration, and Balanced Integration) were used for analyses. RESULTS More Hispanic/Latinx families were at or below the poverty line (75%) relative to NLW (22%) and Black/African-American (39%) families (p < 0.001). Adherence (p < 0.01), Knowledge (p < 0.001), and Symptom Assessment (p < 0.01) were higher for NLW relative to Black/African-American families. Collaboration was higher among NLW (p = 0.01) and Hispanic/Latinx families (p = 0.05). Effect sizes were moderate (η2= 0.10-0.12). Parental race/ethnicity moderated the relationship between adherence and parental perceived medication concern and necessity for NLW and Hispanic/Latinx families. As medication concerns increased, medication adherence decreased, however, only for NLW and Hispanic/Latinx families. CONCLUSIONS In this sample, racial/ethnic differences emerged for elements of asthma management. Interview-based ratings of asthma management among Black/African-American families depicted lower asthma knowledge, lower levels of family-provider collaboration, and lower medication adherence. The relationship between medication concerns and adherence appeared to differ by ethnic group. Future research is needed to elucidate cultural factors that influence family-provider relationships and health-related behaviors, like medication use/adherence.
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Affiliation(s)
- Alayna P Tackett
- Oklahoma Tobacco Research Center, University of Oklahoma Stephenson Cancer Center, Oklahoma City, OK, USA
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Michael Farrow
- Bradley-Hasbro Children's Research Center, Providence, RI, USA
| | - Sheryl J Kopel
- Bradley-Hasbro Children's Research Center, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School Brown University, Providence, RI, USA
| | - Maria T Coutinho
- Bradley-Hasbro Children's Research Center, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School Brown University, Providence, RI, USA
| | - Daphne Koinis-Mitchell
- Bradley-Hasbro Children's Research Center, Providence, RI, USA
- Department of Psychiatry and Human Behavior and Pediatrics, Warren Alpert Medical School Brown University, Providence, RI, USA
| | - Elizabeth L McQuaid
- Bradley-Hasbro Children's Research Center, Providence, RI, USA
- Department of Psychiatry and Human Behavior and Pediatrics, Warren Alpert Medical School Brown University, Providence, RI, USA
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Patel N, Singh S, Desai R, Desai A, Nabeel M, Parikh N, Singh G, Patel S, Parikh R, Mahajan S. Thirty-day unplanned readmission in hospitalised asthma patients in the USA. Postgrad Med J 2021; 98:830-836. [PMID: 37063042 DOI: 10.1136/postgradmedj-2021-140735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/31/2021] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Hospital quality improvement and hospital performance are commonly evaluated using parameters such as average length of stay (LOS), patient safety measures and rates of hospital readmission. Thirty-day readmission (30-DR) rates are widely used as a quality indicator and a quantifiable metric for hospitals since patients are often readmitted for the exacerbation of conditions from index admission. The quality of patient education and postdischarge care can influence readmission rates. We report the 30-DR rates of patients with asthma using a national dataset for the year 2013. OBJECTIVES The aim of our study was to assess the 30- day readmission (30-DR) rate as well as, the causes and predictors of readmissions. STUDY DESIGNS/METHODS Using the Nationwide Readmission Database (NRD) (2013), we identified primary discharge diagnoses of asthma by using International Classification of Diseases, Ninth Revision, Clinical Modification code '493'. Categorical and continuous variables were assessed by a χ2 test and a Student's t-test, respectively. The independent predictors of unplanned 30-DR were detected by multivariate analysis. We used sampling weights, which are provided in the NRD, to generate the national estimates. RESULTS There were 130 490 (weighted N=311 173) inpatient asthma admissions during 2013. The overall 30-DR for asthma was 11.9%. The associated factors for 30-DR were age 45-84 years (40.32% vs 29.05%; p<0.001), enrolment in Medicare (49.33% vs 30.61% p<0.001), extended LOS (mean, 4.40±0.06 vs 3.25±0.04 days; p<0.001), higher mean cost (US$8593.91 vs US$6741.31; p<0.001) and higher disposition against medical advice (DAMA) (4.14% vs 1.51%; p<0.001). The factors that increased the chance of 30-DR were advanced age (≥45-64 vs ≤17 years; OR 4.61, 95% CI 4.04 to 5.27, p<0.0001), male sex (OR 1.19, 95% CI 1.13 to 1.26, p<0.0001), a higher Charlson Comorbidity Index (CCI) (OR 1.16, 95% CI 1.14 to 1.18, p<0.0001), DAMA (OR 2.32, 95% CI 2.08 to 2.59, p<0.0001), non-compliance with medication (OR 1.34, 95% CI 1.24 to 1.46, p<0.0001), post-traumatic stress disorder (OR 1.48, 95% CI 1.22 to 1.79, p<0.0001), alcohol use (OR 1.45, 95% CI 1.27 to 1.65, p<0.0001), gastro-oesophageal reflux disease (OR 1.20, 95% CI 1.14 to 1.27, p<0.0001), obstructive sleep apnoea (OR 1.11, 95% CI 1.03 to 1.18, p<0.0042) and hypertension (OR 1.11, 95% CI 1.06 to 1.17, p<0.0001). CONCLUSIONS We found that the overall 30-DR rate for asthma was 11.9% all-cause readmission. Major causes of 30-DR were asthma exacerbation (36.74%), chronic obstructive pulmonary disease (11.47%), respiratory failure (6.46%), non-specific pneumonia (6.19%), septicaemia (3.61%) and congestive heart failure (3.32%). One-fourth of the revisits occurred in the first week, while half of the revisits took place in the first 2 weeks. Education regarding illness and the importance of medicine compliance could play a significant role in preventing asthma-related readmission.
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Affiliation(s)
- Neel Patel
- Department of Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sandeep Singh
- Department of Neurology, Institute of Human Behaviour and Allied Sciences, New Delhi, India
| | - Rupak Desai
- Department of Cardiology, Atlanta VA Health Care System, Decatur, Georgia, USA
| | - Aakash Desai
- Department of Internal Medicine, University of Connecticut, Farmington, Connecticut, USA
| | - Mohammed Nabeel
- Department of Critical Care Medicine, University of Maryland Medical System, Baltimore, Maryland, USA
| | - Neil Parikh
- Department of Medicine, University at Buffalo, Buffalo, New York, USA
| | - Gagandeep Singh
- Department of Medicine, Saint Francis Hospital, Tulsa, Oklahoma, USA
| | - Smit Patel
- Department of Internal Medicine, UCONN Health, Farmington, Connecticut, USA
| | - Radhika Parikh
- Department of Pulmonary Disease and Critical Care Medicine, University of Vermont, Burlington, Vermont, USA
| | - Supriya Mahajan
- Department of Allergy and Immunology, University at Buffalo, Buffalo, New York, USA
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Abstract
PURPOSE OF REVIEW Sensitization and exposure to triggers in the indoor environment, including aeroallergens, indoor air pollution, and environmental tobacco smoke, have a significant role in asthma development and morbidity. This review discusses indoor environmental exposures and their effect on children with asthma as well as environmental interventions and their role in improving asthma morbidity. RECENT FINDINGS Recent research has emphasized the role of aeroallergen sensitization and exposure in asthma morbidity and the importance of the school indoor environment. There is an established association between indoor exposures and asthma development and morbidity. Recent evidence has highlighted the importance of the indoor environment in childhood asthma, particularly the role of the school indoor environment. While home environmental interventions have had mixed results, interventions in the school environment have the potential to significantly impact the health of children, and ongoing research is needed to determine their effectiveness.
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11
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Srivastava S, Chauhan K, Prasad R. Sensitization to indoor allergens in children with bronchial asthma. Indian J Allergy Asthma Immunol 2020. [DOI: 10.4103/ijaai.ijaai_14_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Oh H, Koyanagi A, DeVylder JE, Stickley A. Seasonal Allergies and Psychiatric Disorders in the United States. Int J Environ Res Public Health 2018; 15:ijerph15091965. [PMID: 30205581 PMCID: PMC6164754 DOI: 10.3390/ijerph15091965] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 09/06/2018] [Accepted: 09/06/2018] [Indexed: 12/22/2022]
Abstract
Seasonal allergies have been associated with mental health problems, though the evidence is still emergent, particularly in the United States. We analyzed data from the National Comorbidity Survey Replication and the National Latino and Asian American Survey (years 2001–2003). Multivariable logistic regression models were used to examine the relations between lifetime allergies and lifetime psychiatric disorders (each disorder in a separate model), adjusting for socio-demographic variables (including region of residence) and tobacco use. Analyses were also stratified to test for effect modification by race and sex. A history of seasonal allergies was associated with greater odds of mood disorders, anxiety disorders, and eating disorders, but not alcohol or substance use disorders, after adjusting for socio-demographic characteristics and tobacco use. The associations between seasonal allergies and mood disorders, substance use disorders, and alcohol use disorders were particularly strong for Latino Americans. The association between seasonal allergies and eating disorders was stronger for men than women. Seasonal allergies are a risk factor for psychiatric disorders. Individuals complaining of seasonal allergies should be screened for early signs of mental health problems and referred to specialized services accordingly.
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Affiliation(s)
- Hans Oh
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 669 W. 34 th St., Los Angeles, CA 90089-0411, USA.
| | - Ai Koyanagi
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Deu, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, 08830 Barcelona, Spain.
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5 Pabellón 11, 28029 Madrid, Spain.
| | - Jordan E DeVylder
- Graduate School of Social Service, Fordham University, 113 W 60th Street, New York, NY 10023, USA.
| | - Andrew Stickley
- The Stockholm Center for Health and Social Change (SCOHOST), Södertörn University, 141 89 Huddinge, Sweden.
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashicho, Kodaira, Tokyo 1878553, Japan.
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Salo PM, Wilkerson J, Rose KM, Cohn RD, Calatroni A, Mitchell HE, Sever ML, Gergen PJ, Thorne PS, Zeldin DC. Bedroom allergen exposures in US households. J Allergy Clin Immunol 2017; 141:1870-1879.e14. [PMID: 29198587 DOI: 10.1016/j.jaci.2017.08.033] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 08/16/2017] [Accepted: 08/28/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Bedroom allergen exposures contribute to allergic disease morbidity because people spend considerable time in bedrooms, where they come into close contact with allergen reservoirs. OBJECTIVE We investigated participant and housing characteristics, including sociodemographic, regional, and climatic factors, associated with bedroom allergen exposures in a nationally representative sample of the US population. METHODS Data were obtained from National Health and Nutrition Examination Survey 2005-2006. Information on participant and housing characteristics was collected by using questionnaires and environmental assessments. Concentrations of 8 indoor allergens (Alt a 1, Bla g 1, Can f 1, Fel d 1, Der f 1, Der p 1, Mus m 1, and Rat n 1) in dust vacuumed from nearly 7000 bedrooms were measured by using immunoassays. Exposure levels were classified as increased based on percentile (75th/90th) cutoffs. We estimated the burden of exposure to multiple allergens and used multivariable logistic regression to identify independent predictors for each allergen and household allergen burden. RESULTS Almost all participants (>99%) had at least 1 and 74.2% had 3 to 6 allergens detected. More than two thirds of participants (72.9%) had at least 1 allergen and 18.2% had 3 or more allergens exceeding increased levels. Although exposure variability showed significant racial/ethnic and regional differences, high exposure burden to multiple allergens was most consistently associated with the presence of pets and pests, living in mobile homes/trailers and older and rental homes, and living in nonmetropolitan areas. CONCLUSIONS Exposure to multiple allergens is common. Despite highly variable exposures, bedroom allergen burden is strongly associated with the presence of pets and pests.
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Affiliation(s)
- Päivi M Salo
- Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC
| | | | | | | | | | | | | | - Peter J Gergen
- Division of Allergy, Immunology, and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Peter S Thorne
- University of Iowa College of Public Health, Iowa City, Iowa
| | - Darryl C Zeldin
- Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC.
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Medsker BH, Forno E, Han YY, Acosta-Pérez E, Colón-Semidey A, Alvarez M, Alcorn JF, Canino GJ, Celedón JC. Cockroach allergen exposure and plasma cytokines among children in a tropical environment. Ann Allergy Asthma Immunol 2017; 119:65-70.e3. [PMID: 28668242 DOI: 10.1016/j.anai.2017.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 04/14/2017] [Accepted: 05/08/2017] [Indexed: 01/26/2023]
Abstract
BACKGROUND Little is known about the effects of socioeconomic status or cockroach allergen on immune responses in school-age children, particularly in tropical environments. OBJECTIVE To examine whether cockroach allergen and/or socioeconomic status is associated with plasma cytokine levels in Puerto Rican children. METHODS This was a cross-sectional study of 532 children (6-14 years old) with (n = 272) and without (n = 260) asthma in San Juan (Puerto Rico). House dust allergens (cockroach [Bla g 2], dust mite [Der p 1], cat dander [Fel d 1], dog dander [Can f 1], and mouse urinary protein [Mus m 1]) were quantified using monoclonal antibody arrays. A panel of 14 cytokines (interleukin [IL]-1β, IL-4, IL-6, IL-10, IL-17A, IL-17F, IL-21, IL-22, IL-23, IL-25, IL-31, IL-33, interferon-γ, and tumor necrosis factor-α) was measured in plasma samples. Low household income was defined as less than $15,000 per year (below the median income for Puerto Rico in 2008-2009). Linear regression was used for the analysis of cockroach allergen and plasma cytokines. RESULTS In a multivariable analysis adjusting for low income and other allergen levels, cockroach allergen was significantly associated with decreased IL-17A and with increased levels of 8 cytokines (IL-4, IL-10, IL-17F, IL-21, IL-25, IL-31, interferon-γ, and tumor necrosis factor-α). After stratifying this analysis by cockroach allergy (ie, having a cockroach positive immunoglobulin E reaction), our findings remained largely unchanged for children sensitized to cockroach but became weaker and statistically nonsignificant for non-sensitized children. CONCLUSION Cockroach allergen has broad effects on adaptive immune responses in school-age children in a tropical environment, particularly in those sensitized to cockroach.
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Affiliation(s)
- Brock H Medsker
- Division of Newborn Medicine, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Erick Forno
- Division of Pulmonary Medicine, Allergy, and Immunology, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Yueh-Ying Han
- Division of Pulmonary Medicine, Allergy, and Immunology, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Edna Acosta-Pérez
- Behavioral Sciences Research Institute, University of Puerto Rico, San Juan, Puerto Rico
| | - Angel Colón-Semidey
- Behavioral Sciences Research Institute, University of Puerto Rico, San Juan, Puerto Rico
| | - Maria Alvarez
- Behavioral Sciences Research Institute, University of Puerto Rico, San Juan, Puerto Rico
| | - John F Alcorn
- Division of Pulmonary Medicine, Allergy, and Immunology, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Glorisa J Canino
- Behavioral Sciences Research Institute, University of Puerto Rico, San Juan, Puerto Rico
| | - Juan C Celedón
- Division of Pulmonary Medicine, Allergy, and Immunology, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania.
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Sánchez-Vizcaíno F, Noble PM, Jones PH, Menacere T, Buchan I, Reynolds S, Dawson S, Gaskell RM, Everitt S, Radford AD. Demographics of dogs, cats, and rabbits attending veterinary practices in Great Britain as recorded in their electronic health records. BMC Vet Res 2017; 13:218. [PMID: 28693574 DOI: 10.1186/s12917-017-1138-9] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 06/30/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Understanding the distribution and determinants of disease in animal populations must be underpinned by knowledge of animal demographics. For companion animals, these data have been difficult to collect because of the distributed nature of the companion animal veterinary industry. Here we describe key demographic features of a large veterinary-visiting pet population in Great Britain as recorded in electronic health records, and explore the association between a range of animal's characteristics and socioeconomic factors. RESULTS Electronic health records were captured by the Small Animal Veterinary Surveillance Network (SAVSNET), from 143 practices (329 sites) in Great Britain. Mixed logistic regression models were used to assess the association between socioeconomic factors and species and breed ownership, and preventative health care interventions. Dogs made up 64.8% of the veterinary-visiting population, with cats, rabbits and other species making up 30.3, 2.0 and 1.6% respectively. Compared to cats, dogs and rabbits were more likely to be purebred and younger. Neutering was more common in cats (77.0%) compared to dogs (57.1%) and rabbits (45.8%). The insurance and microchipping relative frequency was highest in dogs (27.9 and 53.1%, respectively). Dogs in the veterinary-visiting population belonging to owners living in least-deprived areas of Great Britain were more likely to be purebred, neutered, insured and microchipped. The same association was found for cats in England and for certain parameters in Wales and Scotland. CONCLUSIONS The differences we observed within these populations are likely to impact on the clinical diseases observed within individual veterinary practices that care for them. Based on this descriptive study, there is an indication that the population structures of companion animals co-vary with human and environmental factors such as the predicted socioeconomic level linked to the owner's address. This 'co-demographic' information suggests that further studies of the relationship between human demographics and pet ownership are warranted.
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Houghton A, Austin J, Beerman A, Horton C. An Approach to Developing Local Climate Change Environmental Public Health Indicators in a Rural District. J Environ Public Health 2017; 2017:3407325. [PMID: 28352286 DOI: 10.1155/2017/3407325] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 12/29/2016] [Accepted: 02/01/2017] [Indexed: 11/17/2022]
Abstract
Climate change represents a significant and growing threat to population health. Rural areas face unique challenges, such as high rates of vulnerable populations; economic uncertainty due to their reliance on industries that are vulnerable to climate change; less resilient infrastructure; and lower levels of access to community and emergency services than urban areas. This article fills a gap in public health practice by developing climate and health environmental public health indicators for a local public health department in a rural area. We adapted the National Environmental Public Health Tracking Network's framework for climate and health indicators to a seven-county health department in Western Kentucky. Using a three-step review process, we identified primary climate-related environmental public health hazards for the region (extreme heat, drought, and flooding) and a suite of related exposure, health outcome, population vulnerability, and environmental vulnerability indicators. Indicators that performed more poorly at the county level than at the state and national level were defined as "high vulnerability." Six to eight high vulnerability indicators were identified for each county. The local health department plans to use the results to enhance three key areas of existing services: epidemiology, public health preparedness, and community health assessment.
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Rosofsky A, Reid M, Sandel M, Zielenbach M, Murphy J, Scammell MK. Breathe Easy at Home: A Qualitative Evaluation of a Pediatric Asthma Intervention. Glob Qual Nurs Res 2016; 3:2333393616676154. [PMID: 28462348 PMCID: PMC5342293 DOI: 10.1177/2333393616676154] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 09/22/2016] [Accepted: 09/27/2016] [Indexed: 11/15/2022] Open
Abstract
The Breathe Easy at Home Program enables clinicians to refer asthmatic patients to Boston Inspectional Services Department (ISD) if they suspect housing conditions trigger symptoms. The authors conducted one-on-one interviews with clinicians (n = 10) who referred patients, and focus groups with inspectors from the ISD (n = 9) and a variety of stakeholders (n = 13), to gain insight into program function and implementation. Clinician interviews revealed inconsistencies in enrollment approaches, dissatisfaction with the web-based system, and patient follow-up difficulties. Inspectors identified barriers to working effectively with residents and landlords, and the stakeholder focus group highlighted successes of an unusual institutional collaboration. Interviews and focus groups identified strong and personal rapport between clinicians, inspectors, and patients as key to program retention, and that participating families required additional support throughout the process. Despite recommendations for improvement in program implementation, clinicians, inspectors, and stakeholders felt that the program overall improved both the home environment and asthma outcomes.
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Affiliation(s)
| | - Margaret Reid
- Boston Public Health Commission, Boston, Massachusetts, USA
| | - Megan Sandel
- Boston Medical Center, Boston, Massachusetts, USA
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Galobardes B, Granell R, Sterne J, Hughes R, Mejia-Lancheros C, Davey Smith G, Henderson J. Childhood wheezing, asthma, allergy, atopy, and lung function: different socioeconomic patterns for different phenotypes. Am J Epidemiol 2015; 182:763-74. [PMID: 26443417 PMCID: PMC4617295 DOI: 10.1093/aje/kwv045] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 02/10/2015] [Indexed: 11/13/2022] Open
Abstract
Identifying preventable exposures that lead to asthma and associated allergies has proved challenging, partly because of the difficulty in differentiating phenotypes that define homogeneous disease groups. Understanding the socioeconomic patterns of disease phenotypes can help distinguish which exposures are preventable. In the present study, we identified disease phenotypes that are susceptible to socioeconomic variation, and we determined which life-course exposures were associated with these inequalities in a contemporary birth cohort. Participants included children from the Avon Longitudinal Study of Parents and Children, a population-based birth cohort in England, who were born in 1991 and 1992 and attended the clinic at 7–8 years of age (n = 6,378). Disease phenotypes included asthma, atopy, wheezing, altered lung function, and bronchial reactivity phenotypes. Combining atopy with a diagnosis of asthma from a doctor captured the greatest socioeconomic variation, including opposing patterns between phenotype groups: Children with a low socioeconomic position (SEP) had more asthma alone (adjusted multinomial odds ratio = 1.50, 95% confidence interval: 1.21, 1.87) but less atopy alone (adjusted multinomial odds ratio = 0.80, 95% confidence interval: 0.66, 0.98) than did children with high SEP. Adjustment for maternal exposure to tobacco smoke during pregnancy and childhood exposure to tobacco smoke reduced the odds of asthma alone in children with a low SEP. Current inequalities among children who have asthma but not atopy can be prevented by eliminating exposure to tobacco smoke. Other disease phenotypes were not socially patterned or had SEP patterns that were not related to smoke exposure.
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Affiliation(s)
- Bruna Galobardes
- Correspondence to Dr. Bruna Galobardes, University of Bristol, School of Social and Community Medicine, Oakfield House, Oakfield Grove, BS8 2BN, United Kingdom (e-mail: )
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Brown T, Dassonville C, Derbez M, Ramalho O, Kirchner S, Crump D, Mandin C. Relationships between socioeconomic and lifestyle factors and indoor air quality in French dwellings. Environ Res 2015; 140:385-396. [PMID: 25935319 DOI: 10.1016/j.envres.2015.04.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 04/20/2015] [Accepted: 04/21/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND To date, few studies have analyzed the relationships between socioeconomic status (SES) and indoor air quality (IAQ). OBJECTIVE The aim of this study was to examine the relationships between socioeconomic and other factors and indoor air pollutant levels in French homes. METHODS The indoor air concentrations of thirty chemical, biological and physical parameters were measured over one week in a sample of 567 dwellings representative of the French housing stock between September 2003 and December 2005. Information on SES (household structure, educational attainment, income, and occupation), building characteristics, and occupants' habits and activities (smoking, cooking, cleaning, etc.) were collected through administered questionnaires. Separate stepwise linear regression models were fitted to log-transformed concentrations on SES and other factors. Logistic regression was performed on fungal contamination data. RESULTS Households with lower income were more likely to have higher indoor concentrations of formaldehyde, but lower perchloroethylene indoor concentrations. Formaldehyde indoor concentrations were also associated with newly built buildings. Smoking was associated with increasing acetaldehyde and PM2.5 levels and the risk of a positive fungal contamination index. BTEX levels were also associated with occupant density and having an attached garage. The major predictors for fungal contamination were dampness and absolute humidity. CONCLUSION These results, obtained from a large sample of dwellings, show for the first time in France the relationships between SES factors and indoor air pollutants, and believe they should be considered alongside occupant activities and building characteristics when study IAQ in homes.
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Affiliation(s)
- Terry Brown
- Institute of Environment, Health, Risks and Futures, School of Environment, Energy & Agrifoods, Cranfield University, Cranfield, Milton Keynes, Bedfordshire MK43 0AL, UK.
| | - Claire Dassonville
- Paris-East University/Scientific and Technical Centre for Building (CSTB), Observatory on Indoor Air Quality, 84 Avenue Jean Jaurès, Champs-sur-Marne, F-77447 Marne-la-Vallée Cedex 2, France
| | - Mickael Derbez
- Paris-East University/Scientific and Technical Centre for Building (CSTB), Observatory on Indoor Air Quality, 84 Avenue Jean Jaurès, Champs-sur-Marne, F-77447 Marne-la-Vallée Cedex 2, France
| | - Olivier Ramalho
- Paris-East University/Scientific and Technical Centre for Building (CSTB), Observatory on Indoor Air Quality, 84 Avenue Jean Jaurès, Champs-sur-Marne, F-77447 Marne-la-Vallée Cedex 2, France
| | - Severine Kirchner
- Paris-East University/Scientific and Technical Centre for Building (CSTB), Observatory on Indoor Air Quality, 84 Avenue Jean Jaurès, Champs-sur-Marne, F-77447 Marne-la-Vallée Cedex 2, France
| | - Derrick Crump
- Institute of Environment, Health, Risks and Futures, School of Environment, Energy & Agrifoods, Cranfield University, Cranfield, Milton Keynes, Bedfordshire MK43 0AL, UK
| | - Corinne Mandin
- Paris-East University/Scientific and Technical Centre for Building (CSTB), Observatory on Indoor Air Quality, 84 Avenue Jean Jaurès, Champs-sur-Marne, F-77447 Marne-la-Vallée Cedex 2, France
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Hernández-Cadena L, Zeldin DC, Barraza-Villarreal A, Sever ML, Sly PD, London SJ, Escamilla-Nuñez MC, Romieu I. Indoor determinants of dustborne allergens in Mexican homes. Allergy Asthma Proc 2015; 36:130-7. [PMID: 25715241 DOI: 10.2500/aap.2015.36.3801] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Exposure to indoor allergens represents a significant risk factor for allergies and asthma in several parts of the world. In Mexico, few studies have evaluated indoor allergens, including cat, dog, and mouse allergens and the factors that predict their presence. This study evaluates the main environmental and household predictors of high prenatal allergen levels and multiple allergen exposures in a birth cohort from Mexico City. A cross-sectional study was conducted as part of a birth cohort study of 1094 infants recruited during pregnancy and followed until delivery. We collected dust samples in a subset of 264 homes and assessed environmental factors. Der p 1, Der f 1, dust mite group 2, Fel d 1, Can f 1, Rat n 1, Mus m 1, and Bla g 2 concentrations in dust samples were measured using immunoassays. To define detectable allergen levels, the lowest limits of detection for each allergen were taken as cutoff points. Overall allergen exposure was considered high when four or more allergens exceeded detectable levels in the same household. Logistic regression was used for predictive models. Eighty-five percent of homes had at least one allergen in dust over the detection limit, 52.1% had high exposure (four or more allergens above detectable limits), and 11.7% of homes had detectable levels for more than eight allergens. Der p 1, Der p 2, Mus m 1, and Fel d 1 were the most frequent allergens detected. Each allergen had both common and distinct predictors. The main predictors of a high multiple allergen index were the size of the home, pesticide use, mother's age, mother as homemaker, and season. Increased indoor environmental allergen exposure is mainly related to sociodemographic factors and household cleaning.
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Affiliation(s)
- Leticia Hernández-Cadena
- Instituto Nacional de Salud Pública, Av. Universidad No. 655, Col. Santa María Ahuacatitlán, Cuernavaca, Morelos, Mexico
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Kopel LS, Phipatanakul W, Gaffin JM. Social disadvantage and asthma control in children. Paediatr Respir Rev 2014; 15:256-62; quiz 262-3. [PMID: 24928775 DOI: 10.1016/j.prrv.2014.04.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 04/29/2014] [Indexed: 12/22/2022]
Abstract
This review discusses various aspects of social disadvantage and their association with poor asthma control, including socioeconomic status, exposure to psychosocial stress and violence, minority affiliation, environmental concerns such as allergens and pollution, and poverty in rural settings. Each of these elements has been linked with worsened asthma outcomes in children. Known and hypothesized mechanisms behind these associations are described in an effort to further understand the complex entity of poorly controlled asthma among socially deprived children. Intervention studies to improve asthma outcomes in these vulnerable populations are also described.
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Krop EJM, Jacobs JH, Sander I, Raulf-Heimsoth M, Heederik DJJ. Allergens and β-glucans in dutch homes and schools: characterizing airborne levels. PLoS One 2014; 9:e88871. [PMID: 24551183 PMCID: PMC3925184 DOI: 10.1371/journal.pone.0088871] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 01/13/2014] [Indexed: 12/03/2022] Open
Abstract
Background Indoor air quality has an effect on respiratory health. Children are more vulnerable to a decreased indoor air quality as their lungs are still developing. We measured levels of allergens and β-(1,3)-glucans in 19 school buildings and determined whether measured levels could be reproduced. School levels were compared to those in 169 homes and the effect of building characteristics on both home and school exposure was explored. Methods Electrostatic Dust fall Collectors were placed in school buildings for 8 weeks and in homes for 2 weeks to collect settled airborne dust. Cat, dog, and mouse allergen levels, domestic mite antigen levels and β-(1,3)-glucans were measured in the extracts from the collectors. Results were corrected for sampling duration. Using questionnaire data, relations between measured levels and building and classroom characteristics were explored. Results In schools, exposure levels were highest in classrooms and were influenced by the socioeconomic status of the children, the season measurements were performed, moisture status of the building and pet ownership. Repeated measurements in different seasons and over the years showed significantly different levels. Home exposure was influenced by socioeconomic status, occupancy and pet ownership. Domestic mite antigen was found in higher levels in extracts from homes compared to schools while pet allergen levels were 13 times higher in schools compared to homes without pets. For mouse allergen overall levels of exposure were low but still two times higher in schools compared to homes. Levels of β-(1,3)-glucans were also approximately two times higher in schools than in homes. Conclusion Exposure levels of several allergens and β-(1,3)-glucans in schools differ over time and are higher than in homes. For children, exposure levels measured at school could contribute to their total exposure as especially animal allergen levels can be much higher in schools compared to homes.
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Affiliation(s)
- Esmeralda J. M. Krop
- Institute for Risk Assessment Sciences, Utrecht University, Division of Environmental Epidemiology, Utrecht, The Netherlands
- * E-mail:
| | - José H. Jacobs
- Institute for Risk Assessment Sciences, Utrecht University, Division of Environmental Epidemiology, Utrecht, The Netherlands
| | - Ingrid Sander
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany
| | - Monika Raulf-Heimsoth
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany
| | - Dick J. J. Heederik
- Institute for Risk Assessment Sciences, Utrecht University, Division of Environmental Epidemiology, Utrecht, The Netherlands
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Breysse J, Dixon S, Gregory J, Philby M, Jacobs DE, Krieger J. Effect of weatherization combined with community health worker in-home education on asthma control. Am J Public Health 2013; 104:e57-64. [PMID: 24228661 DOI: 10.2105/ajph.2013.301402] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We assessed the benefits of adding weatherization-plus-health interventions to an in-home, community health worker (CHW) education program on asthma control. METHODS We used a quasi-experimental design to compare study group homes (n = 34) receiving CHW education and weatherization-plus-health structural interventions with historical comparison group homes (n = 68) receiving only education. Data were collected in King County, Washington, from October 2009 to September 2010. RESULTS Over the 1-year study period, the percentage of study group children with not-well-controlled or very poorly controlled asthma decreased more than the comparison group percentage (100% to 28.8% vs 100% to 51.6%; P = .04). Study group caregiver quality-of-life improvements exceeded comparison group improvements (P = .002) by 0.7 units, a clinically important difference. The decrease in study home asthma triggers (evidence of mold, water damage, pests, smoking) was marginally greater than the comparison group decrease (P = .089). Except for mouse allergen, the percentage of study group allergen floor dust samples at or above the detection limit decreased, although most reductions were not statistically significant. CONCLUSIONS Combining weatherization and healthy home interventions (e.g., improved ventilation, moisture and mold reduction, carpet replacement, and plumbing repairs) with CHW asthma education significantly improves childhood asthma control.
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Affiliation(s)
- Jill Breysse
- Jill Breysse, Sherry Dixon, and David E. Jacobs are with the National Center for Healthy Housing, Columbia, MD. Joel Gregory is with the King County Housing Authority, Tukwila, WA. Miriam Philby and James Krieger are with Public Health-Seattle and King County, Seattle, WA
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Chiu YH, Coull BA, Sternthal MJ, Kloog I, Schwartz J, Cohen S, Wright RJ. Effects of prenatal community violence and ambient air pollution on childhood wheeze in an urban population. J Allergy Clin Immunol 2014; 133:713-22.e4. [PMID: 24200349 DOI: 10.1016/j.jaci.2013.09.023] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 09/06/2013] [Accepted: 09/16/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Prenatal exposures to stress and physical toxins influence children's respiratory health, although few studies consider these factors together. OBJECTIVES We sought to concurrently examine the effects of prenatal community-level psychosocial (exposure to community violence [ECV]) and physical (air pollution) stressors on repeated wheeze in 708 urban children followed to age 2 years. METHODS Multi-item ECV reported by mothers in pregnancy was summarized into a continuous score by using Rasch modeling. Prenatal black carbon exposure was estimated by using land-use regression (LUR) modeling; particulate matter with a diameter of less than 2.5 μm (PM2.5) was estimated by using LUR modeling incorporating satellite data. Mothers reported child's wheeze every 3 months. The effects of ECV and air pollutants on repeated wheeze (≥ 2 episodes) were examined by using logistic regression. Interactions between ECV and pollutants were examined. RESULTS Mothers were primarily black (29%) and Hispanic (55%), with lower education (62% with ≤ 12 years); 87 (12%) children wheezed repeatedly. In models examining concurrent exposures, ECV (odds ratio [OR], 1.95; 95% CI, 1.13-3.36; highest vs lowest tertile) and black carbon (OR, 1.84; 95% CI, 1.08-3.12; median or greater vs less than median) were independently associated with wheeze adjusting for sex, birth season, maternal atopy, education, race, and cockroach antigen. Associations were similar for PM2.5 (adjusted OR, 2.02; 95% CI, 1.20-3.40). An interaction between ECV with air pollution levels was suggested. CONCLUSIONS These findings suggest that both prenatal community violence and air pollution can contribute to respiratory health in these urban children. Moreover, place-based psychosocial stressors might affect host resistance such that physical pollutants can have adverse effects, even at relatively lower levels.
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Baxi SN, Muilenberg ML, Rogers CA, Sheehan WJ, Gaffin J, Permaul P, Kopel LS, Lai PS, Lane JP, Bailey A, Petty CR, Fu C, Gold DR, Phipatanakul W. Exposures to molds in school classrooms of children with asthma. Pediatr Allergy Immunol 2013; 24:697-703. [PMID: 24112429 PMCID: PMC3782748 DOI: 10.1111/pai.12127] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Students spend a large portion of their day in classrooms which may be a source of mold exposure. We examined the diversity and concentrations of molds in inner-city schools and described differences between classrooms within the same school. METHODS Classroom airborne mold spores, collected over a 2 day period, were measured twice during the school year by direct microscopy. RESULTS There were 180 classroom air samples collected from 12 schools. Mold was present in 100% of classrooms. Classrooms within the same school had differing mold levels and mold diversity scores. The total mold per classroom was 176.6 ± 4.2 spores/m3 (geometric mean ± standard deviation) and ranged from 11.2 to 16,288.5 spores/m3. Mold diversity scores for classroom samples ranged from 1 to 19 (7.7 ± 3.5). The classroom accounted for the majority of variance (62%) in the total mold count, and for the majority of variance (56%) in the mold diversity score versus the school. The species with the highest concentrations and found most commonly included Cladosporium (29.3 ± 4.2 spores/m3), Penicillium/Aspergillus (15.0 ± 5.4 spores/m3), smut spores (12.6 ± 4.0 spores/m3), and basidiospores (6.6 ± 7.1 spores/m3). CONCLUSIONS Our study found that the school is a source of mold exposure, but particularly the classroom microenvironment varies in quantity of spores and species among classrooms within the same school. We also verified that visible mold may be a predictor for higher mold spore counts. Further studies are needed to determine the clinical significance of mold exposure relative to asthma morbidity in sensitized and non-sensitized asthmatic children.
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Affiliation(s)
- Sachin N Baxi
- Division of Allergy and Immunology, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Abstract
In the past, cockroach allergen exposure assessment mainly focused on settled dust in homes in low-income urban cities in the United States. That choice was not wrong; without measureable levels of cockroach allergen, it is difficult to show associations with any home characteristics, much less with health outcomes (e.g., allergy, asthma). However, recent studies in other suburban areas, schools, and other countries have elucidated the importance of cockroach allergen in these environments too. In addition, characterizing the underlying factors that give rise to cockroach allergen exposure (or protect against it) can lead to more targeted public health interventions. This review discusses different approaches to sampling indoor environments, interprets recent asthma and allergy studies, compares cockroach allergen levels from past studies with those of recent studies, and describes strategies for decreasing exposures.
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Abstract
Dust mites, cockroaches, and pets (cats, dogs) are common in homes worldwide, and many species are the source of potent allergens which cause allergic diseases. These diseases are influenced by genetic predisposition and environmental exposure. Generally, the levels of house dust mite (Der p 1 and Der f 1) and cockroach (Bla g 1, Bla g 2) allergens are used as markers of indoor exposure to arthropods.This article reviews the findings of allergens Der p 1, Der f 1, and Bla g 1 in randomly selected urban households in Zagreb (Croatia) measured from 2006 to 2010 and compares them with exposure to arthropod allergens in other countries. In short, house dust mite allergen levels in Croatian homes are low, but exposure is common; Der p 1 was found in 73 % and Der f 1 in 83 % of the households. By contrast, exposure to cockroach allergen Bla g 1 was both low and uncommon (13 %). Exposure to multiple allergens associated with sensitisation and asthma was not frequent in urban homes in Croatia. However, further studies should include monitoring of both arthropod and pet allergens in high-risk populations in inland and coastal Croatia. They should also investigate a complex dose-response relationship between exposure and sensitisation/asthma development, especially in early childhood.
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Sturdy P, Bremner S, Harper G, Mayhew L, Eldridge S, Eversley J, Sheikh A, Hunter S, Boomla K, Feder G, Prescott K, Griffiths C. Impact of asthma on educational attainment in a socioeconomically deprived population: a study linking health, education and social care datasets. PLoS One 2012; 7:e43977. [PMID: 23155367 DOI: 10.1371/journal.pone.0043977] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Accepted: 07/27/2012] [Indexed: 11/19/2022] Open
Abstract
Background Asthma has the potential to adversely affect children's school examination performance, and hence longer term life chances. Asthma morbidity is especially high amongst UK ethnic minority children and those experiencing social adversity, populations which also have poor educational outcomes. We tested the hypothesis that asthma adversely affects performance in national school examinations in a large cohort from an area of ethnic diversity and social deprivation. Methods and Findings With a novel method (using patient and address-matching algorithms) we linked administrative and clinical data for 2002–2005 for children in east London aged 5–14 years to contemporaneous education and social care datasets. We modelled children's performance in school examinations in relation to socio-demographic and clinical variables. The dataset captured examination performance for 12,136 children who sat at least one national examination at Key Stages 1–3. For illustration, estimates are presented as percentage changes in Key Stage 2 results. Having asthma was associated with a 1.1% increase in examination scores (95%CI 0.4 to 1.7)%,p = 0.02. Worse scores were associated with Bangladeshi ethnicity −1.3%(−2.5 to −0.1)%,p = 0.03; special educational need −14.6%(−15.7 to −13.5)%,p = 0.02; mental health problems −2.5%(−4.1 to −0.9)%,p = 0.003, and social adversity: living in a smoking household −1.2(−1.7 to −0.6)%,p<0.001; living in social housing −0.8%(−1.3 to −0.2)% p = 0.01, and entitlement to free school meals −0.8%(−1.5 to −0.1)%,p<0.001. Conclusions Social adversity and ethnicity, but not asthma, are associated with poorer performance in national school examinations. Policies to improve educational attainment in socially deprived areas should focus on these factors.
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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, Phipatanakul W. Allergens in urban schools and homes of children with asthma. Pediatr Allergy Immunol 2012; 23:543-9. [PMID: 22672325 PMCID: PMC3424376 DOI: 10.1111/j.1399-3038.2012.01327.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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.
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Affiliation(s)
- Perdita Permaul
- Division of Pediatric Pulmonary, Allergy and Immunology, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
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Myong JP, Kim H, Lee K, Chang S. Time trends of allergic rhinitis and effects of residence on allergic rhinitis in Korea from 1998 through 2007-2009. Asian Nurs Res (Korean Soc Nurs Sci) 2012; 6:102-6. [PMID: 25030976 DOI: 10.1016/j.anr.2012.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 07/31/2012] [Accepted: 07/31/2012] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Longitudinal changes in the prevalence of self-reported physician-diagnosed allergic rhinitis (AR) in Korea and the association between the prevalence of AR and type of residence area among Korean males and females in 1998, 2001, 2005 and 2007-2009 were evaluated. METHODS Age-standardized prevalence was calculated using the Korea National Health and Nutrition Examination Survey (KNHANES) I-IV. Stratified factors of sex, age, and socioeconomic status were adjusted to compare the prevalence of AR in relation to residential area by multiple logistic analysis. RESULTS The prevalence of AR increased by tenfolds from 1.2 % in 1998 to 12.0 % in 2007-2009. The trends for prevalence of AR were also statistically significant (p < .05). The age-standardized prevalence of AR among urban females was higher (13.9%) than that in rural females (11.5%). After adjustment for survey years, age, socioeconomic levels and asthma, the odds of AR were higher in urban than rural residents, except for males in 1998. CONCLUSION The prevalence of AR in Korea has increased over the past decade, and living in an urban area may be a susceptible factor. For prevention and management of AR, further evaluations of contributing factors and mechanisms underlying differences in AR are needed.
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Affiliation(s)
- Jun-Pyo Myong
- Department of Preventive Medicine, and Center for Occupational and Environmental Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Hyeongsu Kim
- Department of Preventive Medicine, School of Medicine, Konkuk University, Seoul, South Korea.
| | - Kunsei Lee
- Department of Preventive Medicine, School of Medicine, Konkuk University, Seoul, South Korea
| | - Sounghoon Chang
- Department of Preventive Medicine, School of Medicine, Konkuk University, Seoul, South Korea
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Forno E, Cloutier MM, Datta S, Paul K, Sylvia J, Calvert D, Thornton-Thompson S, Wakefield DB, Brehm J, Hamilton RG, Alvarez M, Colón-Semidey A, Acosta-Pérez E, Canino G, Celedón JC. Mouse allergen, lung function, and atopy in Puerto Rican children. PLoS One 2012; 7:e40383. [PMID: 22815744 PMCID: PMC3398035 DOI: 10.1371/journal.pone.0040383] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 06/05/2012] [Indexed: 11/18/2022] Open
Abstract
Objective To examine the relation between mouse allergen exposure and asthma in Puerto Rican children. Methods Mus m 1, Der p 1, Bla g 2, and Fel d 1 allergens were measured in dust samples from homes of Puerto Rican children with (cases) and without (controls) asthma in Hartford, CT (n = 449) and San Juan (SJ), Puerto Rico (n = 678). Linear or logistic regression was used for the multivariate analysis of mouse allergen (Mus m 1) and lung function (FEV1 and FEV1/FVC) and allergy (total IgE and skin test reactivity (STR) to ≥1 allergen) measures. Results Homes in SJ had lower mouse allergen levels than those in Hartford. In multivariate analyses, mouse allergen was associated with higher FEV1 in cases in Hartford (+70.6 ml, 95% confidence interval (CI) = 8.6–132.7 ml, P = 0.03) and SJ (+45.1 ml, 95% CI = −0.5 to 90.6 ml, P = 0.05). In multivariate analyses of controls, mouse allergen was inversely associated with STR to ≥1 allergen in non-sensitized children (odds ratio [OR] for each log-unit increment in Mus m 1 = 0.7, 95% CI = 0.5–0.9, P<0.01). In a multivariate analysis including all children at both study sites, each log-increment in mouse allergen was positively associated with FEV1 (+28.3 ml, 95% CI = 1.4–55.2 ml, P = 0.04) and inversely associated with STR to ≥1 allergen (OR for each log-unit increment in Mus m 1 = 0.8, 95% CI = 0.6–0.9, P<0.01). Conclusions Mouse allergen is associated with a higher FEV1 and lower odds of STR to ≥1 allergen in Puerto Rican children. This may be explained by the allergen itself or correlated microbial exposures.
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Affiliation(s)
- Erick Forno
- Division of Pediatric Pulmonology, Department of Pediatrics, University of Miami, Miami, Florida, United States of America
| | - Michelle M. Cloutier
- Department of Pediatrics, University of Connecticut Health Center, Farmington, Connecticut, United States of America
| | - Soma Datta
- Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Kathryn Paul
- Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Jody Sylvia
- Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Deanna Calvert
- Connecticut Children’s Medical Center, Hartford, Connecticut, United States of America
| | | | - Dorothy B. Wakefield
- Department of Pediatrics, University of Connecticut Health Center, Farmington, Connecticut, United States of America
| | - John Brehm
- Division of Pediatric Pulmonary Medicine, Allergy and Immunology, Department of Pediatrics, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Robert G. Hamilton
- Division of Allergy and Immunology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - María Alvarez
- Behavioral Sciences Research Institute, University of Puerto Rico, San Juan, Puerto Rico
| | - Angel Colón-Semidey
- Behavioral Sciences Research Institute, University of Puerto Rico, San Juan, Puerto Rico
| | - Edna Acosta-Pérez
- Behavioral Sciences Research Institute, University of Puerto Rico, San Juan, Puerto Rico
| | - Glorisa Canino
- Behavioral Sciences Research Institute, University of Puerto Rico, San Juan, Puerto Rico
| | - Juan C. Celedón
- Division of Pediatric Pulmonary Medicine, Allergy and Immunology, Department of Pediatrics, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
- * E-mail:
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Van Dyke MV, Martyny JW, Marola J, Ramamoorthy P, Ridder A, Harbeck RJ, Rose CS. Efficacy of occupant-collected dust samples in the evaluation of residential allergen and fungal levels. J Occup Environ Hyg 2012; 9:14-24. [PMID: 22150472 DOI: 10.1080/15459624.2012.633069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This study evaluated the ability of a resident to evaluate their home for allergens and mold using a settled dust test kit compared with evaluation and collection of settled dust by an industrial hygienist. Forty-three home residents were provided with a kit containing written instructions and a vacuum cleaner attachment for collecting a settled dust sample. Within 2 weeks of receiving the occupant-collected sample, an industrial hygienist evaluated these homes, including a visual inspection, collection of settled dust, and collection of spore trap samples. Settled dust samples were analyzed for major dog, cat, dust mite, and cockroach allergens using immunoassay methods, and for mold spore equivalents using quantitative polymerase chain reaction methods for the 13 mold species or species groups comprising the American Relative Moldiness Index (ARMI). Allergen concentrations and ARMIs were compared between the resident- and industrial hygienist-collected samples. Linear regression between the two sets of samples showed strong correlations for dog allergen (r(2) = 0.92) and cat allergen (r(2) = 0.90). Correlations for dust mite (r(2) = 0.57) and cockroach allergens (r(2) = 0.22) were lower, likely due to most samples being near the limit of detection. ARMIs were highly correlated (r(2) = 0.68) and were in categorical (high, medium, or low) agreement for 76% of residences. These results show that residents can reliably follow directions and collect settled dust samples, providing an efficient method to remotely screen homes for elevated allergen levels and to identify homes with a potential mold or moisture problem that may need further evaluation.
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Affiliation(s)
- M V Van Dyke
- National Jewish Health, Denver, Colorado 80206, USA.
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Adamkiewicz G, Zota AR, Fabian MP, Chahine T, Julien R, Spengler JD, Levy JI. Moving environmental justice indoors: understanding structural influences on residential exposure patterns in low-income communities. Am J Public Health 2011. [PMID: 21836112 DOI: 10.2105/ajph.2011./300119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
OBJECTIVES The indoor environment has not been fully incorporated into the environmental justice dialogue. To inform strategies to reduce disparities, we developed a framework to identify the individual and place-based drivers of indoor environment quality. METHODS We reviewed empirical evidence of socioeconomic disparities in indoor exposures and key determinants of these exposures for air pollutants, lead, allergens, and semivolatile organic compounds. We also used an indoor air quality model applied to multifamily housing to illustrate how nitrogen dioxide (NO(2)) and fine particulate matter (PM(2.5)) vary as a function of factors known to be influenced by socioeconomic status. RESULTS Indoor concentrations of multiple pollutants are elevated in low-socioeconomic status households. Differences in these exposures are driven by the combined influences of indoor sources, outdoor sources, physical structures, and residential activity patterns. Simulation models confirmed indoor sources' importance in determining indoor NO(2) and PM(2.5) exposures and showed the influence of household-specific determinants. CONCLUSIONS Both theoretical models and empirical evidence emphasized that disparities in indoor environmental exposure can be significant. Understanding key determinants of multiple indoor exposures can aid in developing policies to reduce these disparities.
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Affiliation(s)
- Gary Adamkiewicz
- Department of Environmental Health Harvard School of Public Health, Boston, MA 02215, USA.
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Lin S, Jones R, Munsie JP, Nayak SG, Fitzgerald EF, Hwang SA. Childhood asthma and indoor allergen exposure and sensitization in Buffalo, New York. Int J Hyg Environ Health 2011; 215:297-305. [PMID: 21962526 DOI: 10.1016/j.ijheh.2011.08.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Revised: 08/23/2011] [Accepted: 08/31/2011] [Indexed: 11/19/2022]
Abstract
This nested case-control study examined the association between prevalent asthma and indoor allergen sensitization and/or exposure among children (aged 5-17 years) in Buffalo, New York. The study included a self-administered questionnaire, clinical interviews, skin allergen sensitivity tests and home dust sampling for house dust mites, cat, dog, cockroach and mouse allergens. After adjusting for multiple confounders, asthma cases had higher odds of being sensitized to Der p dust mites (odds ratio [OR]=1.94, 95% confidence interval (CI): 1.13-3.35), cat (OR=1.96, 95% CI: 1.13-3.39), or dog allergens (OR=1.89, 95% CI: 1.10-3.22) than the controls. A significantly positive association between asthma status presence of cat allergen in the child's mattress (ORs: 2.61, 95% CI: 1.09-6.28) was also found. Children with both sensitization and environmental exposure to cat allergens had higher odds of asthma (OR=7.08, 95% CI: 2.12-23.62) than those who were only sensitized to cat allergen (OR=2.31, 95% CI: 1.01-5.32) or had only home exposures (OR=1.47, 95% CI: 0.47-4.65). The association between allergen sensitization and asthma was more consistent than for home exposures. The findings help to confirm the role of allergen sensitization and home exposure in regard to asthma, and suggest that both, individually and jointly, are associated with asthma.
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Affiliation(s)
- S Lin
- Bureau of Environmental and Occupational Epidemiology, Center for Environmental Health, New York State Department of Health, Troy, NY 12180, USA
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Abstract
OBJECTIVES To outline the prevalence and disparities of asthma among school-aged urban minority youth, causal pathways through which poorly controlled asthma adversely affects academic achievement, and proven or promising approaches for schools to address these problems. METHODS Literature review. RESULTS Asthma is the most common chronic disease affecting youth in the United States; almost 10 million youth under 18 (14%) have received a diagnosis and 6.8 million (9%) have active asthma. Average annual prevalence estimates were approximately 45% higher for Black versus White children (12.8% vs. 8.8%), as were average annual estimates of asthma attacks (8.4% vs. 5.8%). Urban minority youth have highly elevated prevalence of poorly controlled asthma as evidenced by overuse of emergency departments and under-use of efficacious medications. Poorly controlled asthma has functional consequences on cognition, connectedness with school, and absenteeism. Exemplary asthma programs include management and support systems, school health and mental health services, asthma education, healthy school environments, physical education and activity, and coordination of school, family, and community efforts. CONCLUSIONS Asthma and, more importantly, poorly controlled asthma are highly and disproportionately prevalent among school-aged urban minority youth, has a negative impact on academic achievement through its effects on cognition, school connectedness, and absenteeism, and effective practices are available for schools to address this problem. To reduce the adverse effects of poorly controlled asthma on learning, a multifaceted approach to asthma control and prevention in which schools can and must play a central role is essential.
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Affiliation(s)
- Charles E Basch
- Department of Health and Behavior Studies, Teachers College, Columbia University, 525 West 120th Street, New York, NY 10027, USA.
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Abstract
Cockroach allergy is a health problem in many parts of the world. In urban environments, indoor exposure to cockroach allergens involves a risk of asthma. The aim of this study was to measure the mass fraction of Bla g 1, a major allergen of the German cockroach (Blatella germanica) in 30 house samples, collected at random from Zagreb area households, Croatia. Dust samples were collected on cellulose filters by vacuuming living rooms floors. After extraction, Bla g 1 was detected using the commercial enzyme-linked immunosorbent assay (ELISA). Only four of the thirty households had detectable Bla g 1 levels, and only in one was its concentration higher than 2.0 U g(-1), the threshold associated with sensitisation. The Bla g 1 ELISA proved highly sensitive, with the detection limit of 0.12 U g(-1). The within- and between-assay imprecision was 8.9 % and 14.4 %, respectively, and accuracy 85 % to 120 %. Low Bla g 1 levels in the household dust support previously reported low prevalence of skin sensitisation to B. germanica among Zagreb residents. Further monitoring should reveal if there are differences in cockroach allergen exposure and sensitisation between households from other geographic areas in Croatia.
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Adamkiewicz G, Zota AR, Fabian MP, Chahine T, Julien R, Spengler JD, Levy JI. Moving environmental justice indoors: understanding structural influences on residential exposure patterns in low-income communities. Am J Public Health 2011; 101 Suppl 1:S238-45. [PMID: 21836112 DOI: 10.2105/ajph.2011.300119] [Citation(s) in RCA: 120] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The indoor environment has not been fully incorporated into the environmental justice dialogue. To inform strategies to reduce disparities, we developed a framework to identify the individual and place-based drivers of indoor environment quality. METHODS We reviewed empirical evidence of socioeconomic disparities in indoor exposures and key determinants of these exposures for air pollutants, lead, allergens, and semivolatile organic compounds. We also used an indoor air quality model applied to multifamily housing to illustrate how nitrogen dioxide (NO(2)) and fine particulate matter (PM(2.5)) vary as a function of factors known to be influenced by socioeconomic status. RESULTS Indoor concentrations of multiple pollutants are elevated in low-socioeconomic status households. Differences in these exposures are driven by the combined influences of indoor sources, outdoor sources, physical structures, and residential activity patterns. Simulation models confirmed indoor sources' importance in determining indoor NO(2) and PM(2.5) exposures and showed the influence of household-specific determinants. CONCLUSIONS Both theoretical models and empirical evidence emphasized that disparities in indoor environmental exposure can be significant. Understanding key determinants of multiple indoor exposures can aid in developing policies to reduce these disparities.
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Affiliation(s)
- Gary Adamkiewicz
- Department of Environmental Health Harvard School of Public Health, Boston, MA 02215, USA.
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Williams AH, Smith JT, Hudgens EE, Rhoney S, Ozkaynak H, Hamilton RG, Gallagher JE. Allergens in household dust and serological indicators of atopy and sensitization in Detroit children with history-based evidence of asthma. J Asthma 2011; 48:674-84. [PMID: 21827376 DOI: 10.3109/02770903.2011.599909] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Home exposure to allergens is an important factor in the development of sensitization and subsequent exacerbations of allergic asthma. We investigated linkages among allergen exposure, immunological measurements, and asthma by examining (1) reservoir dust allergen levels in homes, (2) associations between presence of allergens in homes and sensitization status of resident children, and (3) associations between asthma status and total IgE, atopy (by Phadiatop), and positive allergen-specific tests. METHODS The study protocol was approved by Institutional Review Boards (IRBs) of the University of North Carolina Chapel Hill; Westat, Inc.; and the US Environmental Protection Agency Human Research Protocol Office. Data were collected from questionnaires, serum analyses, and household vacuum dust. Children (n = 205) were predominately African American (AA) (85.4%) and 51.6% were asthmatic. Sera from 185 children and home dust samples (n = 141) were analyzed for total and specific IgE antibodies to allergens from cat and dog dander, cockroach, dust mites, mice, rats, and molds. RESULTS Sixty percent of the homes had detectable levels of three or more dust allergens. The proportions of children with positive allergen-specific IgE tests were dust mite (32%), dog (28%), cat (23%), cockroach (18%), mouse (5%), rat (4%), and molds (24-36%). Children testing positive to a single allergen also had positive responses to other allergens. Those children with positive serum tests for cat, dog, and dust mite lived in homes with detectable levels of cat (51%), dog (90%), and dust mite (Der f 1) (92%) allergens. Correlations between children's specific IgE levels and dust levels were linearly related for dog (p < .04), but not for cat (p = .12) or dust mite (Der f 1) (p = .21). Odds ratios (95% CI) for the associations between asthma and serum-specific IgE were over 1.0 for cat, dog, dust mite (Der f 1), cockroach, and four types of molds. House dust allergen exposure levels, however, exhibited no differences between asthmatic and non-asthmatic homes. CONCLUSIONS Both the co-occurrence of multiple allergens in dust and the high frequency of multiple allergen sensitizations indicate that a broad-based intervention aimed at reducing multiple allergens (pets, pests, and molds) would be more successful than any approach that aimed at reducing one type of allergen.
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Affiliation(s)
- Ann Houston Williams
- Epidemiology Branch, National Health and Environmental Effects Research Laboratory, United States Environmental Protection Agency, Research Triangle Park, NC 27711, USA.
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Breysse J, Wendt J, Dixon S, Murphy A, Wilson J, Meurer J, Cohn J, Jacobs DE. Nurse case management and housing interventions reduce allergen exposures: the Milwaukee randomized controlled trial. Public Health Rep 2011; 126 Suppl 1:89-99. [PMID: 21563716 PMCID: PMC3072907 DOI: 10.1177/00333549111260s112] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We examined the impact of a combination of home environmental interventions and nurse case management services on total settled dust loadings and on allergen concentrations in the homes of asthmatic children. METHODS Using a randomized longitudinal controlled trial study design, we randomly assigned homes of asthmatic children in Milwaukee to either a control (n = 64) or an intervention (n = 57) group. Control group homes received a visual assessment, education, bed/pillow dust mite encasings, and treatment of lead-based paint hazards. The intervention group received these same services plus nurse case management that included tailored, individual asthma action plans, provision of minor home repairs, home cleaning using special vacuuming and wet washing, and integrated pest management. Dust vacuum samples were collected from measured surface areas of floors in the TV room, kitchen, and child's bedroom at baseline and at three-, six-, and 12-month follow-up visits. Dust loading (mass per surface area) is a means of measuring total dust and the total amount of allergen present. RESULTS For the intervention group, geometric mean dust loadings declined significantly from baseline (39 milligrams per square foot [mg/ft2]) to postintervention (11 mg/ft2) (p < 0.001). Baseline dust loading, treatment group, visit, and season were significant predictors of follow-up dust loadings. Mean post-intervention dust loadings were 72% higher in the control group. The total amount of allergen in settled house dust declined significantly following the intervention because total dust loading declined; the concentration of allergens in settled dust did not change significantly. CONCLUSION The combination of nurse case management and home environmental interventions promotes collaboration between health and housing professionals and is effective in reducing exposures to allergens in settled dust.
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Affiliation(s)
- Jill Breysse
- National Center for Healthy Housing, Columbia, MD
| | | | - Sherry Dixon
- National Center for Healthy Housing, Columbia, MD
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Takaro TK, Krieger J, Song L, Sharify D, Beaudet N. The Breathe-Easy Home: the impact of asthma-friendly home construction on clinical outcomes and trigger exposure. Am J Public Health 2011; 101:55-62. [PMID: 21148715 DOI: 10.2105/ajph.2010.300008] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the asthma-control benefit of moving into an asthma-friendly Breathe-Easy home (BEH). METHODS We used a quasi-experimental design to compare the asthma outcomes of 2 groups of low-income children and adolescents with asthma: 34 participants who moved into a BEH, and a local matched cohort of 68 participants who had received a previous asthma-control intervention. Both groups received in-home asthma education. BEHs were constructed with moisture-reduction features, enhanced ventilation systems, and materials that minimized dust and off-gassing. RESULTS BEH residents' asthma-symptom-free days increased from a mean of 8.6 per 2 weeks in their old home to 12.4 after 1 year in the BEH. The proportion of BEH residents with an urgent asthma-related clinical visit in the previous 3 months decreased from 62% to 21%. BEH caretakers' quality of life increased significantly. The BEH group improved more than did the comparison group, but most differences in improvements were not significant. Exposures to mold, rodents, and moisture were reduced significantly in BEHs. CONCLUSIONS Children and adolescents with asthma who moved into an asthma-friendly home experienced large decreases in asthma morbidity and trigger exposure.
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Affiliation(s)
- Tim K Takaro
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.
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Kwon JW, Kim BJ, Song Y, Seo JH, Kim TH, Yu J, Kim HB, Lee SY, Kim WK, Kim KW, Ji HM, Kim KE, Kim H, Hong SJ. Changes in the prevalence of childhood asthma in seoul from 1995 to 2008 and its risk factors. Allergy Asthma Immunol Res 2010; 3:27-33. [PMID: 21217922 PMCID: PMC3005315 DOI: 10.4168/aair.2011.3.1.27] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Accepted: 08/31/2010] [Indexed: 11/20/2022]
Abstract
Purpose To investigate the prevalence of asthma and determine its risk factors in elementary school students in Seoul. Methods A modified International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was used to survey 4,731 elementary school students from five areas in Seoul between April and October, 2008. Results In elementary school children, the lifetime and recent 12-month prevalence of wheezing were 11.7% and 5.6%, respectively. The lifetime prevalence of asthma diagnosis was 7.9%, and the recent 12-month prevalence of asthma treatment was 2.7%. Male sex (adjusted odds ratio [aOR], 1.90; 95% confidence interval [CI], 1.36-2.66), history of atopic dermatitis (AD) (aOR, 2.76; 95% CI, 1.98-3.84), history of allergic rhinitis (AR) (aOR, 3.71; 95% CI, 2.61-5.26), history of bronchiolitis before 2 years of age (aOR, 2.06; 95% CI, 1.39-3.07), use of antibiotics during infancy for >3 days (aOR, 1.88; 95% CI, 1.35-2.62), parental history of asthma (aOR, 2.83; 95% CI, 1.52-5.27), exposure to household molds during infancy (aOR, 1.84; 95% CI, 1.18-2.89), and the development or aggravation of asthma symptoms within 6 months after moving to a new house (aOR, 11.76; 95% CI, 5.35-25.86) were the independent risk factors for wheezing within 12 months. Conclusions The prevalence of wheezing and asthma in elementary school students in 2008 was similar to that in the past decade. Male sex, history of AD, history of AR, history of bronchiolitis before 2 years of age, parental asthma, use of antibiotics during infancy, exposure to molds in the house during infancy, and development or aggravation of asthma symptoms within 6 months after moving to a new house, could be risk factors for wheezing within 12 months.
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Affiliation(s)
- Ji-Won Kwon
- Department of Pediatrics, Childhood Asthma Atopy Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Krieger J. Home is Where the Triggers Are: Increasing Asthma Control by Improving the Home Environment. Pediatr Allergy Immunol Pulmonol 2010; 23:139-145. [PMID: 22375276 DOI: 10.1089/ped.2010.0022] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Accepted: 07/04/2010] [Indexed: 11/13/2022]
Abstract
Asthma remains the most common chronic condition of childhood. Strong evidence has linked exposure to allergens and other triggers commonly found in homes to allergen sensitization and asthma incidence and morbidity. A growing body of evidence has demonstrated that a home visit strategy that includes an environmental component that addresses multiple triggers through multiple interventions is effective. Such home visits reduce exposure to triggers, decrease symptoms and urgent health-care use, and increase quality of life. To make home visits widely available will require health-care payor reimbursement, government and health plan funding, training and certification of home visitors, and active referrals from health-care providers. However, a strategy based solely on education and behavior change is limited, because it cannot adequately reduce exposures due to adverse housing conditions. Therefore, approaches that address substandard housing are needed. These include remediation of existing housing and construction of new asthma-friendly homes. Most studies of remediation have made relatively narrow and focused improvements, such as insulation, heating, or ventilation. Outcomes have been mixed. Studies of new asthma-friendly homes are in their infancy, with promising pilot data. Further investigation is needed to establish the effectiveness of improving housing. A final strategy is improving housing quality through policy change, such as implementation of healthy housing guidelines for new construction, enhancement and increased enforcement of housing codes, and assuring smoke-free multi-unit homes. The combination of home visits, improved housing construction, and policy change has great potential for reducing the global burden of asthma.
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Affiliation(s)
- James Krieger
- Chronic Disease and Injury Prevention Section, Public Health-Seattle & King County , Seattle, Washington
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Sheehan WJ, Rangsithienchai PA, Wood RA, Rivard D, Chinratanapisit S, Perzanowski MS, Chew GL, Seltzer JM, Matsui EC, Phipatanakul W. 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. J Allergy Clin Immunol 2010; 125:575-81. [PMID: 20226293 DOI: 10.1016/j.jaci.2010.01.023] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Revised: 12/29/2009] [Accepted: 01/07/2010] [Indexed: 11/19/2022]
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.
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Affiliation(s)
- William J Sheehan
- Division of Immunology, Children's Hospital Boston, Boston, Mass 02115, USA
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Abstract
The prevalence of human allergy to pet danders has increased rapidly over the past six decades, as a consequence of lifestyle changes that have enhanced ambient exposure to pet allergens. This is a problem of global public health importance, as the morbidity associated with allergic diseases disproportionately affects socio-economically disadvantaged populations, particularly children. Although the public often seeks advice from veterinary health-care professionals regarding healthy pet ownership practices, including strategies for reducing residential pet dander exposure, many misconceptions persist in the public domain regarding pet dander allergy, such as the belief that certain dog and cat breeds are 'hypoallergenic' due to their hair/coat type. This review considers the epidemiology of human exposure to the major cat and dog dander allergens, Fel d 1 and Can f 1 respectively, and the sensitization mechanisms to them, including the hygiene hypothesis and the putative role of bacterial endotoxin. The literature regarding primary and secondary exposures in different ambient environments is explored including threshold effects that influence allergen sensitization and elicitation of symptoms, and environmental intervention strategies that seek to reduce allergen exposure. Pet-specific factors, including the aetiopathogenesis of the several cat and dog allergens that have been characterized to the molecular level, individual animal characteristics that influence Fel d 1 and Can f 1 shedding, and pet-directed interventions intended to reduce allergen dispersal, are discussed.
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Affiliation(s)
- Daniel O Morris
- Department of Clinical Studies - Philadelphia, School of Veterinary Medicine, University of Pennsylvania, 3900 Delancey St., Philadelphia, PA 19104, USA.
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Affiliation(s)
- J. K. Murray
- Department of Clinical Veterinary Science; University of Bristol, Langford House; Langford, Bristol BS40 5DU
| | - W. J. Browne
- Department of Clinical Veterinary Science; University of Bristol, Langford House; Langford, Bristol BS40 5DU
| | - M. A. Roberts
- Cats Protection, National Cat Centre; Chelwood Gate, Haywards Heath Sussex RH17 7TT
| | - A. Whitmarsh
- Department of Clinical Veterinary Science; University of Bristol, Langford House; Langford, Bristol BS40 5DU
| | - T. J. Gruffydd-Jones
- Department of Clinical Veterinary Science; University of Bristol, Langford House; Langford, Bristol BS40 5DU
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Mimura T, Yamagami S, Usui T, Funatsu H, Noma H, Honda N, Amano S. Relationship between myopia and allergen-specific serum IgE levels in patients with allergic conjunctivitis. Clin Exp Ophthalmol 2009; 37:670-7. [PMID: 19788663 DOI: 10.1111/j.1442-9071.2009.02130.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Various exogenous allergens can cause allergic conjunctivitis, whereas refractive errors are also related (as an endogenous factor) to the pathogenesis of allergic conjunctivitis. However, little is known about the interaction between exogenous and endogenous factors in patients with allergic conjunctivitis. We investigated the relationship between refractive errors and exogenous allergens in patients with allergic conjunctivitis. METHODS Sixty patients with allergic conjunctivitis and 60 healthy subjects (non-allergy patients) were enrolled. Refraction was carried out in all subjects. In addition, total immunoglobulin E (IgE) and specific IgE levels for 12 inhaled allergens were measured by the capsulated hydrolic carrier polymer system. RESULTS The patients who were positive for-specific IgE to indoor allergens had higher myopia than those who were negative, including those positive for house dust IgE (-3.66 +/- 2.95 vs. -1.05 +/- 3.39, P = 0.0015), Dermatophagoides pteronyssinus (D. pteronyssinus) IgE (-3.50 +/- 2.91 vs. -1.01 +/- 3.46, P = 0.0021), and acarus IgE (-3.45 +/- 2.21 vs. -1.51 +/- 3.73, P = 0.0087), whereas antibody-positive and antibody-negative patients for outdoor allergens showed no significant differences of refraction. Refractions in indoor group (-3.58 +/- 3.42) and indoor/outdoor (-3.70 +/- 2.64) group were higher than those in outdoor group (-0.84 +/- 2.30, P = 0.0047 and P = 0.0032) and the non-allergy group (-1.30 +/- 1.48, P = 0.0082 and P = 0.0054) [-refraction] was significantly correlated with total IgE (r = 0.333, P = 0.0093), house dust (r = 0.355, P = 0.0054) and D. pteronyssinus (r = 0.379, P = 0.0028), while no correlation between refractive error and outdoor allergens was proven. CONCLUSION These results suggest that specific IgE levels for indoor allergens, such as house dust, might be associated with refractive errors.
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Affiliation(s)
- Tatsuya Mimura
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan.
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Newcomb P. Safe Control of Pest and Pet Asthma Triggers. J Nurse Pract 2009; 5:571-578. [DOI: 10.1016/j.nurpra.2009.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kraev TA, Adamkiewicz G, Hammond SK, Spengler JD. Indoor concentrations of nicotine in low-income, multi-unit housing: associations with smoking behaviours and housing characteristics. Tob Control 2009; 18:438-44. [PMID: 19679890 DOI: 10.1136/tc.2009.029728] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE An analysis of airborne nicotine measurements collected in 49 low-income, multi-unit residences across the Greater Boston Area. METHODS Nicotine concentrations were determined using passive monitors placed in homes over a one-week sampling period and air exchange rates (AER) were sampled using the perfluorocarbon tracer technique. Residents were surveyed through a questionnaire about smoking behaviour and a visual inspection was conducted to collect information on housing characteristics contributing to secondhand smoke (SHS) exposure. Using a mass balance model to account for the air exchange rate, volume of the home and sorption and re-emission of nicotine on indoor surfaces, the effective smoking rate (SR(eff)) was determined for each residence. RESULTS Nicotine levels ranged from the limit of detection to 26.92 microg/m(3), with a mean of 2.20 microg/m(3) and median of 0.13 microg/m(3). Nicotine measurements were significantly associated with the number of smokers in the household and the number of cigarettes smoked in the home. The results of this study suggest that questionnaire reports can provide a valid estimate of residential exposure to tobacco smoke. In addition, this study found evidence that tobacco smoke contamination in low-income housing developments is not limited to homes with smokers (either residing in the home or visiting). The frequent report of tobacco smoke odour coming from other apartments or hallways resulted in increased levels of nicotine concentrations and SR(eff) in non-smoking homes, suggestive of SHS infiltration from neighbouring units. CONCLUSION These findings have important implications for smoking regulations in multi-unit homes and highlight the need to reduce involuntary exposure to tobacco smoke among low-income housing residents.
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Affiliation(s)
- T A Kraev
- Department of Environmental Health, Harvard School of Public Health, Boston, MA 02215, USA
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Peters JL, Suglia SF, Platts-Mills TAE, Hosen J, Gold DR, Wright RJ. Relationships among prenatal aeroallergen exposure and maternal and cord blood IgE: project ACCESS. J Allergy Clin Immunol 2009; 123:1041-6. [PMID: 19361844 DOI: 10.1016/j.jaci.2009.02.027] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2008] [Revised: 02/16/2009] [Accepted: 02/17/2009] [Indexed: 01/16/2023]
Abstract
BACKGROUND Whereas some evidence suggests that antigen sensitization may begin prenatally, the influence of maternal allergen exposure during pregnancy has not been fully elucidated. OBJECTIVES We examined the relationship between prenatal maternal aeroallergen exposure and cord blood total IgE and the potential mediating/indirect effect of maternal immune response. METHODS This study was performed in 301 mother-infant pairs enrolled in the Asthma Coalition on Community, Environment, and Social Stress (ACCESS) project, a study examining the effects of prenatal and early life social and physical environmental exposures on urban asthma risk. Dust samples collected prenatally from mothers' bedrooms were analyzed for cockroach and dust mite allergens. Cord blood was analyzed for total IgE, and maternal serum collected during pregnancy for total and specific IgE. We assessed the relationship between prenatal exposure and cord blood total IgE and the potential mediation effect adjusting for maternal age, race, education, smoking status, and dust collection season; and child's sex and season of birth. RESULTS In multivariate models, elevated prenatal dust mite levels (>0.2 microg/g) increased cord blood IgE concentrations by 29% (P = .08), and continuous dust mite concentration was associated with a significant nonlinear increase in cord blood IgE (P = .02). Elevated prenatal exposure to cockroach allergen (>2 U/g) was not associated with cord blood IgE, but showed a significant indirect relationship through maternal total IgE (beta = 0.23; 95% CI, 0.08-0.41). CONCLUSION These results demonstrate that maternal prenatal exposure to household allergens may affect cord blood IgE, albeit the underlying mechanism may be allergen-specific.
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Affiliation(s)
- Junenette L Peters
- Department of Environmental Health, Harvard School of Public Health, Boston, Mass 02215, USA
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Abstract
PURPOSE OF REVIEW We aim to discuss current insights into our understanding of the mechanisms by which socioeconomic status influences the prevalence and severity of asthma in ethnic minorities. In addition, we review potential risk factors for ethnic disparities in asthma that are not mediated by socioeconomic status. RECENT FINDINGS Exposures and factors correlated with ethnicity through socioeconomic status (e.g. indoor and outdoor air quality, smoke exposure, and access to healthcare) are likely to explain a significant proportion of the observed ethnic differences in asthma morbidity. However, other factors correlated with ethnicity (e.g. genetic variation) can impact ethnic disparities in asthma independently of and/or interacting with socioeconomic status-related factors. SUMMARY Socioeconomic status is a rough marker of a variety of environmental/behavioral exposures and a very important determinant of differences in asthma prevalence and severity among ethnic minorities in the United States. However, socioeconomic status is unlikely to be the sole explanation for ethnic disparities in asthma, which may also be due to differences in genetic variation and gene-by-environment interactions among ethnic groups.
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Affiliation(s)
- Erick Forno
- Channing Laboratory, Dept. of Medicine, Brigham and Women’s Hospital, Boston, MA
- Division of Respiratory Diseases, Dept. of Pediatrics, Children’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Juan C. Celedón
- Channing Laboratory, Dept. of Medicine, Brigham and Women’s Hospital, Boston, MA
- Division of Pulmonary/Critical Care Medicine, Dept. of Medicine, Brigham and Women’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
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