Evaluating building-related symptoms using the US EPA BASE study results.

UNLABELLED: In order to develop baseline data about United States office buildings, the United States Environmental Protection Agency conducted the Building Assessment Survey Evaluation (BASE) study, a systematic survey of 100 randomly selected United States office buildings, in the 1990s. This paper analyzes the self-reported work-related symptoms and job and workplace characteristics of 4326 respondents and compares results to the National Institute for Occupational Safety and Health's (NIOSH) study of 80 'complaint' buildings. Four distinct groups of symptoms, representing 'tiredness', 'mucosal irritation', 'neuropsychological', and 'lower respiratory' conditions emerged from factor analysis of work-related symptoms. The symptom grouping is identical for both surveys. Although the prevalence of each symptom is significantly higher in the NIOSH than in the BASE sample, there is overlap of the symptom distributions. In the BASE survey, 45% of the work force reported at least one work-related health symptom; 20% reported at least three symptoms. These findings imply that it is counterproductive to dichotomize buildings into healthy vs. unhealthy; instead the prevalence of health problems related to buildings span a continuum. PRACTICAL IMPLICATIONS: These results indicate that most office buildings have occupants who report building-related symptoms. This paper provides practical guidance for the comparison of building prevalences to the BASE normative data. Work-related symptom distributions and symptom groups can improve investigators' ability to identify IEQ problems.

Outdoor allergens.

Outdoor allergens are an important part of the exposures that lead to allergic disease. Understanding the role of outdoor allergens requires a knowledge of the nature of outdoor allergen-bearing particles, the distributions of their source, and the nature of the aerosols (particle types, sizes, dynamics of concentrations). Primary sources for outdoor allergens include vascular plants (pollen, fern spores, soy dust), and fungi (spores, hyphae). Nonvascular plants, algae, and arthropods contribute small numbers of allergen-bearing particles. Particles are released from sources into the air by wind, rain, mechanical disturbance, or active discharge mechanisms. Once airborne, they follow the physical laws that apply to all airborne particles. Although some outdoor allergens penetrate indoor spaces, exposure occurs mostly outdoors. Even short-term peak outdoor exposures can be important in eliciting acute symptoms. Monitoring of airborne biological particles is usually by particle impaction and microscopic examination. Centrally located monitoring stations give regional-scale measurements for aeroallergen levels. Evidence for the role of outdoor allergens in allergic rhinitis is strong and is rapidly increasing for a role in asthma. Pollen and fungal spore exposures have both been implicated in acute exacerbations of asthma, and sensitivity to some fungal spores predicts the existence of asthma. Synergism and/or antagonism probably occurs with other outdoor air particles and gases. Control involves avoidance of exposure (staying indoors, preventing entry of outdoor aerosols) as well as immunotherapy, which is effective for pollen but of limited effect for spores. Outdoor allergens have been the subject of only limited studies with respect to the epidemiology of asthma. Much remains to be studied with respect to prevalence patterns, exposure and disease relationships, and control.

Predictors of airborne endotoxin in the home.

We identified home characteristics associated with the level of airborne endotoxin in 111 Boston-area homes enrolled in a cohort study of home exposures and childhood asthma, and we developed a predictive model to estimate airborne endotoxin. We measured endotoxin in family-room air and in dust from the baby's bed, family room, bedroom, and kitchen floor. Level of airborne endotoxin was weakly correlated (r < 0.3) with level of endotoxin in each of the four types of dust samples and was significantly correlated with endotoxin in family-room dust (p < 0.05). Endotoxin in family-room dust accounted for < 6% of the variability of airborne endotoxin. In a multivariate model, certain home characteristics were positively (p < 0.05) associated with airborne endotoxin. These included current presence of dog (difference in level, dog vs. no dog = 72%, partial R(2 )= 12.8%), past presence of dog (partial R(2) = 5.5%), and endotoxin level in family-room dust (partial R(2) = 5.3%). Use of a dehumidifier (partial R(2) = 6.4%) was negatively associated (p = 0.02; difference = -31%) with airborne endotoxin. Other home characteristics were identified as important determinants of increased airborne endotoxin in this model, but individual coefficients were not statistically significant (alpha = 0.05): total amount of fine dust collected in the home (partial R(2 )= 3.8%), concrete floor in family room (3.7%), water damage (3.6%), and use of cool-mist humidifier in past year (2.7%). This multivariate model explained 42% of the variability of airborne endotoxin levels, a substantial improvement over that with dust endotoxin alone. Airborne endotoxin in Boston-area homes appears to be determined by the presence of dogs, moisture sources, and increased amounts of settled dust.

Socioeconomic predictors of high allergen levels in homes in the greater Boston area.

In the United States, childhood asthma morbidity and prevalence rates are the highest in less affluent urban minority communities. More than 80% of childhood asthmatics are allergic to one or more inhalant allergens. We evaluated whether socioeconomic status was associated with a differential in the levels and types of indoor home allergens. Dust samples for an ELISA allergen assay were collected from the homes of 499 families as part of a metropolitan Boston, Massachusetts, longitudinal birth cohort study of home allergens and asthma in children with a parental history of asthma or allergy. The proportion of homes with maximum home allergen levels in the highest category was 42% for dust mite allergen (> or = 10 microg/g Der p 1 or Der f 1), 13% for cockroach allergen (> or = 2 U/g Bla g 1 or Bla g 2), 26% for cat allergen (> or = 8 microg/g Fel d 1), and 20% for dog allergen (> or = 10 microg/g Can f 1). Homes in the high-poverty area (> 20% of the population below the poverty level) were more likely to have high cockroach allergen levels than homes in the low-poverty area [51 vs. 3%; OR, 33; 95% confidence interval (CI), 12-90], but less likely to have high levels of dust mite allergen (16 vs. 53%; OR, 0.2; CI, 0.1-0.4). Lower family income, less maternal education, and race/ethnicity (black or Hispanic vs. white) were also associated with a lower risk of high dust mite levels and a greater risk of high cockroach allergen levels. Within a single U.S. metropolitan area we found marked between-community differences in the types of allergens present in the home, but not necessarily in the overall burden of allergen exposure.

Longitudinal study of dust and airborne endotoxin in the home.

To characterize the seasonal variability of endotoxin levels, we measured endotoxin in dust from the bed, bedroom floor, and kitchen floor in 20 homes, and in air from the bedroom in 15 of the homes. All homes were located in the greater Boston, Massachusetts, area and were sampled each month from April 1995 to June 1996. Outdoor air was collected at two locations. We found greater within-home than between-home variance for bedroom floor, kitchen floor, and airborne endotoxin. However, the reverse was true for bed dust endotoxin. Thus, studies using single measurements of dust endotoxin are most likely to reliably distinguish between homes if bed dust is sampled. Dust endotoxin levels were not significantly associated with airborne endotoxin. Airborne endotoxin was significantly (p = 0. 04) and positively associated with absolute humidity in a mixed-effect model adjusting for a random home effect and fixed effect of sampling month and home characteristics. This finding implies that indoor humidity may be an important factor controlling endotoxin exposure. We found a significant (p < 0.05) seasonal effect in kitchen floor dust (spring > fall) and bedroom airborne endotoxin (spring > winter), but not in the other indoor samples. We found significant seasonal pattern in outdoor airborne endotoxin (summer > winter).

Effects of physical interventions on house dust mite allergen levels in carpet, bed, and upholstery dust in low-income, urban homes.

House dust mite allergen exposure is a postulated risk factor for allergic sensitization, asthma development, and asthma morbidity; however, practical and effective methods to mitigate these allergens from low-income, urban home environments remain elusive. The purpose of this study was to assess the feasibility and effectiveness of physical interventions to mitigate house dust mite allergens in this setting. Homes with high levels of house dust mite allergen (Der f 1 + Der p 1 > or = 10 microg/g dust by enzyme-linked immunosorbent assay) in the bed, bedroom carpet, and/or upholstered furniture were enrolled in the study. Carpets and upholstered furniture were subjected to a single treatment of either dry steam cleaning plus vacuuming (carpet only) or intensive vacuuming alone. Bed interventions consisted of complete encasement of the mattress, box spring, and pillows plus either weekly professional or in-home laundering of nonencased bedding. Dust samples were collected at baseline and again at 3 days (carpet and upholstery only) and 2, 4, and 8 weeks posttreatment. We compared pretreatment mean allergen concentrations and loads to posttreatment values and performed between-group analyses after adjusting for differences in the pretreatment means. Both dry steam cleaning plus vacuuming and vacuuming alone resulted in a significant reduction in carpet house dust mite allergen concentration and load (p < 0.05). Levels approached pretreatment values by 4 weeks posttreatment in the intensive vacuuming group, whereas steam cleaning plus vacuuming effected a decrease that persisted for up to 8 weeks. Significant decreases in bed house dust mite allergen concentration and load were obtained in response to encasement and either professional or in-home laundering (p < 0.001). Between-group analysis revealed significantly less postintervention house dust mite allergen load in professionally laundered compared to home-laundered beds (p < 0.05). Intensive vacuuming and dry steam cleaning both caused a significant reduction in allergen concentration and load in upholstered furniture samples (p < 0.005). Based on these data, we conclude that physical interventions offer practical, effective means of reducing house dust mite allergen levels in low-income, urban home environments.

Review of quantitative standards and guidelines for fungi in indoor air.

Existing quantitative standards/guidelines for fungi in indoor air issued by governmental agencies are based primarily on baseline data (rather than health effects data), and are either absolute (numerical) or relative (indoor/outdoor comparisons) or a combination of the two. The Russian Federation is the only governmental agency that has binding quantitative regulations for bioaerosols. Recommended guidelines have been proposed or sponsored by North American and European governmental agencies and private professional organizations. A considerable number of frequently cited guidelines have been proposed by individuals based either on baseline data or on personal experience. Quantitative standards/guidelines range from less than 100 CFU/m3 to greater than 1000 CFU/m3 (total fungi) as the upper limit for non-contaminated indoor environments. Major issues with existing quantitative standards and guidelines are the lack of connection to human dose/response data, reliance on short term grab samples analyzed only by culture, and the absence of standardized protocols for data collection, analysis, and interpretation. Urgent research needs include the study of human responses to specific fungal agents, development and widespread use of standard protocols using currently available sampling methodologies, and the development of long term, time-discriminating personal samplers that are inexpensive, easy to use, and amenable to straightforward, relevant analysis.

Aerometric study of viable fungus spores in an animal care facility.

Studies of airborn fungi were undertaken to evaluate exposure risks for laboratory animals and human handlers which might lead to allergic or invasive disease. Although sporadically high fungus levels were encountered, counts of viable fungus particles were in general low. Recoveries on malt extract agar significantly exceeded those on Sabouraud dextrose agar. The taxa most frequently and abundantly recovered were Penicillium species. Data analyses suggest that 'clean' bedding material may be the principal source of these spores, that cleaning temporarily increases spore levels, and that outdoor airborne fungi contributed little to the indoor air spora identified. Aspergillus fumigatus was infrequently encounted in our samples, and dermatophytes were not recovered.

Monitoring for airborne allergens.

Monitoring for allergens can provide some information on the kinds and levels of exposure experienced by local patient populations, providing volumetric methods are used for sample collection and analysis is accurate and consistent. Such data can also be used to develop standards for the specific environment and to begin to develop predictive models. Comparing outdoor allergen aerosols between different monitoring sites requires identical collection and analysis methods and some kind of rational standard, whether arbitrary, or based on recognized health effects.

Fungi: toxic killers or unavoidable nuisances?

OBJECTIVES: This discussion is focused on the many roles of fungi in human health, and also to put the mycotoxin literature into perspective. DATA SOURCES: Data are derived from the literature referenced in PubMed from the National Library of Medicine, earlier references in the authors' reprint collection, and ongoing research. Studies for review were either selected from the peer-reviewed literature or from standard texts that are well recognized in the field. RESULTS: The review yielded many studies of the role of fungi in allergic disease, but none that systematically documented such a role for mycotoxins or fungal volatiles. Many case studies were found, but none of these unequivocally document a cause/effect relationship between mycotoxin exposure by inhalation and human disease in residential, school, or office settings. CONCLUSIONS: The review led to the conclusion that that the primary result from fungal exposure is allergic disease, and that the evidence for inhalation disease resulting from mycotoxin exposure in residential and office settings is extremely weak.

Indoor air and infectious disease.

The author briefly reviews key elements of airborne infectious disease and factors affecting infection. Diseases linked to air quality are then covered as well as the establishment of cause and effect between indoor air quality parameters and disease.

Aerobiology of the indoor environment.

This review of aerobiology focuses on the principles of aerobiology, the effect of airborne agents on human health, and the characteristics of indoor aerosols and outdoor aerosols that enter the indoor environment. A discussion of representative monitoring describes observational, bulk, and air sampling.

Health risk assessment of fungi in home environments.

LEARNING OBJECTIVES: Reading this article will enable the readers to recognize the public health importance of fungi in the home environment. In view of the recognized impact of fungi on human health, the large population being exposed to fungi, and the large population risk for developing allergic diseases, there is a need to establish guidelines for allowable exposure to fungi based on a health risk assessment. The aim of this study was to evaluate the status of the data on the relationship between exposure to fungi in the home environment and allergic health effects with respect to the development of such guidelines. DATA SOURCES: The past 10 years of peer-reviewed literature focused on the relationships between respiratory disease and exposure to fungi in indoor environments was examined, Indexing terms included mold, fungi, allergy, asthma, and indoor environment, among others. Each study was evaluated on the following criteria: aim and design of the study, methods for assessing exposure and health effects, and data analysis. STUDY SELECTION: Nine population based studies were identified that examined the relationship between allergy and the presence of fungi in the home environment. These studies included quantitative measures of fungal presence in either air or dust. RESULTS: One or more positive associations were found between fungal levels and health outcomes in seven of the nine cross-sectional studies identified. CONCLUSIONS: Despite these positive associations it remains impossible to set guidelines for fungi in home environments based on health risk assessment. This is in part because of the cross-sectional study designs, and inconsistency and inadequate validation of the measures used to evaluate exposure and health effects. Future research designed to generate data that can be used for the development of health risk assessment based guidelines for fungi in home environments should focus on susceptible populations, and use measures that accurately represent exposure and adverse health effects.

Effects of furniture polish on release of cat allergen-laden dust from wood surfaces.

UNLABELLED: The purpose of this study was to evaluate the effects of furniture polish (FP) on the release of cat allergen (Fel d 1)-laden dust from wood surfaces and decay of Fel d 1 in dust over time. About 2 g of sieved (150 microm screen) allergen-laden dust was introduced as an aerosol into an experimental chamber by a Pitt-3 generator and allowed to settle onto two finished wood surfaces pre-treated with either distilled water (DW) or FP. After 24 h, each surface was vacuumed into separate plastic cassettes loaded with 37 mm diameter, 0.4 microm pore, polycarbonate filters. The recovered dust was weighed, extracted in phosphate-buffered saline, and assayed for Fel d 1 content using a two-site monoclonal antibody ELISA. After vacuuming, the remaining dust on the wood surfaces was wiped up with a water-moistened swab. The dusts were extracted from the swabs and assayed by ELISA for Fel d 1. More Fel d 1 was recovered by vacuuming from DW-pre-treated surfaces than from FP pre-treated surfaces (100% vs. 69 +/- 66%). On the contrary, more residual Fel d 1 (>99.9%) on the vacuumed surfaces was recovered from FP than from DW pre-treated surfaces by wet swabs. The concentration of Fel d 1 in dust did not change significantly at room temperature over 80 days. In conclusion, FP on wood surfaces makes dust stick to the surface, which likely reduces the release of allergen-laden dust from the wood surface. PRACTICAL IMPLICATIONS: Re-aerosolization of cat allergen-laden dusts from wood surfaces (e.g. wood floor or furniture) significantly increases the concentration of airborne cat allergens. Our study indicates that exposure to airborne cat allergens might be reduced by surface treatment with commercially available FP because cat allergen-laden dusts stuck more tightly to the wood surface treated with FP.

The time course of responses to intratracheally instilled toxic Stachybotrys chartarum spores in rats.

Stachybotrys chartarum is a fungal species that can produce mycotoxins, specifically trichothecenes. Exposures in the indoor environment have reportedly induced neurogenic symptoms in adults and hemosiderosis in infants. However, little evidence has linked measured exposures to any fungal agent with any health outcome. We present here a study that focuses on quantitatively assessing the health risks from fungal toxin exposure. Male, 10 week old Charles River-Dawley rats were intratracheally instilled with approximately 9.6 million Stachybotrys chartarum spores in a saline suspension. The lungs were lavaged 0 h (i.e., immediately post-instillation), 6, 24 or 72 h after instillation. Biochemical indicators (albumin, myeloperoxidase, lactic dehydrogenase, hemoglobin) and leukocyte differentials in the bronchoalveolar lavage fluid and weight change were measured. We have demonstrated that a single, acute pulmonary exposure to a large quantity of Stachybotrys chartarum spores by intratracheal instillation causes severe injury detectable by bronchoalveolar lavage. The primary effect appears to be cytotoxicity and inflammation with hemorrhage. There is a measurable effect as early as 6 h after instillation, which may be attributable to mycotoxins in the fungal spores. The time course of responses supports early release of some toxins, with the most severe effects occurring between 6 and 24 h following exposure. By 72 h, recovery has begun, although macrophage concentrations remained elevated.

Microbial prevalence in domestic humidifiers.

The prevalence of viable thermophilic bacteria and actinomycetes and mesophilic fungi was examined in 145 samples from 110 domestic humidifiers. A total of 72 and 43% of furnace and console humidifier samples, respectively, contained viable thermophilic bacteria, whereas 60 and 72% of these samples produced mesophilic fungal growth. Thermophilic actinomycetes were recovered from seven humidifier samples. Efforts to detect thermophilic actinomycete antigens in 15 humidifier fluid samples were not successful. Antifoulants added to humidifier fluid reservoirs had no apparent effect on microbial frequency. Airborne microbial recoveries did not reflect patterns of humidifier contamination with respect to either kinds or numbers of microorganisms in 20 homes in which volumetric air samples were obtained during humidifier operation.

Exclusion of particulate allergens by window air conditioners.

Effects of window air-conditioner operation on intramural particle levels were assessed in the bedrooms of 20 homes and in 10 outpatient clinic examining rooms during late summer periods. At each site, pollen and spore collections in the mechanically cooled room and a normally ventilated counterpart were compared using volumetric impactors. Substantially lower particle recoveries (median = 16/m3) were found in air-conditioned rooms than in those with open windows alone (median = 253 particles/m3). Furthermore, substantial exclusion of small (e.g., Ganoderma spores) as well as large (ragweed pollens) aerosol components were found by window units. Control studies within normally ventilated rooms and outside their open windows showed a marked but variable inward flux of particles. Window units appear to substantially reduce indoor allergan levels by maintaining the isolation of enclosed spaces from particle-bearing outdoor air.

Evaluation of indoor plantings as allergen exposure sources.

The role of indoor plantings as allergen sources was assessed by direct sampling of interior air. Homes with 10 or more plants in one room and three University of Michigan greenhouses were studied by means of a dc-powered rotorod and separate Andersen viable sampler collections incubated at 23 degrees and 50 degrees C. Sequential 30 and 60 sec Andersen samples were obtained during 15 min rotorod collections before and during watering of plants as well as during disturbance of foliage by a small fan. Relative humidity averaged 51% in homes and 78% in greenhouses. Aspergillus fumigatus recoveries were rare. Thermophiles, primarily bacteria, were present at low-to-moderate levels in homes, did not increase with watering of fan in homes, and rose only slightly with disturbance at greenhouse sites. Cladosporium and Penicillium dominated Andersen collections. Watering and fan increased levels of these taxa as well as rotorod recoveries of Alternaria. Epicoccum, and Pithomyces slightly in homes and markedly at greenhouse sites. We conclude that modest numbers of undisturbed house plants contribute minimally to aeroallergen prevalence in homes. However, especially under greenhouse conditions, plantings can harbor abundant fungus growth that may become airborne, especially when agitated directly.

Allergen carriage by atmospheric aerosol. I. Ragweed pollen determinants in smaller micronic fractions.

Outdoor air-bearing natural ragweed pollen burdens were drawn through 5 microns membrane filters during 24 hr periods; aerosols penetrating these barriers were collected on individual, in-line, 0.8 microns filters. The 0.8 microns filters were free of intact pollen grains and grain fragments when scanned in toto by transmitted light. Aqueous extracts of 0.8 microns filters were found to elicit wheal-and-flare skin test reactions in a ragweed pollen-sensitive subject but not in nonatopic controls. The same extracts produced significant inhibition of an IgG-ELISA system by use of ragweed pollen protein conjugated to polystyrene plate wells and pooled serum of patients on ragweed immunotherapy. No inhibition resulted from preincubation of serum with an unrelated allergen (hickory pollen extract). These data indicate the presence of airborne ragweed pollen allergen in aerosol fractions below 5 microns during seasonal periods of ragweed pollination, confirming the report of Busse et al. Potential sources of such aerosols are prominent in nature, and their occurrence may help explain existing dose-response disparities in pollinosis.