Association between fungal spore exposure in inner-city schools and asthma morbidity.

BACKGROUND: Home fungus exposures may be associated with development or worsening of asthma. Little is known about the effects of school/classroom fungus exposures on asthma morbidity in students. OBJECTIVE: To evaluate the association of school-based fungus exposures on asthma symptoms in both fungus-sensitized and nonsensitized students with asthma. METHODS: In this prospective study, 280 children with asthma from 37 inner-city schools were phenotypically characterized at baseline and followed-up for 1 year. Fungal spores were collected by using a Burkard air sampler twice during the school year. Clinical outcomes were evaluated throughout the school year and linked to classroom-specific airborne spore sampling. The primary outcome was days with asthma symptoms per 2-week period. RESULTS: Fungal spores were present in all classroom samples. The geometric mean of the total fungi was 316.9 spores/m3 and ranged from 15.0 to 59,345.7 spores/m3. There was variability in total fungus quantity between schools and classrooms within the same school. Mitospores were the most commonly detected fungal grouping. Investigation of the individual mitospores revealed that exposure to Alternaria was significantly associated with asthma symptom days in students sensitized to Alternaria (OR = 3.61, CI = 1.34-9.76, P = .01), but not in children not sensitized to Alternaria (OR = 1.04, CI = 0.72-1.49, P = .85). Students sensitized to Alternaria and exposed to high levels (≥75th percentile exposure) had 3.2 more symptom days per 2-week period as compared with students sensitized but exposed to lower levels. CONCLUSION: Children with asthma who are sensitized to Alternaria and exposed to this fungus in their classroom may have significantly more days with asthma symptoms than those who were sensitized and not exposed. CLINICAL TRIAL REGISTRATION: Clinicaltrials.govNCT01756391.

Elevated CO2 boosts reproduction and alters selection in northern but not southern ecotypes of allergenic ragweed.

PREMISE OF THE STUDY: Many plants increase reproduction in response to rising levels of atmospheric CO2 . However, environmental and genetic variation across heterogeneous landscapes can lead to intraspecific differences in the partitioning of CO2 -induced carbon gains to reproductive tissue relative to growth. METHODS: We measured the effects of rising atmospheric CO2 on biomass allocation in the allergenic plant Ambrosia artemisiifolia (common ragweed) across a geographic climate gradient. We grew plants from three latitudes at 400, 600, and 800 µL·L-1 CO2 and analyzed biomass allocation and natural selection on flowering phenology and growth. KEY RESULTS: Both the latitude of origin and CO2 treatment had significant effects on allocation and on estimates of selection. Northern plants were under stronger selection than southern plants to flower quickly, and they produced larger seeds and more reproductive mass per unit of growth. Northern plants were under stronger selection than southern plants to flower quickly, and they produced larger seeds and more reproductive mass per unit of growth. While all plants grew larger and produced heavier seeds at higher CO2 , only northern plants increased male flower production. Both size and time to flowering were under selection, with a relaxation of the size-fitness function in northern ecotypes at high CO2 . CONCLUSIONS: Northern ecotypes allocate more CO2 -induced carbon gains to reproduction than do southern plants, pointing to a geographic gradient in future pollen and seed production by this species arising from local adaptation. Relaxed selection on size at elevated CO2 could amplify reproductive enhancements to northern ecotypes, although more growth and seed provisioning can be expected overall. Our results demonstrate potential for ecotypic divergence in ragweed responses to climate change.

Northern ragweed ecotypes flower earlier and longer in response to elevated CO2: what are you sneezing at?

Significant changes in plant phenology and flower production are predicted over the next century, but we know relatively little about geographic patterns of this response in many species, even those that potentially impact human wellbeing. We tested for variation in flowering responses of the allergenic plant, Ambrosia artemisiifolia (common ragweed). We grew plants originating from three latitudes in the Northeastern USA at experimental levels of CO2 (400, 600, and 800 µL L(-1)). We hypothesized that northern ecotypes adapted to shorter growing seasons would flower earlier than their southern counterparts, and thus disproportionately allocate carbon gains from CO2 to reproduction. As predicted, latitude of origin and carbon dioxide level significantly influenced the timing and magnitude of flowering. Reproductive onset occurred earlier with increasing latitude, with concurrent increases in the number of flowers produced. Elevated carbon dioxide resulted in earlier reproductive onset in all ecotypes, which was significantly more pronounced in the northern populations. We interpret our findings as evidence for ecotypic variation in ragweed flowering time, as well in responses to CO2. Thus, the ecological and human health implications of common ragweed's response to global change are likely to depend on latitude. We conclude that increased flower production, duration, and possibly pollen output, can be expected in Northeastern United States with rising levels of CO2. The effects are likely, however, to be most significant in northern parts of the region.

Malaria-related knowledge and prevention practices in four neighbourhoods in and around Mumbai, India: a cross-sectional study.

BACKGROUND: India accounts for the highest number of malaria cases outside of Africa. Eighty per cent of India's population lives in malaria-risk areas, with cases increasing in urban areas. Mumbai, India, one of the most populous cities in the world, has experienced such an increase. To be successful, many malaria control efforts require community participation, which in turn depends on individuals' knowledge and awareness of the disease. This study assessed the knowledge and prevention practices regarding malaria in residents of four different areas of Mumbai, India, around the time of a malaria outbreak and the start of a widespread awareness campaign. METHODS: A cross-sectional comparative study assessed malaria-related knowledge and prevention practices in four geographically and socio-demographically distinct areas of Mumbai, India. A structured interviewer-administered questionnaire was administered to a stratified random sample of 119 households between 16 December 2010 and 30 January 2011. Participant socio-demographic characteristics, malaria knowledge, malaria prevention practices, and household environmental factors were examined overall and compared across the four areas of Mumbai. RESULTS: Overall, respondents had excellent knowledge of the mosquito as the means of transmission of malaria, mosquito biting times and breeding sites, and fever as a symptom of malaria. However, many respondents also held misconceptions about malaria transmission and symptoms. Respondents generally knew that bed nets are an effective prevention strategy, but only 30% used them, and only 4% used insecticide-treated bed nets. Knowledge and prevention practices varied across the four areas of Mumbai. CONCLUSIONS: Although most residents know that bed nets are effective in preventing malaria, usage of bed nets is very low, and almost no residents use insecticide-treated bed nets. As the four areas of Mumbai differed in knowledge, prevention practices, and primary sources of information, malaria control campaigns should be tailored according to the knowledge gaps, practices, environments, resources, and preferences in different areas of the city, using the interpersonal and media channels most likely to reach the target audiences. Malaria control efforts involving bed nets should emphasize use of insecticide-treated bed nets.

Exposures to molds in school classrooms of children with asthma.

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.

Ambient pollen concentrations and emergency department visits for asthma and wheeze.

BACKGROUND: Previous studies report associations between aeroallergen exposure and asthma exacerbations. Aeroallergen burdens and asthma prevalence are increasing worldwide and are projected to increase further with climate change, highlighting the importance of understanding population-level relationships between ambient pollen concentrations and asthma. OBJECTIVE: We sought to examine short-term associations between ambient concentrations of various pollen taxa and emergency department (ED) visits for asthma and wheeze in the Atlanta metropolitan area between 1993 and 2004. METHODS: We assessed associations between the 3-day moving average (lag 0-1-2) of Betulaceae (except Alnus species), Cupressaceae, Quercus species, Pinaceae (except Tsuga species), Poaceae, and Ambrosia species pollen concentrations and daily asthma and wheeze ED visit counts, controlling for covarying pollen taxa and ambient pollutant concentrations. RESULTS: We observed a 2% to 3% increase in asthma- and wheeze-related ED visits per SD increase in Quercus species and Poaceae pollen and a 10% to 15% increased risk on days with the highest concentrations (comparing the top 5% of days with the lowest 50% of days). An SD increase in Cupressaceae concentrations was associated with a 1% decrease in ED visits. The association for Quercus species pollen was strongest for children aged 5 to 17 years. Effects of Ambrosia species pollen on asthma exacerbations were difficult to assess in this large-scale temporal analysis because of possible confounding by the steep increase in circulating rhinoviruses every September. CONCLUSION: Poaceae and Quercus species pollen contribute to asthma morbidity in Atlanta. Altered Quercus species and Poaceae pollen production caused by climate change could affect allergen-induced asthma morbidity in the southeastern United States.

Pollen-specific immunoglobulin E positivity is associated with worsening of depression scores in bipolar disorder patients during high pollen season.

OBJECTIVE: An association between allergic disease and depression has been consistently reported, but whether the key mediating ingredients are predominantly biological, psychological, or mere artifacts remains unknown. In the current study, we examined a hypothesized relationship between allergen-specific immunoglobulin E (IgE) status and changes in allergy symptoms with worsening in depression scores. METHODS: In patients with recurrent mood disorders, we individually coupled sensitization to specific seasonal aeroallergens (as assessed by allergen-specific IgE) with temporal windows of exposure to aeroallergens (low versus high tree or ragweed pollen counts, measured according to the National Allergy Bureau guidelines). We compared Structured Interview Guide for the Hamilton Depression Rating Scale-Seasonal Affective Disorder Version (SIGH-SAD) depression score changes in 41 patients with mood disorders [25 with major depression and 16 with bipolar I disorder, diagnosed by Structured Clinical Interview for DSM (SCID)] seropositive for tree or ragweed pollen-specific IgE antibody versus 53 patients with mood disorders (30 with major depression and 23 with bipolar I disorder) seronegative for aeroallergen-specific IgE. RESULTS: Worsening in total depressive scores from low to high pollen exposure was greater in allergen-specific IgE-positive patients as compared to allergen-specific IgE antibody-negative patients (p = 0.01). When stratified by polarity, the association was significant only in patients with bipolar I disorder (p = 0.004). This relationship was resilient to adjustment for changes in allergy symptom scores. CONCLUSION: To our knowledge, this is the first report of coupling a molecular marker of vulnerability (allergen-specific IgE) with a specific environmental trigger (airborne allergens) leading to exacerbation of depression in patients with bipolar I disorder.

The school inner-city asthma study: design, methods, and lessons learned.

BACKGROUND: Children spend a significant amount of time in school. Little is known about the role of allergen exposure in school environments and asthma morbidity. OBJECTIVES: The School Inner-City Asthma Study (SICAS) is a National Institutes of Health (NIH)-funded prospective study evaluating the school/classroom-specific risk factors and asthma morbidity among urban children. METHODS/RESULTS: This article describes the design, methods, and important lessons learned from this extensive investigation. A single center is recruiting 500 elementary school-aged children, all of whom attend inner-city metropolitan schools. The primary hypothesis is that exposure to common indoor allergens in the classroom will increase the risk of asthma morbidity in children with asthma, even after controlling for home allergen exposures. The protocol includes screening surveys of entire schools and baseline eligibility assessments obtained in the spring prior to the academic year. Extensive baseline clinical visits are being conducted among eligible children with asthma during the summer prior to the academic school year. Environmental classroom/school assessments including settled dust and air sampling for allergen, mold, air pollution, and inspection data are collected twice during the academic school year and one home dust sample linked to the enrolled student. Clinical outcomes are measured every 3 months during the academic school year. CONCLUSION: The overall goal of SICAS is to complete the first study of its kind to better understand school-specific urban environmental factors on childhood asthma morbidity. We also discuss the unique challenges related to school-based urban research and lessons being learned from recruiting such a cohort.

Fungal exposure modulates the effect of polymorphisms of chitinases on emergency department visits and hospitalizations.

RATIONALE: Chitinases are enzymes that cleave chitin, which is present in fungal cells. Two types of human chitinases, chitotriosidase and acidic mammalian chitinase, and the chitinase-like protein, YKL-40, seem to play an important role in asthma. We hypothesized that exposure to environmental fungi may modulate the effect of chitinases in individuals with asthma. OBJECTIVES: To explore whether interactions between high fungal exposure and common genetic variants in the two chitinases in humans, CHIT1 and CHIA, and the chitinase 3-like 1 gene, CHI3L1, are associated with severe asthma exacerbations and other asthma-related outcomes. METHODS: Forty-eight single nucleotide polymorphisms (SNPs) in CHIT1, CHIA, and CHI3L1 and one CHIT1 duplication were genotyped in 395 subjects and their parents as part of the Childhood Asthma Management Program. Household levels of mold (an index of fungal exposure) were determined on house dust samples. We conducted family-based association tests with gene-environment interactions. Our outcome was severe exacerbation, defined as emergency department visits and hospitalizations from asthma over a 4-year period, and our secondary outcomes included indices of lung function and allergy-related phenotypes. MEASUREMENTS AND MAIN RESULTS: Of the 395 subjects who had mold levels at randomization, 24% (95 subjects) had levels that were greater than 25,000 units per gram of house dust (high mold exposure). High mold exposure significantly modified the relation between three SNPs in CHIT1 (rs2486953, rs4950936, and rs1417149) and severe exacerbations (P for interaction 0.0010 for rs2486953, 0.0008 for rs4950936, and 0.0005 for rs1417149). High mold exposure did not significantly modify the relationship between any of the other variants and outcomes. CONCLUSIONS: Environmental exposure to fungi, modifies the effect of CHIT1 SNPs on severe asthma exacerbations.

Monitoring microbial populations on wide-body commercial passenger aircraft.

Although exposure to bacteria has been assessed in cabin air previously, minimal numbers of samples have been collected in-flight. The purpose of this research was to comprehensively characterize bacterial concentrations in the aircraft cabin. Twelve randomly selected flights were sampled on Boeing-767 aircraft, each with a flight duration between 4.5 and 6.5 h. N-6 impactors were used to collect sequential, triplicate air samples in the front and rear of coach class during six sampling intervals throughout each flight: boarding, mid-climb, early cruise, mid-cruise, late cruise and deplaning. Comparison air samples were also collected inside and outside the airport terminals at the origin and destination cities. The MIXED procedure in SAS was used to model the mean and the covariance matrix of the natural log-transformed bacterial concentrations. A total of 513 airborne culturable bacterial samples were collected. During flight (mid-climb and cruise intervals), a model-adjusted geometric mean (GM) of 136 total colony-forming units per cubic meter of air sampled (CFU x m(-3)) and geometric standard deviation of 2.1 were observed. Bacterial concentrations were highest during the boarding (GM 290 CFU x m(-3)) and deplaning (GM 549 CFU x m(-3)) processes. Total bacterial concentrations observed during flight were significantly lower than GMs for boarding and deplaning (P values <0.0001-0.021) in the modeled results. Our findings highlight the fact that aerobiological concentrations can be dynamic and underscore the importance of appropriate sample size and design. The genera analysis indicates that passenger activity and high occupant density contribute to airborne bacterial generation. Overall, our research demonstrates that the bacteria recovered on observed flights were either common skin-surface organisms (primarily gram-positive cocci) or organisms common in dust and outdoor air.

How exposure to environmental tobacco smoke, outdoor air pollutants, and increased pollen burdens influences the incidence of asthma.

Asthma is a multifactorial airway disease that arises from a relatively common genetic background interphased with exposures to allergens and airborne irritants. The rapid rise in asthma over the past three decades in Western societies has been attributed to numerous diverse factors, including increased awareness of the disease, altered lifestyle and activity patterns, and ill-defined changes in environmental exposures. It is well accepted that persons with asthma are more sensitive than persons without asthma to air pollutants such as cigarette smoke, traffic emissions, and photochemical smog components. It has also been demonstrated that exposure to a mix of allergens and irritants can at times promote the development phase (induction) of the disease. Experimental evidence suggests that complex organic molecules from diesel exhaust may act as allergic adjuvants through the production of oxidative stress in airway cells. It also seems that climate change is increasing the abundance of aeroallergens such as pollen, which may result in greater incidence or severity of allergic diseases. In this review we illustrate how environmental tobacco smoke, outdoor air pollution, and climate change may act as environmental risk factors for the development of asthma and provide mechanistic explanations for how some of these effects can occur.

Interaction of the onset of spring and elevated atmospheric CO2 on ragweed (Ambrosia artemisiifolia L.) pollen production.

Increasing atmospheric carbon dioxide is responsible for climate changes that are having widespread effects on biological systems. One of the clearest changes is earlier onset of spring and lengthening of the growing season. We designed the present study to examine the interactive effects of timing of dormancy release of seeds with low and high atmospheric CO2 on biomass, reproduction, and phenology in ragweed plants (Ambrosia artemisiifolia L.), which produce highly allergenic pollen. We released ragweed seeds from dormancy at three 15-day intervals and grew plants in climate-controlled glass-houses at either ambient or 700-ppm CO2 concentrations, placing open-top bags over influorescences to capture pollen. Measurements of plant height and weight; inflorescence number, weight, and length; and days to anthesis and anthesis date were made on each plant, and whole-plant pollen productivity was estimated from an allometric-based model. Timing and CO2 interacted to influence pollen production. At ambient CO2 levels, the earlier cohort acquired a greater biomass, a higher average weight per inflorescence, and a larger number of influorescences; flowered earlier; and had 54.8% greater pollen production than did the latest cohort. At high CO2 levels, plants showed greater biomass and reproductive effort compared with those in ambient CO2 but only for later cohorts. In the early cohort, pollen production was similar under ambient and high CO2, but in the middle and late cohorts, high CO2 increased pollen production by 32% and 55%, respectively, compared with ambient CO2 levels. Overall, ragweed pollen production can be expected to increase significantly under predicted future climate conditions.

Indoor fungal exposure.

Fungi affect humans in complex ways and are capable of eliciting a number of disease responses, such as infectious, allergic, and irritant and toxic effects. Fungal exposure is unequivocally associated with exacerbations of asthma, although the role of fungi in causing the disease is yet to be determined. The association between home dampness and respiratory health effects is strong, and fungal exposure is suspected to be associated with this linkage. Fear of toxin exposures has generated debate over the possible toxic health effects of airborne fungi; however, several recent reviews discount the health impacts of mycotoxin through indoor exposures. Nevertheless, fungal contamination of indoor environments is undesirable. Knowledge of sources and characteristics of fungal spore release and dispersal are important for understanding the processes of exposure. Environmental monitoring for fungi and their disease agents are important aspects of exposure assessment, but few guidelines exist for interpreting their health impacts. Much work is needed in isolating, characterizing and standardizing fungal disease agents to properly assess the prevalence of fungal health effects.

Projected carbon dioxide to increase grass pollen and allergen exposure despite higher ozone levels.

One expected effect of climate change on human health is increasing allergic and asthmatic symptoms through changes in pollen biology. Allergic diseases have a large impact on human health globally, with 10-30% of the population affected by allergic rhinitis and more than 300 million affected by asthma. Pollen from grass species, which are highly allergenic and occur worldwide, elicits allergic responses in 20% of the general population and 40% of atopic individuals. Here we examine the effects of elevated levels of two greenhouse gases, carbon dioxide (CO2), a growth and reproductive stimulator of plants, and ozone (O3), a repressor, on pollen and allergen production in Timothy grass (Phleum pratense L.). We conducted a fully factorial experiment in which plants were grown at ambient and/or elevated levels of O3 and CO2, to simulate present and projected levels of both gases and their potential interactive effects. We captured and counted pollen from flowers in each treatment and assayed for concentrations of the allergen protein, Phl p 5. We found that elevated levels of CO2 increased the amount of grass pollen produced by ∼50% per flower, regardless of O3 levels. Elevated O3 significantly reduced the Phl p 5 content of the pollen but the net effect of rising pollen numbers with elevated CO2 indicate increased allergen exposure under elevated levels of both greenhouse gases. Using quantitative estimates of increased pollen production and number of flowering plants per treatment, we estimated that airborne grass pollen concentrations will increase in the future up to ∼200%. Due to the widespread existence of grasses and the particular importance of P. pratense in eliciting allergic responses, our findings provide evidence for significant impacts on human health worldwide as a result of future climate change.

Suicide and prescription rates of intranasal corticosteroids and nonsedating antihistamines for allergic rhinitis: an ecological study.

OBJECTIVE: To estimate the relationship between antiallergy drug prescription rates and suicide across the United States and over time. The relationship between allergy, allergens, and suicidal behavior and suggestions of a possible immune mediation led us to hypothesize that intranasal corticosteroids, known to reduce local airway production of T-helper cell type 2 cytokines, may be associated with reduced risk of suicide relative to antihistamines, which only secondarily affect cytokine production. METHOD: The authors evaluated the relationship of suicide rates at the county level in the United States (N = 120,076 suicides) with prescriptions for intranasal corticosteroids and nonsedating antihistamines, in interaction with antidepressant prescriptions and other socioeconomic variables, for the period from 1999 to 2002. Suicide rate data were derived from state vital record systems based on local death certificate registries, and county-level allergy and antidepressant prescription data were obtained from IMS Health Incorporated (Plymouth Meeting, Pennsylvania). RESULTS: The prescription volume of intranasal corticosteroids was associated with a lower suicide risk (P = .0004), while that of antihistamines was associated with a modestly greater suicide risk (P = .0001). Adjustment for antidepressant prescriptions did not affect these relationships. CONCLUSIONS: This is the first study, to our knowledge, to find a possible association between completed suicide and medications for allergic rhinitis and also the first report of an association of intranasal corticosteroid use with a lower suicide rate. This association should be considered preliminary and deserving of further investigation.

Elevated atmospheric carbon dioxide concentrations amplify Alternaria alternata sporulation and total antigen production.

BACKGROUND: Although the effect of elevated carbon dioxide (CO2) concentration on pollen production has been established in some plant species, impacts on fungal sporulation and antigen production have not been elucidated. OBJECTIVE: Our purpose was to examine the effects of rising atmospheric CO2 concentrations on the quantity and quality of fungal spores produced on timothy (Phleum pratense) leaves. METHODS: Timothy plants were grown at four CO2 concentrations (300, 400, 500, and 600 micromol/mol). Leaves were used as growth substrate for Alternaria alternata and Cladosporium phlei. The spore abundance produced by both fungi, as well as the size (microscopy) and antigenic protein content (ELISA) of A. alternata, were quantified. RESULTS: Leaf carbon-to-nitrogen ratio was greater at 500 and 600 micromol/mol, and leaf biomass was greater at 600 micromol/mol than at the lower CO2 concentrations. Leaf carbon-to-nitrogen ratio was positively correlated with A. alternata spore production per gram of leaf but negatively correlated with antigenic protein content per spore. At 500 and 600 micromol/mol CO2 concentrations, A. alternata produced nearly three times the number of spores and more than twice the total antigenic protein per plant than at lower concentrations. C. phlei spore production was positively correlated with leaf carbon-to-nitrogen ratio, but overall spore production was much lower than in A. alternata, and total per-plant production did not vary among CO2 concentrations. CONCLUSIONS: Elevated CO2 concentrations often increase plant leaf biomass and carbon-to-nitrogen ratio. Here we demonstrate for the first time that these leaf changes are associated with increased spore production by A. alternata, a ubiquitous allergenic fungus. This response may contribute to the increasing prevalence of allergies and asthma.

Mouse allergens in urban elementary schools and homes of children with asthma.

BACKGROUND: The association between allergens in schools and childhood asthma has not been well studied, particularly in the United States. OBJECTIVE: To investigate allergen exposure in schools compared with homes with a specific focus on children with asthma. METHODS: Dust samples were collected from 46 rooms in 4 urban elementary schools (northeastern United States) and from 38 student bedrooms. Samples were analyzed for cat (Fel d 1), dog (Can f 1), cockroach (Bla g 2), dust mites (Der f 1/Der p 1), and mouse urinary protein (MUP). Questionnaires identified students with physician-diagnosed asthma. RESULTS: Cat and dog allergens were detectable in most school samples (96% and 78%, respectively), but at low levels. Cockroach allergen was detectable in only 11% of school samples. Mouse allergen was detectable in 89% of school samples, with 68% having MUP levels greater than 0.5 microg/g. In contrast, MUP was detectable in only 26% of bedroom samples. Matched classroom and home samples from 23 asthmatic students showed higher geometric mean MUP levels in the classroom vs the home (6.45 microg/g vs 0.44 microg/g, P < .001). However, there were lower geometric mean dust mite (Der f 1) levels in the classroom vs the home (0.04 microg/g vs 0.66 microg/g, P < .001). CONCLUSIONS: There are significantly higher levels of MUP but lower levels of Der f 1 in schools vs homes. It is important to recognize that children with asthma may encounter varying levels of allergens in environments outside the home, such as schools.

Alternaria measures in inner-city, low-income housing by immunoassay and culture-based analysis.

BACKGROUND: Sensitivity to Alternaria allergens has been associated with severe asthma and life-threatening exacerbations, and a high prevalence of Alternaria sensitivity has been reported among inner-city populations. Traditionally, epidemiologic studies have measured indoor Alternaria concentrations by cultural analyses; however, the number of viable spores may not be a good proxy for allergen levels. Furthermore, other genera share epitopes with Alternaria that may contribute to the allergenic effect. OBJECTIVE: To compare measures of Alternaria antigen by enzyme-linked immunosorbent assay with measures of Alternaria and cross-reactive genera (Ulocladium, Curvularia, Epicoccum, and Stemphylium) by cultural analysis. METHOD: Antigen assays and cultural analyses were performed on vacuum-collected bed dust samples collected between June 18, 2002, and February 9, 2004, from 3 inner-city, low-income public housing developments. RESULTS: Alternaria antigen was found in all bed dust samples regardless of season. However, culturable Alternaria, Ulocladium, Curvularia, Epicoccum, and Stemphylium were only found in 50%, 35%, 6%, 11%, and 0% of bed samples, respectively. No correlations were found between Alternaria antigen and culturable concentrations of Alternaria or of its cross-reactive genera except for marginal correlation with Ulocladium culturable concentrations. CONCLUSIONS: The results confirm that exposure to Alternaria antigens and allergens can occur even in the absence of culturable Alternaria or its cross-reactive genera, so further refinement and use of assays are essential for characterizing the distribution and determinants of indoor fungal allergen levels forsensitive populations.

Determinants of allergen concentrations in apartments of asthmatic children living in public housing.

There is growing evidence linking poor housing conditions and respiratory diseases, including asthma. The association between housing conditions and asthma in the inner city has been attributed in part to cockroach and mouse infestation and the resulting allergen exposures. Multiple social and behavioral factors can influence environmental exposures and health conditions, necessitating a thorough examination of such factors. As part of the Healthy Public Housing Initiative, we evaluated the association between physical and household characteristics and pest-related allergen levels in three public housing developments in Boston, MA. We detected cockroach allergens (Bla g 1 and Bla g 2) in bedroom air, bed, and especially high concentrations in kitchen samples. In multivariate Tobit regressions controlling for development and season, clutter and lack of cleanliness in the apartment were associated with a tenfold increase in Bla g 1 concentration in the air, a sevenfold increase in Bla g 1 and an eightfold increase in Bla g 2 concentrations in the bed, and an 11-fold increase in Bla g 2 in the kitchen (p<0.05 for all). Holes in the wall/ceiling were associated with a six- to 11-fold increase in kitchen cockroach allergen concentrations (p<0.05). Occupancy in an apartment unit of 2 years or more was also associated with increased cockroach allergen concentrations. In contrast, there were low concentrations of mouse urinary protein in this population. In conclusion, these results suggest that interventions in these homes should focus on reducing cockroach allergen concentrations and that building-wide interventions should be supplemented with targeted efforts focused on high-risk units.