Effects of personalised exposure on self-rated electromagnetic hypersensitivity and sensibility - A double-blind randomised controlled trial.

BACKGROUND: Previous provocation experiments with persons reporting electromagnetic hypersensitivity (EHS) have been criticised because EHS persons were obliged to travel to study locations (seen as stressful), and that they were unable to select the type of signal they reported reacting to. In our study we used mobile exposure units that allow double-blind exposure conditions with personalised exposure settings (signal type, strength, duration) at home. Our aim was to evaluate whether subjects were able to identify exposure conditions, and to assess if providing feedback on personal test results altered the level of self-reported EHS. METHODS: We used double-blind randomised controlled exposure testing with questionnaires at baseline, immediately before and after testing, and at two and four months post testing. Participants were eligible if they reported sensing either radiofrequency or extremely low frequency fields within minutes of exposure. Participants were visited at home or another location where they felt comfortable to undergo testing. Before double-blind testing, we verified together with participants in an unblinded exposure session that the exposure settings were selected were ones that the participant responded to. Double-blind testing consisted of a series of 10 exposure and sham exposures in random sequence, feedback on test results was provided directly after testing. RESULTS: 42 persons participated, mean age was 55years (range 29-78), 76% were women. During double-blind testing, no participant was able to correctly identify when they were being exposed better than chance. There were no statistically significant differences in the self-reported level of EHS at follow-up compared to baseline, but during follow-up participants reported reduced certainty in reacting within minutes to exposure and reported significantly fewer symptoms compared to baseline. CONCLUSION: Our results suggest that a subgroup of persons exist who profit from participation in a personalised testing procedure.

Electromagnetic hypersensitivity (EHS) in occupational and primary health care: A nation-wide survey among general practitioners, occupational physicians and hygienists in the Netherlands.

Subjects who attribute health complaints to every day levels of non-ionizing electromagnetic fields (EMF) have been referred to as electrohypersensitive (EHS). Previous surveys in Europe showed that 68-75% of general practitioners had ever been consulted on EHS. Given the lack of data on EHS in the Netherlands in the general population and on EHS in occupational settings, we performed a national survey among three professional groups that are likely in the first line of being consulted by EHS individuals. Results show that about one third of occupational hygienists, occupational physicians and general practitioners had ever been consulted by one or more EHS subjects. Many of these professionals considered a causal relationship between EMF and health complaints to some degree plausible, and their approach often included exposure reduction advice. Given the lack of scientific evidence for EHS and how low level EMF exposure could cause reported health complaints and given the finding that the majority of these professionals felt insufficiently informed about EMF and health, targeted information campaigns might assist them in their evidence based dealing with subjects who attribute symptoms to EMF.

Outdoor and indoor sources of residential radiofrequency electromagnetic fields, personal cell phone and cordless phone use, and cognitive function in 5-6 years old children.

BACKGROUND: Little is known about the exposure of young children to radiofrequency electromagnetic fields (RF-EMF) and potentially associated health effects. We assessed the relationship between residential RF-EMF exposure from mobile phone base stations, residential presence of indoor sources, personal cell phone and cordless phone use, and children's cognitive function at 5-6 years of age. METHODS: Cross-sectional study on children aged 5-6 years from the Amsterdam Born Children and their Development (ABCD) study, the Netherlands (n=2354). Residential RF-EMF exposure from mobile phone base stations was estimated with a 3D geospatial radio wave propagation model. Residential presence of indoor sources (cordless phone base stations and Wi-Fi) and children's cell phone and cordless phone use was reported by the mother. Speed of information processing, inhibitory control, cognitive flexibility, and visuomotor coordination was assessed using the Amsterdam Neuropsychological Tasks. RESULTS: Residential presence of RF-EMF indoor sources was associated with an improved speed of information processing. Higher residential RF-EMF exposure from mobile phone base stations and presence of indoor sources was associated with an improved inhibitory control and cognitive flexibility whereas we observed a reduced inhibitory control and cognitive flexibility with higher personal cordless phone use. Higher residential RF-EMF exposure from mobile phone base stations was associated with a reduced visuomotor coordination whereas we observed an improved visuomotor coordination with residential presence of RF-EMF indoor sources and higher personal cell phone use. CONCLUSIONS: We found inconsistent associations between different sources of RF-EMF exposure and cognitive function in children aged 5-6 years.

Novel exposure units for at-home personalized testing of electromagnetic sensibility.

Previous experimental studies on electromagnetic hypersensitivity have been criticized regarding inflexibility of choice of exposure and of study locations. We developed and tested novel portable exposure units that can generate different output levels of various extremely low frequency magnetic fields (ELF-MF; 50 Hz field plus harmonics) and radiofrequency electromagnetic fields (RF-EMF). Testing was done with a group of healthy volunteers (n = 25 for 5 ELF-MF and n = 25 for 5 RF-EMF signals) to assess if units were indeed able to produce double-blind exposure conditions. Results substantiated that double-blind conditions were met; on average participants scored 50.6% of conditions correct on the ELF-MF, and 50.0% on the RF-EMF unit, which corresponds to guessing probability. No cues as to exposure conditions were reported. We aim to use these units in a future experiment with subjects who wish to test their personal hypothesis of being able to sense or experience when being exposed to EMF. The new units allow for a high degree of flexibility regarding choice of applied electromagnetic signal, output power level and location (at home or another environment of subjects' choosing).

Environmental Radiofrequency Electromagnetic Fields Exposure at Home, Mobile and Cordless Phone Use, and Sleep Problems in 7-Year-Old Children.

BACKGROUND: We evaluated if exposure to RF-EMF was associated with reported quality of sleep in 2,361 children, aged 7 years. METHODS: This study was embedded in the Amsterdam Born Children and their Development (ABCD) birth cohort study. When children were about five years old, school and residential exposure to RF-EMF from base stations was assessed with a geospatial model (NISMap) and from indoor sources (cordless phone/WiFi) using parental self-reports. Parents also reported their children's use of mobile or cordless phones. When children were seven years old, we evaluated sleep quality as measured with the Child Sleep Habits Questionnaire (CSHQ) filled in by parents. Of eight CSHQ subscales, we evaluated sleep onset delay, sleep duration, night wakenings, parasomnias and daytime sleepiness with logistic or negative binomial regression models, adjusting for child's age and sex and indicators of socio-economic position of the parents. We evaluated the remaining three subscales (bedtime resistance, sleep anxiety, sleep disordered breathing) as unrelated outcomes (negative control) because these were a priori hypothesised not to be associated with RF-EMF. RESULTS: Sleep onset delay, night wakenings, parasomnias and daytime sleepiness were not associated with residential exposure to RF-EMF from base stations. Sleep duration scores were associated with RF-EMF levels from base stations. Higher use mobile phones was associated with less favourable sleep duration, night wakenings and parasomnias, and also with bedtime resistance. Cordless phone use was not related to any of the sleeping scores. CONCLUSION: Given the different results across the evaluated RF-EMF exposure sources and the observed association between mobile phone use and the negative control sleep scale, our study does not support the hypothesis that it is the exposure to RF-EMF that is detrimental to sleep quality in 7-year old children, but potentially other factors that are related to mobile phone usage.

Daily changes of peak expiratory flow and respiratory symptom occurrence around a soy processing factory.

OBJECTIVES: To evaluate sensitization and acute respiratory health effects in inhabitants living in the vicinity of a factory producing soy oil. METHODS: Two panels of potential responders were created on the basis of a response to a short screening questionnaire sent to random samples of 1,000 exposed and 1,000 non-exposed individuals living around the factory and a control area. Individuals responding to the questionnaire were invited for a medical evaluation, including a respiratory symptom questionnaire and skin prick testing, for a panel of common allergens and a soy allergen extract. This resulted in 53 atopic and/or asthmatic inhabitants from the area surrounding the factory and 30 comparable control subjects. In these subjects, morning and evening Peak Expiratory Flow (PEF), respiratory symptoms and medication use were recorded daily during a 10-week period in the autumn. At the same time, soy allergen and endotoxin concentrations were determined in airborne dust in the exposed and the control area. The wind direction relative to the location of a subjects' house and the factory was used to determine whether an individual was exposed on a particular day. RESULTS: Only few of the atopic subjects were sensitized to soy. PEF showed a decrease, respiratory symptoms and bronchodilator use, an increase among soy sensitized subjects after having been downwind from the factory. Airborne soy allergen was found more frequently in the area surrounding the factory and levels were higher than in the control area. Highest levels were found on the factory premises. Only a weak association was found with wind direction. Airborne endotoxin concentrations did not show a consistent pattern with distance, but levels were clearly higher on the factory premises. CONCLUSION: Sensitization to soy allergen was not increased among the population sample living in the vicinity of the factory. Soy sensitized individuals living in the surroundings of the factory reported more respiratory symptoms, used bronchodilators more often and had a lower PEF after having been downwind of the factory.

Design of an ecological momentary assessment study of exposure to radiofrequency electromagnetic fields and non-specific physical symptoms.

INTRODUCTION: Idiopathic Environmental Intolerance (IEI) attributed to electromagnetic fields (EMF) refers to self-reported sensitivity mainly characterised by the attribution of non-specific physical symptoms to low-level EMF exposure emitted from sources such as mobile phones. Scientific studies have not provided evidence for the existence of IEI-EMF, but these studies did not resemble the real-life situation or suffered from poor exposure characterisation and biased recall of health symptoms. To improve existing methods for the study of IEI-EMF, an Ecological Momentary Assessment (EMA) study is designed. METHODS AND ANALYSIS: The study is an EMA study in which respondents carry personal exposure metres (exposimeters) that measure radiofrequency (RF) EMF, with frequent assessment of health symptoms and perceived EMF exposure through electronic diary registration during five consecutive days. Participants will be a selection from an epidemiological study who report to be sensitive to RF EMF. The exposimeters measure electric field strength in 12 frequency bands. Diary questions include the occurrence and severity of 10 non-specific physical symptoms, mood states and perceived exposure to (sources of) EMF. The relationship of actual and perceived EMF exposure and mood with non-specific physical symptoms will be analysed using multilevel regression analysis with time-shift models. DISCUSSION: The study has several advantages over previous studies, including assessment of personal EMF exposure and non-specific physical symptoms by an ecological method with a minimised chance of recall bias. The within-person design reduces confounding by time-stable factors (eg, personal characteristics). In the conduct of the study and the analysis and interpretation of its outcomes, some methodological issues including a high participant burden, reactivity, compliance to the study protocol and the potential of chance findings due to multiple statistical testing will be accounted for and limited as much as possible.

Maternal cell phone and cordless phone use during pregnancy and behaviour problems in 5-year-old children.

BACKGROUND: A previous study found an association between maternal cell phone use during pregnancy and maternal-reported child behaviour problems at age 7. Together with cell phones, cordless phones represent the main exposure source of radiofrequency-electromagnetic fields to the head. Therefore, we assessed the association between maternal cell phone and cordless phone use during pregnancy and teacher-reported and maternal-reported child behaviour problems at age 5. METHODS: The study was embedded in the Amsterdam Born Children and their Development study, a population-based birth cohort study in Amsterdam, the Netherlands (2003-2004). Teachers and mothers reported child behaviour problems using the Strength and Difficulties Questionnaire at age 5. Maternal cell phone and cordless phone use during pregnancy was asked when children were 7 years old. RESULTS: A total of 2618 children were included. As compared to non-users, those exposed to prenatal cell phone use showed an increased but non-significant association of having teacher-reported overall behaviour problems, although without dose-response relationship with the number of calls (OR=2.12 (95% CI 0.95 to 4.74) for <1 call/day, OR=1.58 (95% CI 0.69 to 3.60) for 1-4 calls/day and OR=2.04 (95% CI 0.86 to 4.80) for ≥5 calls/day). ORs for having teacher-reported overall behaviour problems across categories of cordless phone use were below 1 or close to unity. Associations of maternal cell phone and cordless phone use with maternal-reported overall behaviour problems remained non-significant. Non-significant associations were found for the specific behaviour problem subscales. CONCLUSION: Our results do not suggest that maternal cell phone or cordless phone use during pregnancy increases the odds of behaviour problems in their children.

Long-term exposure to traffic-related air pollution and type 2 diabetes prevalence in a cross-sectional screening-study in the Netherlands.

BACKGROUND: Air pollution may promote type 2 diabetes by increasing adipose inflammation and insulin resistance. This study examined the relation between long-term exposure to traffic-related air pollution and type 2 diabetes prevalence among 50- to 75-year-old subjects living in Westfriesland, the Netherlands. METHODS: Participants were recruited in a cross-sectional diabetes screening-study conducted between 1998 and 2000. Exposure to traffic-related air pollution was characterized at the participants' home-address. Indicators of exposure were land use regression modeled nitrogen dioxide (NO2) concentration, distance to the nearest main road, traffic flow at the nearest main road and traffic in a 250 m circular buffer. Crude and age-, gender- and neighborhood income adjusted associations were examined by logistic regression. RESULTS: 8,018 participants were included, of whom 619 (8%) subjects had type 2 diabetes. Smoothed plots of exposure versus type 2 diabetes supported some association with traffic in a 250 m buffer (the highest three quartiles compared to the lowest also showed increased prevalence, though non-significant and not increasing with increasing quartile), but not with the other exposure metrics. Modeled NO2-concentration, distance to the nearest main road and traffic flow at the nearest main road were not associated with diabetes. Exposure-response relations seemed somewhat more pronounced for women than for men (non-significant). CONCLUSIONS: We did not find consistent associations between type 2 diabetes prevalence and exposure to traffic-related air pollution, though there were some indications for a relation with traffic in a 250 m buffer.

Effects on pulmonary health of neighboring residents of concentrated animal feeding operations: exposure assessed using optimized estimation technique.

Potential adverse health effects of concentrated animal feeding operations (CAFOs), which were also shown in the authors' Lower Saxony Lung Study, are of public concern. The authors aimed to investigate pulmonary health effect of neighboring residents assessed using optimized estimation technique. Annual ammonia emission was measured to assess the emission from CAFO and from surrounding fields. Location of sampling points was optimized using cluster analysis. Individual exposure of 457 nonfarm subjects was interpolated by weighting method. Mean estimated annual ammonia levels varied between 16 and 24 µg/m³. Higher exposed participants were more likely to be sensitized against ubiquitous allergens as compared to lower exposed subjects (adjusted odds ratio [OR] 4.2; 95% confidence interval [CI] 1.2-13.2). In addition, they showed a significantly lower forced expiratory volume in 1 second (FEV1) (adjusted mean difference in % of predicted -8%; 95% CI -13% to -3%). The authors' previous findings that CAFOs may contribute to burden of respiratory diseases were confirmed by this study.

A comparison of different approaches to estimate small-scale spatial variation in outdoor NO2 concentrations.

BACKGROUND: In epidemiological studies, small-scale spatial variation in air quality is estimated using land-use regression (LUR) and dispersion models. An important issue of exposure modeling is the predictive performance of the model at unmeasured locations. OBJECTIVE: In this study, we aimed to evaluate the performance of two LUR models (large area and city specific) and a dispersion model in estimating small-scale variations in nitrogen dioxide (NO2) concentrations. METHODS: Two LUR models were developed based on independent NO2 monitoring campaigns performed in Amsterdam and in a larger area including Amsterdam, the Netherlands, in 2006 and 2007, respectively. The measurement data of the other campaign were used to evaluate each model. Predictions from both LUR models and the calculation of air pollution from road traffic (CAR) dispersion model were compared against NO2 measurements obtained from Amsterdam. RESULTS AND CONCLUSION: The large-area and the city-specific LUR models provided good predictions of NO2 concentrations [percentage of explained variation (R²) = 87% and 72%, respectively]. The models explained less variability of the concentrations in the other sampling campaign, probably related to differences in site selection, and illustrated the need to select sampling sites representative of the locations to which the model will be applied. More complete traffic information contributed more to a better model fit than did detailed land-use data. Dispersion-model estimates for NO2 concentrations were within the range of both LUR estimates.

Environmental exposure to confined animal feeding operations and respiratory health of neighboring residents.

BACKGROUND: Despite public concern about potential adverse health effects of concentrated animal feeding operations, objectively assessed data on environmental exposure to concentrated animal feeding operations and respiratory health are sparse. We aimed to assess respiratory health in neighbors of confined animal feeding operations. METHODS: A survey was done in 2002-2004 among all adults (18-45 years old) living in 4 rural German towns with a high density of confined animal feeding operations. Questionnaire data were available for 6937 (68%) eligible subjects. In a random sample we measured the following outcomes: specific IgE to common and farm-specific allergens, lung function, and bronchial hyperresponsiveness to methacholine. Exposure was measured by collecting data on odor annoyance and geo-coded data on the number of animal houses within 500 m of the home. Locally optimal estimating and smoothing scatter plots were used to model the association between exposure and outcome. Analyses were restricted to subjects without private or professional contact with farming environments. RESULTS: The prevalence of self-reported asthma symptoms and nasal allergies increased with self-reported odor annoyance. The number of animal houses was a predictor of self-reported wheeze and decreased forced expiratory volume in 1 second, but not allergic rhinitis or specific sensitization. Self-reported exposure and results of clinical measurements were poorly correlated. CONCLUSIONS: Confined animal feeding operations may contribute to the burden of respiratory disease among their neighbors. Our findings underline the importance of objective assessment of exposure and outcome in environmental epidemiology.

Ambient endotoxin level in an area with intensive livestock production.

High levels of endotoxin are found inside and near to animal houses. However, there is a lack of data on environmental endotoxin in areas with intensive animal production facilities. We conducted a cross-sectional study of respiratory health in two villages of Lower Saxony with intensive livestock production. We assessed the level of endotoxin exposure in the backyards of 32 participants with two 24-hours measurements of inhalable fraction (one in winter and one in summer). The geometric mean (geometric standard deviation) of the levels of endotoxin varied between 2.0 (2.9) EU/m3 in winter and 2.9 (2.4) EU/m3 in summer. Potential predictors--season, sampling sites, and weather conditions--explained 24% of the variability in ambient endotoxin concentration in the study area. The results indicate that, compared with urban residents, exposure to endotoxin is greater among people living in rural areas with intensive animal production. This might affect their respiratory health. However, these exposures are characterized by a large spatial variability.

House dust mite allergen reduction and allergy at 4 yr: follow up of the PIAMA-study.

Exposure to high allergen levels in early life is a risk factor for the development of allergy. We previously reported limited effects of mite allergen impermeable mattress covers in the prevention and incidence of asthma and mite allergy (PIAMA) cohort at the age of 1 and 2 yr. We now present the results of follow-up at 4 yr objectives. To examine the effects of early reduction of house dust mite (HDM) allergen exposure by means of mattress covers on the incidence of allergy and asthma symptoms in the PIAMA birth cohort at the age of 4 yr. High-risk children (allergic mother) were prenatally recruited and randomly allocated to three groups; receiving mite allergen impermeable mattress covers (n = 416), placebo covers (n = 394) or no intervention (n = 472). At 4 yr of age, atopy was assessed by questionnaire; specific Immunoglobulin E (IgE) to inhalant and food allergens was measured in serum. Dust samples collected from the children's mattresses were analysed for mite allergens. Dermatophagoides farinae1 allergen (Der f 1) levels in dust were reduced in the active group. However, Dermatophagoides pteronissinus 1 (Der p 1) levels, sensitization and atopic symptoms were similar in all groups. We found no effect of mite allergen impermeable mattress covers on sensitization and atopy at 4 yr. Moreover, the allergen reducing effects of the covers had disappeared for one of the two mite allergens that were measured.

Does early indoor microbial exposure reduce the risk of asthma? The Prevention and Incidence of Asthma and Mite Allergy birth cohort study.

BACKGROUND: Exposure to microbial agents might inhibit the development of atopy and asthma. OBJECTIVE: We measured the association between microbial exposure assessed at 3 months and the development of atopic sensitization and doctor-diagnosed (DD) asthma and wheeze in the first 4 years in a birth cohort study of children with atopic mothers. METHODS: Endotoxin, fungal (1-->3)-beta-D-glucans, extracellular polysaccharides from the genera Penicillium and Aspergillus (EPS-Pen/Asp), and dust on living room floors were measured at 3 months of age. Serum IgE levels against common allergens were determined at 1 and 4 years, and questionnaire information about respiratory morbidity was collected yearly. RESULTS: Microbial levels in mattresses were low and not associated with serum IgE levels, DD asthma, and wheeze. Floor levels of biocontaminants and dust, on the other hand, were inversely associated with DD asthma, being most pronounced for endotoxin (odds ratio [OR], 0.40; 95% CI, 0.21-0.77) and EPS-Pen/Asp (OR, 0.42; 95% CI, 0.18-0.99). Mutual adjustment for other exposures did not significantly alter the results for endotoxin and only moderately affected the results for EPS-Pen/Asp. Persistent wheeze was also consistently less common in the high-exposure group, being significant only for EPS-Pen/Asp (OR, 0.37; 95% CI, 0.15-0.96). Transient wheeze and wheeze in the past 12 months were also reduced, but effects were smaller and not significant. Relationships with serum-specific IgE levels, which could only be assessed in 41% at age 4 years, were less pronounced and statistically significant only for EPS-Pen/Asp. CONCLUSIONS: Early exposure to common microbial contaminants, including fungal agents, might protect against asthma. CLINICAL IMPLICATIONS: Microbial exposure in early life might protect against asthma and might constitute a novel target for prevention.

Mite and pet allergen levels in homes of children born to allergic and nonallergic parents: the PIAMA study.

The Prevention and Incidence of Asthma and Mite Allergy (PIAMA) study is a birth cohort study that investigates the influence of allergen exposure on the development of allergy and asthma in the first several years of life. The objectives of this study were to investigate the relationship between a family history of allergy and/or asthma and exposure of newborn children to mite and pet allergen and to study the influence of different home and occupant characteristics on mite allergen exposure. Dust was sampled from the child's mattress and the parental mattress at 3 months after birth of the index child and analyzed for mite and pet allergens. Subjects were divided in groups according to history of asthma and allergy in their parents, and allergen exposure was studied in the different groups. Cat allergen exposure was significantly lower on parental mattresses in families with allergic mothers, but dog allergen exposure was not different. Mite allergen exposure was lower on parental mattresses in families with allergic mothers. Use of mite allergen-impermeable mattress covers reduced mite allergen exposure. Some other characteristics such as age of home and mattress were also found to influence mite allergen exposure. Parental mattresses in homes of allergic mothers had lower cat and mite (but not dog) allergen loadings than mattresses in homes of nonallergic parents. Paternal (as opposed to maternal) allergy seemed to have little influence.

Placebo-controlled trial of house dust mite-impermeable mattress covers: effect on symptoms in early childhood.

We investigated the effect of house dust mite (HDM)-allergen avoidance on the development of respiratory symptoms, atopic dermatitis, and atopic sensitization by performing a double blind, placebo-controlled trial. In total, 1,282 allergic pregnant women were selected (416 received HDM allergen-impermeable mattress covers for the parents' and child's mattress in the third trimester of pregnancy [active], 394 received placebo covers, 472 received no intervention). Data on allergen exposure, clinical symptoms, and immunoglobulin E were collected prospectively. The prevalence of night cough without a cold in the second year of life was lower in the group with active covers compared with the group with placebo covers (adjusted odds ratio 0.65; 95% confidence interval 0.4-1.0). No effect of the intervention was seen on other respiratory symptoms, atopic dermatitis, and total and specific immunoglobulin E. It can be concluded that application of HDM-impermeable mattress covers on the child's and parents' beds reduced night cough, but not other respiratory symptoms, atopic dermatitis, and atopic sensitization in the first 2 years of life. Follow-up will determine the long-term effect of the intervention on the development of atopic disease.

The prevention and incidence of asthma and mite allergy (PIAMA) birth cohort study: design and first results.

The Prevention and Incidence of Asthma and Mite Allergy (PIAMA) birth cohort study was initiated in 1996. Children born to allergic mothers were enrolled in a double-blind placebo-controlled trial for evaluating the use of mite-impermeable mattress and pillow covers. Children born to allergic and non-allergic mothers were enrolled in a 'natural history' study to assess the role of environmental and dietary risk factors for the development of allergic disease in childhood. Recruitment started by distributing a validated screening questionnaire among >10,000 pregnant women during their first visit to a prenatal health clinic. Allergic mothers-to-be were invited to participate in the intervention study. Allergic, and a random sample of non-allergic, mothers-to-be were invited to participate in the 'natural history' arm of the study. In the intervention study, homes were visited before birth, 3 months after birth, and 12 months after birth for the collection of dust samples from floors and mattresses. In addition, the homes of about one-third of the children in the 'natural history' part of the study were visited for dust collection when the children were 3 months of age. The intervention study started with 855 participants and the 'natural history' study with 3,291 participants. Follow-up at 3 years of age has now been completed with satisfactory compliance (>90%). A medical investigation and home visit at 4years of age are nearing completion. Preliminary results show that mite-allergen levels were lower than found in previous Dutch studies, and that the intervention measure had a significant effect on mite-allergen levels, without important clinical benefits up to age 2 years old. The allergic families lived in homes with fewer 'triggers' such as pets, smoking and carpets than the non-allergic families, regardless of the intervention. The ongoing PIAMA cohort study will probably reveal useful information concerning effects of allergen load and reduction in the setting of a relatively low mite-allergen exposure, as well as other variables on the development of allergic manifestions and asthma.