Patients referred to an indoor air health clinic: exposure to water-damaged buildings causes an increase of lymphocytes in bronchoalveolar lavage and a decrease of CD19 leucocytes in peripheral blood.
BACKGROUND
Respiratory and other symptoms are often associated with exposure to microbes present in water-damaged buildings.


METHODS
We examined 82 consecutive patients referred to the Indoor Air Clinic, Helsinki University Hospital, due to symptoms suspected of having been caused by long-term exposure to water damage in the home or workplace. Exposure to water damage was assessed by building inspections and microbial analyses as needed. Bronchoalveolar lavage, lung function measurements, skin prick tests to inhalant allergens and radiological examinations were performed in all patients. Leucocyte subsets in peripheral blood were analysed in 35 patients.


RESULTS
Marked water damage was detected in the homes or workplaces of 47 (59%) patients; the remaining 34 patients formed the control group. The exposed group expressed more symptoms in total than the control group: fatigue, conjunctival symptoms, rhinitis with sinusitis, recurrent bronchitis and asthma were more common in the exposed group, but a significant difference was seen only for headache. In BAL (bronchoalveolar lavage) samples, lymphocytes represented 25% of the total cell population in non-smoking-exposed patients compared with 12% in control patients (p=0.004). In peripheral blood, CD19 leucocytes were significantly decreased in the exposed group (7.5% versus 12.3%; p<0.01).


CONCLUSIONS
Confirmed exposure to water damage was associated with an increase in symptoms. Exposure to water damage caused a significant change in the cellular composition in BAL fluid (lymphocytosis) and blood (decrease of CD19 cells). The depletion of CD19 leucocytes in peripheral blood may indicate an active immune response in the lungs.
Finnish Institute of Occupational Health, Biological Mechanisms and Prevention of Work-Related Diseases/Immunopathology, Helsinki, Finland. henrik.wolff@ttl.fi
Henrik
H
Wolff
Helena
H
Mussalo-Rauhamaa
Hanna
H
Raitio
Peter
P
Elg
Arto
A
Orpana
Anneli
A
Piilonen
Tari
T
Haahtela
D000328:Adult; D016902:Air Pollution, Indoor / Q000009:adverse effects* / Q000032:analysis; D018941:Antigens, CD19 / Q000378:metabolism; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology*; D016022:Case-Control Studies; D002462:Cell Membrane / Q000378:metabolism; D004781:Environmental Exposure / Q000032:analysis*; D005260:Female; D006761:Hospitals; D006801:Humans; D018655:Lymphocyte Count; D008214:Lymphocytes / Q000166:cytology*; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation; D055883:Structure Collapse; D014867:Water
D018941:Antigens, CD19; D014867:Water