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Fractional exhaled nitric oxide (FeNO) among elementary school children in Stockholm: Associations with asthma, allergies, and home and school environment
RISE Research Institutes of Sweden, Built Environment, Building and Real Estate.ORCID iD: 0000-0001-7893-6042
Finnish Institute for Health and Welfare, Finland; Aalto University, Finland.
Mid Sweden University, Sweden.
Uppsala University, Sweden.
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2025 (English)In: Science of the Total Environment, ISSN 0048-9697, E-ISSN 1879-1026, Vol. 972, article id 179113Article in journal (Refereed) Published
Abstract [en]

Objective: Few studies have investigated links between fraction exhaled nitric oxide (FeNO), the home and the school environment. FeNO is a biomarker of T helper 2 (Th2) airway inflammation. We investigated associations between FeNO and airway symptoms, allergies, household and classroom exposure among pupils in ten primary schools in Stockholm (N = 415). Methods: Information on health and household environment was obtained by a questionnaire. FeNO was measured at school. Particle mass (PM1, PM2.5, PM10), carbon dioxide (CO2), temperature, and relative air humidity (RH) were measured in the classrooms. Microbial DNA and 3-hydroxy fatty acids (3-OHs) from endotoxin in Gram-negative bacteria were analysed in vacuumed dust from floors and upper surfaces. Three-level linear mixed models were used to analyse associations. Results: In total, 9.7 % of the pupils had elevated FeNO (>20 ppb), 15.2 % doctor diagnosed asthma, 10.7 % current asthma, 17.8 % reported allergy and 9.6 % doctor diagnosed allergy. Reported allergy (p = 0.02), diagnosed allergy (p = 0.002), and current asthma (p = 0.007) were associated with elevated FeNO. Children living in single-family houses with basement had higher FeNO than those in self-owned apartments (p = 0.001). In the classrooms, PM10 (p = 0.008), RH (p = 0.004) and DNA copies from Gram-negative bacteria in vacuumed floor dust (p = 0.008) were associated with higher FeNO. C16 3-OH in floor dust (p = 0.046) and C10 (p = 0.02) and C11 3-OHs (p = 0.04) in upper surface dust were associated with higher FeNO. The association between Gram-negative bacteria at school and FeNO was stronger among girls. Children with parental asthma and allergy, and among those with dampness and mould at home and in single-family houses with basement. Conclusions: FeNO is associated with reported asthma and allergy. In the school environment, PM10 and exposure to some subpopulations of Gram-negative bacteria can increase FeNO. Sex, parental asthma or allergy, dampness at home and type of housing can modify associations between classroom exposure and FeNO. 

Place, publisher, year, edition, pages
Elsevier B.V. , 2025. Vol. 972, article id 179113
Keywords [en]
Air Pollutants; Air Pollution, Indoor; Asthma; Child; Environmental Exposure; Exhalation; Female; Housing; Humans; Hypersensitivity; Male; Nitric Oxide; Particulate Matter; Schools; Sweden; Apartment houses; Diseases; Houses; Pathology; Window screens; biological marker; carbon dioxide; endotoxin; hydroxy fatty acid; nitric oxide; nitric oxide; Endotoxin; Exhaled nitric oxides; Gram-negative bacteria; PM 10; Pm10; Relative air humidities; Respiratory symptoms; School environment; Stockholm; Upper surface; allergy; asthma; DNA; hydroxyl radical; nitric oxide; particulate matter; respiratory disease; adult; aged; allergy; Article; asthma; bioassay; body height; cat allergy; child; DNA extraction; dog allergy; elementary student; female; forced expiratory volume; fractional exhaled nitric oxide; gene dosage; Gram negative bacterium; heredity; household; human; humidity; major clinical study; male; particulate matter 1.0; particulate matter 2.5; pollen allergy; prevalence; questionnaire; real time polymerase chain reaction; rhinoconjunctivitis; risk factor; school child; temperature; ultra performance liquid chromatography; air pollutant; environmental exposure; epidemiology; exhalation; housing; hypersensitivity; indoor air pollution; particulate matter; school; Sweden; Allergies
National Category
Clinical Medicine
Identifiers
URN: urn:nbn:se:ri:diva-78387DOI: 10.1016/j.scitotenv.2025.179113Scopus ID: 2-s2.0-105000157126OAI: oai:DiVA.org:ri-78387DiVA, id: diva2:1999240
Note

Our study had financial support by grants from the Swedish Council for Environmental and Agricultural Science and Spatial Planning (FORMAS) (grant 2016-00955), the Swedish Asthma and Allergy Association’s Research Foundation (grant F2017-0011) and the Swedish Research Council (grant 2017-05845).

Available from: 2025-09-19 Created: 2025-09-19 Last updated: 2025-09-23Bibliographically approved

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