Allergic asthma after flour inhalation in subjects without occupational exposure to flours: an experimental pilot study

Objective  

Cross-reactivity between grass pollen and grain flour allergens is well known, but their significance in apprentice bakers with primary sensitization to grass pollen is not known.     

Childhood asthma and indoor allergens in Native Americans in New York

Background  

The objective of this study was to assess the correlation between childhood asthma and potential risk factors, especially exposure to indoor allergens, in a Native American population.     

Effectiveness of an Integrated Pest Management Intervention in Controlling Cockroaches,Mice, and Allergens in New York City Public Housing

Background

Cockroaches and mice, which are common in urban homes, are sources of allergens capable of triggering asthma symptoms. Traditional pest control involves the use of scheduled applications of pesticides by professionals as well as pesticide use by residents. In contrast, integrated pest management (IPM) involves sanitation, building maintenance, and limited use of least toxic pesticides.

Objectives

We implemented and evaluated IPM compared with traditional practice for its impact on pests, allergens, pesticide use, and resident satisfaction in a large urban public housing authority.

Methods

We assigned IPM or control status to 13 buildings in five housing developments, and evaluated conditions at baseline, 3 months, and 6 months in 280 apartments in Brooklyn and Manhattan, in New York City (New York). We measured cockroach and mouse populations, collected cockroach and mouse urinary protein allergens in dust, and interviewed residents. All statistical models controlled for baseline levels of pests or allergens.

Results

Compared with controls, apartments receiving IPM had significantly lower counts of cockroaches at 3 months and greater success in reducing or sustaining low counts of cockroaches at both 3 and 6 months. IPM was associated with lower cockroach allergen levels in kitchens at 3 months and in beds and kitchens at 6 months. Pesticide use was reduced in IPM relative to control apartments. Residents of IPM apartments also rated building services more positively.

Conclusions

In contrast to previous IPM studies, which involved extensive cleaning, repeat visits, and often extensive resident education, we found that an easily replicable single IPM visit was more effective than the regular application of pesticides alone in managing pests and their consequences.     

Occupational asthma caused by samba (Triplochiton scleroxylon) wood dust in a professional maker of wooden models of airplanes: A case study

Objectives

Wood dust is a known occupational allergen that may induce, in exposed workers, respiratory diseases including asthma and allergic rhinitis. Samba (obeche, Triplochiton scleroxylon) is a tropical tree, which grows in West Africa, therefore, Polish workers are rarely exposed to it. This paper describes a case of occupational asthma caused by samba wood dust.

Material and Methods

The patient with suspicion of occupational asthma due to wood dust was examined at the Department of Occupational Diseases and Clinical Toxicology in the Nofer Institute of Occupational Medicine. Clinical evaluation included: analysis of occupational history, skin prick tests (SPT) to common and occupational allergens, determination of serum specific IgE to occupational allergens, serial spirometry measurements, metacholine challenge test and specific inhalation challenge test with samba dust

Results

SPT and specific serum IgE assessment revealed sensitization to common and occupational allergens including samba. Spirometry measurements showed mild obstruction. Metacholine challenge test revealed a high level of bronchial hyperactivity. Specific inhalation challenge test was positive and cellular changes in nasal lavage and induced sputum confirmed allergic reaction to samba.

Conclusions

IgE mediated allergy to samba wood dust was confirmed. This case report presents the first documented occupational asthma and rhinitis due to samba wood dust in wooden airplanes model maker in Poland.     

Children’s residential exposure to selected allergens and microbial indicators: endotoxins and (1→3)-β-D-glucans

Objectives

The study was aimed at assessment of exposure to endotoxins, (1→3)-β-D-glucans and mite, cockroach, cat, dog allergens present in settled dust in premises of children as agents which may be significantly correlated with the occurrence of allergic symptoms and diseases in children.

Materials and Methods

The study covered 50 homes of one-or two-year-old children in Poland. Samples of settled dust were taken from the floor and the child’s bed. The levels of (1→3)-β-D-glucans (floor), endotoxins (floor) and allergens of mite, cat, dog and cockroach (floor and bed) were analyzed.

Results

Average geometric concentrations (geometric standard deviation) of endotoxins, (1→3)-β-D-glucans, Der p1, Fel d1, Can f1 and Bla g1 in children homes were on the floor 42 166.0 EU/g (3.2), 20 478.4 ng/g (2.38), 93.9 ng/g (6.58), 119.8 ng/g (13.0), 288.9 ng/g (3.4), 0.72 U/g (4.4) and in their beds (only allergens) 597.8 ng/g (14.2), 54.1 ng/g (4.4), 158.6 ng/g (3.1) 0.6 U/g (2.9), respectively. When the floor was covered with the carpet, higher concentrations of endotoxins, (1→3)-β-D-glucans and allergens (each type) were found in the settled dust (p < 0.05). The trend was opposite in case of allergens (except dog) analyzed from bed dust and significantly higher concentrations were found in the rooms with smooth floor (p < 0.05).

Conclusions

Among the analyzed factors only the type of floor significantly modified both the level of biological indicators and allergens. The results of this study could be the base for verifying a hypothesis that carpeting may have a protective role against high levels of cockroach, dog and cat allergens.     

Attitudes and preferences of consumers toward food allergy labeling practices by diagnosis of food allergies

BACKGROUND/OBJECTIVES

The objective of this study was to investigate food allergens and prevalence rates of food allergies, followed by comparison of consumer attitudes and preferences regarding food allergy labeling by diagnosis of food allergies.

SUBJECTS/METHODS

A total of 543 individuals living in Seoul and Gyeonggi area participated in the survey from October 15 to 22 in 2013.

RESULTS

The results show that the prevalence of doctor-diagnosed food allergies was 17.5%, whereas 6.4% of respondents self-reported food allergies. The most common allergens of doctor-diagnosed and self-reported food allergy respondents were peaches (30.3%) and eggs (33.3%), respectively, followed by peanuts, cow''s milk, and crab. Regarding consumer attitudes toward food labeling, checking food allergens as an item was only significantly different between allergic and non-allergic respondents among all five items (P < 0.001). All respondents reported that all six items (bold font, font color, box frame, warning statement, front label, and addition of potential allergens) were necessary for an improved food allergen labeling system. PLSR analysis determined that the doctor-diagnosed group and checking of food allergens were positively correlated, whereas the non-allergy group was more concerned with checking product brands.

CONCLUSIONS

An effective food labeling system is very important for health protection of allergic consumers. Additionally, government agencies must develop policies regarding prevalence of food allergies in Korea. Based on this information, the food industry and government agencies should provide clear and accurate food labeling practices for consumers.     

Indoor allergens in settled dust from kindergartens in city of Łódź, Poland

Objectives

The main objective of the study was to determine the levels of house dust mite (Der p1), dog (Can f1), cat (Fel d1) and cockroach (Bla g2) allergens in kindergartens localized in an urban agglomeration.

Material and Methods

A quantitative analysis of allergens was carried out in settled dust samples collected by vacuuming the floor surface in three kindergartens (N = 84) and children’s clothing (N = 36). The samples were collected in spring-summer and autumn-winter periods as well as at the beginning and end of the week. The allergen dust concentration was determined by enzyme-linked immunoenzymatic assay (ELISA).

Results

The mean geometric concentrations (±geometric standard deviations) of allergens Der p1, Can f1, Fel d1 and Bla g2 determined in kindergartens were: 0.02±3.21 μg/g of dust; 0.97±4.49 μg/g of dust; 0.30±4.43 μg/g of dust and 0.01±3.08 μg/g of dust, respectively. Younger classrooms (children aged from 3 to 4 years) were characterized by almost twice higher mean concentration of allergen Fel d1, as compared to older classrooms (children aged from 5 to 6 years) (p < 0.05). A significant impact of seasonality on the level of dog allergen Can f1 was found (p < 0.05). No significant weekly variation was found in average concentrations of the allergens. Children who had a dog and/or cat at home were characterized by high concentrations of allergens Can f1 and Fel d1 on their clothes (59.2±5.39 μg Can f1/g of dust; 3.63±1.47 μg Fel d1/g of dust), significantly higher than concentrations of allergens in children who did not have any pets (p < 0.001).

Conclusions

Special attention should be paid to keeping the kindergarten rooms tidy and clean and to an appropriate choice of furnishings and fittings which would prevent the proliferation of the house dust mite and accumulation of allergens.     

Spreading of occupational allergens: laboratory animal allergens on hair-covering caps and in mattress dust of laboratory animal workers

Background

Family members of laboratory animal workers are at risk of developing allergy to laboratory animals. Little is known about the spreading of laboratory animal allergens outside the animal facilities.

Objective

To assess the presence of laboratory animal allergens in dust collected from mattresses of laboratory animal workers and unexposed controls.

Methods

Mouse and rat urinary proteins were measured in samples of mattress dust collected by laboratory animal workers and unexposed controls. In addition, rat and mouse allergens were determined in extracts of hair‐covering caps, used during laboratory animal work, to estimate spreading of allergen through dust captured on hair. Allergen concentrations on hair caps were compared with exposure measured by personal airborne dust sampling.

Results

Levels of rat urinary allergens (RUA) and mouse urinary allergens (MUA) and mouse urinary protein (MUP) 8, a specific pheromone‐binding mouse allergen, were significantly higher in mattress samples of laboratory animal workers than in those of controls. Hair‐covering caps used in animal facilities harboured large amounts of RUA and MUA, which correlated significantly with exposure measured by the personal sampling technique in the animal facility.

Conclusions

Occupational laboratory animal allergens are detectable in mattress dust of laboratory animal workers. Transfer of allergens via uncovered hair of animal workers is likely contributing to this phenomenon. This study stresses the importance of using hair caps to prevent spreading of occupational allergens.Occupational allergy against laboratory animals is a common problem among laboratory animal workers. The prevalence of laboratory animal allergy is reported to be 10–25%.¹ Allergens of laboratory animals are potent sensitisers and small amounts can elicit symptoms in sensitised individuals. Moreover, there are also indications that reduction of exposure may lead to a decreased incidence of laboratory animal allergy.^2,3,4 Methods for controlling exposure to laboratory animal allergens include the choice of bedding materials and adjustment of cage‐changing processes, and the use of personal protective equipment.⁵ Despite the fact that the risk of developing laboratory animal allergy is high and personal protective equipment is widely available, respiratory protection is not routinely used. Laboratory coats and protective gloves are widely used, but the use of hair‐covering caps and facemasks is mostly restricted to already sensitised individuals to prevent symptoms.Although direct contact with animals probably accounts for most of the airway exposure, a possibly underestimated route of exposure may be subsequent exposure to allergens transferred from the animal facility through hair, clothing and documents.⁵ It was shown for cat allergen that transfer can lead to exposure of individuals without direct contact with animals.^6,7 Moreover, children of laboratory animal workers were shown to have an increased risk of developing laboratory animal allergy,⁸ suggesting that subsequent exposure also influences allergen loads in houses of laboratory animal workers and may sensitise family members.It has been suggested that allergens captured in human hair can play an important role in exposure to laboratory animal allergens outside the animal facility. So far, evidence supporting the relevance of this route of exposure is scarce, but animal workers are generally advised to wash their hair after work to prevent contamination of the home environment with occupational aeroallergens.⁵ The use of hair‐covering caps is another method to prevent allergen transfer through human hair. Despite this advice, regular use of hair caps or washing hair after finishing work was a standard procedure in <20% of the laboratory animal facilities we studied in The Netherlands. By contrast, special clothing was used in all facilities.We measured the levels of laboratory animal allergens in the mattress dust of laboratory animal workers and compared it with allergen concentrations in mattresses of controls who are not occupationally exposed. The allergen load on hair‐covering caps used by laboratory animal workers was measured to assess whether carry‐over through the hair of workers may be a relevant route of allergen transfer. In addition, the allergen load on hair‐covering caps was compared with the level of airborne exposure as determined by the personal airborne‐dust sampling technique.     

Association of pediatric asthma severity with exposure to common household dust allergens

Background

Reducing exposure to household dust inhalant allergens has been proposed as one strategy to reduce asthma.

Objective

To examine the dose-response relationships and health impact of five common household dust allergens on disease severity, quantified using both symptom frequency and medication use, in atopic and non-atopic asthmatic children.

Methods

Asthmatic children (N=300) aged 4-12 years were followed for 1 year. Household dust samples from two indoor locations were analyzed for allergens including dust mite (Der p 1, Der f 1), cat (Fel d 1), dog (Can f 1), cockroach (Bla g 1). Daily symptoms and medication use were collected in monthly telephone interviews. Annual disease severity was examined in models including allergens, specific IgE sensitivity and adjusted for age, gender, atopy, ethnicity, and mother's education.

Results

Der p 1 house dust mite allergen concentration of 2.0 μg/g or more from the main room and the child's bed was related to increased asthma severity independent of allergic status (respectively, OR 2.93, 95% CI 1.37, 6.30 for 2.0-10.0 μg/g and OR 2.55 95% CI 1.13, 5.73 for ?10.0 μg/g). Higher pet allergen levels were associated with greater asthma severity, but only for those sensitized (cat OR 2.41 95% CI 1.19, 4.89; dog OR 2.06 95% CI 1.01, 4.22).

Conclusion

Higher levels of Der p 1 and pet allergens were associated with asthma severity, but Der p 1 remained an independent risk factor after accounting for pet allergens and regardless of Der p 1 specific IgE status.     

Diagnostic value of the ISAC® allergy chip in detecting latex sensitizations

Purpose

Latex allergy can be diagnosed by different test methods such as IgE quantification, Western blot, cellular antigen stimulation test (CAST), and in vivo methods [e.g. skin prick test (SPT)]. Phadia provides two modern methods using recombinant latex allergens: ImmunoCAP^® and the Immuno Solid-phase Allergen Chip (ISAC^®), which enables simultaneous determination of specific IgE against five latex allergens. We compared the diagnostic sensitivity of the ISAC^® test kit and the conventional Hev b 5—spiked ImmunoCAP^® latex extract.

Methods

Forty sera were sampled from subjects with suspected natural rubber latex (NRL) allergy. These patients had positive SPT to NRL extract, positive NRL Western blots, and positive results in the CAST. All sera were analysed using the ISAC^® and recombinant NRL ImmunoCAP^® allergens and compared to the results of 20 negative control sera.

Results

Only 22 of the 40 subjects (55 %) showed positivity to at least one latex allergen on the ISAC^® (sensitivity ISAC^® 55 %). The sensitivity of the ImmunoCAP^® latex extract was 70 %. The most frequently detected sensitization was against Hev b 6.01 (n = 12). When the serum samples were tested with all recombinant ImmunoCAP^® allergens, three additional sensitizations against latex could be detected compared to the ISAC^®.

Conclusions

Microarrays do offer many potential benefits such as elegant simultaneous determination of sensitizations against different NRL allergens with minimal amounts of serum. However, a negative NRL test result should be regarded with caution and at least be confirmed by other in vitro methods.     

Carbon dioxide (CO2) demand-controlled ventilation in university computer classrooms and possible effects on headache, fatigue and perceived indoor environment: an intervention study

Purpose

To study the effects of a CO₂ demand-controlled ventilation system (variable flow) in computer classrooms on perceived air quality and sick building syndrome.

Methods

University students (27 % women) participated in a blinded study. Two classrooms had variable flow (mean 5.56 ac/h); two others had constant ventilation flow (mean 5.07 ac/h). After one week, ventilation conditions were shifted. The students reported symptoms/perceptions during the last hour on rating scales. Temperature, air humidity, CO₂, PM10 and number concentration of particles were measured simultaneously. Cat (Fel d 1), dog (Can f 1), horse (Equ cx) and house dust mites (Der f 1 and Der p 1) allergens were measured in dust. Those participating twice in the same classroom (N = 61) were analysed longitudinally.

Results

Mean CO₂ was 784 ppm (9 % of time >1,000 ppm) with variable flow and 809 ppm with constant flow conditions (25 % of time >1,000 ppm). Mean temperature (22.6 °C), PM10 (18 μg/m³) and number concentration (1,860 pt/cm³) were unchanged. The median levels of cat, dog, horse and Der f 1 allergens were 10,400 ng/g, 4,900 ng/g, 13,700 U/ng and 260 ng/g dust, respectively. There were slightly less headache (p = 0.003), tiredness (p = 0.007) and improved perceived air quality (p = 0.02) with variable flow.

Conclusions

Use of a CO₂-controlled ventilation system, reducing elevated levels of CO₂, may slightly reduce headache and tiredness and improve perceived air quality. The high levels of pet allergens, due to track in of allergens from the home and possible accumulation due to electrostatic forces, illustrate a need for improved cleaning.     

Risk management by labelling 26 fragrances?: Evaluation of Article 10 (1) of the seventh Amendment (Guideline 2003/15/EC) of the Cosmetic Directive

Background

Some fragrance compounds are severe contact allergens. According to the so-called “26 allergens rule” (Article 1 (10) of Directive 2003/15/EC) (EC, 2003), 26 supposedly allergenic fragrances must be listed on the containers of cosmetics products if they are present above certain mass percentages in the product. This declaration is meant to inform the consumer of potential risks of skin sensitizers in the products.

Objective

The objective of this paper is to validate whether “the 26 allergens rule” meets the expectations to improve consumer protection.

Methods

The method used for this validation was on one hand a reflection on the elements of the approach used in “the 26 allergens rule” and on the other hand a product analysis of 742 products by 4 large producers of cosmetic products on the German market.

Results

It was found that more than 50% of these cosmetic and washing and cleansing products contain at least one of the 26 substances above the thresholds for labelling and that there are 14% of all products which contain strong allergens. Many consumers apparently still buy these products. The indirect effect that producers reduce the amounts of these fragrances to avoid declaration seems to be small.

Discussion and recommendations

Several arguments were assembled which show that other instruments are needed to ensure consumer protection or protection of the environment. This paper recommends different approaches. The use of a list of single substances in such a directive is not in line with scientific standards. It is recommended to base decision making on comprehensive risk assessments or at least on valid and strong criteria. More parameters need to be involved, not only contact allergy. As illustrated in this article, the roles taken over by authorities and manufacturers in risk management of the “26 allergens” are relatively small compared with the responsibility carried by consumers. However, consumers are only able to take over their part properly if they are sufficiently trained and have the necessary infrastructure, capability and time to inform themselves. Regulations are not effective if they load the major responsibility for risk management on consumers, instead of on authorities and manufacturers. A successful risk management would include bans and restrictions of especially hazardous substances issued by governments, as well as efficient surveys to control the implementation of regulations by the responsible authorities. It would also include that producers meet the legal standards and take over voluntary action to make products safer. The evaluation of “the 26 allergens rule” is an example which can be transferred to other regulations and which could help to improve future regulatory approaches, with a focus on the roles authorities, manufacturers and consumers play in a promising risk management.     

A Survey on the Occupational Health Status of Gardeners in Bhopal, India

Background:

Occupational gardeners are exposed to various risk factors like dust, allergens, sharp tools, and pesticides, which make them vulnerable to many diseases. This study was designed to survey the health status of this occupational group.

Objectives:

The objective was to collectsociodemographic and health status information of occupational gardeners.

Materials and Methods:

The study group comprised 75 male occupational gardeners of the Bhopal city and suburb. A pretested proforma questionnaire was used to record the necessary information like medical history, sociodemographic factors, and findings of clinical investigations.

Result and Discussion:

This survey reveals that 50% of gardeners are underweight, 31.99% with high normal to high blood pressure, and none with diabetes. The prevalence of vision disturbance (26.66%), eye inflammation (29.33%), stiff nose (21.33%), joint pain, swelling and muscle stiffness (29.33%), and accidental injury (28%) was significantly high among gardeners. Gardeners should be educated to use protective clothing, quit smoking and tobacco consumption, adopt proper body posture, and ensure vaccination.     

Human antibody response to N-glycans present on plant-made influenza virus-like particle (VLP) vaccines

Background

Plant-made biotherapeutics are gathering momentum and some plant glycoproteins are allergens. Glycans with core β1-2xylose and α1,3fucose motifs and antennae terminated by mannose residues (e.g.: MMXF) are found on several plant allergens and can cross-react with glyco-epitopes from other sources. To date, reactivity to these cross-reactive determinants has not been associated with clinical symptoms.

Objective

We produced VLP vaccines bearing the hemagglutinin(HA) of H5(A/Indonesia/5/05) or H1(A/California/07/09) influenza viruses by transfection of Nicotiana benthamiana. Subjects enrolled in Phase I/II trials were followed for evidence of allergy/hypersensitivity and development of antibodies against plant glyco-epitopes.

Methods

A total of 280/349 subjects received either one (H1) or 2 doses (H5) of vaccine (5–45 μg of HA/dose) intramuscularly including 40 with pre-existing plant allergies. Subjects were monitored for 6 months. IgG and IgE to plant glyco-epitopes were measured by ELISA using corn-/egg-derived avidin and bromelain as target antigens.

Results

No subject developed allergic/hypersensitivity symptoms. Some (34%) developed transient IgG and, in some cases IgE, to plant glyco-epitopes but no subject mounted an IgE response to the MMXF motif. Antibodies returned to baseline by 6 months in most subjects.

Conclusion

VLP vaccines bearing influenza HA glycoproteins can elicit transient IgG and, in some cases, IgE responses that are not associated with either the development or worsening of allergic/hypersensitivity symptoms.     

Risk factors associated with allergic sensitization and asthma phenotypes among poultry farm workers

Background

This study investigated the risk factors for occupational allergic sensitization and various asthma phenotypes in poultry‐workers.

Methods

A cross‐sectional study of 230 workers used a modified ECRHS questionnaire, spirometry, FeNO, Phadiatop, and sIgE to poultry farming related allergens.

Results

Worker's mean age was 37 ± 9 years, 68% male, 43% current‐smokers, 34% atopic, and 5% casual‐workers. The prevalence of non‐atopic asthma (NAA = 7%) was higher than atopic‐asthma (AA = 5%) and probable allergic occupational‐asthma (OA = 3%). Sensitization to at least one poultry farming related allergen was 24%. Workers sensitized to chicken‐specific‐allergens were more likely to be atopic (OR_unadj = 20.9, 95%CI: 4.7‐93.2) or employed as casual‐workers (OR_unadj = 6.0, 95%CI: 1.1‐35.9). Work‐related chest symptoms were associated the rearing‐department (OR_adj = 3.2, 95%CI: 1.2‐8.4) and exposure to high gas/dust/fumes (OR_adj = 4.8, 95%CI: 2.4‐9.5). Airflow reversibility (OR_adj = 10.9, 95%CI: 2.0‐60.3) was significantly associated with casual‐work status.

Conclusion

Allergic and non‐allergic mechanisms play a role in asthma development among poultry‐workers with casual workers demonstrating increased risk.

     

Education and depressive symptoms in 22 European countries

Objectives  

Variations in the association between education and depressive symptoms in 22 European countries are investigated.     

A rapid method for determining arachidonic:eicosapentaenoic acid ratios in whole blood lipids: correlation with erythrocyte membrane ratios and validation in a large Italian population of various ages and pathologies

Background  

Omega-3 and -6 polyunsaturated fatty acids (LCPUFA), are important for good health conditions. They are present in membrane phospholipids.     

Occupational pesticide intoxications among farmers in Bolivia: a cross-sectional study

Background  

Pesticide use and its consequences are of concern in Bolivia due to an intensive and increasing use.     

How “age-friendly” are deprescribing interventions? A scoping review of deprescribing trials

Objective

To assess how age-friendly deprescribing trials are regarding intervention design and outcome assessment. Reduced use of potentially inappropriate medications (PIMs) can be addressed by deprescribing—a systematic process of discontinuing and/or reducing the use of PIMs. The 4Ms—“Medication”, “Mentation”, “Mobility”, and “What Matters Most” to the person—can be used to guide assessment of age-friendliness of deprescribing trials.

Data Source

Published literature.

Study Design

Scoping review.

Data Extraction Methods

The literature was identified using keywords related to deprescribing and polypharmacy in PubMed, EMBASE, Web of Science, ProQuest, CINAHL, and Cochrane and snowballing. Study characteristics were extracted and evaluated for consideration of 4Ms.

Principal Findings

Thirty-seven of the 564 trials identified met the review eligibility criteria. Intervention design: “Medication” was considered in the intervention design of all trials; “Mentation” was considered in eight trials; “Mobility” (n = 2) and “What Matters Most” (n = 6) were less often considered in the design of intervention. Most trials targeted providers without specifying how matters important to older adults and their families were aligned with deprescribing decisions. Outcome assessment: “Medication” was the most commonly assessed outcome (n = 33), followed by “Mobility” (n = 13) and “Mentation” (n = 10) outcomes, with no study examining “What Matters Most” outcomes.

Conclusions

“Mentation” and “Mobility”, and “What Matters Most” have been considered to varying degrees in deprescribing trials, limiting the potential of deprescribing evidence to contribute to improved clinical practice in building an age-friendly health care system.