Re: Allergen Testing Question

November 24, 2008

Will,

A comprehensive IAQ investigation requires a very competent individual

who

has significant experience in detailed investigations.

The doctor probably is unaware of the cost to perform a " comprehensive "

survey.

There are at least 6 different typical animal/insect " allergens " that

can be tested for. What is need is more information on the symptoms,

their time and location dependence and what drugs the asthma responds

to.

I would ask the MD if he has done a RAST test to get an antibody

history. this may help point in some direction.

Bob

November 24, 2008

Will,

As the others have suggested, a " shotgun " approach to find " everything " is cost prohibitive and unnecessary. The physician should be able to limit the testing to just those allergens his patient is allergic to. Then test on those. But with caution because the results vary due to innaccuracies and because the quantity at any location varies over time.

Several of the IAQ labs also analyse dust samples for the main allergens of dust mite, cockroach, cat, dog, rodent, etc. Almost all are based on the antigens from Indoor Biotechnology Labs www.inbio.com

" Threshold " values will be determined by the physician. One patient may react to extremely low levels of a particular allergen and another may not react until levels are hundreds of times higher. And the levels can change over time, especially in combination with other allergens and other types of exposure.

One resource, especially for asthma but including other possible exposure sources and effects, is the the HUD Healthy Housing Reference Manual, a free download at: http://www.cdc.gov/nceh/publications/books/housing/housing.htm

Carl Grimes

Healthy Habitats LLC

-----

> A friend has a child with extreme asthma. Their doctor has asked them

> to have a comprehensive IAQ investigation conducted in their home. In

> addition to the usual mold concerns, they are also focused on common

> allergens. Several questions:

>

> 1. What qualifications should an inspector possess for this

> situation?

> 2. What types of tests should be included in the IAQ investigation

> for allergens?

> 3. Are all allergen tests universal? In other words - do specific

> target allergens require specific type of tests or is there a

> universal sampling protocol?

> 4. Once results are collected - Is there is safe/unsafe threshold for

> the presence of allergens? Is it realistic to have a zero count?

>

> Any information on the process and sampling equipment would be

> helpful in vetting the inspector. This is a money no object situation

> so please detail the perfect world testing scenario for a

> comprehensive evaluation.

>

> Thanks All,

>

> Will

>

> ------------------------------------

>

> FAIR USE NOTICE:

>

> This site contains copyrighted material the use of which has not always been specifically authorized by the copyright owner. We are making such material available in our efforts to advance understanding of environmental, political, human rights, economic, democracy, scientific, and social justice issues, etc. We believe this constitutes a 'fair use' of any such copyrighted material as provided for in section 107 of the US Copyright Law. In accordance with Title 17 U.S.C. Section 107, the material on this site is distributed without profit to those who have expressed a prior interest in receiving the included information for research and educational purposes. For more information go to: http://www.law.cornell.edu/uscode/17/107.shtml. If you wish to use copyrighted material from this site for purposes of your own that go beyond 'fair use', you must obtain permission from the copyright owner.

November 24, 2008

>

> A friend has a child with extreme asthma. Their doctor has asked them

> to have a comprehensive IAQ investigation conducted in their home.

========================================

Hi Will,

There is incomplete medical information from which to proceed here.

There are many types of asthma - is there evidence that this is an

allergic form of the bronchial disorder? Are there high IgE levels or

significant IgA/IgG issues (the latter may point towards diet also).

Combinatorial factors are usually responsible for the most severe

problems found and asthma is also known (current thinking in a recent

CHEST paper by a French researcher) to be systemic. Are there GI tract

abnromalities? Any learning delays indicating neurological issues?

To save money, it may be best to run informal test panels to determine

where to concentrate efforts using formal protocols from experts.

Where is this house, how old is it, how many owners has it had, what

recent renovations has it undergone, what is the pesticide history and

what is in the neighborhood of the home within a couple miles (e.g.

farms, golf courses, factories etc.)?

Also, I assume the parents have already examined their personal choices

for the child in terms of diet (best to have a diary of that),

clothing, bedding, personal care products etc.

Last summer I was living in part of a home in western Ma. but was doing

poorly in what ought to have been a good environment for me (disabled

by pesticides years ago). I was lucky that a secondary assault of

pesticides from a nearby farm (I had been mistakenly informed it was

organically run) led me to become critically ill and test my bedroom.

Filter analysis showed 1.5 parts per million of chlordane, which I

might have lived with for a long time except that an organophophate

pesticide intrusion from the farm forced me to leave before the test

results even arrived (OP exposure confirmed by blood testing). This is

three times the OSHA level for workplace exposure although of course, a

different method of sampling is used in that kind of assessment.

However, my less expensive assessment was very informative and

indicates a high probability that levels of chlordane are present above

the low residues encountered in many locations from applications prior

to the ban in 1988.

So, the unexpected and the invisible can be an issue anywhere. VOCs,

Pesticides, PAHs (heating systems can be very toxic), etc. can exist

singly or in combination to result in significant illness. Allergies

may develop as a result which are then a red herring, with attention

paid to them rather than exposures which damage immune functions but

are hard to find.

Hope that helps.

Barb Rubin

November 24, 2008

Carl:

This is the type of testing the doctor(s) have recommended. Don's

child is being treated at a clinic that specialized in asthma. There

are multiple specialists involved.

They are looking for the common indoor allergens ranging from mites,

cats, dogs, pests, mold, etc. Mold has been ruled out by two

inspectors. The family has no pets, but the owner before did. A

comprehensive cleaning including removal of all carpets, duct

cleaning, HVAC inspection etc was performed before they moved in. All

personal belongings undergo continual cleaning and they have

installed high efficiency filtration to control particulates.

From the responses so far, a dust sample should be collected for

analysis. Based on the Indoor Biotechnology Labs site, a single

sample can be tested with the MARIA test for 8 of the most common

indoor allergens.

The question is, what qualification should they look for in an

inspector? Dust sampling seems to be very straightforward, however,

like everything else, the devil is in the details. Seems that a CIH

or MPH would be the minimum qualifications.

Once the data is collected, it becomes fairly straight forward for

the doctors to compare the findings against the child's elevated IgE

antibodies. If there is a correlation, then they know what to look

for in control measures in the home and school.

Thanks for the feedback all.

Will

>

> Will,

>

> As the others have suggested, a " shotgun " approach to find

> " everything " is cost prohibitive and unnecessary. The physician

> should be able to limit the testing to just those allergens his

> patient is allergic to. Then test on those. But with caution

because

> the results vary due to innaccuracies and because the quantity at

> any location varies over time.

>

> Several of the IAQ labs also analyse dust samples for the main

> allergens of dust mite, cockroach, cat, dog, rodent, etc. Almost

all

> are based on the antigens from Indoor Biotechnology Labs

> www.inbio.com

>

> " Threshold " values will be determined by the physician. One

> patient may react to extremely low levels of a particular allergen

> and another may not react until levels are hundreds of times

> higher. And the levels can change over time, especially in

> combination with other allergens and other types of exposure.

>

> One resource, especially for asthma but including other possible

> exposure sources and effects, is the the HUD Healthy Housing

> Reference Manual, a free download at:

> http://www.cdc.gov/nceh/publications/books/housing/housing.htm

>

> Carl Grimes

> Healthy Habitats LLC

>

> -----

> > A friend has a child with extreme asthma. Their doctor has asked

them

> > to have a comprehensive IAQ investigation conducted in their

home. In

> > addition to the usual mold concerns, they are also focused on

common

> > allergens. Several questions:

> >

> > 1. What qualifications should an inspector possess for this

> > situation?

> > 2. What types of tests should be included in the IAQ

investigation

> > for allergens?

> > 3. Are all allergen tests universal? In other words - do specific

> > target allergens require specific type of tests or is there a

> > universal sampling protocol?

> > 4. Once results are collected - Is there is safe/unsafe threshold

for

> > the presence of allergens? Is it realistic to have a zero count?

> >

> > Any information on the process and sampling equipment would be

> > helpful in vetting the inspector. This is a money no object

situation

> > so please detail the perfect world testing scenario for a

> > comprehensive evaluation.

> >

> > Thanks All,

> >

> > Will

> >

> > ------------------------------------

> >

> > FAIR USE NOTICE:

> >

> > This site contains copyrighted material the use of which has not

always been specifically authorized by the copyright owner. We are

making such material available in our efforts to advance

understanding of environmental, political, human rights, economic,

democracy, scientific, and social justice issues, etc. We believe

this constitutes a 'fair use' of any such copyrighted material as

provided for in section 107 of the US Copyright Law. In accordance

with Title 17 U.S.C. Section 107, the material on this site is

distributed without profit to those who have expressed a prior

interest in receiving the included information for research and

educational purposes. For more information go to:

http://www.law.cornell.edu/uscode/17/107.shtml. If you wish to use

copyrighted material from this site for purposes of your own that go

beyond 'fair use', you must obtain permission from the copyright

owner.

November 25, 2008

I would start with testing of the individual by an allergist to identify any IgE type reactions to classic allergens. Before I tested the house for anything, I would want to know whether symptoms subsided upon removing the individual having problems from a suspect environment. You would want to know that there is a causative exposure occurring in that particular environment before you test so that you at least know you aren't on a wild goose chase.

Just because you find allergens or irritant chemicals, in any concentration, it doesn't mean they are causing a problem. You always need to work with the reactive individual (or their blood) to confirm a cause of a hypersensitivity reaction of any kind.

Whether you hire a PhD, a CIH, or a home inspector, if you ask for testing, you'll get testing. The lab results, per se, will not answer any questions about the individual's immune response.

Steve Temes

Hi there,

In addition to frank allergens (the presence of and reaction to can be

tested for, as described by others,) there can be non-allergen

sensitivities involved.

If the allegen study fails to turn up any likely culprits, testing for

VOCs by EPA Method TO-15, and / or formaldehyde testing by NIOSH

Method 2016 may be appropriate.

There are also several ways to look at the particulate loadings in the

indoor environment.

These areas do not encompass all of the possibilities, but cover a

large number of common potential irritants.

Vince Daliessio, CIH

EMSL Analytical

vdaliessio@...

>

>A friend has a child with extreme asthma. Their doctor has asked them

>to have a comprehensive IAQ investigation conducted in their home. In

>addition to the usual mold concerns, they are also focused on common

>allergens. Several questions:

>

>1. What qualifications should an inspector possess for this

>situation?

>2. What types of tests should be included in the IAQ investigation

>for allergens?

>3. Are all allergen tests universal? In other words - do specific

>target allergens require specific type of tests or is there a

>universal sampling protocol?

>4. Once results are collected - Is there is safe/unsafe threshold for

>the presence of allergens? Is it realistic to have a zero count?

>

>Any information on the process and sampling equipment would be

>helpful in vetting the inspector. This is a money no object situation

>so please detail the perfect world testing scenario for a

>comprehensive evaluation.

>

>Thanks All,

>

>Will

>

November 25, 2008

Will,

I think there are several issues woven together here. 1. Testing: For what and with which method; 2. Inspection: Where to sample. 3. Assessment: What do the numbers mean; 4. Assessment: What does the building history etc mean. 5. Diagnosis and Treatment: Medical issue but it loops back around to the previous.

This is a great example of how the medical falls short and how our environmental expertise falls short - each on their own. What is needed is communication and collaboration between the medical and the environmental experts. We need medical guidance of what to test for and we give them how we can test along with limitations. They need environmental guidance of what can be detected plus an overview of the global conditions of the living space so they can interpret it within the context of their patient.

So I don't see it as who is qualified to test or even to inspect. They don't exist for this sort of collaborative activity. Specific training, education and experience is needed according to an integrated knowledge base.

What can help, however, is to approach it along the lines of what you are doing: Do the best you can with the information you can obtain and present it to the patient or physician with what it does and does not reveal from an environmental focus. Then they get to struggle with what it means for the diagnosis and treatment of their individual patient.

Carl Grimes

Healthy Habitats LLC

-----

> Carl:

>

> This is the type of testing the doctor(s) have recommended. Don's

> child is being treated at a clinic that specialized in asthma. There

> are multiple specialists involved.

>

> They are looking for the common indoor allergens ranging from mites,

> cats, dogs, pests, mold, etc. Mold has been ruled out by two

> inspectors. The family has no pets, but the owner before did. A

> comprehensive cleaning including removal of all carpets, duct

> cleaning, HVAC inspection etc was performed before they moved in. All

> personal belongings undergo continual cleaning and they have

> installed high efficiency filtration to control particulates.

>

> From the responses so far, a dust sample should be collected for

> analysis. Based on the Indoor Biotechnology Labs site, a single

> sample can be tested with the MARIA test for 8 of the most common

> indoor allergens.

>

> The question is, what qualification should they look for in an

> inspector? Dust sampling seems to be very straightforward, however,

> like everything else, the devil is in the details. Seems that a CIH

> or MPH would be the minimum qualifications.

>

> Once the data is collected, it becomes fairly straight forward for

> the doctors to compare the findings against the child's elevated IgE

> antibodies. If there is a correlation, then they know what to look

> for in control measures in the home and school.

>

> Thanks for the feedback all.

>

> Will

>

> >

> > Will,

> >

> > As the others have suggested, a " shotgun " approach to find

> > " everything " is cost prohibitive and unnecessary. The physician

> > should be able to limit the testing to just those allergens his

> > patient is allergic to. Then test on those. But with caution

> because

> > the results vary due to innaccuracies and because the quantity at

> > any location varies over time.

> >

> > Several of the IAQ labs also analyse dust samples for the main

> > allergens of dust mite, cockroach, cat, dog, rodent, etc. Almost

> all

> > are based on the antigens from Indoor Biotechnology Labs

> > www.inbio.com

> >

> > " Threshold " values will be determined by the physician. One

> > patient may react to extremely low levels of a particular allergen

> > and another may not react until levels are hundreds of times

> > higher. And the levels can change over time, especially in

> > combination with other allergens and other types of exposure.

> >

> > One resource, especially for asthma but including other possible

> > exposure sources and effects, is the the HUD Healthy Housing

> > Reference Manual, a free download at:

> > http://www.cdc.gov/nceh/publications/books/housing/housing.htm

> >

> > Carl Grimes

> > Healthy Habitats LLC

> >

> > -----

> > > A friend has a child with extreme asthma. Their doctor has asked

> them

> > > to have a comprehensive IAQ investigation conducted in their

> home. In

> > > addition to the usual mold concerns, they are also focused on

> common

> > > allergens. Several questions:

> > >

> > > 1. What qualifications should an inspector possess for this

> > > situation?

> > > 2. What types of tests should be included in the IAQ

> investigation

> > > for allergens?

> > > 3. Are all allergen tests universal? In other words - do specific

> > > target allergens require specific type of tests or is there a

> > > universal sampling protocol?

> > > 4. Once results are collected - Is there is safe/unsafe threshold

> for

> > > the presence of allergens? Is it realistic to have a zero count?

> > >

> > > Any information on the process and sampling equipment would be

> > > helpful in vetting the inspector. This is a money no object

> situation

> > > so please detail the perfect world testing scenario for a

> > > comprehensive evaluation.

> > >

> > > Thanks All,

> > >

> > > Will

> > >

> > > ------------------------------------

> > >

> > > FAIR USE NOTICE:

> > >

> > > This site contains copyrighted material the use of which has not

> always been specifically authorized by the copyright owner. We are

> making such material available in our efforts to advance

> understanding of environmental, political, human rights, economic,

> democracy, scientific, and social justice issues, etc. We believe

> this constitutes a 'fair use' of any such copyrighted material as

> provided for in section 107 of the US Copyright Law. In accordance

> with Title 17 U.S.C. Section 107, the material on this site is

> distributed without profit to those who have expressed a prior

> interest in receiving the included information for research and

> educational purposes. For more information go to:

> http://www.law.cornell.edu/uscode/17/107.shtml. If you wish to use

> copyrighted material from this site for purposes of your own that go

> beyond 'fair use', you must obtain permission from the copyright

> owner.

November 25, 2008

Will,

Five observations from a parent who dealt with a similar situation

(but by no means identical) thirteen years ago. Would have sent

this privately if it had been possible.

1. It is possible to work through a situation like this.

2. The smartest, most skilled testing person I hired during my

family's sick house incident was not the most credentialled and took

a great deal of networking to find. Had to fly him in. One of the

first things he said to me on site was, " No customer of mine with a

problem like yours has ever [identified the actual substance causing

them problems] before running out of money. " But the he had the

insight to point to some subtly unusual test results, which was

enough for me to find water migrating up through the slab. Never

figured out what it was in that water, though.

Just for the record, the dumbest person I hired was a CIH, who I

fired when he came back with the wonderful news that since the

testing had found nothing there was nothing wrong with the house.

3. There was a debate between mainstream medicine, the " allergists "

and the " clinical ecologists " about a half century ago. The outcome

was recognition for the allergy profession, exile for the clinical

ecologists (now called environmental medicine), and mainstream

medicine limiting itself to recognizing a very focused subset of the

environment as possible allergy triggers. The child's trigger may

be in a blind spot of the mainstream medical profession. Sometimes

those blind spots are put there by special interests: when the food

additive industry successfully defended itself against Ben

Feingold's findings in the same era, they created such a consensus

in medicine that even today if your child is one of the 0.5% of kids

with intractable behavior/attention problems who respond to

eliminating those additives from diet, you won't hear about it from

your doctor.

4. The IAQ industry has similar blind spots, just not the degree of

special interest influence that medicine does. At the national

level did you know that reported NOx is NO and NO2 but not NO3? In

a building is there a way to test for the level of sacrificial

metals in the air (coils + galvanized ductwork + anodized aluminum

finish pieces)?

5. Have the parents tried creating a fragrance free environment (it

takes an MCS person to guide this, way harder than it sounds)? A

formaldehyde free environment (I still remember the trim piece from

my son's favorite sheets, and how his coughing attacks at night

noticeably dropped when we turned that sheet around and put the

decorative strip by his feet)? An anodized/galvanized metal free

environment? Tried experimenting with bringing the humidity down to

say 30%RH? A completely fire retardant free environment?

Eliminated wood finishes (the teak bedside tables my kids had used

all their life caused nighttime coughing fits after we were

sensitized)?

Best of luck to them,

Steve Chalmers

stevec@...

> >

> > Will,

> >

> > As the others have suggested, a " shotgun " approach to find

> > " everything " is cost prohibitive and unnecessary. The physician

> > should be able to limit the testing to just those allergens his

> > patient is allergic to. Then test on those. But with caution

> because

> > the results vary due to innaccuracies and because the quantity

at

> > any location varies over time.

> >

> > Several of the IAQ labs also analyse dust samples for the main

> > allergens of dust mite, cockroach, cat, dog, rodent, etc. Almost

> all

> > are based on the antigens from Indoor Biotechnology Labs

> > www.inbio.com

> >

> > " Threshold " values will be determined by the physician. One

> > patient may react to extremely low levels of a particular

allergen

> > and another may not react until levels are hundreds of times

> > higher. And the levels can change over time, especially in

> > combination with other allergens and other types of exposure.

> >

> > One resource, especially for asthma but including other possible

> > exposure sources and effects, is the the HUD Healthy Housing

> > Reference Manual, a free download at:

> > http://www.cdc.gov/nceh/publications/books/housing/housing.htm

> >

> > Carl Grimes

> > Healthy Habitats LLC

> >

> > -----

> > > A friend has a child with extreme asthma. Their doctor has

asked

> them

> > > to have a comprehensive IAQ investigation conducted in their

> home. In

> > > addition to the usual mold concerns, they are also focused on

> common

> > > allergens. Several questions:

> > >

> > > 1. What qualifications should an inspector possess for this

> > > situation?

> > > 2. What types of tests should be included in the IAQ

> investigation

> > > for allergens?

> > > 3. Are all allergen tests universal? In other words - do

specific

> > > target allergens require specific type of tests or is there a

> > > universal sampling protocol?

> > > 4. Once results are collected - Is there is safe/unsafe

threshold

> for

> > > the presence of allergens? Is it realistic to have a zero

count?

> > >

> > > Any information on the process and sampling equipment would be

> > > helpful in vetting the inspector. This is a money no object

> situation

> > > so please detail the perfect world testing scenario for a

> > > comprehensive evaluation.

> > >

> > > Thanks All,

> > >

> > > Will

> > >

> > > ------------------------------------

> > >

> > > FAIR USE NOTICE:

> > >

> > > This site contains copyrighted material the use of which has

not

> always been specifically authorized by the copyright owner. We are

> making such material available in our efforts to advance

> understanding of environmental, political, human rights, economic,

> democracy, scientific, and social justice issues, etc. We believe

> this constitutes a 'fair use' of any such copyrighted material as

> provided for in section 107 of the US Copyright Law. In accordance

> with Title 17 U.S.C. Section 107, the material on this site is

> distributed without profit to those who have expressed a prior

> interest in receiving the included information for research and

> educational purposes. For more information go to:

> http://www.law.cornell.edu/uscode/17/107.shtml. If you wish to use

> copyrighted material from this site for purposes of your own that

go

> beyond 'fair use', you must obtain permission from the copyright

> owner.

November 26, 2008

Steve,

Excellent observations and history. This is consistent with my personal experience and with my clients. There are leading edge physicians out there and their numbers are increasing. If the focus includes the patient and their response as an end-point, then evidence-based medicine (and science) works. But " evidence-only, " which excludes the person, is found wanting even for the majority in the Bell curve.

We are a nation of law, which is critical. Medicine for the benefit of the patient, is critical. But the end-point of each often conflicts.

Discrediting " junk science " is important. Encouraging innovation is also important. But they often conflict with the law trumping medicine.

These are not issues which can be settled with " science-only, " but with policy. Who determines policy? Not science only. Not people only. But transparantly and democratically with input duly considered by all involved. Especially because we get it wrong sometimes.

Carl Grimes

Healthy Habitats LLC

-----

> Will,

>

> Five observations from a parent who dealt with a similar situation

> (but by no means identical) thirteen years ago. Would have sent

> this privately if it had been possible.

>

> 1. It is possible to work through a situation like this.

>

> 2. The smartest, most skilled testing person I hired during my

> family's sick house incident was not the most credentialled and took

> a great deal of networking to find. Had to fly him in. One of the

> first things he said to me on site was, " No customer of mine with a

> problem like yours has ever [identified the actual substance causing

> them problems] before running out of money. " But the he had the

> insight to point to some subtly unusual test results, which was

> enough for me to find water migrating up through the slab. Never

> figured out what it was in that water, though.

>

> Just for the record, the dumbest person I hired was a CIH, who I

> fired when he came back with the wonderful news that since the

> testing had found nothing there was nothing wrong with the house.

>

> 3. There was a debate between mainstream medicine, the " allergists "

> and the " clinical ecologists " about a half century ago. The outcome

> was recognition for the allergy profession, exile for the clinical

> ecologists (now called environmental medicine), and mainstream

> medicine limiting itself to recognizing a very focused subset of the

> environment as possible allergy triggers. The child's trigger may

> be in a blind spot of the mainstream medical profession. Sometimes

> those blind spots are put there by special interests: when the food

> additive industry successfully defended itself against Ben

> Feingold's findings in the same era, they created such a consensus

> in medicine that even today if your child is one of the 0.5% of kids

> with intractable behavior/attention problems who respond to

> eliminating those additives from diet, you won't hear about it from

> your doctor.

>

> 4. The IAQ industry has similar blind spots, just not the degree of

> special interest influence that medicine does. At the national

> level did you know that reported NOx is NO and NO2 but not NO3? In

> a building is there a way to test for the level of sacrificial

> metals in the air (coils + galvanized ductwork + anodized aluminum

> finish pieces)?

>

> 5. Have the parents tried creating a fragrance free environment (it

> takes an MCS person to guide this, way harder than it sounds)? A

> formaldehyde free environment (I still remember the trim piece from

> my son's favorite sheets, and how his coughing attacks at night

> noticeably dropped when we turned that sheet around and put the

> decorative strip by his feet)? An anodized/galvanized metal free

> environment? Tried experimenting with bringing the humidity down to

> say 30%RH? A completely fire retardant free environment?

> Eliminated wood finishes (the teak bedside tables my kids had used

> all their life caused nighttime coughing fits after we were

> sensitized)?

>

> Best of luck to them,

>

> Steve Chalmers

> stevec@...

>

> > >

> > > Will,

> > >

> > > As the others have suggested, a " shotgun " approach to find

> > > " everything " is cost prohibitive and unnecessary. The physician

> > > should be able to limit the testing to just those allergens his

> > > patient is allergic to. Then test on those. But with caution

> > because

> > > the results vary due to innaccuracies and because the quantity

> at

> > > any location varies over time.

> > >

> > > Several of the IAQ labs also analyse dust samples for the main

> > > allergens of dust mite, cockroach, cat, dog, rodent, etc. Almost

> > all

> > > are based on the antigens from Indoor Biotechnology Labs

> > > www.inbio.com

> > >

> > > " Threshold " values will be determined by the physician. One

> > > patient may react to extremely low levels of a particular

> allergen

> > > and another may not react until levels are hundreds of times

> > > higher. And the levels can change over time, especially in

> > > combination with other allergens and other types of exposure.

> > >

> > > One resource, especially for asthma but including other possible

> > > exposure sources and effects, is the the HUD Healthy Housing

> > > Reference Manual, a free download at:

> > > http://www.cdc.gov/nceh/publications/books/housing/housing.htm

> > >

> > > Carl Grimes

> > > Healthy Habitats LLC

> > >

> > > -----

> > > > A friend has a child with extreme asthma. Their doctor has

> asked

> > them

> > > > to have a comprehensive IAQ investigation conducted in their

> > home. In

> > > > addition to the usual mold concerns, they are also focused on

> > common

> > > > allergens. Several questions:

> > > >

> > > > 1. What qualifications should an inspector possess for this

> > > > situation?

> > > > 2. What types of tests should be included in the IAQ

> > investigation

> > > > for allergens?

> > > > 3. Are all allergen tests universal? In other words - do

> specific

> > > > target allergens require specific type of tests or is there a

> > > > universal sampling protocol?

> > > > 4. Once results are collected - Is there is safe/unsafe

> threshold

> > for

> > > > the presence of allergens? Is it realistic to have a zero

> count?

> > > >

> > > > Any information on the process and sampling equipment would be

> > > > helpful in vetting the inspector. This is a money no object

> > situation

> > > > so please detail the perfect world testing scenario for a

> > > > comprehensive evaluation.

> > > >

> > > > Thanks All,

> > > >

> > > > Will

> > > >

> > > > ------------------------------------

> > > >

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November 26, 2008

> 3. There was a debate between mainstream medicine, the " allergists "

> and the " clinical ecologists " about a half century ago. The

outcome

> was recognition for the allergy profession, exile for the clinical

> ecologists (now called environmental medicine), and mainstream

> medicine limiting itself to recognizing a very focused subset of

the

> environment as possible allergy triggers. The child's trigger may

> be in a blind spot of the mainstream medical profession.

======================================================

This is very true and the suggestions regarding removal of proven

asthma triggers is a necessity in any event. The allergen issues are

more comfortable all-round because they involve concrete measurement

of blood work findings (usually IgE) with substances that may be

found which are known to be sensitizers.

However, the allergies and asthma can just as easily be the result of

other forms of contaminants which induced immune system impairments

and generalized inflammation, rendering a child or other person prone

to multiple disease processes.

Last summmer, I became ill in a bedroom I was renting in western Ma.

I didn't think it was the house until distinct fumes coming in from a

nearby farm made me acutely ill and I had to leave after a few weeks

more of exposure there. In order to find out what happened to me, I

tested the air purifier filter from that room (purchased new for that

location) and also took a blood test for pesticide exposures common

to agricultural locales.

I was shocked to see high levels of chlordane found in the air

purifier, 1.5 ppm, indicating the house itself was contaminated. My

blood work was also positive for significant cholinesterase

suppression - a sign of current use pesticides in the area. These

two toxicants in combination with one another (singly they are bad

enough!) was sufficient to aggravate neurological, cardiac and

respiratory problems I had to life threatening proportions. I did

much better upon leaving there but without the tests, I would not

have thought the house was a problem. Thirty million homes were

treated with chlordane before it was banned in 1988 and it doesn't

break down. The ATSDR site can offer you more details about it but

chlordane can be found in new homes built on contaminated soil as

well.

So, based upon a homes age, location in proximity to industry and

agriculture (even golf courses), military bases - and don't forget

the history of the building site in case it used to be a gas station!-

there may be tests worth taking to look for triggering exposures

which lead to the development of allergies and asthma along with

other signs of more systemic problems. Many asthmatics also have GI

tract problems and French researchers have recently published that

asthma is not a localized disorder but linked to digestive functions

via the inflammation of the same mucosal lining of the organs in

question.

I have come to believe that sensitization responses (and some fifty

million Americans have allergies, 24 million with asthma etc.) may

actually be more common in people with exposures to toxicants not

normally associated with allergy. My testing of homes and offices

indicates this hypothesis is worth researching formally (if I had the

resources to do so). Regardless, this child could easily have less

obvious problems apart from asthma which are not being given due

notice but which might indicate other contaminants are present apart

from allergens. Some culprits might be heating and cooking fuel (gas,

wood, oil); renovation/construction products etc. We often overlook

things because they are ubiquitous.

Just because something is very prevalent in the environment doesn't

mean it isn't injurious.

Hope this helps.

Barb Rubin

November 27, 2008

Steve:

Just a weee editorial comment.....The order of your 2nd and 3rd paragraphs should be switched. Then the paragraph discussing testing should add.....

Not only will testing often not answer the question, but testing often provides results which are of no merit. For example, mold testing will find mold, bacterial testing will find bacteria, VOC testing will find VOC’s, and particulate testing will find particulates. So what is the point? Testing will result in substantial cost! Moreover, the benefits of testing to find an unknown are weak at best. Testing is more appropriate to quantify the known or suspect.

Just a thought.

I would start with testing of the individual by an allergist to identify any IgE type reactions to classic allergens. Before I tested the house for anything, I would want to know whether symptoms subsided upon removing the individual having problems from a suspect environment. You would want to know that there is a causative exposure occurring in that particular environment before you test so that you at least know you aren't on a wild goose chase.

Just because you find allergens or irritant chemicals, in any concentration, it doesn't mean they are causing a problem. You always need to work with the reactive individual (or their blood) to confirm a cause of a hypersensitivity reaction of any kind.

Whether you hire a PhD, a CIH, or a home inspector, if you ask for testing, you'll get testing. The lab results, per se, will not answer any questions about the individual's immune response.

Steve Temes

Hi there,

In addition to frank allergens (the presence of and reaction to can be

tested for, as described by others,) there can be non-allergen

sensitivities involved.

If the allegen study fails to turn up any likely culprits, testing for

VOCs by EPA Method TO-15, and / or formaldehyde testing by NIOSH

Method 2016 may be appropriate.

There are also several ways to look at the particulate loadings in the

indoor environment.

These areas do not encompass all of the possibilities, but cover a

large number of common potential irritants.

Vince Daliessio, CIH

EMSL Analytical

vdaliessio@... <mailto:vdaliessio%40emsl.com>

>

>A friend has a child with extreme asthma. Their doctor has asked them

>to have a comprehensive IAQ investigation conducted in their home. In

>addition to the usual mold concerns, they are also focused on common

>allergens. Several questions:

>

>1. What qualifications should an inspector possess for this

>situation?

>2. What types of tests should be included in the IAQ investigation

>for allergens?

>3. Are all allergen tests universal? In other words - do specific

>target allergens require specific type of tests or is there a

>universal sampling protocol?

>4. Once results are collected - Is there is safe/unsafe threshold for

>the presence of allergens? Is it realistic to have a zero count?

>

>Any information on the process and sampling equipment would be

>helpful in vetting the inspector. This is a money no object situation

>so please detail the perfect world testing scenario for a

>comprehensive evaluation.

>

>Thanks All,

>

>Will

>

November 27, 2008

Carl

Good post!

Science is a wonderful practice that works well if properly understood and done and very poorly if misused to prevent new understandings from moving the 'existing experts' into the 'used-to-be-experts' category. In all fields this movement is often resisted by the existing experts; our egos support whatever action is necessary to preserve our status. Good scientists learn early to transcend their egos so that they can make new discoveries.

If you do not learn the limits of the scientific method and the limits of the tools that you are using you can do a lot of harm. We are seeing that across the board as scientists say they have used science to 'prove' that there is no God and pseudo-scientists prove that mycotoxins cannot make us ill; all for either a buck or fame.

Know yourself and your limitations and you can do great things! Some of the newer doctors are capable of understanding that they do not know it all and yet still function; they are worth more than their weight in gold to those whose illnesses have not yet reached mainstream solution availability. Of course, they are quickly under attack from those who are the present leaders in their field. I guess this has always been so. Just look to Dr. Rae to see how nasty it can get.

Happy thanksgiving to all US Americans (from a Canadian American)

Jim H. White

System Science Consulting

Re: Re: Allergen Testing Question

Steve,

Excellent observations and history. This is consistent with my personal experience and with my clients. There are leading edge physicians out there and their numbers are increasing. If the focus includes the patient and their response as an end-point, then evidence-based medicine (and science) works. But "evidence-only," which excludes the person, is found wanting even for the majority in the Bell curve.

We are a nation of law, which is critical. Medicine for the benefit of the patient, is critical. But the end-point of each often conflicts.

Discrediting "junk science" is important. Encouraging innovation is also important. But they often conflict with the law trumping medicine.

These are not issues which can be settled with "science-only," but with policy. Who determines policy? Not science only. Not people only. But transparantly and democratically with input duly considered by all involved. Especially because we get it wrong sometimes.

Carl Grimes

Healthy Habitats LLC

-----

> Will,

>

> Five observations from a parent who dealt with a similar situation

> (but by no means identical) thirteen years ago. Would have sent

> this privately if it had been possible.

>

> 1. It is possible to work through a situation like this.

>

> 2. The smartest, most skilled testing person I hired during my

> family's sick house incident was not the most credentialled and took

> a great deal of networking to find. Had to fly him in. One of the

> first things he said to me on site was, "No customer of mine with a

> problem like yours has ever [identified the actual substance causing

> them problems] before running out of money." But the he had the

> insight to point to some subtly unusual test results, which was

> enough for me to find water migrating up through the slab. Never

> figured out what it was in that water, though.

>

> Just for the record, the dumbest person I hired was a CIH, who I

> fired when he came back with the wonderful news that since the

> testing had found nothing there was nothing wrong with the house.

>

> 3. There was a debate between mainstream medicine, the "allergists"

> and the "clinical ecologists" about a half century ago. The outcome