Background: Indoor allergens play a major role both in sensitization and as triggers of asthma in children. The relationship between allergen exposure and sensitization to cats, dogs, and mites was studied prospectively in 100 newborn babies with a history of allergy in both parents.

The presence of Volatile Organic Compounds (VOC) in indoor air has in past decades often been associated with adverse health effects such as sensory irritation, odour and the more complex set of symptoms called the Sick Building Syndrome (SBS). More recently, a possible link between the increase in the prevalence of allergies throughout the industrialized areas of the world and exposure to elevated concentrations of VOCs has been suggested. In many cases, the total VOC (TVOC) is used as a measure of the concentration of air pollution and, by extension, as a measure of the health risk in non‐industrial buildings. However, the TVOC concept has been questioned for a number of reasons, including the facts that it is an ambiguous concept, that individual VOCs making up the whole can be expected to give rise to different effects in people and that researchers have been using different definitions and interpretations of TVOC. This means that simple addition of the quantities of individual VOCs may not be relevant from a health point of view. Twelve researchers from the Nordic countries have reviewed the literature on VOC/TVOC and health. A search of the literature resulted in the identification of about 1100 articles, of which 120 were selected for further examination. A final review of the articles reduced their number to 67 that contained data on both exposure and health effects. The group concluded that indoor air pollution including VOC is most likely a cause of health effects and comfort problems in indoor environments in non‐industrial buildings. However, the scientific literature is inconclusive with respect to TVOC as a risk index for health and comfort effects in buildings. Consequently, there is at present an inadequate scientific basis on which to establish limit values/guidelines for TVOC, both for air concentrations, and for emissions from building materials. The group concluded that continued research is required to establish a risk index for health and comfort effects for VOC in non‐industrial buildings.

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In order to screen for mould allergy, extracts of five common atmospheric moulds (Cladosporium, Alternaria, Penicillium, Aspergillus and Mucor) from various manufacturers were investigated in 130 patients (5-60 years old) with clinical symptoms indicating possible mould allergy. The patients were screened by skin prick test (SPT) and radioallergosorbent test (RAST). SPT seemed to be more sensitive than RAST as a diagnostic screening procedure (80% positive reactions to one or more species compared to 50%). With a partially purified, standardized preparation of Cladosporium herbarum more positive reactions were obtained than with crude extracts without evidence of any unspecific reactions. The difference between commercial and standardized extracts is most probably a result of a variation of both the biological potency of allergenic determinants and the allergenic composition. A considerable number of negative RAST reactions with standard discs were found in patients with positive skin reactions to partially purified Cladosporium, but RAST seemed to be more sensitive than SPT with the other commercial mould extracts. Based on the screening, a very convincing tendency to IgE-reactivity to other moulds was found in patients reacting to Cladosporium, the most common cause of mould allergy. The results confirm the inadequacy of most mould extracts used in diagnostic procedures and strengthen the value of using standardized extracts.

We evaluated the efficacy of once‐daily versus twice‐daily treatment with budesonide, delivered by a Turbuhaler®, in the management of children with stable asthma in a randomized, double‐blind, parallel‐group study involving 206 children (age 5–15 years). After a 2‐week run‐in period during which the children were maintained on their usual dose of budesonide (200 μg or 400 μg/day), patients were randomized to receive the same daily dose in either two daily administrations (morning and evening) or as a single dose in the morning over a period of 12 weeks. The primary efficacy variable was morning peak expiratory flow (PEF). The mean morning PEF during the run‐in phase was 271 L/min in patients randomized to once‐daily treatment and 264 L/min in those randomized to twice‐daily treatment. The mean change from baseline to the last 2 weeks of the treatment period in the two groups was −0.3 L/min (95% confidence limits −6.6 to +6.0) and 2.5 L/min (−4.3 to +9.3). The estimated difference between the groups was −2.8 L/min, with 90% confidence limits of −10.4 + 4.5; these were close to the limits regarded as indicative of equivalence (−10 to +10), and hence the difference was not regarded as clinically relevant. Similarly, there were no significant differences between the groups in regard to secondary efficacy measures such as spirometric tests and symptom scores. Both treatments were well tolerated. We conclude that once‐daily administration of budesonide by Turbuhaler® is as effective as twice‐daily treatment in the management of stable asthma in children treated with inhaled steroids at doses of 200–400 μg/day. Pediatr Pulmonol. 1999; 28:337–343. © 1999 Wiley‐Liss, Inc.