Key Research Studies on the Link between Asthma & Allergies and the
Environment (Abstracts of Articles) (Andrea has all PDFs except Mold NAS report, which is online).
ASTHMA/ALLERGIES AND INDOOR ALLERGENS
1. Damp Indoor Spaces and Health/Mold. “Damp Indoor Spaces and Health.”
National Academy of Sciences, Institute of Medicine Report. May 2004.
Available online (see below) although only readable/printable one page at a time.
AH bought a copy.
Science. 2004 May 28;304(5675):1229B.
Related Articles, Links
PUBLIC HEALTH: Asthma Linked to Indoor Dampness.
Stokstad E.
PUBLIC HEALTH:Asthma Linked to Indoor Dampness Erik Stokstad Indoor
mold can cause or exacerbate respiratory problems, says a new report by the U.S.
Institute of Medicine. But its impact on a host of other health problems is much
less clear.
PMID: 15166339 [PubMed - in process]
The press release from the National Academy of Sciences Institute of
Medicine about the report, "Damp Indoor Spaces and Health" can be viewed
at http://www4.nationalacademies.org/news.nsf/ The press page also
includes the opening statement of Committee Chair Dr. Noreen Clark.
The entire report can be viewed online at
http://books.nap.edu/catalog/11011.html?onpi_newsdoc05252004
2. Cockroach allergen.
N Engl J Med. 1997 May 8;336(19):1356-63.
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Comment in:
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N Engl J Med. 1997 May 8;336(19):1382-4.
N Engl J Med. 1997 Sep 11;337(11):791-2.
N Engl J Med. 1997 Sep 11;337(11):791; author reply 792.
The role of cockroach allergy and exposure to cockroach allergen in
causing morbidity among inner-city children with asthma.
Rosenstreich DL, Eggleston P, Kattan M, Baker D, Slavin RG, Gergen P,
Mitchell H, McNiff-Mortimer K, Lynn H, Ownby D, Malveaux F.
Department of Medicine, Albert Einstein College of Medicine, Bronx, NY 10461,
USA.
BACKGROUND: It has been hypothesized that asthma-related health problems
are most severe among children in inner-city areas who are allergic to a specific
allergen and also exposed to high levels of that allergen in bedroom dust.
METHODS: From November 1992 through October 1993, we recruited 476
children with asthma (age, four to nine years) from eight inner-city areas in the
United States. Immediate hypersensitivity to cockroach, house-dust-mite, and cat
allergens was measured by skin testing. We then measured major allergens of
cockroach (Bla g 1), dust mites (Der p 1 and Der f 1), and cat dander (Fel d 1) in
household dust using monoclonal-antibody-based enzyme-linked immunosorbent
assays. High levels of exposure were defined according to proposed thresholds for
causing disease. Data on morbidity due to asthma were collected at base line and
over a one-year period. RESULTS: Of the children, 36.8 percent were allergic to
cockroach allergen, 34.9 percent to dust-mite allergen, and 22.7 percent to cat
allergen. Among the children's bedrooms, 50.2 percent had high levels of
cockroach allergen in dust, 9.7 percent had high levels of dust-mite allergen, and
12.6 percent had high levels of cat allergen. After we adjusted for sex, score on
the Child Behavior Checklist, and family history of asthma, we found that
children who were both allergic to cockroach allergen and exposed to high levels
of this allergen had 0.37 hospitalization a year, as compared with 0.11 for the
other children (P=0.001), and 2.56 unscheduled medical visits for asthma per
year, as compared with 1.43 (P<0.001). They also had significantly more days of
wheezing, missed school days, and nights with lost sleep, and their parents or
other care givers were awakened during the night and changed their daytime plans
because of the child's asthma significantly more frequently. Similar patterns were
not found for the combination of allergy to dust mites or cat dander and high
levels of the allergen. CONCLUSIONS: The combination of cockroach allergy
and exposure to high levels of this allergen may help explain the frequency of
asthma-related health problems in inner-city children.
Publication Types:

Multicenter Study
PMID: 9134876 [PubMed - indexed for MEDLINE]
3. Effective home interventions to clean house of allergens.
J Expo Anal Environ Epidemiol. 2004 Apr;14 Suppl 1:S133-43.
Related Articles, Links
Effect of environmental interventions to reduce exposure to asthma
triggers in homes of low-income children in Seattle.
Takaro TK, Krieger JW, Song L.
[1] aUniversity of Washington School of Public Health and Community
Medicine, USA [2] bUniversity of Washington School of Medicine, USA.
The effectiveness of community health workers (CHWs) assisting families in
reducing exposure to indoor asthma triggers has not been studied. In all, 274 lowincome asthmatic children were randomly assigned to high- or low-intensity
groups. CHWs visited all homes to assess exposures, develop action plans and
provide bedding encasements. The higher-intensity group also received cleaning
equipment and five to nine visits over a year focusing on asthma trigger reduction.
The asthma trigger composite score decreased from 1.56 to 1.19 (Delta=-0.37,
95% CI 0.13, 0.61) in the higher-intensity group and from 1.63 to 1.43 in the lowintensity group (Delta=-0.20, 95% CI 0.004, 0.4). The difference in this measure
due to the intervention was significant at the P=0.096 level. The higher-intensity
group also showed improvement during the intervention year in measurements of
condensation, roaches, moisture, cleaning behavior, dust weight, dust mite
antigen, and total antigens above a cut point, effects not demonstrated in the lowintensity group. CHWs are effective in reducing asthma trigger exposure in lowincome children. Further research is needed to determine the effectiveness of
specific interventions and structural improvements on asthma trigger exposure
and health.Journal of Exposure Analysis and Environmental Epidemiology (2004)
14, S133-S143. doi:10.1038/sj.jea.7500367
4. McConnell and ozone
5. Gilliland and school absences
Asthma and Outdoor Air Pollution
McConnell and ozone
Lancet. 2002 Feb 2;359(9304):386-91.
Erratum in:
Related Articles, Links
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Lancet 2002 Mar 9;359(9309):896.
Comment in:
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Clin J Sport Med. 2003 Jan;13(1):62-3.
Lancet. 2002 Aug 3;360(9330):411.
Asthma in exercising children exposed to ozone: a cohort study.
McConnell R, Berhane K, Gilliland F, London SJ, Islam T, Gauderman WJ,
Avol E, Margolis HG, Peters JM.
Department of Preventive Medicine, University of Southern California School of
Medicine, Los Angeles, CA 90089-9011, USA. mcconne@hsc.usc.edu
BACKGROUND: Little is known about the effect of exposure to air pollution
during exercise or time spent outdoors on the development of asthma. We
investigated the relation between newly-diagnosed asthma and team sports in a
cohort of children exposed to different concentrations and mixtures of air
pollutants. METHODS: 3535 children with no history of asthma were recruited
from schools in 12 communities in southern California and were followed up for
up to 5 years. 265 children reported a new diagnosis of asthma during follow-up.
We assessed risk of asthma in children playing team sports at study entry in six
communities with high daytime ozone concentrations, six with lower
concentrations, and in communities with high or low concentrations of nitrogen
dioxide, particulate matter, and inorganic-acid vapour. FINDINGS: In
communities with high ozone concentrations, the relative risk of developing
asthma in children playing three or more sports was 3.3 (95% CI 1.9-5.8),
compared with children playing no sports. Sports had no effect in areas of low
ozone concentration (0.8, 0.4-1.6). Time spent outside was associated with a
higher incidence of asthma in areas of high ozone (1.4, 1.0-2.1), but not in areas
of low ozone. Exposure to pollutants other than ozone did not alter the effect of
team sports. INTERPRETATION: Incidence of new diagnoses of asthma is
associated with heavy exercise in communities with high concentrations of ozone,
thus, air pollution and outdoor exercise could contribute to the development of
asthma in children.
PMID: 11844508 [PubMed - indexed for MEDLINE]
Gilliland and school absences
Epidemiology. 2001 Jan;12(1):43-54.
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The effects of ambient air pollution on school absenteeism due to
respiratory illnesses.
Gilliland FD, Berhane K, Rappaport EB, Thomas DC, Avol E, Gauderman
WJ, London SJ, Margolis HG, McConnell R, Islam KT, Peters JM.
Department of Preventive Medicine, Keck School of Medicine, University of
Southern California, Los Angeles 90033, USA.
We investigated the relations between ozone (O3), nitrogen dioxide (NO2), and
respirable particles less than 10 microm in diameter (PM10) and school
absenteeism in a cohort of 4th-grade school children who resided in 12 southern
California communities. An active surveillance system ascertained the numbers
and types of absences during the first 6 months of 1996. Pollutants were measured
hourly at central-site monitors in each of the 12 communities. To examine acute
effects of air pollution on absence rates, we fitted a two-stage time-series model to
the absence count data that included distributed lag effects of exposure adjusted
for long-term pollutant levels. Short-term change in O3, but not NO2 or PM10,
was associated with a substantial increase in school absences from both upper and
lower respiratory illness. An increase of 20 ppb of O3 was associated with an
increase of 62.9% [95% confidence interval (95% CI) = 18.4-124.1%] for illnessrelated absence rates, 82.9% (95% CI = 3.9-222.0%) for respiratory illnesses,
45.1% (95% CI = 21.3-73.7%) for upper respiratory illnesses, and 173.9% (95%
CI = 91.3-292.3%) for lower respiratory illnesses with wet cough. The short-term
effects of a 20-ppb change of O3 on illness-related absenteeism were larger in
communities with lower long-term average PM10 [223.5% (95% CI = 90.4449.7)] compared with communities with high average levels [38.1% (95% CI =
8.5-75.8)]. Increased school absenteeism from O3 exposure in children is an
important adverse effect of ambient air pollution worthy of public policy
consideration.
PMID: 11138819 [PubMed - indexed for MEDLINE]
6. ENVIRONMENTAL TOBACCO SMOKE AND SCHOOL
ABSENCES
Am J Epidemiol. 2003 May 15;157(10):861-9.
Comment in:

Am J Epidemiol. 2003 May 15;157(10):870-3.
Related Articles,
Links
Environmental tobacco smoke and absenteeism related to
respiratory illness in schoolchildren.
Gilliland FD, Berhane K, Islam T, Wenten M, Rappaport E, Avol E,
Gauderman WJ, McConnell R, Peters JM.
Department of Preventive Medicine, Keck School of Medicine, University of
Southern California, Los Angeles, CA 90033, USA. gillilan@usc.edu
Household environmental tobacco smoke (ETS) exposure accounts for substantial
morbidity among young children, but the ETS-associated morbidity burden
among school-age children is less well defined. Illness-related school absenteeism
is a measure of a broad spectrum of adverse effects of ETS exposure in schoolage children. The authors investigated the relations between ETS exposure,
asthma status, and illness-related school absenteeism in a cohort of 1,932 fourthgrade schoolchildren from 12 southern California communities during JanuaryJune 1996. Incidence rates and adjusted relative risks of illness-related absences
were determined by using an active surveillance system. The effects of ETS
exposure on absenteeism were assessed by using stratified incidence rates and
Poisson regression to adjust for sociodemographic factors. ETS exposure was
associated with an increased risk of respiratory-illness-related school absences
(relative risk (RR) = 1.27, 95% confidence interval (CI): 1.04, 1.56). Children
living in a household with two or more smokers were at increased risk of such
absences (RR = 1.75, 95% CI: 1.33, 2.30). Children's asthma status affected their
response to ETS. Compared with unexposed children without asthma, children
with asthma were at increased risk of respiratory-illness-related school absences
when exposed to one (RR = 2.35, 95% CI: 1.49, 3.71) or two or more (RR = 4.45,
95% CI: 2.80, 7.07) household smokers. Children without asthma also had an
increased risk if exposed to two or more smokers (RR = 1.44, 95% CI: 1.04,
2.00). Therefore, ETS exposure is associated with increased respiratory-related
school absenteeism among children, especially those with asthma.
PMID: 12746237 [PubMed - indexed for MEDLINE]
6. Overview: Schwartz on children and air pollution
Pediatrics. 2004 Apr;113(4 Suppl):1037-43.
Related Articles, Links
Air pollution and children's health.
Schwartz J.
Department of Environmental Health, Harvard School of Public Health, and
Channing Laboratory, Brigham and Women's Hospital, Boston, Massachusetts
02215, USA. jschwrtz@hsph.harvard.edu
Children's exposure to air pollution is a special concern because their immune
system and lungs are not fully developed when exposure begins, raising the
possibility of different responses than seen in adults. In addition, children spend
more time outside, where the concentrations of pollution from traffic,
powerplants, and other combustion sources are generally higher. Although air
pollution has long been thought to exacerbate minor acute illnesses, recent studies
have suggested that air pollution, particularly traffic-related pollution, is
associated with infant mortality and the development of asthma and atopy. Other
studies have associated particulate air pollution with acute bronchitis in children
and demonstrated that rates of bronchitis and chronic cough declined in areas
where particle concentrations have fallen. More mixed results have been reported
for lung function. Overall, evidence for effects of air pollution on children have
been growing, and effects are seen at concentrations that are common today.
Although many of these associations seem likely to be causal, others require and
warrant additional investigation.
PMID: 15060197 [PubMed - in process]
7. Brunekreef on traffic
Epidemiology. 1997 May;8(3):298-303.
Related Articles, Links
Air pollution from truck traffic and lung function in children living
near motorways.
Brunekreef B, Janssen NA, de Hartog J, Harssema H, Knape M, van Vliet P.
Department of Epidemiology and Public Health, University of Wageningen, The
Netherlands.
The contribution of motorized traffic to air pollution is widely recognized, but
relatively few studies have looked at the respiratory health status of subjects
living near busy roads. We studied children in six areas located near major
motorways in the Netherlands. We measured lung function in the children, and we
assessed their exposure to traffic-related air pollution using separate traffic counts
for automobiles and trucks. We also measured air pollution in the children's
schools. Lung function was associated with truck traffic density but had a lesser
association with automobile traffic density. The association was stronger in
children living closest (< 300 m) to the motorways. Lung function was also
associated with the concentration of black smoke, measured inside the schools, as
a proxy for diesel exhaust particles. The associations were stronger in girls than in
boys. The results indicate that exposure to traffic-related air pollution, in
particular diesel exhaust particles, may lead to reduced lung function in children
living near major motorways.
PMID: 9115026 [PubMed - indexed for MEDLINE]
Am J Respir Crit Care Med. 2002 Oct 15;166(8):1092-8.
Related Articles, Links
Air pollution from traffic and the development of
respiratory infections and asthmatic and allergic symptoms
in children.
Brauer M, Hoek G, Van Vliet P, Meliefste K, Fischer PH, Wijga A,
Koopman LP, Neijens HJ, Gerritsen J, Kerkhof M, Heinrich J,
Bellander T, Brunekreef B.
School of Occupational and Environmental Hygiene, University of
British Columbia, Vancouver, British Columbia, Canada.
brauer@interchange.ubc.ca
Despite the important contribution of traffic sources to urban air
quality, relatively few studies have evaluated the effects of trafficrelated air pollution on health, such as its influence on the development
of asthma and other childhood respiratory diseases. We examined the
relationship between traffic-related air pollution and the development
of asthmatic/allergic symptoms and respiratory infections in a birth
cohort (n approximately 4,000) study in The Netherlands. A validated
model was used to assign outdoor concentrations of traffic-related air
pollutants (nitrogen dioxide, particulate matter less than 2.5 micro m in
aerodynamic diameter, and "soot") at the home of each subject of the
cohort. Questionnaire-derived data on wheezing, dry nighttime cough,
ear, nose, and throat infections, skin rash, and physician-diagnosed
asthma, bronchitis, influenza, and eczema at 2 years of age were
analyzed in relation to air pollutants. Adjusted odds ratios for
wheezing, physician-diagnosed asthma, ear/nose/throat infections, and
flu/serious colds indicated positive associations with air pollutants,
some of which reached borderline statistical significance. No
associations were observed for the other health outcomes analyzed.
Sensitivity analyses generally supported these results and suggested
somewhat stronger associations with traffic, for asthma that was
diagnosed before 1 year of age. These findings are subject to
confirmation at older ages, when asthma can be more readily
diagnosed.
PMID: 12379553 [PubMed - indexed for MEDLINE]
9.
Ozone and wheezing (chamber) (camps) FIND
10/11 Allergies and the OutdoorEnvironment
Saxon and diesel NEED TO FIND full article too old for online
Abstract
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1: Ann Allergy Asthma Immunol. 1996 Oct;77(4):263-8; quiz 26970.
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Global increases in allergic respiratory disease: the possible role of
diesel exhaust particles.
Peterson B, Saxon A.
Hart and Louise Lyon Laboratory, USA.
OBJECTIVE: Reading this article will enable the readers to recognize and
evaluate i e potential relationship between allergic respiratory disease and
polyaromatic hydrocarbons as air pollutants from industrial and automotive fuel
sources. In this article we review the long-term trends in the prevalence of allergic
airway diseases (rhinitis and asthma). We then examine the epidemiologic and
other research data relating to the role that hydrocarbon fuel emissions may have
had on allergic respiratory disease. DESIGN: Published literature on the
relationship between specific air pollutants and trends in allergic respiratory
disease were reviewed. Reports of research on pollutant effects on allergic
antibody (IgE) were also studied. In both cases, the Melvyl-Medline database
since 1975 was used for literature searches. Older references were identified from
the bibliographies of relevant articles and books and with the help of the rare
books collection at UCLA's Louis M. Darling Biomedical library. RESULTS:
Examination of the historical record indicates that allergic rhinitis and allergic
asthma have significantly increased in prevalence over the past two centuries.
Although the reasons for this increase are not fully elucidated, epidemiologic data
suggest that certain pollutants such as those produced from the burning of fossil
fuels may have played an important role in the prevalence changes. Also
important are studies showing that diesel exhaust, a prototypical fossil fuel, is able
to enhance in vitro and in vivo IgE production. CONCLUSION: Increased levels
of the compounds resulting from fossil fuel combustion may be partly responsible
for the increased prevalence of allergic respiratory disease. If the nature of these
compounds and the mechanisms by which they exacerbate allergic disease can be
identified, steps can be taken to reduce the production or the impact of these
allergy producing compounds.
Publication Types:
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Review
Review, Tutorial
PMID: 8885801 [PubMed - indexed for MEDLINE]
Gilliland and diesel and your genes
11.
: Lancet. 2004 Jan 10;363(9403):119-25.
Related Articles, Links
Comment in:

Lancet. 2004 Jan 10;363(9403):95-6.
Effect of glutathione-S-transferase M1 and P1 genotypes on
xenobiotic enhancement of allergic responses: randomised,
placebo-controlled crossover study.
Gilliland FD, Li YF, Saxon A, Diaz-Sanchez D.
Department of Preventive Medicine, University of Southern California, Keck
School of Medicine, Los Angeles, CA 90033, USA. gillilan@usc.edu
BACKGROUND: Particulate pollution is associated with the occurrence of
asthma and allergy. The model pollutant, diesel exhaust particles, can participate
with allergens in starting and exacerbating allergic airway diseases in part by
production of reactive oxygen species. Glutathione-S-transferases (GSTs) can
metabolise reactive oxygen species and detoxify xenobiotics present in diesel
exhaust particles. We tested the hypothesis that null genotypes for GSTM1 and
GSTT1, and GSTP1 codon 105 variants (I105 and V105) are key regulators of
the adjuvant effects of diesel exhaust particles on allergic responses.
METHODS: Patients sensitive to the ragweed allergen were challenged
intranasally with allergen alone and with allergen plus diesel exhaust particles in
a randomised order at separate visits. Nasal allergen-specific IgE, histamine,
interleukin 4, and interferon gamma concentrations were measured before and
24 h after challenge. FINDINGS: Individuals with GSTM1 null or the GSTP1
I105 wildtype genotypes showed enhanced nasal allergic responses in the
presence of diesel exhaust particles. Compared with patients with a functional
GSTM1 genotype, GSTM1 null patients had a significantly larger increase in
IgE (median 102.5 U/mL [range 1.0-510.5] vs 45.5 U/mL [1.5-60.6], p=0.03)
and histamine (14.0 nmol/L [-0.2-24.7] vs 7.4 nmol/L [1.2-12.3], p=0.02) after
diesel exhaust particles plus allergen challenge. The I105 GSTP1 genotype was
associated with an increase in IgE (120.3 U/mL [6.7-510.5] vs 27.7 U/mL [-1.560.6], p=0.03) and histamine (13.8 nmol/L [3.1-24.7] vs 5.2 nmol/L [-0.2-19.6],
p=0.01) after challenge with diesel exhaust particles and allergens. The diesel
exhaust particles enhancement was largest in patients with both the GSTM1 null
and GSTP1 I/I genotypes. INTERPRETATION: GSTM1 and GSTP1 modify the
adjuvant effect of diesel exhaust particles on allergic inflammation.
Publication Types:
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Clinical Trial
Randomized Controlled Trial
PMID: 14726165 [PubMed - indexed for MEDLINE]
Abstract
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12 Asthma and Violence
Am J Public Health. 2004 Apr;94(4):625-32.
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Community violence and asthma morbidity: the Inner-City Asthma
Study.
Wright RJ, Mitchell H, Visness CM, Cohen S, Stout J, Evans R, Gold DR.
Beth Israel Deaconess Medical Center, Pulmonary and Critical Care Division, and
the Channing Laboratory, Department of Medicine, Brigham and Women's
Hospital, Harvard Medical School, Boston, MA 02115, USA.
rosalind.wright@channing.harvard.edu
OBJECTIVES: We examined the association between exposure to violence and
asthma among urban children. METHODS: We obtained reports from caretakers
(n = 851) of violence, negative life events, unwanted memories (rumination),
caretaker-perceived stress, and caretaker behaviors (keeping children indoors,
smoking, and medication adherence). Outcomes included caretaker-reported
wheezing, sleep disruption, interference with play because of asthma, and effects
on the caretaker (nights caretaker lost sleep because of child's asthma).
RESULTS: Increased exposure to violence predicted higher number of symptom
days (P =.0008) and more nights that caretakers lost sleep (P =.02) in a graded
fashion after control for socioeconomic status, housing deterioration, and negative
life events. Control for stress and behaviors partially attenuated this gradient,
although these variables had little effect on the association between the highest
level of exposure to morbidity, which suggests there are other mechanisms.
CONCLUSIONS: Mechanisms linking violence and asthma morbidity need to be
further explored.
PMID: 15054016 [PubMed - indexed for MEDLINE]