Community outbreaks of asthma associated with inhalation of soybean dust. Toxicoepidemiological Committee

Since 1981, 26 outbreaks of asthma have been detected in the city of Barcelona. The geographic clustering of cases close to the harbor led us to consider the harbor as the probable source of the outbreaks. We therefore studied the association between the unloading of 26 products from ships in the harbor and outbreaks of asthma in 1985 and 1986. All 13 asthma-epidemic days in these two years coincided with the unloading of soybeans (lower 95 percent confidence limit of the risk ratio, 7.2). Of the remaining 25 products, only the unloading of wheat was related to the epidemics of asthma, although when adjusted for the unloading of soybeans the relation was not statistically significant. High-pressure areas and mild southeasterly to southwesterly winds, which favored the movement of air from the harbor to the city, were registered on all epidemic days. Particles of starch and episperm cells that were recovered from air samplers placed in the city had morphologic characteristics identical to those of soybean particles. Furthermore, the lack of bag filters at the top of one of the harbor silos into which soybeans were unloaded allowed the release of soybean dust into the air. We conclude that these outbreaks of asthma in Barcelona were caused by the inhalation of soybean dust released during the unloading of soybeans at the city harbor.     

The relationship of housing and household characteristics to the indoor concentrations of Der f 1, Der p 1, and Fel d 1 measured in dust and air samples.

BACKGROUND: Indoor dust mite and cat allergens have been related to the risk of atopic conditions. If allergen levels are influenced by modifiable residential characteristics, potential interventions to prevent disease could be deployed. OBJECTIVE: To evaluate relationships between allergen concentrations in air and dust samples and selected house and household characteristics using a large prospective study with multiple sequential allergen measurements from each residence. METHODS: Fel d 1, Der f 1, and Der p 1 were measured in paired air and dust samples collected at intervals throughout 4 years in suburban homes. House and household characteristics were examined for relationships to allergen concentrations in both univariate and multiple variate analyses. RESULTS: The relationships between house and household characteristics and allergen concentrations in both air and dust were complex. When the housing variables were considered in multiple variate analysis, concentrations of Der f 1 in dust increased with increasing number of residents and relative humidity and declined when forced air heating was used. Dust concentrations of Der p 1 were lower in new homes and during forced air heating use but higher with higher relative humidity and in the presence of dogs. The presence of cats was the dominant determinant of Fel d 1 in both air and dust, but when homes without cats were analyzed separately, dust levels of Fel d 1 were inversely related with relative humidity. CONCLUSIONS: Air and dust concentrations of Der p 1 and Der f 1 were positively related to relative humidity and the size of the family. Fel d 1 was positively related to the presence of cats. The relationship of other house or household characteristics was inconsistent but different for Der f 1 and Der p 1.     

Use of laser flow-type fluorescence aerosol particle counter to evaluate the concentration of microbes in the surface air under high dust content

The paper deals with the use of a laser flow-type fluorescence aerosol particle counter to evaluate the concentrations of microbes in the surface air under high dust content. Various circuits of flow-type optic aerosol recorders are analyzed. Flow spectral luminescence analysis of some particles flow while exciting the fourth harmonics of a pulse laser on yttrium-aluminium garnet with neodymium by ultraviolet radiation is shown to be the most optimum method for indication of individual aerosol particles. Experiments were conducted on the authors' model of a pilot plant based on this method. The model of a laser flow-type optic analyzer was developed for experimental studies that give a clear display of biological aerosols in complex aerosols. The laser flow-type analyzer-based unit developed may provide a fluorescence signal of aerosol particles in the flow of a sample and that light diffusion signal from them at an exciting light wavelength of 266 nm. Experiments with BVC aerosols and soil dust particles were conducted in different regions of Russia. They showed it possible to detect and to rapidly calculate soil microorganisms by laser flow-type fluorescence assay of individual particles when excited by ultraviolet radiation.     

Dust anchoring characteristics of electret fibres with respect to Der p 1 allergen carrying particles

The avoidance of house dust mite allergens is a major area of interest and essentially requires a significant removal of these allergens from the immediately respirable air. Electrostatic attraction and anchoring of particulate matter using electret polymers is commonly used for air filtration purposes. This effect is investigated for its possible use in domestic allergen avoidance. Polypropylene electret, heat-treated electret and non-electret, and wool and nylon fibre samples were soiled with house dust known to contain Der p 1 allergen. These samples were vacuumed at three air face velocities. The proportions of released and anchored dust were calculated. Released dust was collected and analysed for Der p 1 concentration and compared to stock dust values. Results showed that compared to uncharged fibres at least 95% more dust remained anchored in the electret fibres. Also, overall Der p 1 release was reduced by more than 49%. Der p 1 allergen concentrations in the collected dust were relatively constant for all the fibres tested, indicating no selective attraction or repulsion of Der p 1 allergen carrying particles in the experimental dust. The consistently high dust anchoring ability of the electret fibres could be used in many domestic products that are known to harbour particulate allergens, to reduce their release and inhalation.     

Occupational asthma caused by soybean flour in bakers—differences with soybean-induced epidemic asthma

BACKGROUND: Soybean dust has been identified as the causative agent of occupational asthma and asthma epidemics. Two main soybean hull allergens responsible for asthma outbreaks, Gly m 1 and Gly m 2, have been identified and purified. OBJECTIVE: The soybean allergens causing occupational asthma in exposed bakers were investigated and compared with those involved in epidemic asthma. METHODS: We report four bakers or confectioners with work-related respiratory symptoms who were exposed to soybean flour used as a baking additive. The causative role of soybean flour was investigated by immunological tests and specific inhalation challenge tests. Soybean flour allergens causing occupational asthma were characterized by immunoblotting. Immunoglobulin (Ig) E-reactivity to Gly m 1 and Gly m 2 was assessed using enzyme-linked immunosorbent assay. RESULTS: Sensitization to soybean flour was demonstrated by skin and serological tests and was confirmed by positive inhalation tests. Bronchial challenge test to soybean flour extract elicited immediate or dual asthmatic responses. Immunoblotting with soybean flour and soybean hull extracts showed IgE-binding mainly to high molecular weight (MW) allergens. There was an important individually different allergic response to inhalant soybean components. None of the patients showed IgE-reactivity against Gly m 1 and only one patient showed IgE-reactivity to the soybean hull allergen Gly m 2. CONCLUSION: These bakery workers had developed IgE-mediated occupational asthma to soybean flour. The allergens involved in occupational asthma caused by soybean flour are predominantly high MW proteins that are present both in soybean hull and flour, and they are different from the allergens causing asthma outbreaks, which are mainly low MW proteins concentrated in the hull.     

Dustborne and airborne fungal propagules represent a different spectrum of fungi with differing relations to home characteristics

BACKGROUND: Exposure to fungi is often assessed by culturing floor dust or air samples. Our objective was to evaluate the relationships between dustborne and airborne fungi and to identify factors that modify these relationships. METHODS: From November 1994 to September 1996 sequential duplicate 45-l air samples were collected in bedrooms of 496 homes in the Boston area, using a Burkard culture plate sampler. After air sampling, bedroom floors were sampled with a vacuum cleaner that was modified to collect dust in a cellulose extraction thimble. Dust was sieved, and the fine dust was dilution-plated onto DG-18 media. RESULTS: Concentrations of total culturable fungi per gram of bedroom-floor dust were correlated weakly, but significantly, with those of indoor air (r = 0.13, P < 0.05). Concentrations of some individual taxa in the dust and indoor air were also weakly associated. Adjusting for the concentrations of fungi in outdoor air, dustborne fungal concentrations were positively associated with those in indoor air for the taxa Cladosporium and Penicillium, but not for total fungi. The indoor air fungal levels were often predicted by different covariates to those predicting fungal levels in dust. The type of housing (house or apartment) and the presence of carpeting were often predictive factors for dust fungi. In contrast, outdoor fungal levels were often predictive of the indoor air fungal levels. CONCLUSIONS: Because our data do not indicate a strong overall relationship between culturable fungi in dust and indoor air, the results from these two methods (dust and air sampling) likely represent different types of potential fungal exposures to residents. It may be essential to collect both air and dust samples, as well as information on housing characteristics, as indicators for fungal exposure.     

Epidemic asthma in Barcelona: an evaluation of new strategies for the control of soybean dust emission

BACKGROUND: Asthma attacks and mortality due to inhalation of soybean antigens in Barcelona have been well documented. Strict protective measures in the unloading process were established in 1998 to avoid the release of soybean dust into the atmosphere. The present study was undertaken to assess the effectiveness of these latest environmental measures, and, if effective, to recommend their implementation in the many harbours where soybean is unloaded. METHODS: Levels of soybean aeroallergen were analysed daily during a period of 5 years and 2 months in a total of 1,854 samples, 125 from the pre-intervention period and 1,729 from the postintervention period. Additionally, the number of asthma admissions to the emergency rooms of the city's three largest hospitals was recorded. Asthma patients attended at home by the public home emergency service and judicial autopsies registering asthma deaths were also investigated. RESULTS: The mean concentration of soybean aeroallergen was 159 U/m(3) in the pre-intervention period and 39 U/m(3) in the postintervention period (p < 0.0001). Significant differences in postintervention aeroallergen concentrations were found between days of soybean unloading (42 U/m(3)) and days of no unloading (33 U/m(3)), with p < 0.0001. No significant relationship was found between concentrations of environmental soybean aeroallergens and the number of emergency room admissions for asthma. CONCLUSIONS: Implementation of stricter protective measures in silos for the soybean unloading process has reduced the concentration of soybean dust in the atmosphere and evidences the effectiveness of the measures adopted.     

House dust mite allergen in US beds: results from the First National Survey of Lead and Allergens in Housing

BACKGROUND: Although exposure to house dust mite allergen is a major risk factor for allergic sensitization and asthma, nationwide estimates of dust mite allergen levels in US homes have not been reported. OBJECTIVE: The purpose of this study was to estimate the prevalence of dust mite allergen in beds of US homes and to identify predictors of dust mite allergen concentration. METHODS: Data were obtained from the first National Survey of Lead and Allergens in Housing, a cross-sectional survey of 831 permanently occupied noninstitutional housing units that permitted resident children. Dust mite allergen concentration (Der f 1 plus Der p 1) was determined from a dust sample collected from a bed. The percentages of homes with concentrations at or greater than detection, 2.0 microg/g bed dust, and 10.0 microg/g bed dust were estimated. Independent predictors of allergen concentration were assessed with multivariable linear regression. RESULTS: The percentages of US homes with dust mite allergen concentrations at or greater than detection, 2.0 microg/g, and 10.0 microg/g were 84.2% (SE, 1.73), 46.2% (SE, 2.0), and 24.2% (SE, 2.1), respectively. Independent predictors of higher levels were older homes, non-West census regions, single-family homes, no resident children, lower household income, heating sources other than forced air, musty or mildew odor, and higher bedroom humidity. CONCLUSION: Most US homes have detectable levels of dust mite allergen in a bed. Levels previously associated with allergic sensitization and asthma are common in US bedrooms. Predictors can be used to identify conditions under which homes are more likely to have increased dust mite allergen levels.     

Hantaviral biosafety issues in the autopsy room and laboratory: Concerns and recommendations

The need to perform autopsies on and examine laboratory specimens from patients with hantavirus pulmonary syndrome (HPS) has raised questions about biosafety. Human illness associated with hantaviruses is usually the result of exposure to infectious aerosols from saliva or excreta of wild rodents. It is unclear whether or nor certain autopsy and laboratory procedures can also generate similar potentially infectious aerosols. As the biosafety information developed for the HPS agent is limited and the consequences of infection are serious we recommend a cautious approach. Autopsy prosectors should use N-95 particulate respirators as a minimum standard. If aerosols will be generated they should use N-100 particulate respirators or powered air purifying respirators with high-efficiency particulate air (HEPA) filters. Centrifugation and cytocentrifugation of blood or body fluid samples should be performed in bio-contained systems and these specimen containers should be opened in a class II biological safety cabinet.     

Metropolitan home living conditions associated with indoor endotoxin levels

BACKGROUND: Household endotoxin exposure in allergy and asthma has been gaining attention for its dual potential to exacerbate these conditions in individuals with established disease and to abrogate atopy before disease onset. OBJECTIVE: We sought to better understand the home environmental and lifestyle factors influencing house dust endotoxin levels. METHODS: From the homes of 86 infants with wheeze in metropolitan Denver, Colorado, house dust endotoxin (detected with a standardized Limulus Amebocyte Lysate assay) and common indoor allergen (Fel d 1, Can f 1, Der p 1, Der f 1, and Bla g 1) contents were quantified. Comprehensive home environment and lifestyle questionnaires were completed during home visits by trained study staff and parents. RESULTS: House dust endotoxin levels were associated with only 2 home environmental features: animals in the home and the presence of central air conditioning. The strongest positive associations were found with animals in the home. Interestingly, the homes without cats or other animals revealed a negative correlation between house dust Fel d 1 and endotoxin (P =.03). Central air conditioning, especially during months of typical use, was associated with lower house dust endotoxin levels. No significant associations between house dust endotoxin levels and home dampness, number of household inhabitants or young children, cleaning frequency, or presence of tobacco smokers in the home were found. CONCLUSIONS: Indoor endotoxin exposure can be increased by the presence of animals in the home and decreased with central air conditioning. In some homes without animals, where allergen exposure adequate for sensitization still occurs, there are lower levels of house dust endotoxin. Therefore in homes without animals, factors that influence allergen and endotoxin levels in house dust probably differ. Households with detectable allergen levels but low endotoxin levels may provide a predisposing environment for animal allergen sensitization.     

Evaluation of a simple device for bacteriological sampling of respirator-generated aerosols.

The Aerotest sampler (Olympic Medical Corp., Seattle, Wash.) is designed to detect bacterial contamination of respirator-generated aerosols in a simple one-step process. The sampler was evaluated by controlled contamination of Bennett AP-5, PR-2, and MA-1 respirators with Escherichia coli, Pseudomonas aeruginosa, and Acinetobacter. Bacteria present as viable 1.4 to 3.5-mum particles in each of 77 aerosols were quantitated by using the Andersen viable-particle sampler, and the results were compared with those of colonies obtained from 10-s or 15-cycle Aerotest samples. All aerosols containing counts greater than expected in hospital air were detected by the Aerotest method. Thirteen of 14 aerosols containing less than 20 bacteria/0.028 m3 showed fewer than 5 colonies, whereas all aerosols containing greater than 1,000 bacteria/0.028 m3 showed at least 40 colonies. Aerosols with intermediate counts fell in between. Under the conditions described here, the Aerotest sampler was able to discriminate between the low levels of bacteria commonly found in hospital air and the bacterial contamination associated with nosocomial pneumonia. The Aerotest sampler provides a practical method for surveillance sampling of respirator nebulizers.     

Quantitative assays of pharmacologic aerosols used in studying asthma

To more nearly accurately quantitate the dose of pharmacologic agents delivered to human and animal airways via aerosols, we have developed a monodisperse aerosol containing either methacholine or histamine that permits a light scattering device (tyndallometry) to measure accurately the quantity of inspired and expired particles. These aerosols (described in previous studies) are simultaneously tagged with a radioactive label (technetium 99m) to permit the use of external gamma camera imaging. Present work focuses on the development of assay techniques to measure the quantity of methacholine delivered in these aerosols. The lack of specific radioimmune or radioenzyme assays coupled with the cross-reaction of organic contaminants with conventional chemical reagents for measuring methacholine required the development of separative techniques to isolate the methacholine from the organic aerosol contaminants. With aqueous extraction and column separation we have been able to completely isolate the methacholine from these contaminants. This allows the application of standard spectrophotometric assays for methacholine to quantitate the methacholine in the resulting solution. These separative techniques will permit the use of these aerosols in quantitative studies of airway reactivity.     

The role of particulate matter in exacerbation of atopic asthma

Increasing evidence shows that elevated levels of particulate matter (PM) can exacerbate existing asthma, while evidence that PM can promote the induction of asthma is limited. PM in ambient air has been associated with increased emergency room visits and medication use by asthmatics. Controlled human exposure studies of acid aerosols suggest increased responses among adolescent asthmatics. Increased ambient and indoor levels of bioaerosols (e.g., house dust mite, fungal spores, endotoxin) have been associated with exacerbation of asthma. Environmental Protection Agency (EPA) studies focus on the effects of exposing humans and animal models to a combination of various PM samples (e.g., diesel exhaust particles, oil fly ash) and allergens (e.g., house dust mite, ovalbumin). These research efforts to understand the mechanisms by which PM exposure can promote allergic sensitization and exacerbate existing asthma concentrate on the role of transition metals. Exposure of animal models to combined PM and allergen promotes allergic sensitization and increases allergic inflammation and airway hyperresponsiveness. Exposure of healthy human volunteers to emission source PM samples promotes inflammation and increased indices of oxidant formation correlating with the quantity of transition metals in the samples. Results of these studies suggest that transition metals in ambient PM promote the formation of reactive oxygen species and subsequent lung injury, inflammation, and airway hyperresponsiveness leading to airflow limitation and symptoms of asthma.     

Failure of enzyme encapsulation to prevent sensitization of workers in the dry bleach industry

BDE added to dry bleach have been associated with immunologic sensitization and development of clinical allergic disease in detergent workers and occasionally in consumers. However, improved dust control and modification of the manufacturing process through encapsulation of enzyme were believed to have reduced or eliminated these problems. To determine whether or not immunologic sensitization could still develop in the detergent industry, we studied employees of a dry bleach manufacturing plant that incorporated encapsulated BDE into a consumer product. We performed air sampling for enzyme dust and total particulates, administered questionnaires, conducted physical examinations, and spirometry in 13 currently exposed, two previously exposed and nine nonexposed, employees. To assess sensitization status, RAST and ELISA were performed. Air concentrations of enzyme dust ranged from 0.002 to 1.57 micrograms/m3; all of these levels were below the TLV of 3.9 micrograms/m3. Positive BDE-specific RAST results (3.4%, 4.4%, and 8.0% binding) were obtained in three of 12 currently exposed workers. Results of personal breathing-zone air sampling indicated that these workers had high dust-exposure levels. Specificity of RAST was verified by RAST inhibition with BDE. BDE-RAST binding was not significantly elevated in the nonworkers (range: 0.6% to 1.4% binding). Positive results for specific IgG by ELISA were obtained in four of 12 currently exposed and in one of two previously exposed workers but in none of the nonexposed workers. We conclude that immunologic sensitization can develop after occupational exposure to encapsulated BDE in the dry bleach industry. We have not proved, however, that this immunologic reactivity is related to clinical sensitivity.     

Contamination of the environment by special purpose centrifuges used in clinical laboratories.

The generation of aerosols and the contamination of surfaces arising from the use of a number of special purpose centrifuges have been measured. Except when sealed containers were used all the equipment tested generated airborne particles and contaminated surrounding surfaces. The magnitude of this contamination was shown to be associated with several factors, and it could be considerably reduced by the use of sealed containers, and by fitting air filters. The significance of these findings and their application are discussed.     

Demonstration of Microorganisms and Dust in Schools and Offices

"The sick-building syndrome" (WHO) is reported with increasing intensity in non-industrial places of work, such as schools, kindergartens, and offices, all of which have a heavy load of traffic (people). The construction of these buildings (e.g. flat roofs) often leads to water damage with subsequent microbial growth. Further, reduced cleaning budgets in connection with the wide use of needle-felt carpets, as well as ventilation systems not regularly maintained, will lead to pollution by dust and microorganisms. A systematic registration of dust and microbial parameters has been carried out since 1980 in buildings with indoor climate complaints, in order to elucidate the possible influence of these factors.     

Airborne dust and allergen generation during dusting with and without spray polish.

BACKGROUND: Dusting is a commonly used method for dust removal from surfaces in the home. However, the process of dusting may contribute to airborne dust levels by disturbing dust particles from a surface and failing to remove it from the indoor environment. OBJECTIVE: We sought to measure the quantity of allergen-laden dust disturbed into the air during dusting and discover whether applying spray polish to either the dusty surface or the cleaning cloth reduced this amount. METHODS: A common furniture polish was tested for its ability to prevent dust particles and major house dust mite (Der p 1) or major cat (Fel d 1) allergen from becoming airborne during dusting. Tests were completed with a repeatable mechanized dusting procedure with polish sprayed onto either a cleaning cloth or directly onto a surface, and this was compared with a control procedure with a standard duster. Airborne dust was measured with an air-particle counter and by means of anti-Der p 1 or anti-Fel d 1 ELISA. RESULTS: Considerable quantities of dust became airborne during dusting. When polish was sprayed onto the cleaning cloth, the concentration of airborne dust particles was reduced by a mean of 83.4%, house dust mite allergen by 50.3%, and cat allergen by 57.4% when compared with dry-cloth controls. Spraying polish directly onto the surface was even more effective at reducing the generation of airborne particles (92.9%) and allergens (Der p 1 by > or =95% to below the sensitivity of the ELISA and Fel d 1 by 95%). All reductions were significant when compared with dry-cloth controls (P <.01, Mann-Whitney U test). CONCLUSIONS: This study showed that application of a polish spray to either the surface or the cloth during dusting greatly reduced dust and allergen evolution into the air, which should reduce exposure to airborne allergens in the home.     

The influence of air conditioning, humidity, temperature and other household characteristics on mite allergen concentrations in the northeastern United States

BACKGROUND: Information about the influence of housing and occupant characteristics on mite allergen concentrations is crucial to determine which methods could be used to decrease exposure of susceptible subjects. OBJECTIVES: To identify housing and occupant characteristics that are associated with mite allergen concentrations in house dust collected from living rooms and mattresses. METHODS: We collected dust samples from 750 homes in the northeastern US. The influence of various characteristics on concentrations of mite allergens (Der p 1 and Der f 1) was studied using multiple linear regression analysis. RESULTS: Some characteristics, like absence of air conditioners, the presence of mold or mildew, and a lower temperature were consistently associated with higher concentrations of both mite allergens in dust from all sampling locations. However, none of these factors changed Der p 1 or Der f 1 concentrations by more than a factor of 2. People of white ethnic background had roughly two times higher mite allergen concentrations, while family income, family size, and education level only marginally influenced mite allergen concentrations. CONCLUSIONS: Various housing characteristics have some influence on mite allergen concentrations, and could possibly be used to decrease exposure of susceptible subjects. However, only a limited percentage of the variation in mite allergen concentrations was explained by these characteristics.     

Diesel Exhaust Exposure, Wheezing and Sneezing

The rising incidence of allergic disorders in developed countries is unexplained. Exposure to traffic related air pollutants may be an important cause of wheezing and asthma in childhood. Experimental evidence from human studies suggests that diesel exhaust particles, constituents of fine particulate matter less than 2.5 microns (PM_2.5), may act to enhance IgE mediated aeroallergen sensitization and Th2 directed cytokine responses. To date, epidemiologic investigations indicate that children living in close proximity to heavily travelled roads are more likely to be atopic and wheeze. The Cincinnati Childhood Allergy and Air Pollution Study (CCAAPS) birth cohort study was initiated to test the hypothesis that early high exposure to traffic related air pollutants is associated with early aeroallergen sensitization and allergic respiratory phenotypes. Using an exposure cohort design, more than 700 infants born to atopic parents were recruited at age 1 living either less than 400 meters (high traffic pollutant exposure) or greater than 1,500 meters (low exposure) from a major road. Children were medically evaluated and underwent skin prick testing with aeroallergen at screening, and re-evaluated sequentially at ages 1, 2, 3, 4, and 7. In this study, both proximity and land use regression (LUR) models of traffic air pollutant exposure have been assessed. Proximity to stop and go traffic with large concentrations of bus and truck traffic predicted persistent wheezing during infancy. The LUR model estimated elemental carbon attributable to traffic (ECAT) as a proxy for diesel exhaust particulate exposure. High ECAT was significantly associated with wheezing at age 1 as well as persistent wheezing at age 3. High mold exposure predicted a well defined asthma phenotype at age 7.     

Correlations between levels of mite and cat allergens in settled and airborne dust

Thirty homes in Rochester, Minn., 20 of which housed cats, were studied to compare cat and mite allergen concentrations in airborne and settled dust. With Air Sentinels in the bedroom and living room for airborne collections, and a Sample Vac for collections from living room carpet and bedroom mattress, immunochemical quantifications of each were made with various radiometric assays with polyclonal and monoclonal antibodies. The most significant correlations were found between airborne mite in the bedroom and living room (p less than 0.001) and airborne mite in the bedroom and dust from the bedroom mattress (p less than 0.001). Most houses had specific epitopes of both Dermatophagoides pteronyssinus and D. farinae, but D. farinae was present in greater amounts. In seven houses we found greater than 10 micrograms of group I mite allergen per gram of settled dust, indicating that some houses in Minnesota have concentrations of mite allergens high enough to cause allergic disease, even in the winter. Clinical interpretation of these data on air levels is hampered by uncertainty as to whether symptoms are more closely related to average steady-state exposure, which we measured, or to brief heavy concentrations. Further epidemiologic studies are needed to define the concentration of mite and cat allergens in the air that are risk factors for allergic disease. The concentration of cat allergen correlated with mite allergen in the air, but not in settled dust, presumably reflecting the fact that both are influenced by ventilation rate.