Identifying the gaps regarding exposure to aeroallergens in schools: systematic review

This research was funded by the Instituto Politécnico de Lisboa, Lisboa, Portugal for funding Project IPL/2023/FoodAIIEU_ESTeSL. H&TRC authors gratefully acknowledge the FCT/MCTES national support through the 2023.01366.BD and IPL/2022/InChildhealth/BI/12M.Background: Allergic diseases are a major concern in high-income countries, and their occurrence continues to increase worldwide. Despite previous studies reporting the health effects of exposure to both chemical and (micro)biological agents, aeroallergens have been less well studied. Most studies have focused on exposure to indoor allergens at home. However, exposure can happen in other environments, including in schools where children spend much of their time. Review questions: What are the most common indoor allergens in schools? What methods (sampling and assays) are applied to measure the levels of indoor allergens in schools? What are the levels of indoor allergens in schools? What are the determinants of indoor allergens in schools? Which areas of schools have the highest levels of allergens (e.g., wet areas/bathrooms)? What are the effects of exposure to indoor allergens on asthma, asthma-like symptoms, asthma control, allergic sensitization, and allergic diseases?info:eu-repo/semantics/publishedVersio

Respiratory Infections Precede Adult-Onset Asthma

BACKGROUND: Respiratory infections in early life are associated with an increased risk of developing asthma but there is little evidence on the role of infections for onset of asthma in adults. The objective of this study was to assess the relation of the occurrence of respiratory infections in the past 12 months to adult-onset asthma in a population-based incident case-control study of adults 21-63 years of age. METHODS/PRINCIPAL FINDINGS: We recruited all new clinically diagnosed cases of asthma (n = 521) during a 2.5-year study period and randomly selected controls (n = 932) in a geographically defined area in South Finland. Information on respiratory infections was collected by a self-administered questionnaire. The diagnosis of asthma was based on symptoms and reversible airflow obstruction in lung function measurements. The risk of asthma onset was strongly increased in subjects who had experienced in the preceding 12 months lower respiratory tract infections (including acute bronchitis and pneumonia) with an adjusted odds ratio (OR) 7.18 (95% confidence interval [CI] 5.16-9.99), or upper respiratory tract infections (including common cold, sinusitis, tonsillitis, and otitis media) with an adjusted OR 2.26 (95% CI 1.72-2.97). Individuals with personal atopy and/or parental atopy were more susceptible to the effects of respiratory infections on asthma onset than non-atopic persons. CONCLUSIONS/SIGNIFICANCE: This study provides new evidence that recently experienced respiratory infections are a strong determinant for adult-onset asthma. Reducing such infections might prevent onset of asthma in adulthood, especially in individuals with atopy or hereditary propensity to it

Respiratory Infections in Adults with Atopic Disease and IgE Antibodies to Common Aeroallergens

<div><p>Background</p><p>Atopic diseases, including allergic rhinitis, allergic dermatitis and asthma, are common diseases with a prevalence of 30–40% worldwide and are thus of great global public health importance. Allergic inflammation may influence the immunity against infections, so atopic individuals could be susceptible to respiratory infections. No previous population-based study has addressed the relation between atopy and respiratory infections in adulthood. We assessed the relation between atopic disease, specific IgE antibodies and the occurrence of upper and lower respiratory infections in the past 12 months among working-aged adults.</p><p>Methods and Findings</p><p>A population-based cross-sectional study of 1008 atopic and non-atopic adults 21–63 years old was conducted. Information on atopic diseases, allergy tests and respiratory infections was collected by a questionnaire. Specific IgE antibodies to common aeroallergens were measured in serum. Adults with atopic disease had a significantly increased risk of lower respiratory tract infections (LRTI; including acute bronchitis and pneumonia) with an adjusted risk ratio (RR) 2.24 (95% confidence interval [CI] 1.43, 3.52) and upper respiratory tract infections (URTI; including common cold, sinusitis, tonsillitis, and otitis media) with an adjusted RR 1.55 (1.14, 2.10). The risk of LRTIs increased with increasing level of specific IgE (linear trend <i>P</i> = 0.059).</p><p>Conclusions</p><p>This study provides new evidence that working-aged adults with atopic disease experience significantly more LRTIs and URTIs than non-atopics. The occurrence of respiratory infections increased with increasing levels of specific IgE antibodies to common aeroallergens, showing a dose-response pattern with LRTIs. From the clinical point of view it is important to recognize that those with atopies are a risk group for respiratory infections, including more severe LRTIs.</p></div

Occupation and occurrence of respiratory infections among adults with newly diagnosed asthma

Abstract Background Work environments are potential areas for spreading respiratory infections. We hypothesized that certain occupations increase susceptibility to respiratory infections among adults with asthma. Our objective was to compare the occurrence of respiratory infections among different occupations in adults with newly diagnosed asthma. Methods We analysed a study population of 492 working-age adults with newly diagnosed asthma who were living in the geographically defined Pirkanmaa Area in Southern Finland during a population-based Finnish Environment and Asthma Study (FEAS). The determinant of interest was occupation at the time of diagnosis of asthma. We assessed potential relations between occupation and occurrence of both upper and lower respiratory tract infections during the past 12 months. The measures of effect were incidence rate ratio (IRR) and risk ratio (RR) adjusted for age, gender, and smoking habits. Professionals, clerks, and administrative personnel formed the reference group. Results The mean number of common colds in the study population was 1.85 (95% CI 1.70, 2.00) infections in the last 12 months. The following occupational groups showed increased risk of common colds: forestry and related workers (aIRR 2.20, 95% CI 1.15–4.23) and construction and mining (aIRR 1.67, 95% CI 1.14–2.44). The risk of lower respiratory tract infections was increased in the following groups: glass, ceramic, and mineral workers (aRR 3.82, 95% CI 2.54–5.74), fur and leather workers (aRR 2.06, 95% CI 1.01–4.20) and metal workers (aRR 1.80, 95% CI 1.04–3.10). Conclusions We provide evidence that the occurrence of respiratory infections is related to certain occupations

Risk of respiratory infections in the past 12 months in subjects with atopic disease and those with no atopic disease, The Finnish Environment and Asthma Study (FEAS).

<p>Abbreviations: CI, confidence interval; LRTI, lower respiratory tract infections; N, number; RR, risk ratio; URTI, upper respiratory tract infections.</p>a<p>≥1 infection. Common cold ≥2 infections.</p>b<p>RR adjusted for sex, age, education, smoking and SHS exposure (work/home).</p>c<p>Total number of atopic and non-atopic subjects. Information on infections was missing for 41 subjects.</p

Joint effect of LRTIs (≥1 infections) experienced during the past 12 months and parental allergic diseases on the risk of asthma.

a<p>Adjusted for sex, age, education, smoking, SHS exposure (work/home), pets, and exposure to mold (work/home).</p

Occurrence of respiratory infections in the past 12 months and in the past 3 months and the risk of adult-onset asthma.

a<p>Adjusted for sex, age, education, smoking, SHS exposure (work/home), pets, and exposure to mold (work/home).</p>b<p>Total number of cases and controls, information on infections was missing for 50 subjects.</p>c<p>≥2 infections.</p

Characteristics of the total study population and stratified by gender, The Finnish Environment and Asthma Study (FEAS).

<p>Abbreviations: N, number; SHS, secondhand tobacco smoke.</p>a<p>Information on education was missing for 5 subjects.</p>b<p>Information on smoking was missing for 2 subjects.</p

Diagnostic criteria for asthma.

<p>FEV₁ = forced expiratory volume in one second; FVC = forced vital capacity; PEF = peak expiratory flow.</p>a<p>Calculated according to the standard practice of the Tampere University Hospital: maximum daily variation = (highest PEF value during the day – lowest PEF value during the day)/highest PEF value during the day; bronchodilator response = (highest PEF value after bronchodilating medication – highest PEF value before medication)/highest PEF value before medication.</p

Risk of respiratory infections in the past 12 months according to different atopic diseases, The Finnish Environment and Asthma Study (FEAS).

<p>Abbreviations: CI, confidence interval; N, number; RR, risk ratio.</p>a<p>Risk ratios adjusted for sex, age, education, smoking and SHS exposure (work/home).</p>b<p>Information on infections was missing for 41 subjects.</p