title: Sick building syndrome (SBS) among office workers in a Malaysian university--Associations with atopy, fractional exhaled nitric oxide (FeNO) and the office environment.
abstract: There are few studies on sick building syndrome (SBS) including clinical measurements for atopy and fractional exhaled nitric oxide (FeNO). Our aim was to study associations between SBS symptoms, selected personal factors, office characteristics and indoor office exposures among office workers from a university in Malaysia. Health data were collected by a questionnaire (n=695), skin prick test (SPT) (n=463) and FeNO test (n=460). Office settled dust was vacuumed and analyzed for endotoxin, (1,3)-β-glucan and house dust mites (HDM) allergens group 1 namely Dermatophagoides pteronyssinus (Der p 1) and Dermatophagoides farinae (Der f 1). Office indoor temperature, relative air humidity (RH), carbon monoxide (CO) and carbon dioxide (CO2) were measured by a direct reading instrument. Associations were studied by two-levels multiple logistic regression with mutual adjustment and stratified analysis. The prevalence of weekly dermal, mucosal and general symptoms was 11.9%, 16.0% and 23.0% respectively. A combination of SPT positivity (allergy to HDM or cat) and high FeNO level (≥25 ppb) was associated with dermal (p=0.002), mucosal (p<0.001) and general symptoms (p=0.05). Der f1 level in dust was associated with dermal (p<0.001), mucosal (p<0.001) and general (p=0.02) symptoms. Among those with allergy to D. farinae, associations were found between Der f 1 levels in dust and dermal (p=0.003), mucosal (p=0.001) and general symptoms (p=0.007). Office-related symptoms were associated with Der f 1 levels in dust (p=0.02), low relative air humidity (p=0.04) and high office temperature (p=0.05). In conclusion, a combination of allergy to cat or HDM and high FeNO is a risk factor for SBS symptoms. Der f 1 allergen in dust can be a risk factor for SBS in the office environment, particularly among those sensitized to Der f 1 allergen.
authors.affiliation: Department of Environmental and Occupational Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia. Electronic address: limfanglee@gmail.com.
authors.forename: Fang-Lee
authors.initials: FL
authors.lastname: Lim
authors.affiliation: Department of Environmental and Occupational Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia. Electronic address: zailina@upm.edu.my.
authors.forename: Zailina
authors.initials: Z
authors.lastname: Hashim
authors.affiliation: Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia. Electronic address: salmiahms@upm.edu.my.
authors.forename: Salmiah
authors.initials: S
authors.lastname: Md Said
authors.affiliation: Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia. Electronic address: tl_leslie@upm.edu.my.
authors.forename: Leslie Thian-Lung
authors.initials: LT
authors.lastname: Than
authors.affiliation: United Nations University-International Institute for Global Health (UNU-IIGH), UKM Medical Centre, 56000 Cheras, Kuala Lumpur, Malaysia; Department of Community Health, National University of Malaysia, UKM, 50300 Kuala Lumpur, Malaysia. Electronic address: jamal@unu.edu.
authors.forename: Jamal Hisham
authors.initials: JH
authors.lastname: Hashim
authors.affiliation: Department of Medical Science, Occupational and Environmental Medicine, Uppsala University and University Hospital, 75185 Uppsala, Sweden. Electronic address: dan.norback@medsci.uu.se.
authors.forename: Dan
authors.initials: D
authors.lastname: Norbäck
mesh_terms: D016902:Air Pollution, Indoor / Q000032:analysis* / Q000706:statistics & numerical data; D000818:Animals; D039741:Antigens, Dermatophagoides / Q000032:analysis; D060829:Arthropod Proteins / Q000032:analysis; D003546:Cysteine Endopeptidases / Q000032:analysis; D006801:Humans; D008296:Malaysia; D009569:Nitric Oxide / Q000032:analysis*; D018877:Sick Building Syndrome / Q000175:diagnosis*; D012882:Skin Tests; D014495:Universities
chemical_list: D039741:Antigens, Dermatophagoides; D060829:Arthropod Proteins; D009569:Nitric Oxide; D003546:Cysteine Endopeptidases; C451159:Dermatophagoides farinae antigen f 1
keywords: Allergy; Fractional exhaled nitric oxide; House dust mites; Malaysia; Office environment; Sick building syndrome