NIAID, NIEHS, NHLBI, and MCAN Workshop Report: The indoor environment and childhood asthma-implications for home environmental intervention in asthma prevention and management.

Environmental exposures have been recognized as critical in the initiation and exacerbation of asthma, one of the most common chronic childhood diseases. The National Institute of Allergy and Infectious Diseases; National Institute of Environmental Health Sciences; National Heart, Lung, and Blood Institute; and Merck Childhood Asthma Network sponsored a joint workshop to discuss the current state of science with respect to the indoor environment and its effects on the development and morbidity of childhood asthma. The workshop included US and international experts with backgrounds in allergy/allergens, immunology, asthma, environmental health, environmental exposures and pollutants, epidemiology, public health, and bioinformatics. Workshop participants provided new insights into the biologic properties of indoor exposures, indoor exposure assessment, and exposure reduction techniques. This informed a primary focus of the workshop: to critically review trials and research relevant to the prevention or control of asthma through environmental intervention. The participants identified important limitations and gaps in scientific methodologies and knowledge and proposed and prioritized areas for future research. The group reviewed socioeconomic and structural challenges to changing environmental exposure and offered recommendations for creative study design to overcome these challenges in trials to improve asthma management. The recommendations of this workshop can serve as guidance for future research in the study of the indoor environment and on environmental interventions as they pertain to the prevention and management of asthma and airway allergies.

The novel structure of the cockroach allergen Bla g 1 has implications for allergenicity and exposure assessment.

BACKGROUND: Sensitization to cockroach allergens is a major risk factor for asthma. The cockroach allergen Bla g 1 has multiple repeats of approximately 100 amino acids, but the fold of the protein and its biological function are unknown. OBJECTIVE: We sought to determine the structure of Bla g 1, investigate the implications for allergic disease, and standardize cockroach exposure assays. METHODS: nBla g 1 and recombinant constructs were compared by using ELISA with specific murine IgG and human IgE. The structure of Bla g 1 was determined by x-ray crystallography. Mass spectrometry and nuclear magnetic resonance spectroscopy were used to examine the ligand-binding properties of the allergen. RESULTS: The structure of an rBla g 1 construct with comparable IgE and IgG reactivity to the natural allergen was solved by x-ray crystallography. The Bla g 1 repeat forms a novel fold with 6 helices. Two repeats encapsulate a large and nearly spherical hydrophobic cavity, defining the basic structural unit. Lipids in the cavity varied depending on the allergen origin. Palmitic, oleic, and stearic acids were associated with nBla g 1 from cockroach frass. One unit of Bla g 1 was equivalent to 104 ng of allergen. CONCLUSIONS: Bla g 1 has a novel fold with a capacity to bind various lipids, which suggests a digestive function associated with nonspecific transport of lipid molecules in cockroaches. Defining the basic structural unit of Bla g 1 facilitates the standardization of assays in absolute units for the assessment of environmental allergen exposure.

High-throughput fluorescent multiplex array for indoor allergen exposure assessment.

BACKGROUND: Current enzyme immunoassay methods for detection of common indoor allergens in environmental dust samples are labor-intensive and time consuming. OBJECTIVE: To develop and validate a fluorescent multiplex array to measure 6 (Der p 1, Der f 1, Der p 2, Der f 2, Fel d 1, and Can f 1) indoor allergen levels simultaneously. METHODS: A multiplex array for 6 allergens, using mAbs covalently coupled to fluorescent microspheres, was developed using a single universal standard composed of purified natural allergens. The multiplex array was validated by comparing the measured dust mite, cat, and dog allergen levels in household dust samples to those obtained by standard ELISA methods. RESULTS: Linear regression analysis showed a highly significant quantitative correlation between the multiplex array and ELISA for dust mite, cat, and dog allergens: R(2) values ranging from 0.90 to 0.99 (P < .001). In addition, the sensitivity, limit of detection (<0.1 ng/mL), reproducibility, intra-assay coefficient of variance (<5%), and interassay coefficient of variance (<25%) of the fluorescent multiplex array were shown to be equal to or better than the ELISA method. CONCLUSION: A multiplex array has been developed to measure simultaneously 6 indoor allergens from a single sample. The array will facilitate epidemiologic studies and indoor air quality assessments and can, in principle, be expanded to include other allergens and biologics. CLINICAL IMPLICATIONS: The multiplex array lends itself to clinical studies, population-based environmental surveys, and allergen avoidance studies comparing allergen exposure in large populations over several time points.

Peanut allergen exposure through saliva: assessment and interventions to reduce exposure.

BACKGROUND: Exposure to food allergens through saliva (kissing, utensils) can cause local and systemic allergic reactions. OBJECTIVE: To determine the time course of peanut allergen (Ara h 1) persistence in saliva after ingestion of peanut butter and to evaluate mouth cleansing interventions to reduce salivary peanut allergen. METHODS: Thirty-eight individuals ingested 2 tablespoons of peanut butter, and saliva was collected at various time points. At another time, samples were collected after 5 interventions (brushing teeth, brushing and rinsing, rinsing, waiting then brushing, waiting then chewing gum). Detection of Ara h 1 was performed by a monoclonal-based ELISA (detection limit, 15-20 ng/mL). RESULTS: Salivary Ara h 1 varied considerably immediately after ingestion, but included levels expected to invoke reactions (as much as 40 microg/mL). Most (87%) subjects with detectable peanut after a meal had undetectable levels by 1 hour with no interventions. None had detectable levels several hours later after a peanut-free lunch. This result indicates (95% confidence) that 90% would have undetectable Ara h 1 in saliva under these circumstances. All of the interventions reduced salivary Ara h 1, in some cases by >95%, but Ara h 1 remained detectable in approximately 40% of samples (though typically below thresholds reported to induce reactions). CONCLUSION: Patients with peanut allergy require counseling regarding risks of kissing or sharing utensils, even if partners have brushed teeth or chewed gum. Advice to reduce risks, though not as ideal as total avoidance, includes waiting a few hours plus eating a peanut-free meal. CLINICAL IMPLICATIONS: Waiting several hours and ingesting a peanut-free meal were more effective at reducing salivary peanut protein concentration than simple, immediate interventions.

Challenges associated with indoor moulds: Health effects, immune response and exposure assessment.

Assessment of the health effects of indoor moulds is complicated by the diversity of mould species found in homes and the limitations of current methods to determine exposure. Thus it is difficult to establish whether there is a relationship between mould exposure and disease. Allergic respiratory diseases are commonly caused by Alternaria, Aspergillus, Cladosporium and Penicillium spp. IgE-mediated sensitization to these moulds is a strong risk factor for asthma: IgG and IgE antibody responses to Aspergillus fumigatus are common in patients with other respiratory diseases, including allergic bronchopulmonary aspergillosis and cystic fibrosis. Several important mould allergens have been cloned with different biologic functions. These allergens can also serve as immunologic markers which may be associated with disease activity. Evidence for health effects associated with exposure to mould toxins e.g. from Stachybotrys spp. is less compelling. Recently, several new technolgies have been introduced which could be applied to mould exposure assessment. Ion-charging devices can silently sample air within homes and have been successfully used to monitor animal allergens. Fluorescent multiplex array technology is being used to make quantitative measurements of five to ten allergens simultaneously on dust samples. The development of monospecific (monoclonal or polyclonal) antibodies to specific fungal antigens or allergens will facilitate more accurate assessments of the mould burden in homes, schools and commercial buildings. The application of these techniques in well-designed clinical studies will enable better understanding of the health effects of moulds.