Indoor Allergens -- Copyright -- Preface -- Acknowledgments -- Contents -- Executive Summary -- INTRODUCTION -- The Allergic Reaction -- MAGNITUDE OF THE PROBLEM -- AGENTS, SOURCES, AND SOURCE CONTROLS -- MECHANISMS OF IMMUNE FUNCTION -- MEDICAL TESTING METHODS -- Medical History -- Skin Tests -- In Vitro Tests -- Pulmonary Function Tests -- ASSESSING EXPOSURE AND RISK -- ENGINEERING CONTROL STRATEGIES -- THE ROLE OF EDUCATION -- RECOMMENDATIONS AND RESEARCH AGENDA -- Recommendations -- AGENTS, SOURCES, SOURCE CONTROLS, AND DISEASES -- Dust Mite, Cockroach, and Other Arthropoda -- MEDICAL TESTING METHODS -- Skin Tests -- Pulmonary Function Tests -- ASSESSING EXPOSURE AND RISK -- ENGINEERING CONTROL STRATEGIES -- THE ROLE OF EDUCATION -- Patients -- Health Care Providers -- Engineers, Architects, and Building Maintenance Personnel -- Research Agenda -- MAGNITUDE AND DIMENSIONS OF SENSITIZATION AND DISEASE -- AGENTS, SOURCES, SOURCE CONTROLS, AND DISEASES -- Dust Mite, Cockroach, and Other Arthropoda -- Mammals and Birds -- Microbial Allergens -- Chemicals -- PLANTS AND PLANT PRODUCTS -- MECHANISMS OF IMMUNE FUNCTION -- MEDICAL TESTING METHODS -- Medical History and Diagnosis -- Skin Tests -- In Vitro Tests -- Pulmonary Function -- ASSESSING EXPOSURE AND RISK -- ENGINEERING CONTROL STRATEGIES -- 1 Introduction -- ALLERGENS AND THE INDOOR ENVIRONMENT -- CONCEPTS AND DEFINITIONS -- SCOPE AND ORGANIZATION OF THE REPORT -- 2 Magnitude and Dimensions of Sensitization and Disease Caused by Indoor Allergens -- IMMUNOLOGIC SENSITIZATION -- Risk Factors -- Other Types of Sensitization -- DISEASES -- Common Diseases Clearly Related to Allergy and IgE Antibody -- ALLERGIC ASTHMA -- Definition and Diagnosis -- Attributable Fraction -- Prevalence -- Incidence -- Impact -- Trends Over Time -- Risk factors -- Demographics -- ALLERGIC RHINITIS.

Prevalence and Incidence -- Risk Factors -- ECZEMA -- Atopic Dermatitis -- Allergic Contact Dermatitis -- Less Common Diseases Clearly Related to Allergy -- ALLERGIC BRONCHOPULMONARY ASPERGILLOSIS -- Prevalence -- HYPERSENSITIVITY PNEUMONITIS -- Prevalence -- Disease Severity -- Risk Factors -- HUMIDIFIER FEVER -- Prevalence -- Common Diseases Possibly Related to Allergy -- SINUSITIS -- Prevalence and Severity -- Risk Factors -- CHRONIC BRONCHITIS -- SICK BUILDING SYNDROME -- SPECIFIC BUILDING-RELATED ILLNESS -- ACUTE RESPIRATORY ILLNESSES -- CONCLUSIONS AND RECOMMENDATIONS -- 3 Agents, Sources, Source Controls, and Diseases -- DUST MITE, COCKROACH, AND OTHER ARTHROPODA -- Dust Mites as a Source of Indoor Allergens -- DUST MITE ALLERGENS -- COMMERCIALLY AVAILABLE ALLERGEN EXTRACTS -- Insects as a Source of Indoor Allergens -- DOMESTIC COCKROACHES -- Measuring Exposure to House Dust Allergens -- Thresholds: The Relationship Between Exposure, Sensitization, and Disease -- Reducing Exposure to Dust Mites -- Avoidance Measures for Other Allergens -- Conclusions and Recommendations -- MAMMALS AND BIRDS -- Cats -- CONTROL MEASURES -- Dogs -- Rodents -- CONTROL MEASURES -- Farm Animals -- Wild Animals -- Birds -- Conclusions and Recommendations -- MICROBIAL ALLERGENS -- The Fungi -- SOURCES AND DISSEMINATORS -- NATURE OF THE AEROSOLS -- DISEASES -- NATURE OF THE ALLERGENS -- The Bacteria -- SOURCES AND DISSEMINATORS -- NATURE OF THE AEROSOLS -- DISEASES -- NATURE OF THE ALLERGENS -- Protozoa -- Algae -- Slime Molds -- Environmental Control -- PREVENTION -- SOURCE CONTROL -- DUCT CLEANING -- AEROSOL CONTROL -- Conclusions and Recommendations -- CHEMICALS -- Allergic Diseases Caused by LMW Chemicals -- Chemical Agents That Cause Allergic Disease -- Exposure and Risk -- Control by Avoidance and Exposure Reduction -- Conclusions and Recommendations.

PLANTS AND PLANT PRODUCTS -- Plant Products -- LATEX -- CONCLUSIONS AND RECOMMENDATIONS -- 4 Mechanisms of Immune Function -- RESPONSE OF AIRWAY CELLS AND TISSUES TO INDOOR ALLERGENS -- Epithelium and Other Airway Structural Tissues and Cells -- EPITHELIAL CELLS -- SUBEPITHELIAL STRUCTURES -- Immune and Inflammatory Cells in the Airway -- MACROPHAGES -- FUNCTION -- ANTIGEN-PRESENTING CELL FUNCTIONS -- ANTIGEN PROCESSING -- OTHER APCS IN THE AIRWAY -- T LYMPHOCYTES -- T CELL RECEPTORS -- THE CD4 SUBPOPULATION -- CYTOKINES OF T CELL SUBPOPULATIONS -- THE CD8 SUBPOPULATION -- OTHER T CELL SUBPOPULATIONS -- B LYMPHOCYTES -- MAST CELLS -- EOSINOPHILS -- NEUTROPHILS -- MEDIATORS -- GENERATION OF IMMUNE RESPONSE AND HOST DEFENSE TO INDOOR ALLERGENS -- Nonspecific Mechanisms of Airway Host Defense -- Allergen-Specific Mechanisms of Airway Responses -- Adjuvant Effects -- CONCLUSIONS AND RECOMMENDATIONS -- 5 Medical Testing Methods -- MEDICAL HISTORY AND DIAGNOSIS -- History -- Conclusion and Recommendation -- Physical Examination -- Daily Diaries -- SKIN TESTS -- Major Methods -- Variables and Controls -- Shortcomings and Precautions -- Interpretation of Results -- Correlation with Other Tests -- Conclusions and Recommendations -- IN VITRO DIAGNOSTIC TESTS -- Serum Antibody Tests -- Tests of Cell-Mediated Immunity -- Test Reagents -- ALLERGENS -- ANTIBODIES -- Diagnostic Value of In Vitro Tests -- Quality Control -- Conclusions and Recommendations -- PULMONARY FUNCTION TESTS -- Applications and Methodological Challenges -- Spirometry -- Peak Flow Measurements -- Detection of Airway Hyperreactivity -- Bronchoprovocation Testing with Specific Allergens -- Lung Volumes -- Diffusing Capacity Testing -- Exercise Studies -- Measures of Upper Airway Function -- Conclusions and Recommendations -- 6 Assessing Exposure and Risk -- EXPOSURE ASSESSMENT.

Monitoring for Indoor Allergens -- GENERAL PRINCIPLES -- Where to Sample -- When to Sample -- How to Sample -- TYPES OF SAMPLE ANALYSIS -- THE IDEAL AIR MONITOR -- Exposure -- AMBIENT DATA AND TIME-ACTIVITY LOGS -- INDICATOR DATA TO REPRESENT EXPOSURE -- NATURE OF ALLERGEN-CARRYING PARTICLES -- Internal/Actual Dose -- BIOLOGICALLY EFFECTIVE DOSE -- RISK ASSESSMENT -- Steps in a Risk Assessment -- STEP 1: HAZARD IDENTIFICATION -- STEP 2: EXPOSURE ASSESSMENT -- STEP 3: DOSE-RESPONSE ASSESSMENT -- STEP 4: RISK CHARACTERIZATION -- Example of a Risk Assessment: Exposure to Dust Mite Allergen and Sensitization for Asthma -- STEP 1: HAZARD IDENTIFICATION -- STEP 2: EXPOSURE ASSESSMENT -- STEP 3: DOSE-RESPONSE ASSESSMENT -- Step 4: Risk Characterization -- CONCLUSIONS AND RECOMMENDATIONS -- 7 Engineering Control Strategies -- PRINCIPLES AND STRATEGIES -- Building Design for Source Control -- MOISTURE -- CARPETING -- OTHER SUBSTRATES AND RESERVOIRS -- HVAC System Design for Source Control -- OUTDOOR AIR INTAKES -- FILTERS -- HEAT EXCHANGERS -- HUMIDIFIERS -- AIR SUPPLY PLENUM AND DUCT WORK -- PERIPHERAL UNITS -- RETURN AIR SYSTEMS -- POROUS INSULATION -- Building Operation for Source and Exposure Control -- CONTROL STRATEGIES -- MAINTENANCE AND HOUSEKEEPING -- Remediation -- SOURCE CONTROL -- AIR CLEANING -- DILUTION -- RECONTAMINATION -- SUMMARY OF PRACTICAL CONTROL STRATEGIES -- General -- Residential Buildings -- Commercial Buildings -- CONCLUSIONS AND RECOMMENDATIONS -- 8 The Role of Education -- EDUCATING PATIENTS AND THE GENERAL PUBLIC -- Allergen Avoidance and Environmental Control -- Flaws in the First-Generation Programs -- EDUCATING HEALTH CARE PROVIDERS -- CONCLUSIONS AND RECOMMENDATIONS -- Patients -- Health Care Providers -- Engineers, Architects, and Building Maintenance Personnel -- References -- Acronyms -- Glossary.

Committee and Staff Biographies -- COMMITTEE -- STAFF -- Index.