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Knowledge and practice of dust mite control by specialty care.

BACKGROUND: Dust mites are the primary indoor allergen risk for increasing asthma attacks and morbidity. Adherence to allergen avoidance recommendations decreases bronchial reactivity and asthma morbidity. OBJECTIVE: This study compared the knowledge and practice of environmental control advice of families of children with asthma seen by an allergist or a pediatrician. Studies suggest that knowledge and practice of environmental control recommendations is inconsistent. METHODS: Subjects were aged 6 to 17 years, diagnosed with asthma, and had positive skin test to dust mites. There were 114 eligible pediatric patients, and 69 had also seen an allergist before the study. An in-home evaluation was completed during which parents were asked about environmental control knowledge and practice. An environmental technician then completed a walk-through evaluation to observe which recommendations were implemented in the home. RESULTS: Families who saw an allergist demonstrated significantly greater awareness of environmental control recommendations for dust mite allergens than those who had not. Knowledge and placement of allergen-proof mattress and pillow covers was significantly higher in these families. However, 30% of families who saw an allergist reported no knowledge of any environmental control recommendations for dust mites. Less than half of the allergist families (48%) who were advised to use mattress encasements actually had encasements on their children's beds. CONCLUSIONS: The parents of dust mite-sensitive, asthmatic children who saw an allergist were more aware of dust mite allergen control recommendations and made more indoor environmental changes.

Adolescent↗

Hazardous infant and early childhood sleeping environments and death scene examination.

Infants and young children are at risk of accidental asphyxia from unsafe sleeping environments Specific dangers include wedging/entrapment and positional asphyxia when infants slide into gaps between mattresses and cot sides or between beds and walls. Faulty cot construction may result in defects through which infants may fall and become suspended, or in spaces which entrap the head. Projections on the inside of cots may ensnare clothing causing hanging, as may nearby curtain cords and restraining harnesses. The mouth and nose may be covered by plastic sheeting or by the mattress in partially filled waterbeds. Rocking cradles with excessive angles of tilt may also place infants' heads into positions where breathing is compromised. Finally, external pressure by adults in shared sleeping situations may result in fatal chest compression or airway occlusion. In many of these situations the autopsy findings are entirely nonspecific and do not help in establishing a cause of death. Thus, careful death scene examination with later formal review of findings may be the only way to accurately determine the manner of death.

Journal Article↗

[Analysis of statutory health insurance data concerning utilization of support surfaces for pressure ulcers].

BACKGROUND AND OBJECTIVE: Support surfaces are commonly used to prevent and treat pressure ulcers. Up to now little is known about their application in Germany. PATIENTS AND METHODS: We conducted a cross-sectional study using claims data of the Gmuender ErsatzKasse (GEK) for the year 2004 to analyse the utilization of support surfaces for pressure ulcers in primary care. Based on age- and sex-specific treatment prevalences for individuals with at least one prescription, prevalence ratios (PR) were calculated. RESULTS: A total of 1999 subjects with a mean age of 63.4 years (SD: 20.7) received support surfaces for pressure ulcers. With respect to the numbers of prescriptions (n = 2421) alternating pressure mattresses (31.6%), air-filled rings (13.5%) and various seat cushions (13.0%) were used frequently, whereas foam mattresses only came to 4.7%. The treatment prevalence increases continuously with age with no sex-specific differences. Using the 50-59 year olds as a reference, men aged 90+ (PR: 43.94; 95% CI: 31.46-61.37) as well as women aged 90+ (PR: 40.61; 95% CI: 30.77-53.60) received approximately 40-times more often support surfaces for pressure ulcers. CONCLUSION: Support surfaces for pressure ulcers are commonly used in the elderly. Our study suggests that their application does not correspond to the best available evidence. Prevention and treatment of pressure ulcers as well as the selection of support surfaces should be seen as an interdisciplinary task.

Adult↗

Exposure to an abundance of cat (Fel d 1) and dog (Can f 1) allergens in Swedish farming households.

BACKGROUND: Earlier studies have shown that farmers are to a low degree sensitized to animal allergens. We have measured the amount of cat (Fel d 1) and dog (Can f 1) in farm households and examined the relationship between exposure and sensitization to cat and dog allergens. METHODS: Dust samples from the homes of 403 farmers who had participated in an epidemiologic follow-up study on respiratory symptoms were analyzed for allergen content by two-site ELISA methods. RESULTS: Fel d 1 was detected in 99.5% of the farmers' households ranging from 0.055 to 1455 microg/g dust in mattresses (GM 13.2) and to 3775 microg/g dust in living-room carpets (GM 17.1). Can f 1 was detected in 90.6% of the households from 0.2 to 116 microg/g dust in mattresses (GM 2.0) and to 504 microg/g dust in carpets (GM 4.3). Homes with pets present had the highest levels of the allergens (P<0.001). A total of 8.4% and 7.4% of the farmers were sensitized to cat and dog, respectively. A significant correlation was noted between exposure to the allergens and specific IgE to cat and dog, respectively (P<0.001). Sensitization to cat (OR = 4.9) and dog (OR = 17.8) was significantly associated with asthma. CONCLUSIONS: In spite of the abundance of Fel d 1 and Can f 1, farmers are only to a low degree sensitized to cats and dogs.

Agricultural Workers' Diseases↗

Predictors of house-dust-mite allergen concentrations in dry regions in Australia.

BACKGROUND: House-dust-mite allergen content differs between houses and is thought to be a function of the housing characteristics and furnishing choices that affect indoor microclimate and mite proliferation. The importance of these features may differ with regional climates. METHODS: Concentrations of mite allergen were analysed as a function of housing features. Information on housing features was collected by questionnaire in 50 houses in two towns in a dry inland region of Australia. Mite allergen (Der p 1) was measured by ELISA in dust samples collected on five occasions over 2 years from beds and floors. RESULTS: Der p 1 was detected in all houses. Many housing features did not influence mite allergen concentrations. However, the presence of evaporative cooling increased mite allergen by 3.34-fold in beds (P=0.007) and 3.94-fold in floors (P=0.003). Mite allergen was threefold higher in mattresses >5 years old, and synthetic and feather duvets tended to have higher and lower levels of mite allergen, respectively. CONCLUSIONS: In houses in dry, inland regions of Australia, evaporative cooling and older mattresses are associated with higher concentrations of mite allergen. Alternative forms of air conditioning to evaporative cooling may be useful for control of mite allergen in dry regions.

Allergens↗

The prevalence of reported asthma is independent of exposure in house dust mite-sensitized children.

In areas with low house dust mite (HDM) allergen exposure, both mite sensitization and asthma prevalence are low. In most other areas, HDM allergen exposure is higher than the threshold for sensitization. In this setting, is HDM allergen exposure a factor which is causally related to the development of asthma in HDM-sensitive individuals? To answer this question, the cumulative prevalence of asthma was evaluated in a group of 157 schoolchildren, aged 10 and 11 yrs, who were allergic to HDM allergen, and compared it with HDM allergen exposure and atopic status, using univariate and multivariate analysis. HDM allergen levels were measured in mattress dust using an enzyme-linked immunosorbent assay (ELISA) method. Of mattress dust samples, 94% had an HDM allergen level >2 microg x g dust(-1). Atopy was evaluated by means of skin prick tests using five common allergens. Among the predictive variables studied by means of univariate analysis, only the number of positive skin tests and male sex correlated with asthma prevalence, but not HDM allergen exposure. Logistic regression analysis also demonstrated that the number of positive skin tests correlated with asthma prevalence (odds ratio (OR)=1.38, p=0.05), whereas the OR for HDM allergen exposure was 1.0. This survey suggests that, in a geographical area with high HDM allergen exposure, asthma prevalence is not linked with HDM allergen levels.

Allergens↗

The prevention and incidence of asthma and mite allergy (PIAMA) birth cohort study: design and first results.

The Prevention and Incidence of Asthma and Mite Allergy (PIAMA) birth cohort study was initiated in 1996. Children born to allergic mothers were enrolled in a double-blind placebo-controlled trial for evaluating the use of mite-impermeable mattress and pillow covers. Children born to allergic and non-allergic mothers were enrolled in a 'natural history' study to assess the role of environmental and dietary risk factors for the development of allergic disease in childhood. Recruitment started by distributing a validated screening questionnaire among >10,000 pregnant women during their first visit to a prenatal health clinic. Allergic mothers-to-be were invited to participate in the intervention study. Allergic, and a random sample of non-allergic, mothers-to-be were invited to participate in the 'natural history' arm of the study. In the intervention study, homes were visited before birth, 3 months after birth, and 12 months after birth for the collection of dust samples from floors and mattresses. In addition, the homes of about one-third of the children in the 'natural history' part of the study were visited for dust collection when the children were 3 months of age. The intervention study started with 855 participants and the 'natural history' study with 3,291 participants. Follow-up at 3 years of age has now been completed with satisfactory compliance (>90%). A medical investigation and home visit at 4years of age are nearing completion. Preliminary results show that mite-allergen levels were lower than found in previous Dutch studies, and that the intervention measure had a significant effect on mite-allergen levels, without important clinical benefits up to age 2 years old. The allergic families lived in homes with fewer 'triggers' such as pets, smoking and carpets than the non-allergic families, regardless of the intervention. The ongoing PIAMA cohort study will probably reveal useful information concerning effects of allergen load and reduction in the setting of a relatively low mite-allergen exposure, as well as other variables on the development of allergic manifestions and asthma.

Air Pollution, Indoor↗

Study on the prevention of allergy in Children in Europe (SPACE): allergic sensitization in children at 1 year of age in a controlled trial of allergen avoidance from birth.

Several studies have demonstrated that early intervention may modulate the natural course of atopic disease. Our objective was to prevent sensitization to house-dust mite and food allergens, as well as the development of atopic symptoms during infancy, by the combination of an educational package and the use of mite allergen-impermeable mattress encasings. A multicentre European, population-based, randomized, controlled study of children at increased atopic risk [Study on the Prevention of Allergy in Children in Europe (SPACE)] was performed in five countries (Austria, Germany, Greece, the UK, and Lithuania), and included three cohorts - schoolchildren, toddlers, and newborns. We report on the newborn cohort. A total of 696 newborns were included from Austria, the UK, and Germany. Inclusion criteria were: a positive history of parental allergy; and a positive skin-prick test or specific immunoglobulin E (IgE) (IgE > or = 1.43 kU/L) against at least one out of a panel of common aeroallergens in one or both parents. At 1 year of age, the overall sensitization rate against the tested allergens [dust-mite allergens: Dermatophagoides pteronyssinus and Dermatophagoides farinae (Der p and Der f)] and food allergens (egg, milk) in the prophylactic group was 6.21% vs. 10.67% in the control group. The prevalence of sensitization against Der p was 1.86% in the prophylactic group vs. 5% in the control group. In conclusion, we were able to demonstrate, in a group of newborns at risk for atopic diseases, that the sensitization rate to a panel of aero- and food allergens could be effectively decreased through the use of impermeable mattress encasings and the implementation of easy-to-perform preventive measures.

Allergens↗

Domestic aeroallergen levels in Barcelona and Menorca (Spain).

Exposure to common indoor allergens is known to be associated with sensitization and triggers of asthma. Levels of allergens have been barely described in Mediterranean countries. This study reports domestic allergen levels among the general population of two regions of Spain. Dust samples were collected from living rooms and mattresses in homes of infants in Barcelona (n = 366) and Menorca (n = 475) and assayed for house dust mite (Der p 1) and cat allergen (Fel d 1) concentrations by enzyme-linked immunoabsorbent assay (ELISA). Geometric mean values (95% CI) of Der p 1 were 0.77 micro g/g (0.65, 0.92) in living rooms and 0.68 (0.56, 0.82) in children's mattresses in Barcelona, and 9.06 (7.93-10.34) and 3.12 (2.71-3.59) in Menorca, respectively. Fel d 1 levels were 0.37 micro g/g (0.31, 0.45) and 0.14 (0.12, 0.18) in Barcelona, and 0.42 (0.35, 0.50) and 0.20 (0.18, 0.24) in Menorca. Home characteristics were not consistently related to levels of aeroallergens in either location. Differences in Der p 1 levels in the two locations indicate that levels cannot be extrapolated from one part of a country to another with any certainty. Additionally, allergen reduction measures related to indoor sources must be specific to each location.

Air Pollution, Indoor↗

Study on the Prevention of Allergy in Children in Europe (SPACE): allergic sensitization at 1 year of age in a controlled trial of allergen avoidance from birth.

Several studies have demonstrated that early intervention may modulate the natural course of atopic disease. The objective of this study was to prevent sensitization to house dust mite and food allergens, as well as development of atopic symptoms, during infancy. To achieve this we employed the combination of an educational package with the use of mite allergen-impermeable mattress encasings. A multi-center European, population-based, randomized controlled study of children at increased atopic risk [study on the prevention of Allergy in Children in Europe (SPACE)] was performed in five countries (Austria, Germany, Greece, Great Britain, Lithuania) and included three cohorts of schoolchildren, toddlers and newborns. We report on the newborn cohort. A total of 696 newborns were included in Austria, Great Britain and Germany. Inclusion criteria were a positive history of parental allergy and a positive skin-prick test or specific immunoglobulin E (IgE) of >or= 1.43 kU/l against at least one out of a panel of common aeroallergens in one or both parents. At 1 year of age the overall sensitization rate against the tested allergens [dust mite allergens: Dermatophagoides pteronyssinus and D. farinae (Der p and Der f, respectively)] and food allergens (egg, milk) in the prophylactic group was 6.21% vs. 10.67% in the control group. The prevalence of sensitization against Der p was 1.86% in the prophylactic group vs. 5% in the control group. In conclusion, we demonstrated, in a group of newborns at risk for atopic diseases, that the sensitization rate to a panel of aero- and food allergens could be effectively decreased through the use of impermeable mattress encasings and the implementation of preventive measures that were easy to perform.

Allergens↗

Comparison of multiple environmental factors for asthmatic children in public housing.

Nine families of a public housing development in Boston were enrolled in a pilot asthma intervention program designed to gather dense environmental data and generate hypotheses about the relative importance of different contaminants and the viability of interventions. Despite formidable challenges working with this inner-city population, the project team succeeded in gaining active support for the project by forming a partnership with a community-based organization and by building positive relationships between the field team and the residents. Families were provided with physical interventions such as air filters, industrial cleaning and mattress covers to each apartment. Indoor temperature was high and relative humidity low during winter. Insulation of exposed steam pipes did not lower temperature. Cockroach, mouse and pet antigen levels were variable and frequently high in settled dust. Viable fungal spore levels were variable and high in some apartments. Dust-mite allergen levels were below the level of concern. Industrial cleaning led to transient reduction in mouse and cockroach antigen burden. Mattress and pillow covers lowered dust-mite antigen in bedrooms, but not living rooms. Nitrogen dioxide (NO2) levels exceeded ambient concentrations due to use of gas stoves and concentrations of particulate matter with aerodynamic diameter <2.5 microm (PM2.5) were above ambient levels because of smoking. Air filtering systems did not reduce PM levels. Several volatile organic compounds (VOCs) were above adverse risk concentrations. We hypothesize that our findings are consistent with a multifactorial model for exacerbation of asthma in this population and that no single problem dominates.

Adolescent↗

Spinal fractures resulting from the 1995 Great Hanshin Earthquake of the Kobe-Osaka area of Japan.

One of the worst earthquakes hit the Hanshin area between Kobe and Osaka, in the early morning at 5:46 AM on January 17th 1995. The destructive force with MG 7.2 severely damaged buildings, houses, roads and railways, leaving 6500 dead, and 34,900 injured. Hyogo College of Medicine located in this area was also severely damaged, thus there was a major challenge to provide post-quake medical support. A post-quake investigation in this area was done by 50 affiliated hospitals. More than 15,000 victim-patients were treated at these hospitals during the first 3 days after the quake. Major injuries were spinal fractures, and other trunk fractures, including rib or pelvis fractures, but fractures of long bones were uncommon, because the quake hit this area in the early morning when most people were asleep. In this study, the mechanisms of these major injuries were analysed by direct interview soon after the quake, with 230 victim-patients who had 140 spinal fractures, and 100 with rib or pelvis fractures. Most of those who had a spinal fracture had either sat up or stood up on their 'Futon' mattresses without bed frames and were struck on their backs by falling furniture or ceilings. On the other hand, patients who had fractures of the ribs or the pelvis had been lying in the supine or lateral position and were hit on their chest or pelvis. This characteristic lifestyle pattern of the Japanese people to lie down on the floor directly beside furniture, resulted in these injuries. From these results, we will emphasize the following precautions:- If an earthquake occurs during sleeping hours at home, do not stand up or sit up. The best position is to crouch on the 'Futon' mattress.

Adult↗

Determination of selected microbial volatile organic compounds by diffusive sampling and dual-column capillary GC-FID--a new feasible approach for the detection of an exposure to indoor mould fungi?

A new, analytically valid procedure is described to assess the exposure of human beings to the so-called microbial volatile organic compounds (MVOCs) in air. The method can be used routinely for large sample numbers and is especially valuable as a basis for further research on the correlation between single MVOCs and indoor mould growth. The procedure is based on the fact that fungi produce a variety of volatile organic compounds, such as 3-methylbutan-1-ol, 3-methylbutan-2-ol, fenchone, heptan-2-one, hexan-2-one, octan-3-one, octan-3-ol, pentan-2-ol, alpha-terpineol, and thujopsene, which they emit into the indoor environment. Using diffusive samplers, these MVOCs are adsorbed onto charcoal during a sampling interval of four weeks. The described method is thus superior to existing methods which use short-term active sampling. After desorption with carbon disulfide, the MVOCs were determined by dual-column gas chromatography with flame ionization detection using the large-volume injection technique for sample introduction. The detection limits ranged between 0.15 and 0.53 microgram m-3, within-series precision was found to range between 6.5 and 19.0%, and recovery was between 77 and 118%. The procedure has been successfully applied in the context of a large field study to measure the indoor MVOC exposure in children's rooms of 132 dwellings. The objective of the study was to examine the relation between indoor mould growth, the indoor MVOC exposure and the prevalence of adverse health effects. Information about mould formation has been obtained by a questionnaire and by the determination of colony forming units of mould fungi in mattress dust. With the exception of 3-methylbutan-2-ol, fenchone, nonan-2-one, octan-2-one, and thujopsene, indoor air concentrations of all MVOCs under investigation were significantly higher inside damp and mouldy dwellings. From the primary MVOCs under investigation, 3-methylbutan-1-ol, hexan-2-one, heptan-2-one, and octan-3-ol were found to be most reliable indicators for mould formation. A correlation was also found between selected MVOCs and the occurrence of mould species in mattress dust. Aspergillus sp. correlated with heptan-2-one, hexan-2-one, octan-3-ol, octan-3-one, and alpha-terpineol, while the occurrence of Eurotium sp. was correlated with higher indoor air concentrations of 3-methylbutan-1-ol, 3-methylbutan-2-ol, heptan-2-one, hexan-2-one, octan-3-ol, and thujopsene. Children living in dwellings with elevated MVOC levels had a higher prevalence of asthma, hay fever, wheezing, and irritations of the eyes. These positive associations persisted after controlling for confounding factors such as age, sex, body-mass index, number of siblings, social status, passive smoking, type of heating, and ventilation habits. However, they were not statistically significant. This lack of significance may be a result of the small number of investigated samples.

Air Pollution, Indoor↗

Sudden unexpected death in infants under 3 months of age and vaccination status- -a case-control study.

AIMS: To determine whether DTPP+Hib vaccination (diphtheria, tetanus, pertussis, poliomyelitis +/- haemophilus) increased the risk of sudden unexpected death (SUD) in children under 3 months of age. METHODS: We conducted a multicentre case-control study in the 28 French 'SIDS Centers'. Case selection was based on death labelled sudden infant death syndrome (SIDS) of an infant aged between 30 and 90 days. Three living controls were selected, matched for sex, gestational age and born immediately after the victim in the same maternity unit. RESULTS: We identified 114 cases of SUD aged between 30 and 90 days and 341 live controls matched for age and sex and born in the same maternity unit as the case. DTPP+/-Hib immunization did not increase the risk of SUD (OR 1.08) (95% CI 0.49, 2.36) in children under 3 months of age when adjusted for sleeping position, illness in the week before death, maternal tobacco consumption, birth weight, type of mattress, breastfeeding and sex. However, low birth-weight (6.53 [2.29, 18.9]), multiple birth (5.1 [1.76, 15.13]), no breastfeeding (1.77 [1.1, 2.85]), prone sleeping position (9.8 [5, 8, 18, 9]), soft mattress (3.26 [1.69, 6.29]), recent illness (3.44 [1.84, 6.41]) and parental smoking (1.74 [1.2, 2.96]) were confirmed as risk factors in early SIDS. CONCLUSIONS: DTPP+/-Hib immunization is not a risk factor for early SUD. In this population, we found the same risk factors as described for SIDS.

Bacterial Capsules↗

Double-blind placebo-controlled house dust mite control measures in adult patients with atopic dermatitis.

BACKGROUND: Avoidance of allergens has been shown to be of benefit in patients with atopic asthma sensitized to indoor allergens. In atopic dermatitis, there is so far little information about the effect of house dust mite elimination strategies. OBJECTIVES: We therefore performed a randomized controlled study of house dust mite control in patients with this disease. METHODS: Twenty adult patients with moderate to severe atopic dermatitis were included. Inclusion criteria were a positive RAST to house dust mite antigen (CAP class > 3) and a concentration of > 2 microg g(-1) of the house dust mite antigen Der p1 in the patient's mattress dust. Patients were randomized to either the active treatment group (allergen-impermeable mattress encasing, acaricide spray containing tannic acid and benzylbenzoate) or a control group (allergen-permeable encasing, spray containing water and traces of ethanol). Severity of disease was estimated every 2 months by an established score (SCORAD), and eosinophil cationic protein (ECP) in the serum was determined by enzyme-linked immunosorbent assay. Furthermore, the use of topical steroids was quantified. Patients assessed daytime pruritus and pruritus-induced sleeplessness weekly on a visual analogue scale. The study lasted 1 year. RESULTS: At the end of the study, the active treatment group showed a statistically significant reduction in Der p1 exposure as compared with the control group. However, when comparing the change from the start to the end of the study, there was no statistically significant difference between active treatment and control groups as measured by the SCORAD score and by ECP levels in the serum. Some patients in the active treatment group reported less pruritus-induced sleeplessness, but there was no statistically significant difference between the two treatment groups. CONCLUSIONS: For adult patients with atopic dermatitis it was shown that 1 year of house dust mite avoidance reduced the allergen exposure, but an improvement of overall disease activity was not demonstrated.

Adolescent↗

Domestic allergens in public places III: house dust mite, cat, dog and cockroach allergens in British hospitals.

BACKGROUND: Exposure and sensitization to indoor allergens is a major cause of asthma. OBJECTIVES: This study investigated the levels of house dust mite, cat, dog and cockroach allergens in the dust and air in hospitals and the effects of regular vacuum cleaning on allergen levels in hospital chairs. METHODS: Der p 1, Fel d 1, Can f 1 and Bla g 2 were measured in the dust collected by vacuuming upholstered chairs and a 1 m2 area of carpet and mattress in 14 hospitals. Air samples were collected using an air sampler (flow rate 60 L/min) on 10 separate days for 4 h in the outpatient department in one of the hospitals during busy clinics when patients were waiting for their appointments. In addition, dust samples were collected on four occasions, at 4-weekly intervals, from 36 fabric covered chairs in the outpatient area of a busy chest clinic by vacuuming each chair for 2 min. During the intervening weeks, 18 of the chairs (active group) were each cleaned by vacuuming for 1 min, three times per week. Der p 1, Fel d 1, Can f 1 and Bla g 2 were assayed using monoclonal antibody-based ELISA. RESULTS: In total, 83 carpets, 69 mattresses and 42 upholstered chairs were sampled. The levels of dust mite allergen Der p 1 and cockroach allergen Bla g 2 found in the hospital setting were low. High levels of Fel d 1 (GM 22.9 microg/g, range 4.5-58) and Can f 1 (GM 21.6 microg/g, range 4-63) were found in upholstered chairs. Airborne Can f 1 was detected on every occasion (range 0.12-0.56 ng/m3), whilst detectable airborne Fel d 1 was found on 7 out of the 10 sampling days (range 0.09-0.22 ng/m3). Der p 1 and Bla g 2 were below the detection limit in all airborne samples. Following repeated vacuuming the mean cat and dog allergen levels decreased significantly (P<0.001) and were almost fivefold lower in the vacuumed chairs compared with the control group. CONCLUSIONS: Low levels of mite allergen are unlikely to be of any clinical significance to mite-sensitive asthmatic patients. However, upholstered chairs in hospitals constitute a significant reservoir of cat and dog allergen. Inhalation of airborne allergen in patients attending their hospital appointment may exacerbate asthma in those highly allergic to cats or dogs. These results question the wisdom of introducing soft furnishings and carpets into hospitals. Three-times weekly vacuuming significantly reduces allergen levels in upholstered chairs.

Air Pollution, Indoor↗

Mechanical ventilation protects one-storey single-dwelling houses against increased air humidity, domestic mite allergens and indoor pollutants in a cold climatic region.

BACKGROUND: Poor ventilation in modern, highly insulated housing is an important factor in promoting indoor humidity levels to exceed 7 g/kg in cold climatic regions. OBJECTIVE: To investigate the ventilation rate in houses with different ventilation systems in relation to indoor air humidity, domestic mite allergen levels and volatile organic compounds (VOC). METHODS: Measurements were performed regarding ventilation rate, indoor temperature, air humidity, mattress mite allergen concentrations using enzyme-linked immunosorbent assay and total indoor VOC in 59 similarly constructed one-storey single-dwelling houses. In 22 of the houses, a mechanical supply and exhaust ventilation were installed after construction. RESULTS: In only five of the houses with mechanical supply and exhaust ventilation the air exchange rate per hour (ACH) was below 0. 5 compared with 24 of the 29 houses with natural ventilation (OR = 0. 06, CI 95% 0.01-0.2). None of the 23 houses with an ACH >/= 0.5 had an absolute indoor humidity (AIH) of 7 g/kg air or more, compared with 10 of the 36 houses with an ACH < 0.5 (P = 0.01 ). In none of the 23 houses with an ACH >/= 0.5 were concentrations of mite allergen exceeding 2 microg/g of dust found, compared with six of the 36 houses (17%) with an ACH below 0.5 (P = 0.04). Further, 10 of the 34 houses with a total VOC exceeding 200 microg/m3 had mite allergen in mattress dust exceeding 0.5 microg/g, compared with one of the 22 houses with VOC < 200 microg/m3 (P = 0.04). CONCLUSION: The study shows that in modern, highly insulated, one-storey single-dwelling houses in cold temperate regions, mechanical ventilation increases the possibility of reaching an ACH of >/= 5 which protects against indoor humidity levels contributing to mite survival as well as high levels of indoor air pollutants in winter.

Air Pollution, Indoor↗

House dust mite fauna of tropical Singapore.

INTRODUCTION AND AIMS: Sensitization to house dust mites is very common in the tropics. This study evaluated the dust mite fauna in Singaporean homes. METHODS: A total of 134 dust samples from 50 homes were evaluated. Dust mites were isolated, identified and quantified by standard techniques. RESULTS: Dust mites were isolated from 130/134 (97%) samples, with mites identified in all samples from sofas (n = 21) and carpets (n = 13), and 49/50 (98%) and 47/50 (94%) from mattresses and bedroom floors, respectively. All samples from sofas and carpets had more than 500 mites/g compared with 47/50 (94%) and 23/50 (46%) from mattresses and floors, respectively. Blomia tropicalis was the predominant mite (62% of total mites) followed by D. pteronyssinus (16% of total mites). Eight samples had a predominance of Sturnophagoides brasiliensis and Tarsonemus granarius. Other species that accounted approximately 1% of mites identified included D. farinae, Austroglycyphagus malaysiensis, Cheyletus malaccensis, Malayoglyphus intermedius, Suidasia pontifica and Tyrophagus putrescentiae. CONCLUSION: Dust mites were highly prevalent and present in high densities in Singaporean homes with B. tropicalis being the most prevalent species.

Animals↗