Environmental and occupational respiratory disorders
Advances in environmental and occupational diseases 2004

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2004 was another good year for publications on environmental and occupational disorders in our journal. The major focus is clearly on the environment and particularly on environmental risk factors for sensitization and asthma. There is a growing consensus that exposure to pets is good, provided there is enough of it. Low levels enhance sensitization, and higher levels protect against the consequences of that sensitization. Following on from previous work on cockroaches, we now see allergy to feral mice as an emergent problem—at least we now have the tools to study this properly. Emphasis seems to be swinging away from the outdoor environment as a cause of allergic disease and toward the indoor environment, which is, after all, where most of us spend most of our lives. New techniques for studying isocyanate allergy might kindle a revival of interest in the mechanisms of occupational asthma caused by low-molecular-weight compounds. But for all types of occupational allergy, prevention remains key, and it is good to see that comprehensive programs of allergen reduction can pay off in reduced rates of latex allergy in health care workers. Further work in the area of recombinant allergens is welcome but needs soon to be translated into new diagnostic and therapeutic strategies. This sector of allergy research remains vibrant, and the editors will continue to welcome outstanding contributions in this area.

Section snippets

Risk factors for allergic sensitization and disease

There is now a general consensus that the increasing trends in allergic disease reflect a complex gene-environment interaction. Although there is still a lot of interest in the genetic basis of allergic disease, early opportunities to intervene in the allergy epidemic are likely to come from a better understanding of the environmental factors rather than trying to manipulate the gene pool or develop magic bullets based on genetic analysis. In a general review of the area, von Mutius1 outlined

Pet ownership

Five studies reported on the relationship of pet ownership to atopy and asthma. Arbes et al5 analyzed data from the National Survey of Lead and Allergens in Housing, which looked at 831 US homes and analyzed the dust samples from the bed, bedroom floor, living room floor, and living room sofa. Both dog and cat allergens were present in significant quantities in all homes studied. Levels associated with an increased risk of allergic sensitization were found even in homes without pets, presumably

Mouse allergens

It has been known for some time that laboratory animals can cause sensitization and asthma, but the role of mouse allergens in conventional asthma is less clear. Four articles in last year's journal addressed this issue. Two of these were technical, describing assays for mouse allergens in dust samples.10, 11 Time will tell whether polyclonal ELISAs10 or assays for recombinant major allergens11 are optimal for this type of approach, but it is helpful to know that the technologies are now well

Outdoor environment

There is considerable interest in the role of the outdoor environment in the causation and exacerbation of asthma. Nobody is really sure whether outdoor allergens are important in triggering episodes of asthma or hospitalization. Some people believe that allergens are important as a risk factor for the development of asthma but might not play a particularly important part in episodes of asthma once the disease is established. We already know that viral infections are a key trigger for episodes

Occupational allergies

Relatively few articles addressed occupational allergy last year. We had one article on isocyanates and 4 on various aspects of latex allergy. Wisnewski et al21 developed a new method for creating conjugates of hexamethylene diisocyanate (HDI) with human albumin. The rationale for the work is that previous studies have found it difficult to find appropriate materials to assess sensitization to isocyanates. This means that many patients with suspected isocyanate-induced asthma end up being

Endotoxin

In a mouse model of latex allergy, Howell et al25 reported that coexposure of latex with endotoxin (LPS) decreased the specific IgE response to latex but increased airways hyperreactivity in a nonspecific manner. They suggest that because significant levels of endotoxin have been found in latex gloves, there might be an interaction between the endotoxin and the latex allergens that affects both the likelihood of becoming sensitized to latex and perhaps the downstream consequences of the

Allergens

Identification of major allergens remains a popular topic, although there is now a priority to move forward and make use of all the information that we have gained to develop novel diagnostic and therapeutic agents. Ibarrola et al28 identified a major allergen of the plane tree Platanus acerifolia. Planes are common trees throughout western cities, partly because they provide excellent summer shade and are visually pleasing. They also can be pollarded regularly, allowing them to remain

Conclusions

2004 was another good year for publications on environmental and occupational disorders in our journal. The major focus is clearly on the environment and particularly on environmental risk factors for sensitization and asthma. There is a growing consensus that exposure to pets is good, provided there is enough of it. Low levels enhance sensitization, and higher levels protect against the consequences of that sensitization. Following on from previous work on cockroaches, we now see allergy to

References (31)

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    The effect of environmental exposures on the genesis of allergic respiratory diseases has been the focus of some investigation and far more controversy. Allergens present in ambient air play a role in driving the development of specific hypersensitivities.6-8 However, evidence suggests that living environments are also rich in additional factors (ie, TLR ligands and industrial pollutants) that directly activate innate immunity and thereby indirectly influence responses to airway allergen encounter.9,11,14,15

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