Indoor Allergens Assessing and Controlling Adverse Health Effects (1993) / Chapter Skim
Currently Skimming:
3 Agents, Sources, Source Controls, and Diseases
3 Agents, Sources, Source Controls, and Diseases
Pages 86-130
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 86... ...
Homes, apartment buildings, schools, offices, hospitals, stores, and factories each have unique features that affect the types and quantities of allergens that are present. The major allergenic protein molecules and in some cases, even the allergenic epitopes have been identified and characterized in the case of house dust mites, cats, dogs, and certain fungi.
|
From page 87... ...
In that year, however, Voorhorst and his colleagues in the Netherlands observed large numbers of mites in dust samples and demonstrated that dust TABLE 3-1 Biological Sources of Allergens in Houses Acarids Dust mites Dermatophagoides pteronyssinus Dermatophagoides farinae Euroglyphus maynei Blomia tropicalis Storage mites Spiders Insects Cockroaches Blattella germanica (German) Periplanetta americana (American)
|
From page 88... ...
Most patients with positive skin tests to house dust have specific immunoglobulin E (IgE) antibodies to dust mite allergens (Johansson et al., 19711.
|
From page 89... ...
DUST MITE ALLERGENS The first mite allergen to be purified, D pteronyssinus allergen I (or Der p I; Chapman and Platts-Mills, 1980)
|
From page 90... ...
9o CQ a' 1 o o Is an ¢ ;^ en cD at At Act ~ cO o .
|
From page 91... ...
The quantity of dust mite allergen in commercial house dust extracts varies from 0.05 to 2.0 ,ug of Der p I/ml.i Commercial dust mite extracts can be made from either whole mite culture or from isolated mite bodies. At present, the FDA requires that mite extracts be made from isolated mites.
|
From page 92... ...
Positive skin tests have been reported in several urban clinic populations including Boston, New York, Kansas City, Detroit, Chicago, and Washington, D.C.
|
From page 93... ...
Fewer data are available on the levels of exposure associated with sensitization or disease for allergens other than dust mite. However, there are data about the levels of cat allergen present in house dust.
|
From page 94... ...
Chapter 6 addresses issues related to assessing exposure and risk and presents a risk assessment for sensitization related to dust mite exposure as an example. Reducing Exposure to Dust Mites Reducing exposure to so-called "trigger factors," i.e., factors that trigger an allergic response, has been a standard part of the treatment of allergic disease for many years, and for many years it was normal practice to recommend avoidance measures to patients who had skin tests that were positive for house dust.
|
From page 95... ...
. Recently, four controlled studies of the effects of avoidance measures conducted in the homes of patients have found significant improvement in both asthma symptoms and bronchial hyperreactivity (Dorward et al., 1988; Ehnert et al., 1991; Murray and Ferguson, 1983; Walshaw and Evans, 1986~.
|
From page 96... ...
have been shown to achieve 90 percent reduction in allergen levels for a month or more. In addition, 1 or 3 percent solutions of tannic acid have been recommended for denaturing mite allergens (Green et al., 1989~.
|
From page 97... ...
, fitted carpets, and cool-wash detergents which have led to water temperatures for washing bedding that do not kill mites. Once identified, reducing exposure to allergenic "trigger factors" has been a standard part of the treatment of allergic disease for many years.
|
From page 98... ...
devices advertised as reducing indoor allergen concentrations. More specifically, test the effectiveness of allergen avoidance protocols on the management of allergic asthma and other allergic diseases using protocols that have been demonstrated to reduce exposure by 90 percent or more.
|
From page 99... ...
Skin test reactions to animal extracts are frequent, but the relationship between sensitization as demonstrated by a positive skin test and the frequency of clinical symptoms is unknown. Nonetheless, exposure to domestic pets, particularly cats and dogs, accounts for most of the allergic diseases caused by mammals.
|
From page 100... ...
In recent years, the complete amino acid sequence of Fel d I has been determined, the genes encoding the protein have been identified, and several allergenic epitopes have been mapped (Morgenstern et al., 1991~. Commercially available cat extract reagents for skin testing have variable quantities of Fel d I and serum albumin.
|
From page 101... ...
CONTROL MEASURES home: The following are several animal allergen avoidance measures for the 1. Remove the animal from the home.
|
From page 102... ...
The prevalence of clinically significant allergic diseases caused by dogs appears to be less than that for cats; nevertheless, dog sensitivity can be a major cause of allergic symptoms, including asthma, in some persons. In a survey of U.S.
|
From page 103... ...
Moreover, patients with a family history of allergy and positive skin tests to other environmental allergens may be at risk for the development of asthma (Sjostedt and Willers, 1989~. Hypersensitivity pneumonitis resulting from exposure to rodent proteins is rare.
|
From page 104... ...
Occasionally, hamsters and gerbils may account for allergic symptoms. Positive skin tests to hamster dander extracts have been reported among laboratory workers, and gerbil extracts prepared from serum and hair/epithelium have produced positive skin tests in sensitized patients.
|
From page 105... ...
The allergenic sources of that condition appear to be hair and dander, and possibly saliva (Petry et al., 1985~. Birds Positive skin test reactions to feather extracts but not fresh feathers are common, a finding that may be explained by contamination from dust mites.
|
From page 106... ...
The diagnosis of the disease is based on clinical presentation and the presence of IgG precipitating antibodies to the allergen in question. Patients with pigeon breeder's disease may have positive skin tests and IgE antibodies to pigeon serum as well; however, crude extracts often are nonspecifically irritating and therefore not useful for diagnosis.
|
From page 107... ...
Research Agenda Item: Investigate the potential role of mammalian- and avian-allergen-contaminated ventilation systems in the development of allergic disease among inhabitants of apartments, offices, and other large buildings. Although control measures may reduce airborne concentrations of mammalian and avian allergens, the ability of these approaches to influence symptoms in sensitized patients or to prevent the sensitization of naive individuals requires clarification and study.
|
From page 108... ...
Fungi reproduce both asexually and sexually and often produce spores by one or both of these kinds of life cycles. The fungal spores are allergenic; that is, responsible for causing allergic responses.
|
From page 109... ...
. Fungal spores and other effluents become airborne indoors when disturbed by air movement and normal human activities (O'Rourke et al., 19901.
|
From page 110... ...
Airborne fungal allergens have been implicated in allergic rhinitis/coniunctivitis, allergic asthma, and hypersensitivity pneumonitis. Certain fungi grow saprophytically in the mucous lining of the lungs of patients with allergic bronchopulmonary fungosis or aspergillosis and in the sinuses of people with allergic fungal sinusitis.
|
From page 111... ...
For some fungi, possibly because the actual allergens are enzymes associated with germination, it may be necessary for a living unit to begin growth on the respiratory tract mucosa before allergen exposure occurs (Savolainen et al., 19901.
|
From page 112... ...
Thermophilic organisms occupy indoor reservoirs such as humidifiers attached to heating systems, refrigerator drip pans, evaporative cooler media, clothes dryer exhausts, and other such places characterized by organic material, water, and warm temperatures. Air movements, inadvertent human activity, and activities that allow direct handling of contaminated material (e.g., in removal or cleaning procedures)
|
From page 113... ...
Concentrations of bacteria that constitute a significant risk for sensitizing or provoking human allergic reactions are unknown. DISEASES Exposure to bacterial allergens has been associated with work-related asthma, hypersensitivity pneumonitis, humidifier fever, and a disease resembling allergic bronchopulmonary fungosis.
|
From page 114... ...
There is some evidence that these spores are sensitizing (Giannini et al., 1975; Santilli et al., 19901. Environmental Control Environmental control strategies are intended to reduce airborne concentrations of allergens.
|
From page 115... ...
PREVENTION To prevent the contamination of indoor air by microbial aerosols, the penetration of outdoor aerosols must be reduced, and growth in indoor reservoirs must be eliminated. Keeping indoor environments physically separated from outdoors (by keeping doors and windows closed)
|
From page 116... ...
Conclusions and Recommendations Overall, the fungus-associated allergies have been the least well-studied. Little data is available on the distribution of airborne fungal products, dynamics of human exposure, nature of the allergens, factors influencing the quality of skin test and immunotherapy materials, and the basic nature of fungus-related allergic disease.
|
From page 117... ...
In addition, chemical allergy in the industrial setting serves as a model for improving our understanding of allergy mechanisms. More than 150 LMW chemical agents have been reported to cause allergic reactions such as asthma and hypersensitivity pneumonitis (Table 3-3; Butcher et al., 1989; Grammer et al., 19891.
|
From page 118... ...
. However, for many chemicals and many industries the number of exposed workers and the prevalence of allergic disease are not known and have not been studied.
|
From page 120... ...
120 Cal an ~ o Ct - ~ ~ ;~ so {I Cal Ct 53 ._ Cal o {so : - ~ Cal ~ .
|
From page 121... ...
Metal salts of nickel, platinum, and chromates can cause rhinitis, conjunctivitis, or asthma (Block and Chan-Yeung, 1982; Cromwell et al., 1979; Dolovich et al., 1984; Malo et al., 1982; McConnell et al., 1973; Novey et al., 1983; Pepys et al., 1972, 1979; Pickering, 19724. Positive skin tests, specific IgE, and positive bronchial challenges have all been reported.
|
From page 122... ...
Only workers in the highest exposure categories developed specific antibody and allergic reactions to TMA. In contrast to human studies, estimates of exposure in animal models are considerably more accurate.
|
From page 123... ...
If these thresholds and relationships could be defined for chemical allergens, reducing exposure could be the best approach to preventing allergic disease caused by these substances. Exposure reduction measures would include improved ventilation, work practices, and protective equipment.
|
From page 124... ...
Research Agenda Item: Determine the types of allergic diseases caused by reactive allergenic chemicals, their prevalence rates, and the mechanisms responsible for the resulting airway reactions. A body of knowledge about chemical allergens is available, but many areas have not been well studied.
|
From page 125... ...
In particular, if immune responses that are predictive of allergic disease can be identified, and reduced exposure can be shown to result in resolution of disease (and disappearance of immunologic sensitization) , then reduced exposure may represent the most practical approach for preventing allergic disease arising from chemical exposure.
|
From page 126... ...
report the development of IgE antibodies to pollen allergens from Parietaria Judaica, an outdoor allergenic member of the nettle family found in the Mediterranean region but not likely to be found indoors. Most recent reports in the literature regarding allergic reactions to indoor plants involve contact dermatitis produced by airborne allergens.
|
From page 127... ...
Although there is only limited knowledge of the extent of allergic disease from allergenic indoor plants, it seems logical to assume that if increased use is made of indoor plants that are pollen producers, atopic individuals may find indoor environments as unpleasant as the outdoors during the traditional pollen season. In addition, indoor blooming patterns are sometimes manipulated to be different from outdoor "normal" seasonal patterns.
|
From page 128... ...
can cause allergic reactions. _ On rare occasions, latex condoms Most cases of allergy to latex are mediated by IgE antibodies.
|
From page 129... ...
Research Agenda Item: Assess the significance of workplace expo sures to indoor plants, including the contribution to the overall magnitude of indoor allergic disease. Latex allergy has recently received substantial attention because of increasing reports of its occurrence and its potential, in certain individuals, to produce life-threatening anaphylactic reactions.
|
From page 130... ...
This effort should include studies of the incidence and prevalence of natural-rubber-related allergic disease.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.