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- Robert G. Hamilton, Ph.D.
- Johns Hopkins University
- School of Medicine
- Baltimore, MD
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- Estimated 20% of US population is allergic to something (pollen, venoms,
insects, mites, molds, foods, epidermals, drugs)
- Largest group of sufferers: allergic rhinitis (sneezing) and asthma
- In 1990, asthma accounted for $3.5 billion in direct medical
expenditures (nearly 1% of total health care cost)
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- Cutaneous: hives, rash, swelling, redness, irritation, pruritus,
urticaria, angioedema
- Eyes: itchy, tears, watery, redness
- Upper Airway: runny nose, itchy-swollen-tight throat, sneezing,
- Lower Airway: wheezing, cough, asthma, shortness of breath, respiratory
arrest
- Gastrointestinal: nausea, vomiting
- Cardiovascular: hypotension,arrhythmias, cardiac arrest, myocardial
infarction
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- Dust Mites (Dermatophagoides pteronyssinus, D. farinae: Der p 1, Der f
1)
- Non-biting insects (cockroach Bla g 1/2, storage mites)
- Pet Epidermals (Felis Domesticus, Fel d 1; Canis Familarius, Can f 1)
- Mold Spores (Alternaria, Cladosporium, Aspergillus, Penicillium, viable
mold spore analysis)
- Pollens (trees, grasses, weeds), Foods, Drugs
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- 2 mite species are commonly found in American homes (D. farinae, D
pteronyssinus)
- Each mite produces > 200 x its body weight in fecal particles during
a 2-3.5 Mo life span
- Mites breed in the dust, deep in mattresses upholstered furniture; feed
on human skin.
- Der p 1/f 1 “indicator allergen” levels in home aid in identifying risk.
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- Of the 50 species of cockroach, 8 are common found in American homes.
- Blatella germanica, Periplaneta americana have been most extensively
studied.
- Bla g I/II are “indicator allergens” in dust for presence and quantity
of Blatella.
- Sample dust from kitchens, bathrooms and basements, near food and
central heating.
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- Mid 1980, >100 million domestic pets in USA.
- Cats, dogs, guinea pigs, hamsters, rabbits, rats, mice, birds produce
potent allergens in the home.
- The fur of pets can transport allergen containing pollens, dust, mold by
static attraction into homes.
- Occult exposure to pet epidermal allergens can occur while visiting the
homes of friends that have pets.
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- Established (1980) to provide clinical laboratory testing for
individuals with suspected of having dermatologic or allergic diseases.
- Federal (CLIA-88) and State licenses to perform complex laboratory
testing which requires yearly inspections.
- Full service allergy laboratory to assess patient (IgE antibody) and
environment (allergens).
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- Separate allergic patient from the allergen-containing environment
- 1. Confirm subject’s allergic disease is present and driven by indoor
aeroallergens
- 2. Evaluate indoor environment for quantity of aeroallergen content.
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- Receive written request
- Collect dust specimen: vacuum, collector
- Process dust (sieve-50 mesh, weigh 100 mg)
- Extract allergen (PBS-5% BSA, 16 hr, 1:20)
- Centrifuge and sterile filter
- Analyze: MAb-based immunoenzymetric assay
- Report allergen level (ng/G, U/G)
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- Separate allergic patient from the allergen-containing environment
- 1. Confirm subject’s allergic disease is present and driven by indoor
aeroallergens
- 2. Evaluate indoor environment for quantity of aeroallergen content.
- 3. Remediate environment, monitor routinely and manage individual’s
allergic disease.
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- 1. In the Physical Facilities Manual, schools have been
instructed to call Environmental Services for any air quality issue.
- 2. Calls are received by the Supervisor of Environmental Services.
- 3. If the Supervisor is not available, the individual taking the
call contacts the Specialist directly.
- 4. The Supervisor acquires more information related to the
situation as required.
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- 5. The Call is recorded on an Indoor Air Quality Complaint Form and
entered into a Log.
- 6. The Complaint Form is forwarded to the Air Quality Specialist
for Investigation.
- 7. If the Supervisor decides that the situation requires immediate
attention, the Specialist will be notified or the Supervisor will
respond personally, whichever provides the most effective and timely
response.
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- 8. The individual responding has the option of responding alone or if
the nature of the complaint warrants, to enlist the assistance of a
group of multi-discipline individuals.
These individuals include maintenance personnel, mechanics,
engineers, a physician, nurses from the Employee Health Office and
contractual environmental firms.
Only those support individuals needed for the particular
situation would respond with the Specialist.
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- 9. The affected individuals are interviewed on site. Any health related information is
referred to the medical support individuals for evaluation.
- 10. The building personnel are interviewed.
- 11. The building is inspected.
This includes the interior, exterior and mechanical equipment.
- 12. Samples are taken only if the Specialist determines that they
are necessary to assist in the investigation.
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- 13. Based on the interviews, observations, the input from the supporting
personnel and the results of any sampling, a diagnosis is made.
- 14. Remediation is begun based on the diagnosis.
- 15. Remediation can include removal of material, replacement of
materials, repairs to mechanical equipment, changes in design or
operation of mechanical equipment, addition of new mechanical equipment,
cleanup and decontamination of surfaces, repairs to the building,
changes to drainage patterns, adjustment of equipment, changing
materials being used or the time at which they are being used, and
changes in work practices.
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- 16. At the completion of the remediation, the affected area is checked
to determine if the efforts were successful or if more work is required.
- 17. All appropriate administrators are informed of the progress of the
investigation as necessary.
- 18. An incident report will be forwarded to the Office of Risk
Management when the situation may involve lost employee time, health
affects or the possibility of litigation.
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Notes