Most of us spend the vast majority of each day indoors, where air quality can be 2-5 times worse than outside. Indoor air quality issues revolve around environmental contaminants such as allergens and airborne chemicals.

• Chemicals that release fumes, called volatile organic compounds (VOCs), are in solvents, cleaning products, air fresheners, polishes, adhesives, paints, new carpeting and furniture. One study found that young kids in homes with high VOC levels were four times as likely to develop asthma.
• Dust mites and other indoor allergens love pillows and mattresses, and we often hear the statistic that up to 10 percent of the weight of a two-year-old pillow is made up of dust mites, living and dead, and their droppings. Enclosing mattresses and pillows in allergen-proof covers can keep the mites at bay, as can washing sheets and blankets in hot water weekly. Dust mite populations can also be controlled by reducing indoor humidity to below 60 percent and removing carpets from the bedroom.
• Stoves or heaters that burn gas, propane, kerosene, wood or charcoal produce carbon monoxide, and the gas can accumulate in poorly ventilated areas. Another dangerous source is from gasoline motors (such as cars or lawn mowers) that are running in enclosed spaces. Carbon monoxide is second only to heroin as a cause of death by poisoning in the US. A carbon monoxide detector is a simple tool that will give you peace of mind.
• One six-inch houseplant per 100 square feet of living area can filter VOCs and vastly improve your indoor air quality. Bamboo palms, Chinese evergreens and English ivies are the three best in removing formaldehyde, benzene and carbon monoxide from indoor air.
• Opening your windows to let polluted air out and fresh air in can noticeably improve indoor air quality.
• Household chores can help with air quality: dust often, keep your ducts clean and forego chemical cleaning products and air fresheners. Also, use a HEPA-filtered vacuum at least twice a week (plus a HEPA air purifier in a the bedroom of a child with asthma), and keep your plumbing in good repair to avoid mold growth.
• Keep the chemicals outside by taking your shoes off at the door to avoid tracking of contaminants, hanging dry-cleaned clothes outside before they make it to the closet and never smoking inside (better yet – take the pledge to never smoke!).

One of the most exciting reports I have ever read, Reducing Environmental Cancer Risk – What We Can Do Now, was released this week by the President’s Cancer Panel, along with significant coverage by Nicholas Kristof in The NY Times, Lyndsey Layton in The Washington Post and Liz Szabo in USA Today.

This signals a pivotal change in how we approach cancer (and, I hope, how we approach other illnesses that have increased in our lifetimes). The report acknowledges that we face “grievous harm” from chemicals that surround us every day and that we have “grossly underestimated” the amount of illness caused by these exposures – illness “that could have been prevented through appropriate national action.”

Why is this so exciting? By recognizing the importance of chemical and environmental causes of disease, we open the door to achievable environmental solutions. We can run in the right direction as we race toward prevention – not just race toward a cure. This report is about cancer – but the same issues apply to asthma, autism, learning disabilities, allergies, and more.

And it starts with kids. The report highlights the game-changing Environmental Working Group studies on umbilical cord blood that I helped EWG develop and release, where we found 180 carcinogens in babies (and 217 chemicals that were toxic to the brain or nervous system), even before the babies were born – chemicals that could set a trajectory for disease much later in life.

Parents can take simple steps right now to lower their children’s risk, from the cleaners you use in your home, to the plastics you use around food and beverages (watch our for BPA and phthalates!), to the sunscreens you put on your family’s skin.

In particular, the report highlights the value of organic food. There are ten foods (eleven, if you count wine) that I see as most important to choose organic.

And we can work together to change our chemical laws, under which the government has only assessed about 200 chemicals for safety out of the 80,000 chemicals on the market.

It’s a new era in our fight against cancer. It’s a new era for health.

Parents are often surprised when I tell them that a great number of the products we use in our homes are not necessarily evaluated and declared safe by a government entity. The paints that cover your walls, the stain-resistant fabric that covers your furniture, the very carpet under your feet… these things can contain toxic chemicals that could be harmful to you and your family.

This fall I filmed a short video for Healthy Child Healthy World (I’m proud to be a member of their advisory board) that talks about how you can be a knowledgeable, diligent advocate for products that are good for your family and for the planet. Kids have the most to gain. According to the EPA, carcinogens average 10 times more potent for your kids than for an adult – and in some cases 65 times more potent – or even more – at the same dose that adults get. And kids get typically get higher doses. Adults may eat about 1/40th of their body weight each day; kids may eat 1/10th of theirs. Pound for pound, kids eat more than we do, drink more than we do, and inhale more fumes than we do.

Many of the biggest health concerns for our children are on the rise: asthma, ADHD, allergies, cancer in babies, diabetes, etc.. All of these are linked to environmental exposures. When you’re making decisions about the products in your home, cast a knowledgeable eye from the ground up. Think about the carpet and the pad underneath, the paint on your walls, the antibacterial cleansers you use throughout the home – even the personal care products you use on your body. The choices you make today are opportunities that could give your kids a better chance for the best of health throughout their lives.

Getting plenty of DHA, one of the important omega-3 fats found in breast milk, could help to prevent allergies, asthma, and eczema in young children. Dr. Eileen Birch, who has previously studied links between DHA and improved mental and visual development, followed 89 formula-fed children who received formula with or without DHA included.

Her results were presented at the 2008 Pediatric Societies Meeting. Strikingly, more than half of the children fed standard formula throughout the first year had been diagnosed with some form of allergy by the third birthday. By comparison, allergies, asthma, or eczema had been diagnosed in only 26 percent of those who were fed DHA formula for a year.

This small randomized study does not prove that DHA reduces allergies, but the idea is intriguing. Omega-3 fats including DHA are useful in reducing inflammation. Clearly, babies are designed to receive DHA in their diets.

I enthusiastically support the recommendation of the American Academy of Pediatrics that babies breastfeed throughout the first year, when possible, and for as long after that as both the mother and the baby desire. If nursing stops before age two or three, I recommend that babies get DHA from another source.

DHA is a valuable nutrient throughout life, but it is especially important for developing babies from before birth through age three.

Get ready for some surprising recommendations. Eczema, asthma, and food allergies are all on the rise in children, each having more than doubled in the last several decades. This rapid increase has lead to many differing recommendations on the timing and selection of foods offered to babies, to err on the side of caution before scientific studies were completed.

A January 2008 evidence-based policy from the American Academy of Pediatrics turns some of this conventional wisdom on its head.

For preventing allergies, when is it best to start solids for babies?

Previously, it was recommended to delay solids until 6 months if possible, and to limit the choices to things like rice cereal, oatmeal, or barley if they must be started sooner. The new policy reports that solids should not be started before 4 to 6 months, but that there is no convincing evidence that delaying any solids beyond this period helps to prevent allergies.

In fact, with some foods, starting on the earlier side may even help. What about highly allergic foods such as eggs, peanuts, milk, or fish? The previous guidelines were that in allergic families, whole cow milk should be delayed until 12 months of age; eggs until 2 years; and nuts, peanuts, and fish until age 3. The new guidelines say that there is no convincing evidence that delaying even eggs (yolks or whites), fish, milk, nuts, and peanuts beyond 6 months prevents allergies!

A few things to keep in mind: First, this discussion is only about preventing asthma, eczema, and food allergies. There are other reasons to delay certain foods (e.g. honey to prevent botulism, whole peanuts to prevent choking). Second, if a child does show signs of an allergic reaction, removing the possible culprits from the diet is wise — these guidelines are about preventing, not treating allergies. Third, these new guidelines are not the final word, they are just the current state of the science. Other benefits of particular timing may one day be uncovered. Finally, I am a fan of introducing a wide variety of healthy foods to babies between 6 and 12 months old,  but I prefer organic foods for babies in the first year when possible. Particularly, if I were going to give some of the more allergenic foods like eggs, or cheese, milk, or nuts, I would be even more inclined to choose organic.

AAP Clinical Report: Greer FR, Sicherer SH, Burks AW, and the Committee on Nutrition and the Section on Allergy and Immunology. Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The Role of Maternal Dietary Restriction, Breastfeeding, Timing of Introduction of Complementary Foods, and Hydrolyzed Formulas. Pediatrics2008; 121: 183-191.

Zutavern A, Brockow I, Schaaf B, von Berg A, Diez U, Borte M, Kraemer U, Herbarth O, Behrendt H, Wichmann H, Heinrich J (The LISA Study Group). Timing of Solid Food Introduction in Relation to Eczema, Asthma, Allergic Rhinitis, and Food and Inhalant Sensitization at the Age of 6 Years: Results From the Prospective Birth Cohort Study LISA. Pediatrics 2008; 121: e44-e52

Regular contact with farm animals is associated with a dramatically lower risk of a young child’s later developing an inflammatory bowel disease (IBD) such as Crohn disease (CD) or ulcerative colitis (UC), according to a fascinating study in the August 2007 Pediatrics.

This is consistent with previous studies that showed early contact with farm animals could lower the risk of asthma, eczema, and allergies. The theory that children living in environments that are too sterile tend to develop more allergic and autoimmune diseases is called the hygiene hypothesis . Exposure to a variety of microbes could be important while the young immune system is learning how to react.

Crohn disease and ulcerative colitis are autoimmune conditions, where the body’s immune system mistakenly attacks the person’s gut.

Radon, K, Windstetter D, Poluda AL, Mueller B, Von Mutius E, The Chronic Autoimmune Disease and Animal Contact Study Group. Contact with farm animals in early life and juvenile inflammatory bowel disease: a case-control study. Pediatrics. 2007:120:354-361. Von Ehrenstein OS, Von Mutius E, Illi S, Baumann L, Bohm O, von Kries R. Reduced risk of hay fever and asthma among children of farmers. Clin Exp Allergy. 2000;30 :187 –193. Ernst P, Cormier Y. Relative scarcity of asthma and atopy among rural adolescents raised on a farm. Am J Respir Crit Care Med. 2000;161 :1563 –1566. Riedler J, Eder W, Oberfeld G, Schreuer M. Austrian children living on a farm have less hay fever, asthma and allergic sensitization. Clin Exp Allergy. 2000;30 :194 –200

What happens when women with asthma get pregnant? Does their asthma get better or worse? Should they use more asthma medicines when pregnant? Or less? How does the asthma itself affect their babies? The current state of evidence appears in the January 2005 Journal of Allergy and Clinical Immunology. Asthma is more common in pregnant women than previously thought, affecting up to 1 in 12 pregnant women – and the number is rising.

Careful study suggests that during pregnancy asthma improves significantly in about 23 percent of women, stays the same in about 47 percent and gets worse in about 30 percent. Most pregnant women appear to be under treated for their asthma, partly because of legitimate concerns about medication use during pregnancy. But untreated asthma is associated with a higher rate of problems for the baby than is asthma that is treated with the right medications. A number of studies have shown that, used correctly, the short-acting inhaler albuterol and inhaled steroids, especially budesonide (Pulmicort), can be safe and effective during pregnancy. There is not enough data yet to be sure about other inhaled steroids and other long-acting inhalers. Oral steroids are better to avoid, if possible. These findings have all been taken into account in the new evidence-based guidelines for managing asthma during pregnancy published in this issue of the journal. If you have asthma during pregnancy you may want to review the latest guidelines with your doctor.

Asthma in children is increasing around the globe. It’s not unusual for it to be a country’s number one reason for a child to be hospitalized. Researchers from Australia (a continent where asthmais the leading cause of childhood hospitalization) have completed an important, long study.

They followed over two thousand children from birth until the children were 6 years old. Their findings were published in the September 2004 American Journal of Public Health. The researchers defined asthma in the study as doctor-diagnosed asthma with wheezing still present within the final year. The key finding was that even after taking into account exposure to tobacco smoke, prematurity, gender, gender infection history, and asthma in the family, breastfeeding offers significant protection against asthma. Specifically, every additional month of exclusive breastfeeding (by which they meant no formula – not no solids) resulted in an additional 4 percent decrease in the chance of developing asthma. In addition, breastfeeding protected against eczema. The study also showed that overweight and obese kids had a higher chance of getting asthma, as others have found previously.

Changes in the home environment can be as powerful as medications in treating asthma, according to an exciting study in the September 9, 2004 New England Journal of Medicine. Researchers in the Inner-City Asthma Study Group followed almost 1,000 elementary school children with allergic asthma severe enough to require at least one hospitalization or two emergency visits. The study lasted for two years.

Half of the children received routine asthma treatment. The other half had 5 to 7 home visits by environmental counselors during the first year of the study in order to identify and reduce allergens in the home. The visitors looked for dust mites, passive smoking, cockroaches, pets, rodents, and mold, and helped with home changes depending on the child.s allergy skin testing. Part of the plan included creating an environmentally safe sleep zone for the child. Allergy covers were placed on the mattress, box spring, and pillows of the child’s bed. The environmental counselors gave the families a vacuum cleaner equipped with a high-efficiency particulate air (HEPA) filter and either a power brush if the child’s bedroom or family room was carpeted or a bare-floor brush and instructed in its use. A HEPA air purifier was set up in the child’s bedroom if the child was exposed to tobacco smoke, allergic to cats or dogs, or sensitized to mold. For children sensitized and exposed to cockroach allergen, professional pest control came. The results were outstanding, both during the year of the visits, and the following year.

The benefit of the changes translates into 34 fewer days with reported wheeze during the 2 years of the study, compared with similar children who did not have the home changes. They also averaged missing almost 2 weeks less school during the two years, and four fewer urgent or emergency visits for their asthma. This effect is similar to what we see from inhaled steroid medicines for asthma.

Aren’t all these changes expensive? If you add together the all the equipment and professional services costs, the environmental changes cost about $1,500 to $2,000 per child. This is about the same as the cost of two years of an inhaled corticosteroid and albuterol for a child with moderately severe asthma. The benefit of the environmental changes lasted for at least a year after the visits. If the benefits continue longer, the cost per year of benefit would be even lower. And these same changes could be implemented by many families at much less expense. Keep in mind, though, that the effort to address multiple possible triggers in this study was much more effective than previous studies where only a single change was made.

For my own child, I would want to do all I could to create an environment that reduced the triggers of his asthma. I expect this would decrease the medicines needed to keep his asthma under optimal control. When possible, I prefer addressing causes to treating symptoms.

Could it be that how you clean or how you decorate your home might influence whether your child develops asthma? Could the smell of new wall-to-wall carpets be linked to asthma risk? A provocative study in the September 2004 issue of Thorax suggests there is a strong connection. Researchers from Australia analyzed air quality inside children’s homes, including temperature, humidity, and the presence of chemicals in the air.

The young children exposed to high levels of volatile organic compounds (VOCs) in the air were four times more likely to develop asthma. VOCs are chemicals that release fumes. They are found in many solvents, cleaning products, air fresheners, polishes, adhesives, paints, and new fitted carpets (as well as in tobacco smoke). VOCs are also found in some new pieces of furniture. The ‘new’ smell may be a bad smell. The three VOCs with the biggest impact in the study were benzene (with the highest risk), followed by ethylbenzene and toluene. Every 10-unit increase of toluene in the home air doubled the risk of asthma; each similar increase in benzene tripled it.

We already knew that these fumes could trigger wheezing in people with asthma. This study goes further, suggesting that the fumes can cause lung damage resulting in asthma. Getting asthma depends on a combination of inheritance and exposures. While many diseases are becoming less common, asthma continues to increase each year. It has already become the most common chronic disease in children. Reducing exposure to VOCs in your home might be one way you can lessen your child’s risk of developing asthma.