Program

All people are encouraged to bring ideas, questions and data etc for discussion and presentation.  Please bring as individual PowerPoint slides on laptops, CDs or USB cards. We are not expecting any didactic presentations. The idea is sit around and try in an open format to discuss topics of mutual interest in relation to asthma and its causation / assessment / environmental risks / protection / interventions.

  Thurs:>6:30  BBQ for early-birds at ET’s home.

  Friday 

 9:00-10:30  “what I am interested in” – self-introduction, ~5 minute/person

 10:30-11   Morning tea

 11-12:30  Techniques and methods – endotoxin, fungi, b-glucans, extracellular polysaccharides   G+ve, mites, mycotoxins  assessing exposure / assessing health outcomes

12:30-1:30   Lunch

 1:30-3:00  Genes – SNPs – how/why/when/risks – Graham Jones

   Asthma ecology

   New trends in asthma prevalence and measurement of asthma

   Transmigration/different populations – Ginger / Julian / Guy

 3:00-3:15   Afternoon tea

 3:15-5:00  Role of fungi, mites, other allergens and endotoxin in asthma

  What interventions should we test in future?

   What interventions should we recommend now?

 >6:30 pm   Dinner at local restaurant

  Saturday

  9:00-10:30   Hygiene Hypothesis

   Housing/indoor – risk/tolerance: cat/mite/cockroach/other

 10:30-11:00  Morning Tea

 11- until finish  Designing future studies – where to, collaborations etc

  EXPOSURE ASSESSMENT OF BIOLOGICAL AGENTS IN THE INDOOR ENVIRONMENT – A SUMMARY OF THE 2004 MAD WORKSHOP IN SYDNEY, AUSTRALIA

 Introduction

 Indoor dampness has been associated with adverse health effects including respiratory symptoms and asthma. Exposure to microorganisms and indoor allergens (particularly mite allergens) has widely been recognized as plausible cause of these health effects. However, their specific role in indoor-environment-related diseases is still poorly understood. The relative lack of knowledge regarding the role of microorganisms and indoor allergens in the development (and exacerbation) of those diseases is largely due to the lack of valid quantitative exposure assessment methods. Exposure assessment of allergens and microorganisms in the indoor environment is therefore associated with large uncertainties, potentially resulting in large measurement errors and biased exposure-response relationships. Measurement errors in indoor exposure assessment are likely substantially larger than those in assessing related health effects. It is therefore of crucial importance to develop improved methods and procedures for indoor exposure assessment.

  The MADD 2004 workshop was organized to provide a forum for Australian and New Zealand scientists from a wide range of disciplines to discuss housing and health, with a particular focus on exposure assessment. The aim is to provide guidance with regard to exposure assessment issues in the indoor environment. These guidelines are not only highly relevant to New Zealand and Australia (sharing both the highest asthma rates, and the highest levels of house dust mites) but may also be of great value for public health scientists, physicians, nurses and other health workers, policy makers and building engineers from many other areas of the world where damp buildings are a major public health concern.

  Workshop notes

  1. Use of occupational studies to address indoor related problems;
  2. Performance criteria for exposure measurements – reliability, reproducibility, accuracy, etc.;
  3. Biologically relevant measures of exposure – particle size, route of entry, airborne versus settled dust sampling;
  4. Defining principles for exposure assessment similar to “Bradford Hill criteria”;
  5. Correlation between different assessment methods e.g. self assessment, skilled observer, instrumentation/objective measures;
  6. Temporal and spatial variation between and within studies – repeated versus single measurements;
  7. Units or parameters of measurements – capacity for integration of measurements (e.g. RH) in an explanatory/marker/indicator context.
  8. Testing assumptions about the sites of allergen reservoirs and their significance – can you just focus on the bed?
  9. Models of natural exposure – cat allergen, pollen in thunderstorms;
  10. Measuring biological particles could be a poor proxy of allergen exposure – whole pollen/spores/mites/hyphal fragments
  11. Co-exposures – Adjuvants and allergens
  12. Allergen – tolerance – dichotomy;
  13. Fungi – IgE mediated or other pathways (e.g. toxins, enzymes) – common denominator of pathogenesis of fungi in allergic diseases – non IgE immune response;
  14. Common assay for stimulus to the innate immune sytem (as opposed to allergic arm of the IS);
  15. Measurements of factors in relation to aerosolisation due to domestic activity;
  16. Domestic characteristics associated with exposure – greater emphasis on documenting observable risk factors – e.g. water staining, moulds, house design;
  17. Fungi – total (e.g. ß(1,3)-glucan) versus specific groups/genera versus species.