WHO Guidelines for Indoor Air Quality. Dampness and Mould.

Bookshelf ID: NBK143941PMID: 23785740

WHO Guidelines for Indoor Air Quality

Dampness and Mould

Geneva: World Health Organization; 2009.

ISBN-13: 978-92-890-4168-3

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Abstract

Microbial pollution is a key element of indoor air pollution. It is caused by hundreds of species of bacteria and fungi, in particular filamentous fungi (mould), growing indoors when sufficient moisture is available. This document provides a comprehensive review of the scientific evidence on health problems associated with building moisture and biological agents. The review concludes that the most important effects are increased prevalences of respiratory symptoms, allergies and asthma as well as perturbation of the immunological system. The document also summarizes the available information on the conditions that determine the presence of mould and measures to control their growth indoors. WHO guidelines for protecting public health are formulated on the basis of the review. The most important means for avoiding adverse health effects is the prevention (or minimization) of persistent dampness and microbial growth on interior surfaces and in building structures.

Contents

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• Contributors
• Acknowledgements
• Foreword
• Executive summary
• 1. Introduction
  • 1.1 Background
  • 1.2 Scope of the review
  • 1.3 Preparation of the guidelines
  • 1.4 Guidelines and indoor air quality management
• 2. Building dampness and its effect on indoor exposure to biological and non-biological pollutants
  Jeroen Douwes.
  • 2.1 Frequency of indoor dampness
  • 2.2 Effects of dampness on the quality of the indoor environment
  • 2.3 Dampness-related indoor pollutants
  • 2.4 Exposure assessment
  • 2.5 Summary and conclusions
• 3. Moisture control and ventilation
  Olli Seppänen and Jarek Kurnitski.
  • 3.1 Introduction
  • 3.2 Sources of moisture
  • 3.3 Mould and mites as indicators of building performance
  • 3.4 Ventilation performance
  • 3.5 Ventilation systems
  • 3.6 Outdoor and other sources of pollution related to ventilation
  • 3.7 Ventilation and spread of contaminants
  • 3.8 Moisture control in buildings
  • 3.9 Measures to protect against damage due to moisture
  • 3.10 Conclusions and recommendations
• 4. Health effects associated with dampness and mould
  Mark J Mendell, Anna G Mirer, Kerry Cheung, Jeroen Douwes, Torben Sigsgaard, Jakob Bønløkke, Harald W Meyer, Maija-Riitta Hirvonen, and Marjut Roponen.
  • 4.1 Review of epidemiological evidence
  • 4.2 Clinical aspects of health effects
  • 4.3 Toxicological mechanisms
  • 4.4 Synthesis of available evidence on health effects
• 5. Evaluation of human health risks and guidelines
  • 5.1 Summary
  • 5.2 Conditions that contribute to health risks
  • 5.3 Guidelines
• 6 References
• Annex 1 Summary of epidemiological studies
• Annex 2 Summary of in vitro and in vivo studies

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The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Where the designation ‘country or area’ appears in the headings of tables, it covers countries, territories, cities and areas. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.

The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.

The World Health Organization does not warrant that the information contained in this publication is complete or correct and shall not be liable for any damages incurred as a result of its use. The views expressed by authors or editors do not necessarily represent the decisions or the stated policy of the World Health Organization.

Copyright © 2009, World Health Organization.

All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. Address requests for publications of the WHO Regional Office for Europe to: Publications, WHO Regional Office for Europe, Scherfigsvej 8, DK-2100 Copenhagen Ø, Denmark. Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Office web site (http://www.euro.who.int/pubrequest).

Investigating the effectiveness of the Mediterranean diet in pregnant women for the primary prevention of asthma and allergy in high-risk infants: protocol for a pilot randomised controlled trial

Study protocolInvestigating the effectiveness of the Mediterranean diet in pregnant women for the primary prevention of asthma and allergy in high-risk infants: protocol for a pilot randomised controlled trial

Dean A Sewell^1*, Victoria S Hammersley¹, Graham Devereux², Ann Robertson³, Andrew Stoddart⁴, Chris Weir⁵, Allison Worth⁶ and Aziz Sheikh⁶

• *Corresponding author: Dean A Sewell d.a.sewell@hw.ac.uk

Author Affiliations

¹School of Life Sciences, Heriot-Watt University, Riccarton, Edinburgh EH14 4AS, UK

²Public Health Nutrition Research Group, University of Aberdeen, Aberdeen AB25 2ZD, UK

³Centre for Population Health Sciences, The University of Edinburgh, Medical School, Teviot Place, Edinburgh EH8 9AG, UK

⁴Edinburgh Health Services Research Unit/Edinburgh Clinical Trials Unit, Western General Hospital, Edinburgh EH4 2XU, UK

⁵MRC Hub for Trials Methodology Research, Centre for Population Health Sciences, The University of Edinburgh, Medical School, Teviot Place, Edinburgh EH8 9AG, UK

⁶Allergy and Respiratory Research Group, Centre for Population Health Sciences, The University of Edinburgh, Medical School, Teviot Place, Edinburgh EH8 9AG, UK

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Trials 2013, 14:173 doi:10.1186/1745-6215-14-173

The electronic version of this article is the complete one and can be found online at:http://www.trialsjournal.com/content/14/1/173

Received:	26 November 2012
Accepted:	23 May 2013
Published:	14 June 2013

© 2013 Sewell et al.; licensee BioMed Central Ltd. 

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Over recent decades there has been a substantial increase in asthma and allergic disease especially in children. Given the high prevalence, and the associated high disease burden and costs, there is a need to identify effective strategies for the primary prevention of asthma and allergy. A recent systematic review of the literature found strong supportive epidemiological evidence for a protective role of the Mediterranean diet, which now needs to be confirmed through formal experimental studies. This pilot trial in pregnant women aims to establish recruitment, retention and acceptability of a dietary intervention, and to assess the likely impact of the intervention on adherence to a Mediterranean diet during pregnancy.

Methods/Design

This study was a pilot, two-arm, randomised controlled trial in a sample population of pregnant women at high risk of having a child who will develop asthma or allergic disease.

Discussion

The work ultimately aims to contribute to improving health outcomes through seeking to reduce the incidence of asthma and allergic problems. This pilot trial will prove invaluable in informing the subsequent planned large-scale, parallel group, randomised controlled trial.

Trial registration

ClinicalTrials.gov: NCT01634516

Keywords: 

Allergy; Asthma; Mediterranean diet; Pregnancy

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Med J Malaysia. 2012 Oct;67(5):540-1.

Exotic food anaphylaxis and the broken heart: sago worm and takotsubo cardiomyopathy.

Yew KL, Kok VS.

Source

Sarawak General Hospital, Cardiology Department, Kota Samarahan, 94300, Sarawak, Malaysia. yewkuanleong@yahoo.com.

Abstract

There is increasing consumption of exotic food in Malaysia. Animals such as insects, worms and wild life animals also form part of the staple food of the local population. This practice may lead to more incidence of food allergy and anaphylaxis. We report a non-indigenous man who developed food anaphylaxis after consuming fried sago worms and consequently Takotsubo cardiomyopathy. We postulate that certain food allergy and anaphylaxis could be another causative trigger for Takotsubo cardiomyopathy.

PMID:

 

23770880

 

[PubMed - in process] 

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• Allergy Rhinol (Providence)
• v.4(1); Spring 2013
• PMC3679565

Allergy Rhinol (Providence). 2013 Spring; 4(1): e32–e35.

Published online 2013 May 14. doi:  10.2500/ar.2013.4.0045

PMCID: PMC3679565

Immunotherapy in allergic fungal sinusitis: The controversy continues. A recent review of literature

Mary S. Doellman, D.O.,1 Gregory R. Dion, M.D.,1 Erik Kent Weitzel, M.D.,1 and Erika Gonzalez Reyes, M.D.2

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Abstract

Allergic fungal sinusitis (AFS), also referred to as allergic fungal rhinosinusitis (AFRS), is a noninvasive, eosinophilic form of recurrent chronic allergic hypertrophic rhinosinusitis. AFS has distinct clinical, histopathological, and prognostic findings that differentiate it from other forms of sinusitis. The core pathogenesis and optimum treatment strategies remain debated. Concerns surround the use of immunotherapy for AFS because allergen-specific immunoglobulin G (IgG) induced by immunotherapy could theoretically incite a Gell and Coombs type III (complex mediated) reaction. Type I hypersensitivity is established by high serum levels of allergen-specific IgE to various fungal antigens and positive Bipolaris skin test results. Type III hypersensitivity is established by an IgG-mediated process defined by the presence of allergen-specific IgG that forms complexes with fungal antigen inducing an immunologic inflammatory response. These reveal the multiple immunologic pathways through which AFS can impact host responses. Recent literature establishing benefits of fungal immunotherapy and no evidence of type III–mediated reactions, severe local reactions, or delayed reactions, indicate that application of AFS desensitization is a reasonable therapeutic strategy for this difficult to manage entity. Our review should encourage further clinical acceptance of AFS desensitization because the existing literature on this subject shows benefits of fungal immunotherapy and no evidence of type III–mediated reactions, severe local reactions, or delayed reactions.

Keywords: Allergic fungal sinusitis, chronic rhinosinusitis, eosinophilic mucus, literature review

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Characteristics of Patients With Advanced Heart Failure Having Eosinophilic Infiltration of the Myocardium in the Recent Era

International Heart Journal
Vol. 54 (2013) No. 3 p. 146-148

Language:      English     Japanese   

Clinical Studies

http://dx.doi.org/10.1536/ihj.54.146

 

DN/JST.JSTAGE/ihj/54.146

Characteristics of Patients With Advanced Heart Failure Having Eosinophilic Infiltration of the Myocardium in the Recent Era
Investigation of Explanted Hearts for Transplantation

Saeko Yoshizawa¹⁾, Tomoko Sugiyama Kato²⁾, Donna Mancini²⁾, Charles C. Marboe¹⁾

1) Department of Pathology & Cell Biology, Columbia University Medical Center and The New York Presbyterian Hospital 2) Department of Medicine, Division of Cardiology, Columbia University Medical Center and The New York Presbyterian Hospital

 Released on J-STAGE 20130615  

Keywords: Heart transplantation, Myocarditis, Eosinophils, Drugs

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Eosinophilic infiltration of the myocardium is occasionally observed as an incidental histological finding in endomyocardial biopsy specimens before heart transplantation (HTx) as well as in explanted heart obtained at the time of HTx. However, the indications for HTx in these patients have not yet been fully established. We investigated the pre-HTx characteristics of the recipients with myocardial eosinophilic infiltration in the explanted heart and diagnosed as hypersensitivity myocarditis (HSM) (21 among 761 recipients, 2.8%). Dobutamine, a common cause of HSM, was administered to 12 patients (57%). Ten patients (47.6%) were on milrinone and 4 (19.0%) were on ventricular assist devices. Post-transplant survival of HSM patients was comparable to that of patients transplanted for active myocarditis or other cause of heart failure. In conclusion, myocardial eosinophilic infiltration is associated with multiple medications in patients with advanced heart failure; however, it does not affect the post-transplant prognosis.

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Copyright © 2013 by the International Heart Journal Association

Lung Cancer Diagnosed More Than Five Years after the Development of Polymyositis/Dermatomyositis

ISRN Pulmonology
Volume 2013 (2013), Article ID 409862, 6 pages
http://dx.doi.org/10.1155/2013/409862

Clinical Study

Lung Cancer Diagnosed More Than Five Years after the Development of Polymyositis/Dermatomyositis

Ken Uchibori, Tomoyuki Ogata, Tuyoshi Shirai, Shuta Yamauchi,Masahiro Masuo, Sahoko Chiba, Haruhiko Furusawa, Kimitake Tsuchiya,Toshihide Fujie, Meiyo Tamaoka, Hiroyuki Sakashita, Yuki Sumi, Yasunari Miyazaki, and Naohiko Inase

Department of Pulmonary Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan

Received 29 March 2013; Accepted 8 May 2013

Academic Editors: C. Flores and A. S. Melani

Copyright © 2013 Ken Uchibori et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. The patients with polymyositis (PM) and dermatomyositis (DM) often develop the malignancies in their clinical course. The incidence of cancer is estimated at about 15%. The risk of cancer is the highest within the first year of myositis diagnosis and drops substantially thereafter. The patients with lung cancer diagnosed more than 5 years after the onset of PM or DM are the minority.Methods and Patients. We surveyed the medical records of patients with lung cancer over the period from 1995 to 2011. Results. We found five patients who developed lung cancer more than 5 years after the diagnosis of PM/DM. Three patients were male, and two were female. The median age was 61.2 (±11.7). Histological types were diverse. The clinical stages ranged from IA to IV. Three patients had smoking histories. Four patients suffered from DM, and one suffered from PM. All patients received oral corticosteroid therapy. Two patients also received ciclosporin, and another two received azathioprine. Anti-Jo-1 antibody was positive in one patient. Four patients were complicated with interstitial pneumonia (IP). Conclusion. These lung cancers diagnosed more than 5 years after the onset of PM/DM were probably related to IP or smoking but might not be comorbid with PM/DM.

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Grass pollen allergy in children and adolescents-symptoms, health related quality of life and the value of pollen prognosis

Research

Grass pollen allergy in children and adolescents-symptoms, health related quality of life and the value of pollen prognosis

Hampus Kiotseridis, Corrado M Cilio, Leif Bjermer, Alf Tunsäter, Helene Jacobsson and Åslög Dahl

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Clinical and Translational Allergy 2013, 3:19 doi:10.1186/2045-7022-3-19

Published: 22 June 2013

Abstract (provisional)

Introduction

An association between pollen count (Poaceae) and symptoms is well known, but to a lesser degree the importance of priming and lag effects. Also, threshold levels for changes in symptom severity need to be validated. The present study aims to investigate the relationship between pollen counts, symptoms and health related quality of life (HRQL), and to validate thresholds levels, useful in public pollen warnings.

Material and methods

Children aged 7--18 with grass pollen allergy filled out a symptom diary during the pollen season for nose, eyes and lung symptoms, as well as a HRQL questionnaire every week. Pollen counts were monitored using a volumetric spore trap.

Results

89 (91%) of the included 98 children completed the study. There was a clear association between pollen count, symptom severity and HRQL during the whole pollen season, but no difference in this respect between early and late pollen season. There was a lag effect of 1--3 days after pollen exposure except for lung symptoms. We found only two threshold levels, at 30 and 80 pollen grains/m3 for the total symptom score, not three as is used today. The nose and eyes reacted to low doses, but for the lung symptoms, symptom strength did hardly change until 50 pollen grains/m3.

Conclusion

Grass pollen has an effect on symptoms and HRQL, lasting 2--5 days after exposure. Symptoms from the lungs appear to have higher threshold levels than the eyes and the nose. Overall symptom severity does not appear to change during the course of season. Threshold levels need to be revised. We suggest a traffic light model for public pollen warnings directed to children, where green signifies "no problem", yellow signifies "can be problems, especially if you are highly sensitive" and red signifies "alert -- take action".

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Research article

All-trans retinoic acid attenuates airway inflammation by inhibiting Th2 and Th17 response in experimental allergic asthma

Jinhong Wu, Yanjie Zhang, Qi Liu, Wenwei Zhong and Zhenwei Xia

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BMC Immunology 2013, 14:28 doi:10.1186/1471-2172-14-28

Published: 22 June 2013

Abstract (provisional)

Background

Airway inflammation is mainly mediated by T helper 2 cells (Th2) that characteristically produce interleukin (IL)-4, IL-5, and IL-13. Epidemiological studies have revealed an inverse association between the dietary intake of vitamin A and the occurrence of asthma. Serum vitamin A concentrations are significantly lower in asthmatic subjects than in healthy control subjects. It has been reported that all-trans retinoic acid (ATRA), a potent derivative of vitamin A, regulates immune responses. However, its role in Th2-mediated airway inflammation remains unclear. We investigated the effects of ATRA in a mouse model of allergic airway inflammation.

Results

We found that ATRA treatment attenuated airway inflammation and decreased mRNA levels of Th2- and Th17-related transcription factors. The data showed that airway inflammation coincided with levels of Th2- and Th17-related cytokines. We also showed that ATRA inhibited Th17 and promoted inducible regulatory T-cell differentiation, whereas it did not induce an obvious effect on Th2 differentiation in vitro. Our data suggest that ATRA may interfere with the in vivo Th2 responses via T-cell extrinsic mechanisms.

Conclusions

Administration of ATRA dramatically attenuated airway inflammation by inhibiting Th2 and Th17 differentiation and/or functions. ATRA may have potential therapeutic effects for airway inflammation in asthmatic patients.

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