Chapter 13
Environmental and occupational allergies

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Airborne allergens are the major cause of allergic rhinitis and asthma. Daily exposure comes from indoor sources, chiefly at home but occasionally at schools or offices. Seasonal exposure to outdoor allergens, pollens, and molds is another important source. Exposure to unusual substances at work causes occupational asthma, accounting for about 5% of asthma in adults. Indoor and outdoor air pollutants trigger airway inflammation and increase the severity of asthma. Diesel exhaust particles increase the production of IgE antibodies. Identification and reduction of exposure to allergens is a very important part of the management of respiratory allergic diseases. The first section of this chapter discusses domestic allergens, arthropods (mites and cockroaches), molds, and mammals (pets and mice). Indoor humidity and water damage are important factors in the production of mite and mold allergens, and discarded human food items are important sources of proliferation of cockroaches and mice. Means of identifying and reducing exposure are presented. The second section discusses outdoor allergens: pollens and molds. The particular plants or molds and the amount of exposure to these allergens is determined by the local climate, and local pollen and mold counts are available to determine the time and amount of exposure. Climate change is already having an important effect on the distribution and amount of outdoor allergens. The third section discusses indoor and outdoor air pollution and methods that individuals can take to reduce indoor pollution in addition to eliminating cigarette smoking. The fourth section discusses the diagnosis and management of occupational asthma.

Section snippets

Background

The primary indoor allergens that contribute to allergic disease include arthropod allergens, mammalian allergens (from either pets or pests), and fungal allergens.1, 2, 3, 4, 5 Additionally, indoor pollutants can also influence host response to allergens and should be considered when developing environmental interventions.6 Seasonal outdoor allergens can also play a role in the indoor environment when they penetrate into the indoor setting.6

Pathogenesis: Allergens

There is overwhelming evidence that indoor domestic

Background

Airborne pollens and molds are important causes of allergic rhinitis and asthma and therefore have been a major focus of research since the 19th century. In as much as the details of each local climate determine which plants and molds will grow there, recently, there has been considerable interest in the effect of climate change on outdoor allergens.64 The dates and amount of exposure to specific allergens at specific locations can be measured by using several methods. The most common is

Air pollution and asthma

Increased exposure to respirable particulate matter (<10 μm in size) is associated with exacerbation of asthma across the world.74, 75, 76, 77, 78, 79, 80, 81, 82, 83 Studies performed in Utah clearly demonstrated the relationship between airborne particulates and occurrence of respiratory disease associated with the activity of a steel mill that was inactive for a year because of a labor dispute.84, 85 Occurrence of asthma and the level of particulates were less during the strike year compared

Background

The 2 main occupational allergies are contact dermatitis (see chapter 12 of this Primer)135 and asthma. Hypersensitivity pneumonitis is uncommon. Farmers' lung has virtually disappeared because silos are no longer used to store food on dairy farms. Occupational asthma is the most common occupational respiratory disorder in industrialized countries, estimated to account for 5% to 15% of asthma cases in adults of working age, especially those with newly developed asthma. More than 250 agents have

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    Disclosure of potential conflict of interest: D. Peden is a consultant for ICAGEN, GlaxoSmithKline, Genentech, and Funxional Therapeutics Ltd and has received research support from the National Institutes of Health, National Institute of Allergy and Infectious Diseases, and National Institute of Environmental Health Sciences, and National Heart, Lung, and Blood Institute. C. E. Reed has declared that he has no conflict of interest.

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