We reviewed the literature on Indoor Air Quality (IAQ), ventilation, and building-related health problems in schools and identified commonly reported building-related health symptoms involving schools until 1999. We collected existing data on ventilation rates, carbon dioxide (CO2) concentrations and symptom-relevant indoor air contaminants, and evaluated information on causal relationships between pollutant exposures and health symptoms. Reported ventilation and CO2 data strongly indicate that ventilation is inadequate in many classrooms, possibly leading to health symptoms. Adequate ventilation should be a major focus of design or remediation efforts. Total volatile organic compounds, formaldehyde (HCHO) and microbiological contaminants are reported. Low HCHO concentrations were unlikely to cause acute irritant symptoms (<0.05 ppm), but possibly increased risks for allergen sensitivities, chronic irritation, and cancer. Reported microbiological contaminants included allergens in deposited dust, fungi, and bacteria. Levels of specific allergens were sufficient to cause symptoms in allergic occupants. Measurements of airborne bacteria and airborne and surface fungal spores were reported in schoolrooms. Asthma and 'sick building syndrome' symptoms are commonly reported. The few studies investigating causal relationships between health symptoms and exposures to specific pollutants suggest that such symptoms in schools are related to exposures to volatile organic compounds (VOCs), molds and microbial VOCs, and allergens.

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Indoor air quality, ventilation and health symptoms in schools: an analysis of existing information

This guideline was developed as a joint interdisciplinary European project, including physicians from all relevant disciplines as well as patients. It is a consensus-based guideline, taking available evidence from other guidelines, systematic reviews and published studies into account. This second part of the guideline covers antimicrobial therapy, systemic treatment, allergen-specific immunotherapy, complementary medicine, psychosomatic counselling and educational interventions, whereas the first part covers methods, patient perspective, general measures and avoidance strategies, basic emollient treatment and bathing, dietary intervention, topical anti-inflammatory therapy, phototherapy and antipruritic therapy. Management of AE must consider the individual clinical variability of the disease. Systemic immunosuppressive treatment with cyclosporine, methotrexate, azathioprine and mycophenolic acid is established option for severe refractory cases, and widely available. Biologicals targeting the T helper 2 pathway such as dupilumab may be a safe and effective, disease-modifying alternative when available. Oral drugs such as JAK inhibitors and histamine 4 receptor antagonists are in development. Microbial colonization and superinfection may cause disease exacerbation and can require additional antimicrobial treatment. Allergen-specific immunotherapy with aeroallergens may be considered in selected cases. Psychosomatic counselling is recommended especially in stress-induced exacerbations. Therapeutic patient education ('Eczema school') is recommended for children and adult patients. General measures, basic emollient treatment, bathing, dietary intervention, topical anti-inflammatory therapy, phototherapy and antipruritic therapy have been addressed in the first part of the guideline.

https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdv.14891

Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part I.

The existing evidence for treatment of atopic eczema (atopic dermatitis, AE) is evaluated using the national standard Appraisal of Guidelines Research and Evaluation. The consensus process consisted of a nominal group process and a DELPHI procedure. Management of AE must consider the individual symptomatic variability of the disease. Basic therapy is focused on hydrating topical treatment, and avoidance of specific and unspecific provocation factors. Anti-inflammatory treatment based on topical glucocorticosteroids and topical calcineurin inhibitors (TCI) is used for exacerbation management and more recently for proactive therapy in selected cases. Topical corticosteroids remain the mainstay of therapy, but the TCI tacrolimus and pimecrolimus are preferred in certain locations. Systemic immune-suppressive treatment is an option for severe refractory cases. Microbial colonization and superinfection may induce disease exacerbation and can justify additional antimicrobial treatment. Adjuvant therapy includes UV irradiation preferably with UVA1 wavelength or UVB 311 nm. Dietary recommendations should be specific and given only in diagnosed individual food allergy. Allergen-specific immunotherapy to aeroallergens may be useful in selected cases. Stress-induced exacerbations may make psychosomatic counselling recommendable. 'Eczema school' educational programs have been proven to be helpful. Pruritus is targeted with the majority of the recommended therapies, but some patients need additional antipruritic therapies.

https://www.onlinelibrary.wiley.com/doi/epdf/10.1111/j.1468-3083.2012.04635.x

Guidelines for treatment of atopic eczema (atopic dermatitis) part I.

A substantial number of studies have investigated the prevalence of contact allergy in the general population and in unselected subgroups of the general population. The aim of this review was to determine a median prevalence and summarize the main findings from studies on contact allergy in the general population. Published research mainly originates from North America and Western Europe. The median prevalence of contact allergy to at least 1 allergen was 21.2% (range 12.5-40.6%), and the weighted average prevalence was 19.5%, based on data collected on all age groups and all countries between 1966 and 2007. The most prevalent contact allergens were nickel, thimerosal, and fragrance mix. The median nickel allergy prevalence was 8.6% (range 0.7-27.8%) and demonstrates that nickel was an important cause of contact allergy in the general population and that it was widespread in both men and women. Numerous studies demonstrated that pierced ears were a significant risk factor for nickel allergy. Nickel was a risk factor for hand eczema in women. Finally, heavy smoking was associated with contact allergy, mostly in women. Population-based epidemiological studies are considered a prerequisite in the surveillance of national and international contact allergy epidemics.

https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1600-0536.2007.01220.x

The epidemiology of contact allergy in the general population – prevalence and main findings

The Textbook of Contact Dermatitis covers every conceivable aspect of modern day management of contact dermatitis. Both irritatnt and allergic types of contact dermatitis are dealt with clearly and comprehensively, special emphasis being given to occupational aspects as well as to prevention, diagnosis and treatment. Also covered are epidemiological aspects, computerization of patch test data and patient imformation systems, noninvasive bioengineering measurement techniques, methods of skin testing other than patch testing, histopathology of both irritant and allergic contact dermatitis, and subjective reactions. The editors and contributing authors are all leading practitioners in the field. Their expertise has been brought to bear to

Textbook of Contact Dermatitis

In 424 schoolchildren (223 boys and 201 girls) aged 7–12 years undergoing routine patch tests, 21.0% (89 children), 38.8% (78/201) of girls and 4.9% (11/223) of boys, had had their ears pierced. 18.6% (79 children, 55 girls and 24 boys) gave a history of cutaneous reactions to metallic jewellery, and in 17.2% (73 children, 49 girls and 24 boys), sensitivity to one or more metals was confirmed. Metal allergy was confirmed by patch testing in only 34.2% of the children with a history of metal dermatitis, and 13.3% of those without a history of metal reactions had, in fact, positive patch tests to 1 or more metals. The low sensitivity (37.0%) and low positive predictive value (34.2%), together with high specificity (85.2%) and high negative predictive value (86.7%), seem to justify dermatological examination of individuals with a positive symptom-based diagnosis only. Nickel sensitivity was found in 14.9% (63 children, 44 girls and 19 boys). There is clearly a relationship between ear piercing and induction of nickel allergy in girls, as nickel sensitivity in girls with pierced ears was 2 × (30.8%) that found in those without (16.3%) pierced ears. In boys, nickel sensitivity was much less frequent and few cases were related to ear piercing. Atopy appeared to influence the propensity for developing metal sensitivity in girls, as atopic girls showed positive metal tests 2xas frequently (30.8%) as non-atopic (17.0%). No such differences were found in boys. Girls with a combination of atopy and ear piercing showed the highest frequency of positive metal tests (45.5%). The frequency of metal allergy increased with increasing number of holes in the ear lobes. Symptoms of nickel allergy were reported in 30.2% (19/63) of mothers whose children had nickel allergy, compared to 16.3% (59/361) of mothers whose children had negative nickel tests. Only 4 children reported symptoms of nickel allergy in their father. The high frequency of nickel sensitivity in all children tested may indicate an influence of sources other than ear piercing.

Metal allergy in north Norwegian schoolchildren and its relationship with ear piercing and atopy.

HLA-DRB1,-DQA1, and -DQB1 genomic typing of 50 patients with dermatitis herpetiformis and of 290 healthy blood donors was performed. Genes encoding the DQ (alpha 1*0501, beta 1*02) heterodimer were carried by 43 (86%) of the patients and 72 (25%) of the controls. Of the remaining seven patients six (12% of all the patients) carried genes encoding the DQ (alpha 1*03, beta 1*0302) heterodimer. These HLA associations are very similar to those observed in patients with celiac disease. We thus conclude that dermatitis herpetiformis and celiac disease are associated to the very same HLA-DQ alpha beta heterodimers.

Dermatitis herpetiformis and celiac disease are both primarily associated with the HLA-DQ (α1*0501, (β1*02) or the HLA-DQ (α1*03, (β1*0302) heterodimers

Serum total IgE levels were found to be increased in thirty-nine of ninety-four patients with scabies investigated at the time of clinical presentation. One hundred and fifty-four patients were found to have a slightly lower serum concentration of IgA during infection than when measured 6 weeks and 9 months following successful treatment (P less than 0.05). The serum concentration of IgA at 6 weeks and 9 months after treatment did not differ significantly. The serum concentration of IgG during infection was significantly higher than 6 weeks later (P less than 0.05), and than 9 months later (P less than 0.01). The 6 weeks levels were significantly higher than the results at 9 month (P less than 0.01). The serum concentration of IgM during infection was higher than 6 weeks later (P less than 0.1). The 6 weeks levels were lower than those at 9 months (P less than 0.1), whereas there was no difference between the pretreatment and 9 months levels. No differences were noted in the concentration of C3 and C4. Antinuclear antibodies (ANA) and rheumatoid factor (RF) were not found in any of the patients. In thirty-two patients with lichen planus no changes in immunoglobulins or complement were observed. This suggests that scabies infection may be associated with a humoral immumological response against the scabies infection.

Serum immunoglobulin values in patients with scabies

OBJECTIVES: To investigate Staphylococcus aureus and Staphylococcus epidermidis quantitatively in adult patients with atopic dermatitis and in healthy controls treated with UVB radiation. STUDY DESIGN: Twenty-three adult patients (of these, 3 were excluded) with flexural atopic dermatitis and 20 healthy controls were randomly selected at the outpatient clinic of the Dermatological Department, University Hospital, North Norway. METHODS: Adult patients with atopic dermatitis (n = 20) and healthy controls (n = 20) were given 20 UVB treatments. Bacterial samples were collected before treatment, after 4 weeks of treatment, and finally after 2 weeks follow-up. RESULTS: The main bacteria found were Staphylococcus aureus and Staphylococcus epidermidis. 16 of the 20 patients with atopic dermatitis had Staphylococcus aureus in lesional skin and 12 in non-lesional skin. None of the healthy controls had Staphylococcus aureus in the sample from the flexural elbow. The Staphylococcus aureus counts decreased (not significant) in lesional skin after 4 weeks of treatment and Staphylococcus aureus counts were slightly higher after 2 weeks follow up. The same figures were also seen in non-lesional skin and forehead. CONCLUSIONS: Staphylococcus aureus is widely colonised in the skin of atopic dermatitis patients, but is rare in healthy adults. UVB treatment decreases the Staphylococcus aureus count in patients with atopic dermatitis. Keywords: anti-microbial effect; atopic dermatitis; phototherapy; Staphylococcus aureus; Staphylococcus epidermidis (Int J Circumpolar Health 2008; 67(2):254-260)

The effect of UVB radiation on skin microbiota in patients with atopic dermatitis and healthy controls.

SUMMARY

An extract prepared from 200 adult female scabies mites was used for prick and intracutaneous testing in twelve patients with previous scabies infestation, as well as in six healthy controls and three persons with skin sensitivity to Dermatophagoides pteronyssinus who had never had scabies before. Seven individuals who had had scabies less than a year prior to the testing had positive intracutaneous (immediate type) reactions, whereas all the five who had had scabies more than a year before had negative reactions. The prick tests were negative in all cases. No skin reactions could be evoked in the controls. The passive transfer, or Prausnitz-Kustner, test was positive with the scabies mite extract and serum from three of five patients tested on one healthy individual, and with both of two sera tested on a second healthy individual. These findings indicate that immediate type hypersensitivity reactions may occur with scabies infection.

Edvard S. Falk

Papers

Metal allergy in north Norwegian schoolchildren and its relationship with ear piercing and atopy.

Dermatitis herpetiformis and celiac disease are both primarily associated with the HLA-DQ (α10501, (β102) or the HLA-DQ (α103, (β10302) heterodimers

Serum immunoglobulin values in patients with scabies

The effect of UVB radiation on skin microbiota in patients with atopic dermatitis and healthy controls.

In vitro demonstration of specific immunological hypersensitivity to scabies mite.