Mucous Membrane Symptoms Research Articles

BUILDING-RELATED SYMPTOMS AMONG U.S. OFFICE WORKERS AND RISK FACTORS FOR MOISTURE AND CONTAMINATION

Introduction Moisture and other risks for indoor microbiologic growth have been associated with increased prevalence of symptoms in many studies. We assessed relationships between health symptoms in office workers and risk factors related to moisture and contamination, using data collected from a representative sample of 100 U.S. office buildings in the U.S. EPA BASE study. Methods Analyses assessed associations between three types of buildingrelated symptoms (defined as occurring at least weekly and improving when away from the building)-lower respiratory, mucous membrane, and neurologic-and risk factors for moisture or contamination in these office buildings. Multivariate logistic regression models were used to estimate the strength of associations for these risk factors as odds ratios (ORs) adjusted for personal-level potential confounding variables related to demographics, health, job, and workspace. Results A number of risk factors were associated significantly (e.g., 95% confidence limits excluded 1.0) in adjusted models with small to moderate increases in one or more symptom outcomes. Significantly elevated ORs for mucous membrane symptoms were associated with the following risk factors: presence of humidification system in good condition versus no system present (OR = 1.4); air handler inspection annually versus daily (OR = 1.6); current water damage in the building (OR = 1.2); and less than daily vacuuming in study space (OR = 1.2). Significantly elevated ORs for lower respiratory symptoms were associated with: air handler inspection annually versus daily (OR = 2.0); air handler inspection less than daily but at least semi-annually (OR = 1.6); less than daily cleaning of offices (1.7); and less than daily vacuuming of the study space (OR = 1.4). Only two statistically significant risk factors for neurologic symptoms were identified: presence of any humidification system versus none (OR = 1.3); and less than daily vacuuming of the study space (OR = 1.3). Dirty cooling coils, dirty or poorly draining drain pans, and standing water near outdoor air intakes were not identified as risk factors in these analyses, despite predictions based on previous findings elsewhere, except that very dirty cooling coils were associated with a statistically nonsignificant increase (OR = 1.3, 95% confidence interval = 0.9–2.1) in lower respiratory symptoms Conclusions These preliminary findings suggest that some factors indicating risks for moisture or contamination in office buildings may have adverse effects on respiratory or neurologic health of office workers. Expanded analyses are underway that will include in multivariate models additional potential confounders and risk factors, such as ventilation rate and indoor temperature. Future analyses will also assess risk in susceptible sub-groups such as previously diagnosed asthmatics.

Sign of eye irritation in female hospital workers and the indoor environment.

The relationships between indoor environment factors and signs of eye irritation were studied in a sample of female personnel with (n = 112) and without (n = 64) mucous membrane symptoms working in 36 nursing departments at geriatric hospitals in the municipality of Trondheim, Norway. The indoor climate was characterised by high room temperature (interquartile range 23.0-23.7 degrees C), low relative air humidity (interquartile range 17-26%) and high outdoor airflow rate, as indicated by low indoor levels of carbon dioxide (interquartile range 490-650 ppm). An altered microbial flora was observed in nine of the departments, and Aspergillus fumigatus was found in three of these. Five of the hospitals were situated in urban parts of the municipality near roads with heavy traffic. In the initial analyses decreased tear-film stability (BUT) was observed in subjects working in departments with increased dust settlement rate (P = 0.03), in hospitals situated in urban areas with heavy traffic (P < 0.001), and in subjects working in departments with presence of A. fumigatus (P = 0.04). Increased conjunctival staining (CS) was related to alteration of the microbial flora. In the final multivariate analyses statistically significant relationships were observed between BUT and dust settlement rate and urban vicinity of workplace and between CS and alteration of the microbial flora.

Serum IgE specific to indoor moulds, measured by basophil histamine release, is associated with building-related symptoms in damp buildings.

To study the relationship between basophil histamine release (HRT) to indoor moulds, indicating specific IgE, and building-related symptoms (BRS), asthma, and hay fever in individuals working in damp and mouldy buildings. A cross-sectional study was performed among 86 school staff members, who on average had worked 143 months (range: 3-396) in moist buildings with mould growth in the constructions. A questionnaire concerning mucous membrane symptoms, facial skin symptoms, central nervous system symptoms, hay fever, and asthma was fulfilled by the participants, and blood samples were taken. Eight mould species growing on building constructions were identified and cultivated to obtain allergenic materials for testing. The presence in serum of IgE specific to moulds was verified by histamine release test (HRT) based on passive sensitization of basophil leukocytes. The validity of the method was confirmed by parallel testing of patients allergic to grass- and birch pollen and by the shift from positive to negative response after removal of serum IgE and by using sham sensitization. The prevalence of most BRS was between 32% and 62%. Positive HRT, showing serum IgE specific to one or more of the moulds, was observed in 37% of the individuals. The highest frequency of positive HRT was found to Penicillium chrysogenum and then to Aspergillus species, Cladosporium sphaerospermum and Stachybotrys chartarum. A significant association was found between most BRS and positive HRT, whereas no association was observed between positive HRT to moulds and self reported hay fever or asthma. Positive HRT to indoor moulds, showing the presence in serum of IgE specific to the fungi, was found to be related to BRS in individuals working in damp and mouldy buildings. Whether the association is of causal character is a question for further studies. The test may be useful in the evaluation and study of possible mould induced BRS.

The Effect of Interior Planting on Health and Discomfort among Workers and School Children

Plants are widely used in building environments; however, studies reporting the health and discomfort symptoms of people in response to indoor foliage plants are few. The objective of the presented studies was to assess the effect of foliage plants or a combination of foliage plants and full-spectrum fluorescent lamps on self-reported health and discomfort complaints in three different work environments: an office building, an X-ray department in a Norwegian hospital, and a junior high school. Health and discomfort symptoms were found to be 21% to 25% lower during the period when subjects had plants or plants and full-spectrum lighting present compared to a period without plants. Neuropsychological symptoms, such as fatigue and headache, and mucous membrane symptoms, such as dry and hoarse throat, seemed to be more affected by the treatments than skin symptoms, such as itching skin.

The Effect of Indoor Foliage Plants on Health and Discomfort Symptoms among Office Workers

Indoor plantings are widely used in building environments though little is known regarding the way office workers respond to indoor foliage plants. The objective of the present study was to assess the effect of foliage plants in the office on health and symptoms of discomfort among office personnel. A cross-over study with randomised period order was conducted; one period with plants in the office and one period without. A questionnaire consisting of 12 questions related to neuropsychological symptoms, mucous membrane symptoms and skin symptoms was distributed among the 51 healthy subjects who participated in the study. It was found that the score sum of symptoms was 23% lower during the period when subjects had plants in their offices compared to the control period. (Mean score sum was 7.1 during the period without plants vs. 5.6 during the period with plants.) Complaints regarding cough and fatigue were reduced by 37 and 30%, respectively, if the offices contained plants. The self-reported level of dry/hoarse throat and dry/itching facial skin each decreased approximately 23% when plants were present. Overall, a significant reduction was obtained in neuropsychological symptoms and mucous membrane symptoms, while skin symptoms seemed to be unaffected by the presence of plants. The results from this study suggest that an improvement in health and a reduction in symptoms of discomfort may be obtained after introduction of foliage plants into the office environment.

The Effect of Indoor Foliage Plants on Health and Discomfort Symptoms among Office Workers

Indoor plantings are widely used in building environments though little is known regarding the way office workers respond to indoor foliage plants. The objective of the present study was to assess the effect of foliage plants in the office on health and symptoms of discomfort among office personnel. A cross over study with randomised period order was conducted; one period with plants in the office and one period without. A questionnaire consisting of 12 questions related to neuropsychological symptoms, mucous membrane symp toms and skin symptoms was distributed among the 51 healthy subjects who participated in the study. It was found that the score sum of symptoms was 23% lower during the period when subjects had plants in their offices com pared to the control period. (Mean score sum was 7.1 during the period with out plants vs. 5.6 during the period with plants.) Complaints regarding cough and fatigue were reduced by 37 and 30%, respectively, if the offices contained plants. The self-reported level of dry/hoarse throat and dry/itching facial skin each decreased approximately 23% when plants were present. Overall, a sig nificant reduction was obtained in neuropsychological symptoms and mucous membrane symptoms, while skin symptoms seemed to be unaffected by the presence of plants. The results from this study suggest that an improvement in health and a reduction in symptoms of discomfort may be obtained after intro duction of foliage plants into the office environment.

The prevalence of pulmonary and upper respiratory tract symptoms and spirometric test findings among newspaper pressroom workers exposed to solvents.

To investigate the relationship between exposure to organic solvents and the presence of pulmonary and upper respiratory tract mucous membrane symptoms, we conducted a cross-sectional study of 215 newspaper pressroom workers who were occupationally exposed to organic solvent and lubricant mixtures. Thirty-four compositors, who were not occupationally exposed to the solvents or lubricants, served as controls. Pressroom workers and compositors underwent spirometric testing and were also asked about the presence of cough, phlegm, hemoptysis, dyspnea, wheezing, chest tightness, nose or throat irritation, eye irritation, and sinus trouble. The spirometric results did not significantly differ between the two groups. However, the pressroom workers were significantly more likely to report pulmonary or upper respiratory tract mucous membrane symptoms than were compositors (P < 0.005). An exposure-response relationship could be demonstrated when comparing the number of solvents exposed with the total number of symptoms (P < 0.001). Similarly, an exposure-response relationship could be demonstrated when comparing the frequency of use of each of the seven solvents with the total number of symptoms (P < 0.002). Each of these findings was supported in a multivariable linear regression model that adjusted for potential confounders such as age, smoking history, and number of years in the industry. A high prevalence of these symptoms was reported even though the degree of exposure to solvents and lubricants was within the current permissible exposure limits.

Significance of indoor environment for the development of allergic symptoms in children followed up to 18 months of age

The development of symptoms possibly related to allergy or other forms of hypersensitivity was studied in a group of 638 children on two occasions: when the children were 3 and 18 months of age. Standardized questions were used to collect basic information about the child, technical characteristics of the home, and the mother's perception of the indoor climate. All reported exposure factors were analyzed in relation to the child's symptoms at 18 months of age, by logistic regression techniques. A family history of atopy was associated with a high incidence of most of the investigated symptoms. Attendance at a day nursery before 18 months of age increased the risk of recurrent colds and the need for several courses of treatment with antibiotics. If the mother smoked, the children more often suffered from protracted coughing episodes. If the child has a sibling, the risk of developing a wheeze, repeated colds, and the need for antibiotic treatment increased. No building factors, such as size of the home, heating and ventilation system, type of foundation, dampness, or presence of wall-to-wall carpets, showed a significant correlation to symptoms reported in the children. However, if the mothers reported symptoms that are often connected with "sick buildings", the children more often had eczema, dry skin, or reactions to food. The mothers' complaints about indoor air quality and climate and mucous membrane symptoms were significantly related to the type of building and presence of condensation on the windows in winter, a finding which may indicate that indoor climate factors also have some effect on the health of the children. This study reports the prevalences of symptoms until the age of 18 months. At this age, the allergic manifestations are usually nonspecific, and follow-up examinations to 4-5 years of age are needed before any definite conclusions can be drawn about the development of atopic diseases due to indoor climate factors.

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

Nitrous acid, a component of photochemical smog and a common indoor air pollutant, may reach levels of 100 ppb where gas stoves and unvented portable kerosene heaters are used. Nitrous acid is a primary product of combustion and may also be a secondary product by reaction of nitrogen dioxide with water. Because the usual assays for nitrogen dioxide measure several oxides of nitrogen (including nitrous acid) together, previous studies of indoor nitrogen dioxide may have included exposure to and health effects of nitrous acid. To assess the respiratory effects of nitrous acid exposure alone, we carried out a double-blinded crossover chamber exposure study with 11 mildly asthmatic adult subjects. Each underwent 3-hr exposures to 650 ppb nitrous acid and to filtered room air with three 20-min periods of moderate cycle exercise. Symptoms, respiratory parameters during exercise, and spirometry after exercise were measured. A statistically significant decrease in forced vital capacity was seen on days when subjects were exposed to nitrous acid. This effect was most marked at 25 min and 85 min after exposure began. Aggregate respiratory and mucous membrane symptoms were also significantly higher with nitrous acid. We conclude that this concentration and duration of exposure to nitrous acid alters lung mechanics slightly, does not induce significant airflow obstruction, and produces mild irritant symptoms in asthmatics.

Effect of Nitrous Acid on Lung Function in Asthmatics: A Chamber Study

Nitrous acid, a component of photochemical smog and a common indoor air pollutant, may reach levels of 100 ppb where gas stoves and unvented portable kerosene heaters are used. Nitrous acid is a primary product of combustion and may also be a secondary product by reaction of nitrogen dioxide with water. Because the usual assays for nitrogen dioxide measure several oxides of nitrogen (including nitrous acid) together, previous studies of indoor nitrogen dioxide may have included exposure to and health effects of nitrous acid. To assess the respiratory effects of nitrous acid exposure alone, we carried out a double-blinded crossover chamber exposure study with 11 mildly asthmatic adult subjects. Each underwent 3-hr exposures to 650 ppb nitrous acid and to filtered room air with three 20-min periods of moderate cycle exercise. Symptoms, respiratory parameters during exercise, and spirometry after exercise were measured. A statistically significant decrease in forced vital capacity was seen on days when subjects were exposed to nitrous acid. This effect was most marked at 25 min and 85 min after exposure began. Aggregate respiratory and mucous membrane symptoms were also significantly higher with nitrous acid. We conclude that this concentration and duration of exposure to nitrous acid alters lung mechanics slightly, does not induce significant airflow obstruction, and produces mild irritant symptoms in asthmatics.

Mechanical Ventilation in Office Buildings and the Sick Building Syndrome. An Experimental and Epidemiological Study

The effects of mechanical ventilation on the sick building syndrome (SBS) were studied in an office building with 2150 employees, where the mechanical ventilation and indoor air quality were commonly blamed for causing symptoms typical of the SBS (nasal, eye, and mucous membrane symptoms, lethargy, skin symptoms and headache). The mechanical ventilation rates in the building were high (mean 26 l/s/person). To test the hypothesis that mechanical ventilation causes the SBS, a controlled experimental study was carried out by shutting off the ventilation in one part of the building and reducing the ventilation rate by 75% and 60% in two areas while leaving one part unaltered as a control. The experimental reduction of the ventilation rate did not alleviate the symptoms. On the contrary, the reduction of the ventilation rate caused a slight but statistically significant relative increase in symptoms (p < 0.05). In the cross-sectional analysis of the baseline data the SBS symptoms did not associate significantly with the ventilation rate (range 7–70 l/s/person). In the linear regression model, a positive correlation was found between temperatures above 22°C and the occurrence of symptoms (p < 0.05). Subjects exposed to environmental tobacco smoke had more symptoms than those not exposed (p < 0.01). Women reported more symptoms than men (p < 0.001). In addition, any prior history of allergic diseases (p < 0.001) and a negative attitude towards the social atmosphere at work (p < 0.001) were significant determinants of the SBS.

Irritative symptoms and exposure to mineral wool

In a cross-sectional study undertaken in 1981 using a postal questionnaire, the prevalence of irritative symptoms was investigated among 2,654 Danish construction workers working with mineral wool. An evaluation was undertaken in a multivariate logit analysis of the relationship between exposure level (measured by hours of exposure to mineral wool per month) and prevalence of symptoms. The analysis controlled for the confounders of age, smoking habits, and exposure to organic solvents. With greater exposure to mineral wool, there was a statistically significant increase in the frequency of irritative symptoms from the eyes, the skin, and the upper respiratory tract. Among construction workers working with mineral wool 160-180 hours per month, two-thirds had these symptoms once a week or oftener. The occurrence was 2-3 times higher compared with the construction workers not working with mineral wool. The relationship between exposure to mineral wool and skin and mucous membrane symptoms may be explained by the irritative action of the fibers that are given off during insulation work.

A search for discomfort-inducing factors in carbonless copying paper.

Connections between various types of carbonless copying paper and the occurrence of work-related symptoms of the skin and mucous membranes were studied. The analysis started from the exposure factor, i.e., from the carbonless copying papers and not from the exposed persons. In total, 276 paper samples were investigated. One hundred ninety samples were carbonless copying papers for which information was obtained concerning both the handling of the papers and the symptoms occurring among those handling the papers. To distinguish between carbonless copying papers of different makes, gas chromatography of paper extracts was performed, sometimes combined with thin-layer chromatography of the color formers. By coding the paper samples, the analyses of the papers and the interviews of the exposed persons could be performed "blindly." In the carbonless copying paper most frequently associated with complaints, mono-iso-propylbiphenyl (MIPB) was used as solvent for the color formers. It is probable, however, that the symptoms connected to this paper were induced by some component of the paper other than MIPB. A covariation between papers associated with skin symptoms and mucous membrane symptoms was observed. Exposure to carbonless copying papers treated with desensitizing ink (D-ink) covariated statistically with work-related skin irritation. The causative factor was probably two specific D-inks available on the Swedish market at the period of the investigation.

Neurobehavioral and respiratory symptoms of formaldehyde and xylene exposure in histology technicians.

Disturbances of memory, mood, equilibrium, and sleep that occurred simultaneously with headache and indigestion, were experienced more frequently among women working in histology who had daily exposure to formaldehyde, xylene, and toluene than in unexposed female clerical workers working in the same hospitals. Neurobehavioral symptoms were accompanied by irritation of eyes, upper airways, and trachea. Formaldehyde exposure correlated better with neurobehavioral symptoms and with respiratory and mucous membrane symptoms than did exposure to xylene/toluene or to other agents.

A deadly oil.

On 1 May 8-year-old Jaime Vaquero, of Torrej on de Ardoz, a Madrid suburb, died after a brief illness characterised by fever and lower respiratory tract symptoms. Two days later five other members of the family and three of their neighbours were in hospital with a similar illness. A week later 100 more had been admitted and four more had died; an epidemic was officially declared. Mainly the younger population was affected, their ages ranging from 5 to 50. All had presented with some or all of the following: a mild-to-moderate fever (38?-40?C), a dry cough, muscular aches and pains, headache, chest pains, dyspnoea, vomiting, diarrhoea, and an itchy rash. No patient had mucous membrane or upper respiratory symptoms or signs.

Contact eczema produced by a beta-adrenergic blocking agent (alprenolol).

In a pharmaceutical industry, several cases of allergic contact eczema caused by the beta-adrenergic blocking agent alprenolol (Aptin) have appeared. This report deals with 12 men and two women who developed eczema during work with the substance. In 13 of the 14 cases, the induction time for sensitization was less than 1 year. The skin reactions were very florid. After healing they could be reproduced by very small quantities of the substance. In one case, eczema could also be produced after ingestion of Aptin tablets. All the cases were transferred to other work within the factory. An intensive programme was implemented to remove dust from the working areas. Despite this, isolated new cases still appear. Some employees in contact with the substance also experienced mucous membrane symptoms. These symptoms could not be shown to have an allergic aetiology, but were considered to be irritant reactions. Alprenolol must be considered a very strong contact allergen.

Cutaneous hypersensitivity due to beryllium; a study of thirteen cases.

DERMATITIS caused by beryllium compounds is one of the principal occupational hazards in beryllium-extraction plants. Gelman 1 cited Pack as having observed a papulovesicular dermatitis on the exposed surfaces of workers engaged in the extraction of beryllium. Ulcers resembling those caused by chromates and dichromates occurred on the fingers of these workers. De Nardi 2 reported 202 cases of dermatitis, 131 cases of tracheobronchitis, and 57 cases of pneumonitis from two beryllium-extraction plants near Cleveland during the period from 1940 to Jan. 17, 1950. Of the 202 cases of dermatitis, De Nardi lists 156 as due to beryllium fluoride (BeF 2 ) and 45 as due to beryllium sulfate (BeSO 4 ). 3 Many of the workers who acquired the dermatitis also acquired conjunctivitis and rhinopharyngitis. Van Ordstrand and De Nardi and associates 4 observed that the skin and mucous membrane symptoms occurred in about 25% of the new employees