Copyright © 2008 American Academy of Allergy, Asthma & Immunology Published by Mosby, Inc.
The health effects of nonindustrial indoor air pollution
Jonathan A. Bernstein MDa, 
, 
, Neil Alexis PhDb, Hyacinth Bacchus NPc, I. Leonard Bernstein MDa, Pat Fritz BSd, Elliot Horner PhDe, Ning Li MD, PhDf, Stephany Mason PhDe, Andre Nel MD, PhDf, John Oullette MDg, Kari Reijula MDh, Tina Reponen PhDi, James Seltzer MDj, Alisa Smith PhDk and Susan M. Tarlo MBBSl
aDepartment of Internal Medicine, Allergy Section, Division of Immunology, University of Cincinnati, Cincinnati, Ohio
bCenter for Environmental Medicine and Lung Biology, University of North Carolina, Chapel Hill, NC
cMinistry of Health and the Environment, Orange, Los Angeles
dNew York State Department of Health, New York, NY
eAir Quality Sciences Inc, Atlanta, Ga
fUCLA School of Medicine, Los Angeles, Calif
gAdult Allergy Clinics, Madison, Wis
hFinnish Institute of Occupational Health, Helsinki, Finland
iUniversity of Cincinnati Center for Environmental Health, Cincinnati, Ohio
jSharp Mission Park Medical Group, Vista, Calif
kUS Environmental Protection Agency, Washington, DC
lToronto Western Hospital, Toronto, Ontario, Canada
Received 2 July 2007; revised 15 October 2007; accepted 19 October 2007. Available online 21 December 2007.
Background
There is growing public awareness regarding the risk associated with poor indoor air quality in the home and workplace. Because Americans spend approximately 22 hours every day indoors, susceptible individuals are at much greater risk of adverse health effects from chronic low levels of exposure to indoor air pollutants over time. Along with particulate matter, gases such as ozone, nitrogen dioxide, carbon monoxide, and sulfur dioxide; microbial and chemical volatile organic compounds; passive smoke; and outdoor ambient air are the most common types of air pollutants encountered indoors.
Objective
To provide the allergists with necessary information that will assist them in making useful recommendations to patients seeking advice regarding indoor environmental triggers beyond traditional perennial allergens.
Methods
Review of the literature pertaining to indoor exposure and health effects of gaseous and particular matter.
Results
Indoor pollutants act as respiratory irritants, toxicants, and adjuvants or carriers of allergens.
Conclusion
The allergist should be prepared to evaluate patient exposure to allergic and nonallergic triggers and understand how outdoor air pollution is affecting indoor environments. This requires being familiar with methodologies for monitoring and interpreting indoor air quality and interpreting results in the context of the patients exposure history and advising patients about rational environmental control interventions.
Key words: Indoor air pollutants; ozone; particulate matter; nitrogen dioxide; carbon monoxide; sulfur dioxide; health effects; volatile organic compounds; tobacco smoke; passive smoke exposure; cotinine; fungal allergens
Abbreviations: ETS, Environmental tobacco smoke; IAQ, Indoor air quality; mVOC, Microbial volatile organic compound; PM, Particulate matter; SBS, Sick building syndrome; TVOC, Total volatile organic compound; VOC, Volatile organic compound
Disclosure of potential conflict of interest: J. A. Bernstein has consultant arrangements with Medpointe, Cornerstone, and Flint Industries; has received research support from Merck, GlaxoSmithKline, and Medpointe; has served on the speakers' bureau for AstraZeneca, GlaxoSmithKline, UCB-Sanofi Aventis, Novartis, Merck, and Tera; and has served as an expert witness in legal cases regarding environmental issues. E. Horner is employed by and owns stock in Air Quality Sciences; has provided litigation support to both defendant and plaintiff attorneys; and has received grants/research support from the American Society of Heating, Refrigerating, and Air Conditioning Engineers. S. M. Tarlo receives referrals from the Ontario workers' compensation system, insurance companies, and physicians of patients with building-related complaints. The rest of the authors have declared that they have no conflict of interest.Reprint requests: Jonathan A. Bernstein, MD, 231 Albert Sabin Way ML#563, Cincinnati, OH 45267-0563.
Journal of Allergy and Clinical Immunology
Article in Press, Corrected Proof
