Assessment of indoor air conditions in households of Portuguese families with newborn children. Implementation of the HEALS IAQ checklist.

Conducting epidemiological and risk assessment research that considers the exposome concept, as in the case of HEALS project, requires the acquisition of higher dimension data sets of an increased complexity. In this context, new methods that provide accurate and interpretable data summary on relevant environmental factors are of major importance. In this work, a questionnaire was developed to collect harmonized data on potential pollutant sources to air in the indoor environment where children spend an important part of their early life. The questionnaire was designed in a user friendly checklist format to be filled out at the maternity in ten European cities. This paper presents and discusses the rationale for the selection of the questionnaire contents and the results obtained from its application in the households of 309 HEALS-enrolled families with babies recently born in Porto, Portugal. The tool was very effective in providing data on the putative air pollution sources in homes, with special focus on the bedroom of the newborns. The data collected is part of a wider effort to build the databases and risk assessment models of the HEALS project. The results of the analysis of the collected data suggest that, for the population under study, the main concerns on early life exposures at home can be related to emissions from the use of household solid fuels, indoor tobacco, household cleaning products, fragranced consumer products (e.g. air fresheners, incense and candles), moisture-related pathologies and traffic-related outdoor pollution. Furthermore, it is anticipated that the tool can be a valuable means to empower citizens to actively participate in the control of their own exposures at home. Within this context, the application of the checklist will also allow local stakeholders to identify buildings presenting most evident IAQ problems for sampling or intervention as well as to guide them in preparing evidence-based educational/awareness campaigns to promote public health through creating healthy households.

Evaluation of the occurrence of pathogenic free-living amoeba and bacteria in 20 public indoor swimming pool facilities.

Recently, indoor swimming pool activities have increased to promote health-enhancing physical activities, which require establishing suitable protocols for disinfection and water quality control. Normally, the assessment of the microbial quality of the water in the pools only considers the presence of different bacteria. However, other less frequent but more resistant pathogens, such as free-living amoebas (FLA), are not contemplated in both existing recommendation and research activities. FLA represent a relevant human health risk, not only due to their pathogenicity but also due to the ability to act as vehicles of other pathogens, such as bacteria. Therefore, this work aimed to study the physicochemical characteristics and the occurrence of potentially pathogenic FLA and bacteria in water samples from 20 public indoor swimming facilities in Northern Portugal. Our results showed that some swimming pools presented levels of pH, free chlorine, and conductivity out of the recommended limits. Pathogenic FLA species were detected in two of the facilities under study, where we also report the presence of both, FLA and pathogenic bacteria. Our findings evidence the need to assess the occurrence of FLA and their existence in the same environmental niche as pathogenic bacteria in swimming pool facilities worldwide and to establish recommendations to safeguard the health of the users.

Assessment of the air quality in 20 public indoor swimming pools located in the Northern Region of Portugal.

Air exposures occurring in indoor swimming pools are an important public health issue due to their popularity and regular use by the general population, including vulnerable groups such as children and elderly people. More comprehensive information on indoor air quality (IAQ) in swimming pools is thus needed in order to understand health risks, establish appropriate protective limits and provide evidence-based opportunities for improvement of IAQ in these facilities. In this context, twenty public indoor swimming pools located in the Northern Region of Portugal were examined in two sampling campaigns: January-March and May-July 2018. For each campaign, a comprehensive set of environmental parameters was monitored during the entire period of the facilities' operating hours of a weekday, both indoors and outdoors. In addition, four air (1-h samplings) and water samples were collected. Findings show that comfort conditions, ultrafine particles number concentrations and exposure to substances in the indoor air (concentration and composition) is likely to vary greatly from one public indoor swimming pool to another. Trihalomethanes (THM) and dichloroacetonitrile were the predominant disinfection by-products identified in the indoor air but other potentially hazardous volatile organic compounds, such as limonene, 1,2,4-trimethylbenzene, 2,2,4,4,6,8,8-heptamethylnonane, 2- and 3-methylbutanenitrile, acetophenone, benzonitrile, and isobutyronitrile were found to have relevant putative emission sources in the environment of the swimming pools analyzed. Furthermore, indicators of poor ventilation conditions (namely carbon dioxide, relative humidity and existence of signs of condensation in windows) and some water-related parameters (THM levels, conductivity and salinity) were found to be determining factors of the measured airborne THM concentrations that appeared to significantly potentiate the exposure. In summary, this work provides evidence for the need to establish adequate standards for the comprehensive evaluation of IAQ in public swimming pools, in order to guide further development of evidence-based prevention/remediation strategies for promoting healthy environments in swimming pools.

Alternaria alternata allergens: Markers of exposure, phylogeny and risk of fungi-induced respiratory allergy.

Alternaria alternata spores are considered a well-known biological contaminant and a very common potent aeroallergen source that is found in environmental samples. The most intense exposure to A. alternata allergens is likely to occur outdoors; however, Alternaria and other allergenic fungi can colonize in indoor environments and thereby increase the fungal aeroallergen exposure levels. A consequence of human exposure to fungal aeroallergens, sensitization to A. alternata, has been unequivocally associated with increased asthma severity. Among allergenic proteins described in this fungal specie, the major allergen, Alt a 1, has been reported as the main elicitor of airborne allergies in patients affected by a mold allergy and considered a marker of primary sensitization to A. alternata. Moreover, A. alternata sensitization seems to be a triggering factor in the development of poly-sensitization, most likely because of the capability of A. alternata to produce, in addition to Alt a 1, a broad and complex array of cross-reactive allergens that present homologs in several other allergenic sources. The study and understanding of A. alternata allergen information may be the key to explaining why sensitization to A. alternata is a risk factor for asthma and also why the severity of asthma is associated to this mold. Compared to other common environmental allergenic sources, such as pollens and dust mites, fungi are reported to be neglected and underestimated. The rise of the A. alternata allergy has enabled more research into the role of this fungal specie and its allergenic components in the induction of IgE-mediated respiratory diseases. Indeed, recent research on the identification and characterization of A. alternata allergens has allowed for the consideration of new perspectives in the categorization of allergenic molds, assessment of exposure and diagnosis of fungi-induced allergies.

From respiratory sensitization to food allergy: Anaphylactic reaction after ingestion of mushrooms (Agaricus bisporus).

We report a case of a 38-year-old mold-allergic patient who developed episodes of generalized urticaria and systemic anaphylactic shock immediately after ingesting button mushrooms. A manganese-dependent superoxide dismutase (MnSOD) and a NADP-dependent mannitol dehydrogenase (MtDH) from Agaricus bisporus mushroom were identified as patient-specific IgE-binding proteins. Cross-reactivity between A. bisporus MnSOD and mold aeroallergens was confirmed. We conclude that prior sensitization to mold aeroallergens might explain severe food reactions to cross-reacting homologs mushroom proteins.

Characterisation of Alternaria alternata manganese-dependent superoxide dismutase, a cross-reactive allergen homologue to Asp f 6.

It is well known that Alternaria alternata presents a significant level of allergenic cross-reactivity with several other phylogenetically related and non-related allergenic moulds. To improve the molecular diagnosis, the identification and characterisation of all clinically relevant allergens, including both species-specific and cross-reacting proteins, is required. In this study we report the molecular and immunological characterisation of the A. alternata manganese-dependent superoxide dismutase (Alt a MnSOD) and its cross-reactivity with Asp f 6, a diagnostic marker allergen in allergic bronchopulmonary aspergillosis (ABPA). The cDNA coding for Alt a MnSOD sequence was isolated by RACE and PCR. Alt a MnSOD is a protein of 191 amino acids that presented significant homology and potential cross-reactive epitopes with Asp f 6. The recombinant protein was produced in Escherichia coli and the immunoreactivity was evaluated in patient sera. Immunoblotting analyses showed that seven of sixty-one A. alternata-sensitised patient sera and two ABPA patient sera reacted with the recombinant Alt a MnSOD. The native counterpart contained in both A. alternata and Aspergillus fumigatus extracts inhibited IgE binding to the recombinant molecule. The allergen was named Alt a 14 by the official Allergen nomenclature subcommittee. Thus, Alt a 14 is a relevant allergen in A. alternata sensitisation that may be used to improve diagnostic procedures. Evidence of cross-reactivity between Asp f 6 and Alt a 14-recognition by ABPA patient sera suggest the existence of an Alt a 14-mediated mechanism that, similar to Asp f 6, may be related to the pathogenesis of ABPA.