Subject(s)
Asthma/chemically induced , Mannans/poisoning , Occupational Diseases/chemically induced , Occupational Exposure/adverse effects , Bronchial Provocation Tests , Female , Food Industry , Forced Expiratory Volume , Humans , Immunoglobulin E/blood , Immunoglobulin G/blood , Mannans/immunology , Middle Aged , Skin Tests , United States , Vital CapacityABSTRACT
OBJECTIVE: Centrally installed ultraviolet (UV) irradiation units were investigated to determine the potential health benefits in mold-sensitized asthmatic children. METHODS: Nineteen mold-sensitized asthmatic children 5 to 17 years of age with home central ventilation systems were enrolled in a 28-week double-blinded placebo controlled cross-over trial. Clinical outcome measurements included morning and evening peak expiratory flow rates (PEFR), PEFR variability, change in forced expiratory volume in 1 second (FEV1), change in total rhinoconjunctivitis and asthma symptom scores, change in rhinoconjunctivitis and asthma quality-of-life scores, and total (rescue and controller) medication use from baseline and between time periods. Environmental outcomes included changes in temperature, relative humidity, dew point, and indoor airborne mold and bacterial counts from baseline and between time periods. Analysis of variance (ANOVA) and regression analysis and t test were used to evaluate relationships between environmental exposure(s) and clinical outcome measurements during each study period. RESULTS: Twelve male and seven female children, average age 10.6 years, were enrolled. A statistically significant improvement in PEFR variability in subjects receiving CREON2000 units followed by placebo units was observed (p < 0.05) across both treatment periods. Within group analysis during treatment period 1, a statistically significant improvement in reduction of asthma symptom scores, the number of days with asthma symptoms, total asthma medication use, and PEFR variability were observed in subjects receiving CREON2000 units versus placebo units (p < 0.05). No significant differences were observed between the CREON 2000 and placebo units for other clinical or environmental outcome measurements. CONCLUSIONS: Central UV irradiation was effective at reducing airway hyperresponsiveness manifested as PEFR variability and some clinical symptoms. A larger cohort controlled longitudinal study to validate the clinical health effects of UV irradiation as a primary indoor environmental intervention for allergic asthma is necessary to confirm this finding.
Subject(s)
Air Pollution, Indoor/prevention & control , Environmental Monitoring/methods , Fungi/immunology , Quality of Life , Ultraviolet Rays , Adolescent , Air Pollution, Indoor/analysis , Allergens/adverse effects , Analysis of Variance , Child , Child, Preschool , Cross-Over Studies , Desensitization, Immunologic , Double-Blind Method , Female , Health Status , Humans , Male , Peak Expiratory Flow Rate , Probability , Reference Values , Respiratory Function Tests , Risk Assessment , Statistics, NonparametricABSTRACT
BACKGROUND: Numerous epidemiologic studies have reported a relationship between dampness and increased respiratory symptoms in adults and children, which has led to increasing concerns among the general population about potential mold-related health effects. OBJECTIVE: To identify characteristics of patients with possible mold-related health effects that might help allergists better understand how to evaluate such patients in their practices. METHODS: The parameters that were evaluated for the total population included age, sex, upper and lower respiratory tract symptoms, systemic symptoms, atopic status, pet ownership, smoking history, mold sensitization, mold exposure, and exposure location. Subgroups stratified by atopic status, mold sensitization, and indoor mold exposure confirmed by an environmental mold report prepared by certified industrial hygienists were also analyzed. Significant associations were determined by correlation coefficients and logistic regression analysis. RESULTS: A total of 135 patients with possible mold-related health effects secondary to prolonged indoor mold exposure were evaluated. For the overall population, a strong correlation was found among atopy, mold sensitization, and sensitization to specific molds identified in the patient's environmental report. Mold intracutaneous testing was not useful for discriminating between atopic and nonatopic individuals. There were no associations among the patients' presenting symptoms, atopic status, and magnitude of mold exposure. Similar findings were identified when subgroup analysis was performed. CONCLUSIONS: Patients who present with mold-related health effects manifest heterogeneous characteristics. Medical history, skin testing, and current indoor mold sampling practices have significant limitations in establishing a causal link among mold exposure health effects.
