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• W1991451888 abstract "Most studies that have examined exposure to indoor allergens have focused on home environments. However, allergen exposures can be encountered in environments other than the home. For example, many children spend a large part of their time in schools and day care facilities. Over the past 2 decades, a large number of studies have been conducted in school and day care environments. However, the role of indoor exposures in allergy and asthma development or morbidity in these settings is not well characterized. The purpose of this review is to evaluate the importance of indoor allergen exposures in school and day care settings. We summarize the key findings from recent scientific literature, describe exposure characteristics, discuss the role of these exposures in relation to asthma and allergy symptoms, and provide information on the effectiveness of published interventions. Most studies that have examined exposure to indoor allergens have focused on home environments. However, allergen exposures can be encountered in environments other than the home. For example, many children spend a large part of their time in schools and day care facilities. Over the past 2 decades, a large number of studies have been conducted in school and day care environments. However, the role of indoor exposures in allergy and asthma development or morbidity in these settings is not well characterized. The purpose of this review is to evaluate the importance of indoor allergen exposures in school and day care settings. We summarize the key findings from recent scientific literature, describe exposure characteristics, discuss the role of these exposures in relation to asthma and allergy symptoms, and provide information on the effectiveness of published interventions. Information for Category 1 CME CreditCredit can now be obtained, free for a limited time, by reading the review articles in this issue. Please note the following instructions.Method of Physician Participation in Learning Process: The core material for these activities can be read in this issue of the Journal or online at the JACI Web site: www.jacionline.org. The accompanying tests may only be submitted online at www.jacionline.org. Fax or other copies will not be accepted.Date of Original Release: August 2009. Credit may be obtained for these courses until July 31, 2011.Copyright Statement: Copyright © 2009-2011. All rights reserved.Overall Purpose/Goal: To provide excellent reviews on key aspects of allergic disease to those who research, treat, or manage allergic disease.Target Audience: Physicians and researchers within the field of allergic disease.Accreditation/Provider Statements and Credit Designation: The American Academy of Allergy, Asthma & Immunology (AAAAI) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The AAAAI designates these educational activities for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.List of Design Committee Members: Authors: Päivi M. Salo, PhD, Michelle L. Sever, MSPH, and Darryl C. Zeldin, MDActivity Objectives1.To recognize factors that influence pet and dust mite allergen levels in schools and day care centers and the evidence supporting various methods of intervention.2.To identify the levels of environmental allergen that have been associated with allergic sensitization.3.To become familiar with studies examining the association between asthma and pet allergen exposure in schools.4.To understand the limitations of the assessment of fungal allergen exposure and the hypothesized underlying mechanisms of the observed health effects.Recognition of Commercial Support: This CME activity is supported by an educational grant from Merck & Co., Inc.Disclosure of Significant Relationships with Relevant CommercialCompanies/Organizations: The authors have declared that they have no conflict of interest.GlossaryAIR SAMPLINGThere are multiple methods to sample aeroallergens, including sedimentation/gravity sampling (nonquantitative), rotating arm impactors, suction impactors, centrifugal sampling, and filtration sampling. The selection of the method/device depends on several factors, including the characteristics of the aeroallergen(s) (eg, particle size), sampling conditions and time, and analytical techniques used for quantification.AMBIENT RELATIVE HUMIDITYRelative humidity is calculated as the amount of moisture in the air divided by the maximum amount of moisture possible in the air at a specified temperature. Dust mites thrive in environment with temperatures of 70°F to 80°F and greater than 55% relative humidity.β-1,3 GLUCAN AND ADJUVANTβ-1,3 Glucans are glucose polymers in the cell walls of plants and fungi. Exposure to elevated levels of this glucose polymer has been associated with increased atopy, increased conjunctival/respiratory symptoms, and decreased FEV1. In addition, β-1,3 glucans can act as adjuvants to increase antigen-specific IgE levels in animal models.CROSS-SECTIONALA cross-sectional analysis examines relationships or associations at a single point in time (as opposed to a prospective cohort study, which looks at a sample population over time). In a cross-sectional study, disease prevalence can be determined, but due to the single time point, a causal relationship between a risk factor and disease cannot be established.ELISAAn ELISA uses a color detection system to quantify the amount of a protein of interest (antibody or antigen). In a sandwich ELISA a capture antibody is coupled to a solid phase followed by incubation with a biologic fluid (eg, serum, dust extract) and detection of the antigen by a second antibody.LARGE-SIZED PARTICLEOnly particles of 5 μm or less reach the lower airway. For example, intact pollen grains (15-75 μm) have the greatest effects on the upper airway and conjunctiva because of their size and subsequent trapping before reaching the lower airways.LOW INCOMEThe definition of a low-income family is one in which the income from the preceding year does not exceed 150% of the poverty line income. In 2009, the low-income threshold for the 48 contiguous states was defined as $33,075 for a family of 4 (poverty level of $22,050 for a family of 4).TAPE SAMPLINGA hand-held roller with adhesive tape can be used to collect samples from clothing. Rolled tape samples are immunostained to detect allergen.VOLATILE ORGANIC COMPOUNDSVolitile organic compounds include a variety of organic chemicals that are emitted as gases from certain solids and liquids. Many household products, such as paints, cleaning supplies, pesticides, printers, glues, adhesives, and permanent markers are sources of volitile organic compounds in indoor environments. Volatile organic compounds can be up to 10 times more concentrated in indoor air compared with those in outdoor air.The Editors wish to acknowledge Seema Aceves, MD, PhD, for preparing this glossary.Exposure and sensitization to indoor allergens are important risk factors for asthma and allergic respiratory diseases.1Platts-Mills T.A. Vervloet D. Thomas W.R. Aalberse R.C. Chapman M.D. Indoor allergens and asthma: report of the Third International Workshop.J Allergy Clin Immunol. 1997; 100: S2-S24Abstract Full Text Full Text PDF PubMed Google Scholar Although the role of indoor allergen exposure in the development of allergic sensitization and asthma remains subject to debate, there is strong evidence that indoor allergens play a key role in triggering and exacerbating allergy and asthma symptoms.2Langley S.J. Goldthorpe S. Craven M. Morris J. Woodcock A. Custovic A. Exposure and sensitization to indoor allergens: association with lung function, bronchial reactivity, and exhaled nitric oxide measures in asthma.J Allergy Clin Immunol. 2003; 112: 362-368Abstract Full Text Full Text PDF PubMed Scopus (81) Google ScholarMost studies of indoor allergens have targeted home environments because homes are often considered the primary sites of exposure. Over the past decades, the importance of nonresidential indoor environments has also been recognized.3Committee on the Assessment of Asthma and Indoor Air, Division of Health Promotion and Disease Prevention, Institute of MedicineClearing the air: asthma and indoor exposures. National Academy Press, Washington (DC)2000Google Scholar For example, in schools and day care facilities, allergen and other indoor exposures can affect children's health because children spend a large part of their childhood and adolescent years in these environments.This review focuses on the importance of indoor allergen exposures in day care and school environments. The purpose of this article is to summarize key findings from the scientific literature and to identify future research needs. Studies for this review were searched by using the following databases: PubMed, Embase, Web of Science, Scopus, and Education Resources Information Center. Although inhalation of food allergens might induce allergic reactions in sensitive individuals, food allergens, which can constitute an important part of allergen exposures in day care and school settings, are beyond the scope of this review. Furthermore, the relevance of exposures other than aeroallergens (eg, environmental tobacco smoke, endotoxin, volatile organic compounds, and other irritants) will not be discussed, although these exposures might also affect indoor air quality and occupants' health status.Exposure to indoor allergens in day care and school environmentsStudy designs and exposure assessmentIndoor allergen exposures in schools and day care centers have been an area of continuing research interest. Studies have been conducted worldwide,4Custovic A. Green R. Taggart S.C. Smith A. Pickering C.A. Chapman M.D. et al.Domestic allergens in public places. II: Dog (Can f1) and cockroach (Bla g 2) allergens in dust and mite, cat, dog and cockroach allergens in the air in public buildings.Clin Exp Allergy. 1996; 26: 1246-1252Crossref PubMed Scopus (118) Google Scholar, 5de Andrade A.D. Charpin D. Birnbaum J. Lanteaume A. Chapman M. Vervloet D. Indoor allergen levels in day nurseries.J Allergy Clin Immunol. 1995; 95: 1158-1163Abstract Full Text Full Text PDF PubMed Scopus (63) Google Scholar, 6Einarsson R. Munir A.K. Dreborg S.K. Allergens in school dust: II. Major mite (Der p I, Der f I) allergens in dust from Swedish schools.J Allergy Clin Immunol. 1995; 95: 1049-1053Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar, 7Engelhart S. Bieber T. Exner M. House dust mite allergen levels in German day-care centers.Int J Hyg Environ Health. 2002; 205: 453-457Crossref PubMed Google Scholar, 8Kim J.L. Elfman L. Norbäck D. Respiratory symptoms, asthma and allergen levels in schools—comparison between Korea and Sweden.Indoor Air. 2007; 17: 122-129Crossref PubMed Scopus (24) Google Scholar, 9Oldfield K. Siebers R. Crane J. Endotoxin and indoor allergen levels in kindergartens and daycare centres in Wellington, New Zealand.N Z Med J. 2007; 120 (U2400)PubMed Google Scholar, 10Patchett K. Lewis S. Crane J. Fitzharris P. Cat allergen (Fel d 1) levels on school children's clothing and in primary school classrooms in Wellington, New Zealand.J Allergy Clin Immunol. 1997; 100: 755-759Abstract Full Text Full Text PDF PubMed Scopus (87) Google Scholar, 11Rullo V.E. Rizzo M.C. Arruda L.K. Solé D. Naspitz C.K. Daycare centers and schools as sources of exposure to mites, cockroach, and endotoxin in the city of Sao Paulo, Brazil.J Allergy Clin Immunol. 2002; 110: 582-588Abstract Full Text Full Text PDF PubMed Scopus (47) Google Scholar, 12Zhang L. Chew F.T. Soh S.Y. Yi F.C. Law S.Y. Goh D.Y. et al.Prevalence and distribution of indoor allergens in Singapore.Clin Exp Allergy. 1997; 27: 876-885Crossref PubMed Scopus (51) Google Scholar, 13Zhao Z.H. Elfman L. Wang Z.H. Zhang Z. Norbäck D. A comparative study of asthma, pollen, cat and dog allergy among pupils and allergen levels in schools in Taiyuan city, China, and Uppsala, Sweden.Indoor Air. 2006; 16: 404-413Crossref PubMed Scopus (21) Google Scholar, 14Zock J.P. Brunekreef B. House dust mite allergen levels in dust from schools with smooth and carpeted classroom floors.Clin Exp Allergy. 1995; 25: 549-553Crossref PubMed Scopus (31) Google Scholar, 15Zuraimi M.S. Ong T.C. Tham K.W. Chew F.T. Determinants of indoor allergens in tropical child care centers.Pediatr Allergy Immunol. 2008; 19: 746-755Crossref PubMed Scopus (8) Google Scholar but the research has been most active in the United States and Scandinavian countries.16Abramson S.L. Turner-Henson A. Anderson L. Hemstreet M.P. Bartholomew L.K. Joseph C.L. et al.Allergens in school settings: results of environmental assessments in 3 city school systems.J Sch Health. 2006; 76: 246-249Crossref PubMed Scopus (25) Google Scholar, 17Almqvist C. Larsson P.H. Egmar A.C. Hedrén M. Malmberg P. Wickman M. School as a risk environment for children allergic to cats and a site for transfer of cat allergen to homes.J Allergy Clin Immunol. 1999; 103: 1012-1017Abstract Full Text Full Text PDF PubMed Scopus (157) Google Scholar, 18Amr S. Bollinger M.E. Myers M. Hamilton R.G. Weiss S.R. Rossman M. et al.Environmental allergens and asthma in urban elementary schools.Ann Allergy Asthma Immunol. 2003; 90: 34-40Abstract Full Text PDF PubMed Google Scholar, 19Arbes S.J. Sever M. Mehta J. Collette N. Thomas B. Zeldin D.C. Exposure to indoor allergens in day-care facilities: results from 2 North Carolina counties.J Allergy Clin Immunol. 2005; 116: 133-139Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar, 20Chew G.L. Correa J.C. Perzanowski M.S. Mouse and cockroach allergens in the dust and air in northeastern United States inner-city public high schools.Indoor Air. 2005; 15: 228-234Crossref PubMed Scopus (42) Google Scholar, 21Dybendal T. Elsayed S. Dust from carpeted and smooth floors. VI. Allergens in homes compared with those in schools in Norway.Allergy. 1994; 49: 210-216Crossref PubMed Google Scholar, 22Fernández-Caldas E. Codina R. Ledford D.K. Trudeau W.L. Lockey R.F. House dust mite, cat, and cockroach allergen concentrations in daycare centers in Tampa, Florida.Ann Allergy Asthma Immunol. 2001; 87: 196-200Abstract Full Text PDF PubMed Google Scholar, 23Foarde K. Berry M. Comparison of biocontaminant levels associated with hard vs. carpet floors in nonproblem schools: results of a year long study.J Expo Anal Environ Epidemiol. 2004; 14: S41-S48Crossref PubMed Scopus (17) Google Scholar, 24Instanes C. Hetland G. Berntsen S. Løvik M. Nafstad P. Allergens and endotoxin in settled dust from day-care centers and schools in Oslo, Norway.Indoor Air. 2005; 15: 356-362Crossref PubMed Scopus (26) Google Scholar, 25Kim J.L. Elfman L. Mi Y. Johansson M. Smedje G. Norbäck D. Current asthma and respiratory symptoms among pupils in relation to dietary factors and allergens in the school environment.Indoor Air. 2005; 15: 170-182Crossref PubMed Scopus (56) Google Scholar, 26Munir A.K. Einarsson R. Dreborg S.K. Mite (Der p I, Der f I), cat (Fel d I) and dog (Can f I) allergens in dust from Swedish day-care centres.Clin Exp Allergy. 1995; 25: 119-126Crossref PubMed Scopus (82) Google Scholar, 27Munir A.K. Einarsson R. Schou C. Dreborg S.K. Allergens in school dust. I. The amount of the major cat (Fel d I) and dog (Can f I) allergens in dust from Swedish schools is high enough to probably cause perennial symptoms in most children with asthma who are sensitized to cat and dog.J Allergy Clin Immunol. 1993; 91: 1067-1074Abstract Full Text PDF PubMed Scopus (176) Google Scholar, 28Perry T.T. Vargas P.A. Bufford J. Feild C. Flick M. Simpson P.M. et al.Classroom aeroallergen exposure in Arkansas head start centers.Ann Allergy Asthma Immunol. 2008; 100: 358-363Abstract Full Text Full Text PDF PubMed Google Scholar, 29Perzanowski M.S. Rönmark E. Nold B. Lundbäck B. Platts-Mills T.A. Relevance of allergens from cats and dogs to asthma in the northernmost province of Sweden: schools as a major site of exposure.J Allergy Clin Immunol. 1999; 103: 1018-1024Abstract Full Text Full Text PDF PubMed Scopus (115) Google Scholar, 30Ramachandran G. Adgate J.L. Banerjee S. Church T.R. Jones D. Fredrickson A. et al.Indoor air quality in two urban elementary schools–measurements of airborne fungi, carpet allergens, CO2, temperature, and relative humidity.J Occup Environ Hyg. 2005; 2: 553-566Crossref PubMed Scopus (19) Google Scholar, 31Sarpong S.B. Wood R.A. Karrison T. Eggleston P.A. Cockroach allergen (Bla g 1) in school dust.J Allergy Clin Immunol. 1997; 99: 486-492Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar, 32Smedje G. Norbäck D. Incidence of asthma diagnosis and self-reported allergy in relation to the school environment—a four-year follow-up study in schoolchildren.Int J Tuberc Lung Dis. 2001; 5: 1059-1066PubMed Google Scholar, 33Smedje G. Norbäck D. Edling C. Asthma among secondary schoolchildren in relation to the school environment.Clin Exp Allergy. 1997; 27: 1270-1278Crossref PubMed Google Scholar, 34Tortolero S.R. Bartholomew L.K. Tyrrell S. Abramson S.L. Sockrider M.M. Markham C.M. et al.Environmental allergens and irritants in schools: a focus on asthma.J Sch Health. 2002; 72: 33-38Crossref PubMed Google Scholar, 35Sheehan W.J. Rangsithienchai P.A. Muilenberg M.L. Rogers C.A. Lane J.P. Ghaemghami J. et al.Mouse allergens in urban elementary schools and homes of children with asthma.Ann Allergy Asthma Immunol. 2009; 102: 125-130Abstract Full Text Full Text PDF PubMed Google Scholar Although most studies have targeted school environments, the number of studies that have assessed allergen levels in day care centers has increased over the past decade.7Engelhart S. Bieber T. Exner M. House dust mite allergen levels in German day-care centers.Int J Hyg Environ Health. 2002; 205: 453-457Crossref PubMed Google Scholar, 9Oldfield K. Siebers R. Crane J. Endotoxin and indoor allergen levels in kindergartens and daycare centres in Wellington, New Zealand.N Z Med J. 2007; 120 (U2400)PubMed Google Scholar, 11Rullo V.E. Rizzo M.C. Arruda L.K. Solé D. Naspitz C.K. Daycare centers and schools as sources of exposure to mites, cockroach, and endotoxin in the city of Sao Paulo, Brazil.J Allergy Clin Immunol. 2002; 110: 582-588Abstract Full Text Full Text PDF PubMed Scopus (47) Google Scholar, 15Zuraimi M.S. Ong T.C. Tham K.W. Chew F.T. Determinants of indoor allergens in tropical child care centers.Pediatr Allergy Immunol. 2008; 19: 746-755Crossref PubMed Scopus (8) Google Scholar, 19Arbes S.J. Sever M. Mehta J. Collette N. Thomas B. Zeldin D.C. Exposure to indoor allergens in day-care facilities: results from 2 North Carolina counties.J Allergy Clin Immunol. 2005; 116: 133-139Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar, 22Fernández-Caldas E. Codina R. Ledford D.K. Trudeau W.L. Lockey R.F. House dust mite, cat, and cockroach allergen concentrations in daycare centers in Tampa, Florida.Ann Allergy Asthma Immunol. 2001; 87: 196-200Abstract Full Text PDF PubMed Google Scholar, 24Instanes C. Hetland G. Berntsen S. Løvik M. Nafstad P. Allergens and endotoxin in settled dust from day-care centers and schools in Oslo, Norway.Indoor Air. 2005; 15: 356-362Crossref PubMed Scopus (26) Google Scholar, 28Perry T.T. Vargas P.A. Bufford J. Feild C. Flick M. Simpson P.M. et al.Classroom aeroallergen exposure in Arkansas head start centers.Ann Allergy Asthma Immunol. 2008; 100: 358-363Abstract Full Text Full Text PDF PubMed Google Scholar To date, studies have mainly been cross-sectional in design. Some studies, however, have examined seasonal variation in allergen levels.16Abramson S.L. Turner-Henson A. Anderson L. Hemstreet M.P. Bartholomew L.K. Joseph C.L. et al.Allergens in school settings: results of environmental assessments in 3 city school systems.J Sch Health. 2006; 76: 246-249Crossref PubMed Scopus (25) Google Scholar, 20Chew G.L. Correa J.C. Perzanowski M.S. Mouse and cockroach allergens in the dust and air in northeastern United States inner-city public high schools.Indoor Air. 2005; 15: 228-234Crossref PubMed Scopus (42) Google ScholarCat (Fel d 1), dog (Can f 1), dust mite (Der f 1 and Der p 1), cockroach (Bla g 1 and Bla g 2), and mouse (Mus m 1 and mouse urinary protein [MUP]) allergens and molds have been the most frequently studied allergens. Although sampling and analytic procedures used in the studies vary considerably, allergen concentrations are usually quantified by using antibody-based ELISAs.36Tranter D.C. Indoor allergens in settled school dust: a review of findings and significant factors.Clin Exp Allergy. 2005; 35: 126-136Crossref PubMed Scopus (28) Google Scholar However, methodological differences can contribute to the variability of the findings and complicate comparisons between studies. For example, differences in sampling equipments (eg, flow rate, vacuum power, and collection devices), sampling locations, and used metrics can make comparisons difficult.36Tranter D.C. Indoor allergens in settled school dust: a review of findings and significant factors.Clin Exp Allergy. 2005; 35: 126-136Crossref PubMed Scopus (28) Google Scholar In general, correlations between different sampling methods have been poor.37Karlsson A.S. Renström A. Hedrén M. Larsson K. Comparison of four allergen-sampling methods in conventional and allergy prevention classrooms.Clin Exp Allergy. 2002; 32: 1776-1781Crossref PubMed Scopus (19) Google Scholar In most studies allergen levels have been assessed in settled dust samples collected from various indoor sites. Air sampling techniques have been primarily used for pet allergens (eg, Fel d 1), which are carried on aerodynamically smaller-sized particles and remain airborne for longer periods of time. Studies that have assessed allergen levels on the surface of clothing have also used tape sampling.38Karlsson A.S. Andersson B. Renström A. Svedmyr J. Larsson K. Borres M.P. Airborne cat allergen reduction in classrooms that use special school clothing or ban pet ownership.J Allergy Clin Immunol. 2004; 113: 1172-1177Abstract Full Text Full Text PDF PubMed Scopus (30) Google ScholarAllergen levels and exposure characteristicsTable E1, Table E2, Table E3, Table E4, Table E5 in this article's Online Repository at www.jacionline.org summarize the main findings on cat, dog, dust mite, cockroach, and mouse allergen levels from published studies that have examined indoor allergen exposures in day care and school environments in the past 2 decades.Exposure to cat and dog allergensNumerous studies have shown that animal allergens can be present in environments in which no animals reside.3Committee on the Assessment of Asthma and Indoor Air, Division of Health Promotion and Disease Prevention, Institute of MedicineClearing the air: asthma and indoor exposures. National Academy Press, Washington (DC)2000Google Scholar, 4Custovic A. Green R. Taggart S.C. Smith A. Pickering C.A. Chapman M.D. et al.Domestic allergens in public places. II: Dog (Can f1) and cockroach (Bla g 2) allergens in dust and mite, cat, dog and cockroach allergens in the air in public buildings.Clin Exp Allergy. 1996; 26: 1246-1252Crossref PubMed Scopus (118) Google Scholar In schools and day care centers, cat (Fel d 1) and dog (Can f 1) allergens are frequently detected, but the levels of exposure vary greatly. In general, these common aeroallergens are found at low levels (see Table E1, Table E2) in these settings. Nonetheless, although the magnitude of exposure tends to be low, studies have demonstrated that allergen levels in educational facilities can be higher than in homes where no pets are present.21Dybendal T. Elsayed S. Dust from carpeted and smooth floors. VI. Allergens in homes compared with those in schools in Norway.Allergy. 1994; 49: 210-216Crossref PubMed Google Scholar, 29Perzanowski M.S. Rönmark E. Nold B. Lundbäck B. Platts-Mills T.A. Relevance of allergens from cats and dogs to asthma in the northernmost province of Sweden: schools as a major site of exposure.J Allergy Clin Immunol. 1999; 103: 1018-1024Abstract Full Text Full Text PDF PubMed Scopus (115) Google ScholarCat and dog allergen levels have generally been found in higher levels in carpeted and upholstered areas.4Custovic A. Green R. Taggart S.C. Smith A. Pickering C.A. Chapman M.D. et al.Domestic allergens in public places. II: Dog (Can f1) and cockroach (Bla g 2) allergens in dust and mite, cat, dog and cockroach allergens in the air in public buildings.Clin Exp Allergy. 1996; 26: 1246-1252Crossref PubMed Scopus (118) Google Scholar, 10Patchett K. Lewis S. Crane J. Fitzharris P. Cat allergen (Fel d 1) levels on school children's clothing and in primary school classrooms in Wellington, New Zealand.J Allergy Clin Immunol. 1997; 100: 755-759Abstract Full Text Full Text PDF PubMed Scopus (87) Google Scholar, 18Amr S. Bollinger M.E. Myers M. Hamilton R.G. Weiss S.R. Rossman M. et al.Environmental allergens and asthma in urban elementary schools.Ann Allergy Asthma Immunol. 2003; 90: 34-40Abstract Full Text PDF PubMed Google Scholar, 19Arbes S.J. Sever M. Mehta J. Collette N. Thomas B. Zeldin D.C. Exposure to indoor allergens in day-care facilities: results from 2 North Carolina counties.J Allergy Clin Immunol. 2005; 116: 133-139Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar, 23Foarde K. Berry M. Comparison of biocontaminant levels associated with hard vs. carpet floors in nonproblem schools: results of a year long study.J Expo Anal Environ Epidemiol. 2004; 14: S41-S48Crossref PubMed Scopus (17) Google Scholar, 26Munir A.K. Einarsson R. Dreborg S.K. Mite (Der p I, Der f I), cat (Fel d I) and dog (Can f I) allergens in dust from Swedish day-care centres.Clin Exp Allergy. 1995; 25: 119-126Crossref PubMed Scopus (82) Google Scholar Levels in carpeting are often significantly lower than levels in upholstered seats.4Custovic A. Green R. Taggart S.C. Smith A. Pickering C.A. Chapman M.D. et al.Domestic allergens in public places. II: Dog (Can f1) and cockroach (Bla g 2) allergens in dust and mite, cat, dog and cockroach allergens in the air in public buildings.Clin Exp Allergy. 1996; 26: 1246-1252Crossref PubMed Scopus (118) Google Scholar, 27Munir A.K. Einarsson R. Schou C. Dreborg S.K. Allergens in school dust. I. The amount of the major cat (Fel d I) and dog (Can f I) allergens in dust from Swedish schools is high enough to probably cause perennial symptoms in most children with asthma who are sensitized to cat and dog.J Allergy Clin Immunol. 1993; 91: 1067-1074Abstract Full Text PDF PubMed Scopus (176) Google Scholar It is not uncommon that allergen levels in these locations sometimes exceed thresholds that have been associated with allergic sensitization (1.0 μg/g for Fel d 1 and 2.0 μg/g for Can f 1) or asthma symptoms in sensitized individuals (8.0 μg/g for Fel d 1 and 10.0 μg/g for Can f 1).39Custovic A. Fletcher A. Pickering C.A. Francis H.C. Green R. Smith A. et al.Domestic allergens in public places III: house dust mite, cat, dog and cockroach allergens in British hospitals.Clin Exp Allergy. 1998; 28: 53-59Crossref PubMed Scopus (96) Google Scholar, 40Ingram J.M. Sporik R. Rose G. Honsinger R. Chapman M.D. Platts-Mills T.A. Quantitative assessment of exposure to dog (Can f 1) and cat (Fel d 1) allergens: relation to sensitization and asthma among children living in Los Alamos, New Mexico.J Allergy Clin Immunol. 1995; 96: 449-456Abstract Full Text Full Text PDF PubMed Scopus (222) Google Scholar The highest average concentrations have been found in US and Swedish schools; in samples collected from chairs and desks, geometric means reached as high as 11.3 μg/g for Fel d 1 and 15.0 μg/g for Can f 1.29Perzanowski M.S. Rönmark E. Nold B. Lundbäck B. Platts-Mills T.A. Relevance of allergens from cats and dogs to asthma in the northernmost province of Sweden: schools as a major site of exposure.J Allergy Clin Immunol. 1999; 103: 1018-1024Abstract Full Text Full Text PDF PubMed Scopus (115) Google ScholarThere is strong evidence that clothing is the primary transfer mechanism and source of pet allergens.10Patchett K. Lewis S. Crane J. Fitzharris P. Cat allergen (Fel d 1) levels on school children's clothing and in primary school classrooms in Wellington, New Zealand.J Allergy Clin Immunol. 1997; 100: 755-759Abstract Full Text Full Text PDF PubMed Scopus (87) Google Scholar, 17Almqvist C. Larsson P.H. Egmar A.C. Hedrén M. Malmberg P. Wickman M. School as a risk environment for children allergic to cats and a site for transfer of cat allergen to homes.J Allergy Clin Immunol. 1999; 103: 1012-1017Abstract Full Text Full Text PDF PubMed Scopus (157) Google Scholar, 41Berge M. Munir A.K. Dreborg S. Concentrations of cat (Fel d1), dog (Can f1) and mite (Der f1 and Der p1) allergens in the clothing and school environment of Swedish schoolchildren with and without pets at home.Pediatr Allergy Immunol. 1998; 9: 25-30Crossref PubMed Google Scholar, 42De Lucca S.D. O'Meara T.J. Tovey E.R. Exposure to mite and cat allergens on a range of clothing items at home and the transfer of cat allergen in the workplace.J Allergy Clin Immunol. 2000; 106: 874-879Abstract Full Text Full Text PDF PubMed Scopus (58) Google Scholar Among schoolchildren, allergen levels have been found to be significantly higher in dust collected from pet owners' clothing than from clothing of non–pet owners.10Patchett K. Lewis S. Crane J. Fitzharris P. Cat allergen (Fel d 1) levels on school children's clothing and in primary school classrooms in Wellington, New Zealand.J Allergy Clin Immunol. 1997; 100: 755-759Abstract Full Text Full Text PDF PubMed Scopus (87) Google Scholar, 38Karlsson A.S. Andersson B. Renström A. Svedmyr J. Larsson K. Borres M.P." @default.
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• W1991451888 date "2009-08-01" @default.
• W1991451888 modified "2023-10-18" @default.
• W1991451888 title "Indoor allergens in school and day care environments" @default.
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