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A new patient-operated sampling device for measurement of aeroallergens
Ann Allergy Asthma Immunol xxx (2016) 1e2
Contents lists available at ScienceDirect
Letter
A new patient-operated sampling device for measurement of aeroallergens A recent publication and editorial letter1,2 in this journal have drawn attention to the fact that dust collection is widely used for collection of material for testing asthmatic patient exposure to allergens for purely practical reasons, despite extensive recommendations that the airborne compartment of allergens is relevant to actual patient exposure. Barnes et al1 used capture of allergens by the air filter in homes run for a period of months to assess allergens in the air. They reported the widespread presence of cat or dog allergens in homes with no pets. A simple plug-in device for air sampling,3 which is inconspicuous and requires no technical skill for operation in a variety of settings, has been developed. Performance compared with a reference method for mold species and bacterial microbiome analysis was examined. A study using this system for common allergen profiling in the homes of 22 patients has been previously presented.4 Selection criteria were homes of patients with allergic rhinitis and/or allergic asthma and ownership of cat, dog, or both. Dust mite allergens were also found to be detectable4 in the airborne fraction. Because of their relatively low concentration in the airborne fraction, detection of dust mites has been problematic in the past.5 These authors5 introduced the use of a commercially available ion propulsion air cleaning device for air sampling. Inspirotec Inc has optimized the design of a miniature device based on the same principle. The device incorporates a removable cartridge with releasable electrodes. The released stainless steel electrode strips are extracted directly with standard buffer. The extracts were analyzed with the MARIA common household allergen multiplex assay6,7 by Indoor Biotechnologies (Charlottesville, VA). Test results from samples in which patients ran the devices in the bedroom for 24 hours and 7 days are given in Table 1. Patients executed Health Insurance Portability and Accountability Act and informed consent agreements. They were given a questionnaire with particulars about patient home environment and avoidance measures, including pet avoidance measures. All patients successfully completed runs without supervision. Of the 22 patients, 21 completed the questionnaire. Of those, 20 reported that the system was easy to use. These data can be used to test for consistency with patient-reported presence or absence of pets and efficacy of reported mitigation measures. Table 1 reveals that 7 of the 11 patients not owning a cat had no detectable cat allergen, and the remaining 4 were at the borderline of detectability. All patients reporting cat ownership had some measurable level of cat allergen in the bedroom, except patient 20, who was apparently successful
Disclosures: Ms Gandhi and Dr Gordon reported being cofounders of Inspirotec Inc. Dr Detjen reported serving as medical director of Inspirotec Inc. Funding Sources: This work was self-funded by Ms Gandhi and Dr Gordon.
Table 1 Effect of Patient-Reported Action on Corresponding Airborne Allergena Patient No.
Cat 11 10 2 18 1 17 6 3 19 20 12 13 16 14 4 5 7 8 15 21 22 9 Dog 20 6 7 8 19 21 15 4 22 2 18 3 5 13 12 14 16 9 1 10 11 17
Always
Sometimes
Rarely
Never
X X X X X X X X X X
X X X X X X X X X X X X X X X
a
X
No. of Pets
Allergy, ng 24 Hours
7 Days
4 2 1 1 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0
61.2 111.0 21.2 30.3 21.3 15.2 1.6 2.9 <0.20 <0.20 <0.20 <0.20 <0.20 0.4 <0.20 <0.20 <0.20 <0.20 <0.20 <0.20 <0.20 <0.20
695.9 273.0 137.3 68.8 59.3 54.6 14.6 5.6 3.97 <0.20 0.7 0.5 0.5 0.3 <0.20 <0.20 <0.20 <0.20 <0.20 <0.20 <0.20 <0.20
2 0 1 1 1 1 1 2 1 2 1 1 1 1 1 1 1
122.6 13.1 67.9 13.1 3.6 15.6 13.0 6.6 5.2 2.7 4.2 5.9 3.3 2.1 2.7 4.1 1.1 <0.60 <0.60 <0.60 <0.60 <0.60
123.2 89.8 89.1 89.0 48.3 42.6 39.8 20.5 17.0 11.6 7.3 7.2 6.8 6.3 6.3 3.3 3.2 2.2 <0.60 <0.60 <0.60 <0.60
1 0 0 0
Patient 9 did not provide a report. Allergen values are from MARIA immunoassays for corresponding allergen. Values were based on 1/10, 1/100, and 1/1000 dilutions of the samples. By contingency analysis, the 24-hour results represent, according to ownership of cat, a sensitivity of 80.0% and a specificity of 90.9%, with degree of agreement by Cohen k coefficient of 0.71 (P ¼ .001). The 7-day results reveal a sensitivity of 90.0% and a specificity of 63.4%, with degree of agreement by Cohen k coefficient of 0.53 (P ¼ .0115). For dog, contingency analysis revealed that the 24-hour and 7-day results represent, according to ownership of dog, a sensitivity of 100% and a specificity of 100%, with degree of agreement by Cohen k coefficient of 1 (P < .001).
http://dx.doi.org/10.1016/j.anai.2016.03.006 1081-1206/Ó 2016 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
2
Letter / Ann Allergy Asthma Immunol xxx (2016) 1e2
in excluding the cat from the bedroom and eliminated measurable airborne allergen. Homes with no dog had no detectable dog allergen, with one exception. The presence of dog allergen in homes with no dog has been reported elsewhere.1 Patients 5, 12, and 16 had some level of dog allergen in the bedroom despite reporting that they excluded the dogs from the bedrooms. Those who reported dogs in the bedroom had exposure that correlated with the presence of the Can f 1 allergen in their bedrooms. Thus, the sampling device provides data that are an empirical metric for evaluating the efficacy of abatement measures undertaken by the patients. Combination of the home allergen profiles with medical records led to specific individual potential actions, which would not have been considered in the absence of the patient allergen profiles.4 In 17 of 22 cases, the allergen profile generated by the patients will potentially have an effect on patient management by prioritization of problematic allergens, many of which would not otherwise be anticipated, and avoidance measures that permit more focused patient management than is currently feasible. Patient profiles are a potentially useful didactic tool for improving patient adherence. Objective data will help change patient behavior. In summary, the ability of patients to generate allergen profiles of the breathable air in their own homes provides an otherwise unavailable adjunct to patient care. Acknowledgments The dedicated support of Chris Nottoli, RN, Karla Schaefer, RN, and Trish Detjen, RN, in coordination with the patients is gratefully acknowledged.
Julian Gordon, PhD* Paul Detjen, MDy David Kelso, PhDz Prasanthi Gandhi, MBA, MPH* *Inspirotec Inc Glenview, Illinois y Kenilworth Medical, Allergy and Immunology Kenilworth, Illinois z Department of Biomedical Engineering Northwestern University Chicago, Illinois [email protected]
References [1] Barnes CS, Allenbrand R, Mohammed M, et al. Measurement of aeroallergens from furnace filters. Ann Allergy Asthma Immunol. 2015;114:221e225. [2] Sublett JL. A new method for air sampling with real-world results. Ann Allergy Asthma Immunol. 2015;114:160e161. [3] Gordon J, Gandhi P, Shekhawat G, Frazier A, Hampton-Marcell J, Gilbert J. A simple novel device for air sampling by electrokinetic capture. Microbiome. 2015;3:1e8. [4] Gandhi P, Detjen P, Gordon J. A new tool that fingerprints allergens in homes to individualize and improve patient care. J Allergy Clin Immunol. 2015;135: AB384. [5] Custis NJ, Woodfolk JA, Vaughan JW, Platts-Mills TAE. Quantitative measurement of airborne allergens from dust mites, dogs, and cats using an ioncharging device. Clin Exp Allergy. 2003;33:986e991. [6] Earle CD, King EM, Tsay A, et al. High-throughput fluorescent multiplex array for indoor allergen exposure assessment. J Allergy Clin Immunol. 2007;119: 428e433. [7] King E, Filep S, Smith B, et al. A multi-center ring trial of allergen exposure assessment using fluorescent multiplex array technology. Allergy. 2009;64:4e5.
Contents lists available at ScienceDirect
Letter
A new patient-operated sampling device for measurement of aeroallergens A recent publication and editorial letter1,2 in this journal have drawn attention to the fact that dust collection is widely used for collection of material for testing asthmatic patient exposure to allergens for purely practical reasons, despite extensive recommendations that the airborne compartment of allergens is relevant to actual patient exposure. Barnes et al1 used capture of allergens by the air filter in homes run for a period of months to assess allergens in the air. They reported the widespread presence of cat or dog allergens in homes with no pets. A simple plug-in device for air sampling,3 which is inconspicuous and requires no technical skill for operation in a variety of settings, has been developed. Performance compared with a reference method for mold species and bacterial microbiome analysis was examined. A study using this system for common allergen profiling in the homes of 22 patients has been previously presented.4 Selection criteria were homes of patients with allergic rhinitis and/or allergic asthma and ownership of cat, dog, or both. Dust mite allergens were also found to be detectable4 in the airborne fraction. Because of their relatively low concentration in the airborne fraction, detection of dust mites has been problematic in the past.5 These authors5 introduced the use of a commercially available ion propulsion air cleaning device for air sampling. Inspirotec Inc has optimized the design of a miniature device based on the same principle. The device incorporates a removable cartridge with releasable electrodes. The released stainless steel electrode strips are extracted directly with standard buffer. The extracts were analyzed with the MARIA common household allergen multiplex assay6,7 by Indoor Biotechnologies (Charlottesville, VA). Test results from samples in which patients ran the devices in the bedroom for 24 hours and 7 days are given in Table 1. Patients executed Health Insurance Portability and Accountability Act and informed consent agreements. They were given a questionnaire with particulars about patient home environment and avoidance measures, including pet avoidance measures. All patients successfully completed runs without supervision. Of the 22 patients, 21 completed the questionnaire. Of those, 20 reported that the system was easy to use. These data can be used to test for consistency with patient-reported presence or absence of pets and efficacy of reported mitigation measures. Table 1 reveals that 7 of the 11 patients not owning a cat had no detectable cat allergen, and the remaining 4 were at the borderline of detectability. All patients reporting cat ownership had some measurable level of cat allergen in the bedroom, except patient 20, who was apparently successful
Disclosures: Ms Gandhi and Dr Gordon reported being cofounders of Inspirotec Inc. Dr Detjen reported serving as medical director of Inspirotec Inc. Funding Sources: This work was self-funded by Ms Gandhi and Dr Gordon.
Table 1 Effect of Patient-Reported Action on Corresponding Airborne Allergena Patient No.
Cat 11 10 2 18 1 17 6 3 19 20 12 13 16 14 4 5 7 8 15 21 22 9 Dog 20 6 7 8 19 21 15 4 22 2 18 3 5 13 12 14 16 9 1 10 11 17
Always
Sometimes
Rarely
Never
X X X X X X X X X X
X X X X X X X X X X X X X X X
a
X
No. of Pets
Allergy, ng 24 Hours
7 Days
4 2 1 1 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0
61.2 111.0 21.2 30.3 21.3 15.2 1.6 2.9 <0.20 <0.20 <0.20 <0.20 <0.20 0.4 <0.20 <0.20 <0.20 <0.20 <0.20 <0.20 <0.20 <0.20
695.9 273.0 137.3 68.8 59.3 54.6 14.6 5.6 3.97 <0.20 0.7 0.5 0.5 0.3 <0.20 <0.20 <0.20 <0.20 <0.20 <0.20 <0.20 <0.20
2 0 1 1 1 1 1 2 1 2 1 1 1 1 1 1 1
122.6 13.1 67.9 13.1 3.6 15.6 13.0 6.6 5.2 2.7 4.2 5.9 3.3 2.1 2.7 4.1 1.1 <0.60 <0.60 <0.60 <0.60 <0.60
123.2 89.8 89.1 89.0 48.3 42.6 39.8 20.5 17.0 11.6 7.3 7.2 6.8 6.3 6.3 3.3 3.2 2.2 <0.60 <0.60 <0.60 <0.60
1 0 0 0
Patient 9 did not provide a report. Allergen values are from MARIA immunoassays for corresponding allergen. Values were based on 1/10, 1/100, and 1/1000 dilutions of the samples. By contingency analysis, the 24-hour results represent, according to ownership of cat, a sensitivity of 80.0% and a specificity of 90.9%, with degree of agreement by Cohen k coefficient of 0.71 (P ¼ .001). The 7-day results reveal a sensitivity of 90.0% and a specificity of 63.4%, with degree of agreement by Cohen k coefficient of 0.53 (P ¼ .0115). For dog, contingency analysis revealed that the 24-hour and 7-day results represent, according to ownership of dog, a sensitivity of 100% and a specificity of 100%, with degree of agreement by Cohen k coefficient of 1 (P < .001).
http://dx.doi.org/10.1016/j.anai.2016.03.006 1081-1206/Ó 2016 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
2
Letter / Ann Allergy Asthma Immunol xxx (2016) 1e2
in excluding the cat from the bedroom and eliminated measurable airborne allergen. Homes with no dog had no detectable dog allergen, with one exception. The presence of dog allergen in homes with no dog has been reported elsewhere.1 Patients 5, 12, and 16 had some level of dog allergen in the bedroom despite reporting that they excluded the dogs from the bedrooms. Those who reported dogs in the bedroom had exposure that correlated with the presence of the Can f 1 allergen in their bedrooms. Thus, the sampling device provides data that are an empirical metric for evaluating the efficacy of abatement measures undertaken by the patients. Combination of the home allergen profiles with medical records led to specific individual potential actions, which would not have been considered in the absence of the patient allergen profiles.4 In 17 of 22 cases, the allergen profile generated by the patients will potentially have an effect on patient management by prioritization of problematic allergens, many of which would not otherwise be anticipated, and avoidance measures that permit more focused patient management than is currently feasible. Patient profiles are a potentially useful didactic tool for improving patient adherence. Objective data will help change patient behavior. In summary, the ability of patients to generate allergen profiles of the breathable air in their own homes provides an otherwise unavailable adjunct to patient care. Acknowledgments The dedicated support of Chris Nottoli, RN, Karla Schaefer, RN, and Trish Detjen, RN, in coordination with the patients is gratefully acknowledged.
Julian Gordon, PhD* Paul Detjen, MDy David Kelso, PhDz Prasanthi Gandhi, MBA, MPH* *Inspirotec Inc Glenview, Illinois y Kenilworth Medical, Allergy and Immunology Kenilworth, Illinois z Department of Biomedical Engineering Northwestern University Chicago, Illinois [email protected]
References [1] Barnes CS, Allenbrand R, Mohammed M, et al. Measurement of aeroallergens from furnace filters. Ann Allergy Asthma Immunol. 2015;114:221e225. [2] Sublett JL. A new method for air sampling with real-world results. Ann Allergy Asthma Immunol. 2015;114:160e161. [3] Gordon J, Gandhi P, Shekhawat G, Frazier A, Hampton-Marcell J, Gilbert J. A simple novel device for air sampling by electrokinetic capture. Microbiome. 2015;3:1e8. [4] Gandhi P, Detjen P, Gordon J. A new tool that fingerprints allergens in homes to individualize and improve patient care. J Allergy Clin Immunol. 2015;135: AB384. [5] Custis NJ, Woodfolk JA, Vaughan JW, Platts-Mills TAE. Quantitative measurement of airborne allergens from dust mites, dogs, and cats using an ioncharging device. Clin Exp Allergy. 2003;33:986e991. [6] Earle CD, King EM, Tsay A, et al. High-throughput fluorescent multiplex array for indoor allergen exposure assessment. J Allergy Clin Immunol. 2007;119: 428e433. [7] King E, Filep S, Smith B, et al. A multi-center ring trial of allergen exposure assessment using fluorescent multiplex array technology. Allergy. 2009;64:4e5.