The health effects of nonindustrial indoor air pollution

doi:10.1016/j.jaci.2007.10.045

Journal of Allergy and Clinical Immunology

Volume 121, Issue 3, March 2008, Pages 585-591

https://doi.org/10.1016/j.jaci.2007.10.045 Get rights and content

Background

There is growing public awareness regarding the risk associated with poor indoor air quality in the home and workplace. Because Americans spend approximately 22 hours every day indoors, susceptible individuals are at much greater risk of adverse health effects from chronic low levels of exposure to indoor air pollutants over time. Along with particulate matter, gases such as ozone, nitrogen dioxide, carbon monoxide, and sulfur dioxide; microbial and chemical volatile organic compounds; passive smoke; and outdoor ambient air are the most common types of air pollutants encountered indoors.

Objective

To provide the allergists with necessary information that will assist them in making useful recommendations to patients seeking advice regarding indoor environmental triggers beyond traditional perennial allergens.

Methods

Review of the literature pertaining to indoor exposure and health effects of gaseous and particular matter.

Results

Indoor pollutants act as respiratory irritants, toxicants, and adjuvants or carriers of allergens.

Conclusion

The allergist should be prepared to evaluate patient exposure to allergic and nonallergic triggers and understand how outdoor air pollution is affecting indoor environments. This requires being familiar with methodologies for monitoring and interpreting indoor air quality and interpreting results in the context of the patients exposure history and advising patients about rational environmental control interventions.

Section snippets

O₃

Acute exposure to O₃ produces decrements in pulmonary function and exercise capacity and induces airways inflammation in both healthy individuals and those with pre-existing airways disease (ie, asthma, chronic obstructive pulmonary disease).2, 3, 4 In individuals with allergy, O₃ acts as an adjuvant, enhancing the allergic response to inhaled allergen.⁵ Interactions between ozone and particulate matter in office settings has also been reported.⁶ O₃-induced health effects are dependent on the

Tobacco smoke: passive and sidestream exposure

Tobacco is the leading cause of preventable death. Tobacco smoke contains more than 4000 chemicals in the form of particles and gases, many of which are known or suspected carcinogens.³³

The 2001 European Community Respiratory Health Survey reported that 65% of respondents identified at least 1 smoking parent during their childhood, and 39% currently were being exposed to ETS.³⁴ In the United States, 37% of adult nontobacco users reported ETS exposure at home or work, yet 88% demonstrated

Classification

The regulation of ambient PM and the implementation of enforcement laws for emissions by the US Environment Protection Agency have made a significant step in improving outdoor air quality. However, there has been growing concern about the adverse health effects of indoor particulate matter and its associated chemical or biological agents. In industrialized countries, people spend approximately 22 hours of their time indoors. Recent studies have demonstrated an association between indoor PM and

SBS

Sick building is a term first used to describe workplaces with poor ventilation where an excess above the expected numbers of occupants report symptoms of fatigue, headache, nasal, eye or skin irritation, sore throat, and cough that temporally occur with being in the building and improve away from the building. SBS has been defined as having 3 or more symptoms including dry or irritated eyes, sore or dry throat, stuffy or runny nose, unusual fatigue, and weekly headaches that improve away from

Current methods for monitoring IAQ

Diagnostic techniques used for IAQ evaluations are usually divided into a qualitative and a quantitative phase.⁷³ Instrumentation used during the qualitative IAQ evaluation is limited and is intended primarily to supplement the investigators visual observations. Direct-reading instruments are used to measure relative humidity, room temperature, O₃, CO, CO₂, and particulate concentrations. The qualitative evaluation for microbial contaminants includes an assessment of the building and heating,

Building procedures

The allergy specialist should have some familiarity with building a healthy home because patients are frequently presenting with health complaints related to poor IAQ attributed to their home or workplace. The 3 primary considerations in improving IAQ are (1) evaluation of construction failures that allow moisture into the walls of a building, (2) poor ventilation causing excessive humidity and accumulation of gaseous and/or chemical exposure from materials in the living space, and (3) poorly

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: Disclosure of potential conflict of interest: J. A. Bernstein has consultant arrangements with Medpointe, Cornerstone, and Flint Industries; has received research support from Merck, GlaxoSmithKline, and Medpointe; has served on the speakers' bureau for AstraZeneca, GlaxoSmithKline, UCB-Sanofi Aventis, Novartis, Merck, and Tera; and has served as an expert witness in legal cases regarding environmental issues. E. Horner is employed by and owns stock in Air Quality Sciences; has provided litigation support to both defendant and plaintiff attorneys; and has received grants/research support from the American Society of Heating, Refrigerating, and Air Conditioning Engineers. S. M. Tarlo receives referrals from the Ontario workers' compensation system, insurance companies, and physicians of patients with building-related complaints. The rest of the authors have declared that they have no conflict of interest.

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Reviews and feature articleThe health effects of nonindustrial indoor air pollution

Background

Objective

Methods

Results

Conclusion

Section snippets

O3

Tobacco smoke: passive and sidestream exposure

Classification

SBS

Current methods for monitoring IAQ

Building procedures

Clin Immunol

Ann Allergy Asthma Immunol

Lancet

Free Radic Biol Med

Toxicology

Environ Res

Soc Sci Med

Lancet

Environ Int

J Allergy Clin Immunol

J Allergy Clin Immunol

Atmos Environ

Ann Allergy Asthma Immunol

Health effects of air pollution

J Allergy Asthma Clin Immunol

Editorial: deadly household pollution: a call to action

Indoor Air

Use of submaximal inhalation and spirometry to assess the effects of ozone exposure

Arch Environ Health

Interaction between ozone and airborne particulate matter in office air

Indoor Air

Ozone exposure has both a priming effect on allergen-induced responses and an intrinsic inflammatory action in the nasal airways of perennially allergic asthmatics

Am J Respir Crit Care Med

Effects of an ozone-generating air purifier on indoor secondary particles in three residential dwellings

Indoor Air

Association of indoor nitrogen dioxide exposure with respiratory symptoms in children with asthma

Am J Respir Crit Care Med

Exposure to NO2 and nitrous acid and respiratory symptoms in the first year of life

Epidemiology

Nitrogen dioxide exposure enhances asthmatic reaction to inhaled allergen in subjects with asthma

Am J Respir Crit Care Med

Effect of nitrous acid on lung function in asthmatics: a chamber study

Environ Health Perspect

Short-term effects of ambient sulphur dioxide and particulate matter on mortality in 12 European cities: results from time series data from the APHEA project. Air Pollution and Health: A European Approach

BMJ

Indoor, outdoor, and regional summer and winter concentrations of PM10, PM2.5, SO4(2)-, H+, NH4+, NO3-, NH3, and nitrous acid in homes with and without kerosene space heaters

Environ Health Perspect

Airway sensitivity of asthmatics to sulfur dioxide

Toxicol Ind Health

The effect of sulphurous air pollutant exposures on symptoms, lung function, exhaled nitric oxide, and nasal epithelial lining fluid antioxidant concentrations in normal and asthmatic adults

Occup Environ Med

Indoor heating sources and respiratory symptoms in nonsmoking women

Epidemiology

Hyperbaric oxygen for acute carbon monoxide poisoning

N Engl J Med

Association between ambient carbon monoxide levels and hospitalizations for congestive heart failure in the elderly in 10 Canadian cities

Epidemiology

Organic compounds in office environments: sensory irritation, odor, measurements and the role of reactive chemistry

Indoor Air

Detection of single and mixed VOCs by smell and by sensory irritation

Indoor Air

European indoor air quality audit project in 56 office buildings

Indoor Air

Identification of volatile microbiological compounds from household waste and building materials by thermal desorption-capillary gas chromatography-mass spectroscopy

J High Resol Chromatogr

Building-related respiratory symptoms can be predicted with semi-quantitative indices of exposure to dampness and mold

Indoor Air

Volatile compounds originating from mixed microbial cultures on building materials under various humidity conditions

Appl Environ Microbiol

Asthma among school employees in relation to the school environment

Nasal lavage biomarkers: effects of water damage and microbial growth in an office building

Arch Environ Health

Reviews and feature article
The health effects of nonindustrial indoor air pollution

O₃