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Sick building syndrome, chemical sensitivity, and irritant rhinosinusitis
J ALLERGY CLIN IMMUNOL VOLUME 109, NUMBER 1
Abstracts
with a traditional life style were clinically examined and questionnaire replies assessed. Faecal samples were analysed by bacterial enumeration, bacterial typing through biochemical fingerprinting and by measuring microflora-associated characteristics (MACs). The numbers of colony forming units (Cfu) per g of faeces were significantly higher for enterococci and lactic acid bacteria in children who had never been exposed to antibiotics (5.5x10"7 vs 2.1×10"7; p<0.001) and (10×10"7 vs 4.1×10"7; p<0.01), respectively. Furthermore, the number of enterococci was significantly higher in breastfed and vegetarian infants (p<0.01). The diversity (Simpson's diversity index) of lactobacilli, as determined by biochemical fingerprinting, was higher in infants born at home, than in those born in hospital (p<0.01). Several MACs were related to specific life style features, and infants with an anthroposophic life style had a higher proportion of acetic acid and a lower proportion of propionic acid in their stool, as compared to the control children. In conclusion, life style factors related to the anthroposophic way of life influenced the composition of the gut flora in the infants. These differences may contribute to the lower prevalence of atopic disease previously observed in children in anthroposophic families.
1 f~J~l Lower Prevalence of Asthma, Rhinitis and Atopy in Rural India IJr'lr Is Associated With Higher House-Dust Endotoxin Levels Pudupakkam K Vedanthan*, PA Mahesh§, AD Holla§, Rajesh Vedanthane Andrew H Liu~ *University of Colorado, Fort Collins, CO §Allergy, Asthma and Chest Center, Mysore, India ¥School of Medicine, University of Caifornia, San Francisco, San Francisco, CA ~National Jewish Medical and Research Center, Denver, CO OBJECTIVES: (1) To determine the prevalence of asthma, rhinitis and allergen sensitization in rural vs. urban cohorts of children in India; (2) to determine if household endotoxin exposure differs in these locales. METHODS: The study took place in two locations: Mysore, an urban center in south India; and Vinobha, a rural village 25 miles from Mysore. Included in this study were 164 children (97 rural, 67 urban), ages 6 to 16 years, from 103 randomly selected households (50 urban, 53 rural). Data was collected from three sources: (1) parents of the children were interviewed using a modified version of the International Study of Asthma & Allergies in Childhood (ISAAC) questionnaire; 2) children underwent prick allergy skin testing to common indoor inhalant antigens (cockroach, dust mite, cat, dog, cattle); and 3) house-dust samples were analyzed for endotoxin content using a standardized Limulus Amebocyte Lysate assay. RESULTS: All ISAAC questions related to asthma and rhinitis revealed a significantly lower prevalence of these airways atopic diseases in the rural India cohort. For example, reported wheezing and sneezing were more common among urban children compared to the rural group (Table). Rural children were also less likely to be atopic based on skin test sensitivity, especially for dust mite and cockroach antigens (Table). There were no urban vs. rural differences in the prevalence of animal dander sensitization (i.e. cat, dog, cattle). House dust endotoxin levels were significantly higher in the rural vs. urban homes (geometric mean: 297 vs. 201 EU/mg dust, p=0.03, t-test). CONCLUSIONS: Rural living conditions in India are associated with lower prevalences of childhood asthma, rhinitis and atopy, and greater endotoxin exposure, when compared with an urban India locale. [AH Liu is supported by AAAAI (ERT) and NIH (HL04272-01A1)] Asthma, Rhinitis & Atopy are Less Common in Rural India
Wheezing Sneezing PST+ Dust mite** PST+ Cockroach
Rural
Urban
OR (CI)*
13% 17% 17% 22%
34% 45% 46% 43%
0.30 (0.14, 0.64) 0.26 (0.13, 0.53) 0.23 (0.11, 0.48) 0.37 (0.18, 0.73)
*Odds Ratio (5-95% confidence intervals); **Prick skin test + if 3ram or greater wheal (skin test data missing for one subject).
05
$51
Sick Building Syndrome, Chemical Sensitivity, and Irritant Rhinosinusitis
William Joel Meggs Brody School of Medicine at East Carolina University, Greenville, NC
OBJECTIVE: To assess for airway abnormalities and the multiple chemical sensitivity syndrome (MCS) in a cohort with Sick Building Syndrome (SBS). METHODS: Standardized histories and physical examinations, rhinomanometry, PFT's, and fiberoptic rhinolaryngoscopy were performed. Medical records and industrial hygiene reports were reviewed. Two case definitions (Cullen and Kipen) were used to screen for MCS. RESULTS: 38 patients with building related illness associated with a poorly ventilated office building (CO2>4,000 ppm) were examined. Mean age was 36.5_+12 yrs (range 18 to 61 yrs), with 8 men and 30 women. Complaints associated with the workplace included rhinosinusitis (100%), asthma (97%), fatigue (95%), headache (95%), difficuhies with memory (71%), and mental confusion (42%). Prior or current treatment with beta agonist inhalers, steroid inhalers, and montelukast was almost universal. PFF's were abnormal in 60% without discontinuation of medications. Nasal resistance was abnormal in 93% (mean right 1.32_+0.96 Pa/cm3/sec, range 0.45 to 4.41 Pa/cm3/sec, left 1.15_+0.75 Pa/cm3/sec, range 0.32 to 4.41 Pa/cm3/sec). Rhinolarygoscopy was abnormal in all 35 of 38 who underwent the evaluation, with findings characteristic of chemical irritant rhinitis. Discoloration of mucosa with injection, cobblestoning, edema, and injection of the uvula and soft pallet were common. 13% were still employed in the building, 13% were employed elsewhere, 74% were not currently employed. Irritant sensitivity was reported by 100%. 92% met the Cullen criteria for MCS, and 68% met the Kipen criteria. CONCLUSION: Rhinosinusitis, irritant sensitivity, asthma, fatigue, headaches, difficulty with memory, and objective measures of airway inflammation were found in association with employment in a sick building. These findings suggest a relationship between SBS and MCS, and irritant rhinosinusitis and asthma may underlie these disorders.
I N ~ Exposure to Ambient Particulate Spikes increases Exhaled eN0 U ~ I I Levels in Asthmatic Schoolchildren With a Clinical Sensitivity to Air Pollution Nathan Rabinovitch, Steven Dutton, Erwin W Gelfand National Jewish Medical and Research Center, Denver, CO Epidemiological and cohort studies have repeatedly demonstrated that acute exposure to ambient particulate less than 2.5 microns in diameter (PM2.5) is associated with increased asthma morbidity and mortality. Nevertheless, it remains unclear how PM2.5 may exert its effects on the airway and which asthmatics may be clinically susceptible to PM2.5. Twenty-six schoolchildren with moderate to severe asthma were initially enrolled in this 2-year study. Forced expiratory volume (FEV 1) measurements and rescue medication usage were recorded daily and were used to define sensitivity. Following Year 1, 7 children from the cohort were selected who demonstrated clinical sensitivity to PM2.5 levels (sensitive group) and were compared to 7 children who did not (control group). Urinary leukotriene FA (LIE4) and exhaled nitric oxide (eNO) were obtained from these 14 children on days when ambient PM2.5 was above the 90th percentile ("spike days") and below the 25th percentile ("baseline days"). Mean LTE4 levels did not significantly differ between spike and baseline days, regardless of whether data from the entire cohort or from the sensitive group alone was analyzed. Mean eNO levels, however, were significantly (p=0.0092) increased on spike days among the entire cohort. Subset analysis revealed that this finding was due to a highly significant (p<0.0001) increase in mean eNO levels (>60%) in the sensitive group. The control group demonstrated no such differences. Ambient PM2.5 particulate spikes are associated with increased levels of the airway inflammatory marker eNO in asthmatic children with a demonstrated clinical sensitivity to air pollution, eNO may serve as a marker of clinical sensitivity to air pollution spikes in children with asthma, Sponsor: EPA # R825702-05; GCRC# NJC 160.
Abstracts
with a traditional life style were clinically examined and questionnaire replies assessed. Faecal samples were analysed by bacterial enumeration, bacterial typing through biochemical fingerprinting and by measuring microflora-associated characteristics (MACs). The numbers of colony forming units (Cfu) per g of faeces were significantly higher for enterococci and lactic acid bacteria in children who had never been exposed to antibiotics (5.5x10"7 vs 2.1×10"7; p<0.001) and (10×10"7 vs 4.1×10"7; p<0.01), respectively. Furthermore, the number of enterococci was significantly higher in breastfed and vegetarian infants (p<0.01). The diversity (Simpson's diversity index) of lactobacilli, as determined by biochemical fingerprinting, was higher in infants born at home, than in those born in hospital (p<0.01). Several MACs were related to specific life style features, and infants with an anthroposophic life style had a higher proportion of acetic acid and a lower proportion of propionic acid in their stool, as compared to the control children. In conclusion, life style factors related to the anthroposophic way of life influenced the composition of the gut flora in the infants. These differences may contribute to the lower prevalence of atopic disease previously observed in children in anthroposophic families.
1 f~J~l Lower Prevalence of Asthma, Rhinitis and Atopy in Rural India IJr'lr Is Associated With Higher House-Dust Endotoxin Levels Pudupakkam K Vedanthan*, PA Mahesh§, AD Holla§, Rajesh Vedanthane Andrew H Liu~ *University of Colorado, Fort Collins, CO §Allergy, Asthma and Chest Center, Mysore, India ¥School of Medicine, University of Caifornia, San Francisco, San Francisco, CA ~National Jewish Medical and Research Center, Denver, CO OBJECTIVES: (1) To determine the prevalence of asthma, rhinitis and allergen sensitization in rural vs. urban cohorts of children in India; (2) to determine if household endotoxin exposure differs in these locales. METHODS: The study took place in two locations: Mysore, an urban center in south India; and Vinobha, a rural village 25 miles from Mysore. Included in this study were 164 children (97 rural, 67 urban), ages 6 to 16 years, from 103 randomly selected households (50 urban, 53 rural). Data was collected from three sources: (1) parents of the children were interviewed using a modified version of the International Study of Asthma & Allergies in Childhood (ISAAC) questionnaire; 2) children underwent prick allergy skin testing to common indoor inhalant antigens (cockroach, dust mite, cat, dog, cattle); and 3) house-dust samples were analyzed for endotoxin content using a standardized Limulus Amebocyte Lysate assay. RESULTS: All ISAAC questions related to asthma and rhinitis revealed a significantly lower prevalence of these airways atopic diseases in the rural India cohort. For example, reported wheezing and sneezing were more common among urban children compared to the rural group (Table). Rural children were also less likely to be atopic based on skin test sensitivity, especially for dust mite and cockroach antigens (Table). There were no urban vs. rural differences in the prevalence of animal dander sensitization (i.e. cat, dog, cattle). House dust endotoxin levels were significantly higher in the rural vs. urban homes (geometric mean: 297 vs. 201 EU/mg dust, p=0.03, t-test). CONCLUSIONS: Rural living conditions in India are associated with lower prevalences of childhood asthma, rhinitis and atopy, and greater endotoxin exposure, when compared with an urban India locale. [AH Liu is supported by AAAAI (ERT) and NIH (HL04272-01A1)] Asthma, Rhinitis & Atopy are Less Common in Rural India
Wheezing Sneezing PST+ Dust mite** PST+ Cockroach
Rural
Urban
OR (CI)*
13% 17% 17% 22%
34% 45% 46% 43%
0.30 (0.14, 0.64) 0.26 (0.13, 0.53) 0.23 (0.11, 0.48) 0.37 (0.18, 0.73)
*Odds Ratio (5-95% confidence intervals); **Prick skin test + if 3ram or greater wheal (skin test data missing for one subject).
05
$51
Sick Building Syndrome, Chemical Sensitivity, and Irritant Rhinosinusitis
William Joel Meggs Brody School of Medicine at East Carolina University, Greenville, NC
OBJECTIVE: To assess for airway abnormalities and the multiple chemical sensitivity syndrome (MCS) in a cohort with Sick Building Syndrome (SBS). METHODS: Standardized histories and physical examinations, rhinomanometry, PFT's, and fiberoptic rhinolaryngoscopy were performed. Medical records and industrial hygiene reports were reviewed. Two case definitions (Cullen and Kipen) were used to screen for MCS. RESULTS: 38 patients with building related illness associated with a poorly ventilated office building (CO2>4,000 ppm) were examined. Mean age was 36.5_+12 yrs (range 18 to 61 yrs), with 8 men and 30 women. Complaints associated with the workplace included rhinosinusitis (100%), asthma (97%), fatigue (95%), headache (95%), difficuhies with memory (71%), and mental confusion (42%). Prior or current treatment with beta agonist inhalers, steroid inhalers, and montelukast was almost universal. PFF's were abnormal in 60% without discontinuation of medications. Nasal resistance was abnormal in 93% (mean right 1.32_+0.96 Pa/cm3/sec, range 0.45 to 4.41 Pa/cm3/sec, left 1.15_+0.75 Pa/cm3/sec, range 0.32 to 4.41 Pa/cm3/sec). Rhinolarygoscopy was abnormal in all 35 of 38 who underwent the evaluation, with findings characteristic of chemical irritant rhinitis. Discoloration of mucosa with injection, cobblestoning, edema, and injection of the uvula and soft pallet were common. 13% were still employed in the building, 13% were employed elsewhere, 74% were not currently employed. Irritant sensitivity was reported by 100%. 92% met the Cullen criteria for MCS, and 68% met the Kipen criteria. CONCLUSION: Rhinosinusitis, irritant sensitivity, asthma, fatigue, headaches, difficulty with memory, and objective measures of airway inflammation were found in association with employment in a sick building. These findings suggest a relationship between SBS and MCS, and irritant rhinosinusitis and asthma may underlie these disorders.
I N ~ Exposure to Ambient Particulate Spikes increases Exhaled eN0 U ~ I I Levels in Asthmatic Schoolchildren With a Clinical Sensitivity to Air Pollution Nathan Rabinovitch, Steven Dutton, Erwin W Gelfand National Jewish Medical and Research Center, Denver, CO Epidemiological and cohort studies have repeatedly demonstrated that acute exposure to ambient particulate less than 2.5 microns in diameter (PM2.5) is associated with increased asthma morbidity and mortality. Nevertheless, it remains unclear how PM2.5 may exert its effects on the airway and which asthmatics may be clinically susceptible to PM2.5. Twenty-six schoolchildren with moderate to severe asthma were initially enrolled in this 2-year study. Forced expiratory volume (FEV 1) measurements and rescue medication usage were recorded daily and were used to define sensitivity. Following Year 1, 7 children from the cohort were selected who demonstrated clinical sensitivity to PM2.5 levels (sensitive group) and were compared to 7 children who did not (control group). Urinary leukotriene FA (LIE4) and exhaled nitric oxide (eNO) were obtained from these 14 children on days when ambient PM2.5 was above the 90th percentile ("spike days") and below the 25th percentile ("baseline days"). Mean LTE4 levels did not significantly differ between spike and baseline days, regardless of whether data from the entire cohort or from the sensitive group alone was analyzed. Mean eNO levels, however, were significantly (p=0.0092) increased on spike days among the entire cohort. Subset analysis revealed that this finding was due to a highly significant (p<0.0001) increase in mean eNO levels (>60%) in the sensitive group. The control group demonstrated no such differences. Ambient PM2.5 particulate spikes are associated with increased levels of the airway inflammatory marker eNO in asthmatic children with a demonstrated clinical sensitivity to air pollution, eNO may serve as a marker of clinical sensitivity to air pollution spikes in children with asthma, Sponsor: EPA # R825702-05; GCRC# NJC 160.