Building a Home for those with Multiple Chemical Sensitivity
What Sets You Apart You’re Builder or an Interior Designer
We hope you don’t believe it’s because you are socially acceptable but simply, they understand their clients and their family needs- if you’re an owner buy your builder and or Interior designer a coffee and make them read this-
Building a family home is a huge undertaking but ensuring it’s a healthy home for the family is an even greater undertaking but extremely important.
24% of individuals have a microbial gene susceptibility, these are Genes which can be a factor in susceptibility to Mold and Bacteria toxicity leading to serious health challenges. Those who carry a specific gene called the HLA-DR and DQ susceptibility, can have difficulty recovering from mould/bacteria and other toxin exposures, these may lead to asthma, inflammatory issues, mast cell activation, suppressed speech, learning difficulties and much more, possibly in time we will see more published connections with cancers, Parkinson’s, ADD and many more diseases.
We would like you to understand the following if you are a builder so you can make a point of difference i.e., give others more reason to be pick as the builder, this is why offering a building wrap is so important, along with exhaust bathroom timers, real timber skirting boards, sarking under roof tiles, bathroom exhausts which go to the outside air, ensure weep holes are installed and drain water from the building cavity, as well as perimeter drainage.
If we can help you to keep your home dry there is less chance your home can impact on your growing family and here’s how it can be done.
- 2 of the most important steps we advise to take, is using a moisture barrier under the timber bottom wall plates when you have a concrete slab, so that moisture from a curing concrete slab does not allow mould and bacterial growth to develop under the bottom wall plates. When the prefabricated frame is installed, the roof follows as quickly as possible so that framing and floors are not impacted by water (rain/storms)- extremely important when the second floor in a home is made from particle board.
- Brick cavity wall, with a steel or timber frame- any good builder should offer you a building wrap as part of the package. That building wrap when installed properly will not allow the moisture during wet weather to transfer from the brickwork into the wall plaster- the wall plaster is only paper, bacteria and mould can growth on the internal wall cavity side of the plaster, producing toxins, VOCs and particulates which can impact on the family.
- The building wrap also will stop insulation breaching, where the insulation can touch the brickwork allowing moisture transfer to the wall plaster.
- A building wrap will allow the condensation in the wall cavity to drop down to the weep holes and drain away. If the home is rendered, ensure those weep holes are not covered over.
- It’s a very simple thing but when you finish showering and exhaust is connected to the light switch but when you turn the lights off, your building company should have installed timers, so the exhaust continues running, removing the built-up condensation which encourages mould growth. Keep it dry and very little mould and bacteria will develop.
- MDF or as we call it “was wood”, is a cheap way to fit out a home but the material is high in nutrients and with very little moisture will promote bacterial build. If your builder or interior designer suggest MDF replace them, not the timber but the builder.
- Not everyone has an interior designer but some of these loves to use MDF as it can have wonderful shapes- really that no excuse for using that crap.
- In bathrooms we don’t suggest vanities which touch the floor as the moisture source creates damage to kick boards, once again providing another source of exposure- here no MDF.
- The kickboards on kitchen cupboards are removeable, so that should you have an overflow they can be removed and the floor dried. Carcasses should be on plastic windup legs.
- Bathroom water proofing should cover the complete bathroom and should be done to a standard that’s important, yes doing it properly costs more.
- If you have chemical sensitivities, we understand the huge impact that TILT (toxicant induced loss of tolerance) can have. We have a defined programme for those with health issues and suggest the importance of using the LED catalytic lamps to be installed in your ducted air conditioning system which reduce air borne moulds and bacteria portable units as these do not produce ozone.
- With timber framed homes, inspect all timber packs to ensure they have not been sweating allowing contamination to build- if the framework is premade check it when it arrives on to ensure there is no pre-contamination, if there is, it should be sent back to be remade.
Building a Home for those with MCS/TILT and possibly CIRS
Chris Winder from the School of Safety Science University of New South Wales published on MCS and his extract does help establish the scope of this issue.
“The basis of MCS is still to be identified, although a large number of hypersensitivity, immunological, psychological, neurological and toxicological mechanisms have been suggested, including: allergy; autosuggestion; cacosmia; conditioned response; immunological; impairment of biochemical pathways involved in energy production; impairment of neurochemical pathways; illness belief system; limbic kindling; olfactory threshold sensitivity; panic disorder; psychosomatic condition; malingering; neurogenic inflammation; overload of biotransformation pathways (also linked with free radical production); psychological or psychiatric illness; airway reactivity; sensitisation of the neurological system; time dependent sensitisation, toxicant induced loss of tolerance. Most of these theories tend to break down into concepts involving: (1) disruption in immunological/allergy processes; (2) alteration in nervous system function; (3) changes in biochemical or biotransformation capacity; (4) changes in psychological/neurobehavioral function. Research into the possible mechanisms of MCS is far from complete.”
But what is important in clients with MCS is that every possible step is taken to decrease building products and paints that are high in Volatile Organic Compounds (VOCs) thus decreasing any possible exposure within a building. It is important that the client is listened too as a poor choice of materials can severely exacerbate existing health problems, which may lead to higher ongoing medical costs for an individual who is poorly financially resourced to deal with further ongoing costs after a rebuild due to previous exposures which may have been the cause of the development of the MCS.
An outline that Builders should be aware of when dealing with a client with MCS.
1.Timber framed buildings do present issues in that some frames can arrive to site pre-contaminated and other frames may be left to stand in outside weather during construction long enough to allow contamination to develop. Also, when installed if timber is to be used the bottom plates should be placed on a membrane barrier so no moisture from the curing concrete slab can wick into the base plate, eliminating a possibility of microbial growth under the bottom plate.
2. Homes with joists and bearers can either have real timber floors or particle board floors which can either be carpeted or have a timber floor laid over the particle board- the issue here is that when there is any subfloor moisture vapour in a crawl space, mould and bacteria can develop between the particle board sheeting and the timber boards laid on top. Naturally we would suggest particleboard should not be used due to the level of VOC’s associated with that material.
3. Wall plaster sheeting comes with a level of pre-contamination but as long as the wall cavities remain dry this may not be an issue. A building wrap is extremely important especially in a brick veneer building where during wet weather the brick will hold moisture and creating high levels of moisture vapour impinging on the wall plaster. Once again if gyprock/plaster board is being used it should be acceptable to the client.
4. Roofing – terracotta (clay) tiles, whirly birds in roof to increase air exchange and a roof sarking should be installed. Some individuals with chemical sensitivities react to electromagnetic radiation. They may not feel well under a metal roof, but once again this should be discussed with the owner/occupant so that a credible decision can be made as to the type of roofing material.
5. Flooring – ceramic tiles, solid timber. Carpet should always be avoided as should cement floors. Cement floors can be a source of cement dust that can be highly irritating, an added problem with cement is that it contains additives such as chrome and formaldehyde (both sensitisers). Timber flooring is a better option. For a client with arthritis or joint disorders, hard concrete floors will exacerbate their pain state. Polished concrete is an alternative even though it is less forgiving, carpets mats which have off gassed can be added.
6. It has become acceptable to be using MDF or man-made timbers or what is referred to as “Was Wood” in kitchens, bathrooms, skirting boards and even some cases as door frames. These can produce during high moisture activities greater emissions of formaldehyde. As well MDF absorbs water easily and provides a source of nutrients for microbial growth. Find a builder who hates MDF, and you may have a friend for life.
7.Use of 25mm gyprock fire rated panels for fire separation, certainly should not be used when someone has sensitivities as these have to be built into the framework as the building progresses, leaving a gyprock panel in external weather is a recipe for disaster.
8. Paints should be low VOC paints or soy-based paints and under no circumstances should old paints be used which may have become microbially contaminated from previous jobs.
9. Concrete slabs, if used should be to the BCA requirements and the moisture barrier under the concrete should be wrapped around edge beams and extend under the damp course. This rarely is done but does stop edge beam moisture during wet weather or runoff, ensure you builder signs off that the concrete slab will be as per the BCA.
10. Wet wall areas – ceramic tiles with discussions undertaken with the client as to what glues can be used.
11. Cupboards – solid timber (Kitchen and Bathroom) or stainless steel. Avoid any form of chipboard as it is a major source of formaldehyde (VOC) contamination. Melamine can also cause severe reactions in chemically sensitive individuals.
12. Bench tops – stainless steel, ceramic or stone- once again adhesives should be discussed with the client/occupant.
13.Electric stove, cooling, heating and hot water service- gas stoves should be exhausted and wired so that the exhaust turns on when the gas is lit
14.Bath and basin – porcelain, enamelled metal, stainless steel (no fiberglass or plastics)
15. Shower Base – stainless steel or ceramic tile, glues used in laying of tiles needs to be approved by the occupant or owner.
16. Laundry tub – stainless steel
17. Built-in wire shelving and wire baskets are a good alternative to chipboard and also allow airing of the cupboards.
18. Installation of whirly birds which are mechanically driven should be used, these can be powered or solar and based on one unit per 100 sq. metres. This will allow a certain draw from wall cavities which will enhance quicker drying of the wall cavity.
19. One-way valves can be installed to reduce the exposure to bacterial build in waste drains throughout the home.
20. We are having success in utilizing ducted air systems which simply take air from a return grill drawing from the house in through filters and running over catalytic lamps which also produce high levels of negative ions- this air is then ducted throughout the house, with outlets placed in the furthest corner in each room- these can also be ducted to built-ins providing clean air flow throughout and being recycled a number of times per hour which reduces any microbial inhalation exposures- there is no air taken from the ceiling cavity in this process but heat tubes can be placed in line in the ceiling ducting to assist in reducing the need for more expensive heating during colder months.
Safe Product Usage After Successful Exposure
1. Chipboard – a source of formaldehyde,
2. Carpet – Ossiform synthetic materials in underfelt, adhesives and materials
in the carpet.
3. Plastics/Synthetic finishes`– VOCs
4. Melamine – VOCs
5.Laminated chipboard – VOCs may cause issues for the occupant
6.Fiberglass products – VOCs may cause issues
7. Fluorescent lighting – not full spectrum, flickers, can cause migraine and epileptic seizures
8. Gas cooking and or heating – VOCs
9. Gyprock – too many additives, VOCs. Not well tolerated by some chemically sensitive individuals the client should expose themselves to this, if they are going to be used.
10. Solvent based products – water-based products should be used in place of these but only after exposure has confirmed no negative reactions.
11.Pest control – housing for individuals with allergy/chemical sensitivity/respiratory disease should not be treated with pesticides.
12.Cleaning – if a dwelling has been previously occupied, or building works have been undertaken and needs to be cleaned, it is essential that the client must be consulted prior to any cleaning to ensure that only tolerated cleaning products are used. Should the dwelling have carpets care must be taken to ensure that no chemicals are used or if there has been building glues paints etc which require removal once again the owner or occupiers should be consulted.
13. Concrete slabs should be laid critically so that self-levelling compounds are not required throughout the home except for bathrooms where sloping would be required for drains.
14 Bathrooms which are tiled should have a waterproofing membrane installed before any leveling for drain fall is installed, after that material is installed, it should be re waterproofed so that those materials do not hold water.
Developing a Scope for a New Home
While the above provides more awareness, it certainly is not black and white, with some people having reactions which differ from others. With our clients I discuss the need to be exposed to what has to be used, say like glues for floor and wall tiles, as a small exposure may produce a response, if a mistake is made, a larger response which could be long term, is a far greater concern.
Each builder and client should take the information outlined above and tailor a scope which will meet their individual needs.
As each client will have different levels of sensitivities, going by accepted criteria levels will not meet the individual’s requirements but works completed by CETEC do outline what levels can be produced by what building and internal fittings, naturally this is only a guide of what their research found.
Enhancing Business and Client Satisfaction with a Client-Centric Approach
- What has to be understood are the issues which can develop in a water damaged building- of particular importance is CIRS-WDB which involves a systemic inflammatory response that results when an individual does not have the immune response genes to eliminate neurotoxins produced by their exposure to a WDB. CIRS affects multiple systems in the body, causing patients to exhibit multiple symptoms.
- Symptoms can include fatigue, weakness, aches, muscle cramps, unusual pain, ice pick pain, headache, light sensitivity, red eyes, blurred vision, tearing, sinus problems, cough, shortness of breath, abdominal pain, diarrhea, joint pain, morning stiffness, memory issues, focus/concentration issues, word recollection issues, decreased learning of new knowledge, confusion, disorientation, skin sensitivity, mood swings, appetite swings, sweats (especially night sweats), temperature regulation or dysregulation problems, excessive thirst, increased urination, static shocks, numbness, tingling, vertigo, metallic taste, tremors, multiple chemical sensitivities.
- A suitably qualified doctor specializing in this field can carry out genetic testing to determine if the occupants have one or more of the mould susceptible HLA-dr and dq gene sequences and carry out the blood tests which can confirm whether inflammatory markers need to be addressed. This testing can now be carried out during exposure to the building and away from the building after inflammatory markers have had time to subside, showing causality of the building if required.
- While it is natural to refer to the levels of organisms found what is more important is the relationship which occurs in a water damaged building which is not dried immediately. Mould will produce a level of mycotoxins, fungal glucans and gram-negative bacteria will increase the level of bacterial endotoxins, along with PAMPs from both organisms. These organisms will produce mVOC’s (microbial volatile organic compounds)
- The synergism which has been shown between these organisms is shown below where the individual components in a water damaged building provide a level of inflammatory response it’s not until the individual is faced with co-exposure that the response becomes far greater.
In the above you can see that glucans by themselves provide a low response and endotoxins by themselves produce a greater response but when an individual is exposed to both at the same time response increases as can be seen by the endo+gluc combination/co-exposure.
- Dr Lewis Thomas was hailed as “the father of modern immunology and experimental pathology” at a symposium held in his honour in 1982. He’s possibly the first to describe what small amounts of endotoxins do to the human host. Dr Thomas has been quoted as saying “the response of the host makes the disease” -(NEJM 1972; 287:553-555), but not the dose,understanding this in the context of individuals adversely affected by a contamination event allows better understanding of low-level chronic co-exposure to emission of toxins in a home. What this means is that the individual’s response will be reflective of the individuals’ genetic makeup. Some will suffer profound activation of their innate immune system, others not so much. Some will suffer debilitating symptoms more than others.
- Health Impacts
A wide body of peer reviewed research has shown the links between damp buildings and resultant health issues, these include:
- The Institute of Medicine (IOM) of the National Academies of Science publication “ Damp Indoor Spaces and Health” is a comprehensive review of the scientific literature requested by the “CDC” (Centre for Disease Control and Prevention in America) regarding the relationship between damp or mould indoor environments and the manifestation of adverse health effects, concluded that excessive dampness in buildings is a public health problem.( Pechter-E; Committee on Damp Indoor Spaces and Health, Institute of Medicine of the National Academies)
The committee reviewed published scientific journal articles and categorized the strength of evidence supporting the association of dampness and molds with health effects into three categories: “sufficient,” “limited or suggestive” or “inadequate.” Table 1 shows the results of this review, systematically attributing symptoms associated with dampness based on research findings. In the full report, a separate table categorizes the evidence for mold and health effects. The committee found sufficient evidence for a link between damp conditions with coughing, wheezing and other upper respiratory tract symptoms in otherwise healthy people. They also found that damp conditions were associated with asthma symptoms among those who are sensitive to mold. There is limited or suggestive evidence that damp conditions are associated with the development of asthma and shortness of breath in healthy children. Insufficient evidence was found to determine an association with a number of other reported health effects, including gastrointestinal problems, fatigue, neuro-psychiatric symptoms and skin problems.
Table 1. Evidence supporting an association between exposure to damp indoor environments and certain health effects.
Sufficient evidence | Limited or suggestive evidence | Inadequate or insufficient information |
upper respiratory tract (nasal and throat) symptoms cough wheeze asthma symptoms in sensitized asthmatic persons | shortness of breath/respiratory illness in otherwise healthy children development of asthma in susceptible persons | a variety of other health outcomes, including acute idiopathic pulmonary hemorrhage in infants |
- Health Canada published in “Fungal Contamination in Public Buildings” that damp conditions and mould growth need to be prevented and that fungal contaminated buildings need to be remediated. Mold growth on building surfaces not only damages these surfaces, but also affects air quality as intact spores, as well as spore and mycelial fragments, are dispersed in the air. These can be inhaled depending on their size and concentration. Exposure to mold is associated with increased rates of respiratory disease. (2004
ISBN: 0-662-37432-0 Cat. No.: H46-2/04-358E)
- The American Industrial Hygiene Association (AIHA) in its guide for “The Determination of Biological Contaminants” concluded that in 1996 that although biological contaminants had been given little attention a substantial portion of building related illnesses are the result of exposure to such contaminants, these included:
2.2.1 Allergic Rhinitis, Sinusitis, Conjunctivus
2.2.2 Building-related Asthma– occupants in damp buildings had an approximate 3 fold risk of onset during building occupancy.
2.2.3 Hypersensitivity Pneumonitis– caused by repeated inhalation of and sensitization to any of a wide array of organic agents to include microbial agents.
2.2.4 Humidifier fever-a flue like illness caused by the inhalation of high concentrations of microbial agents.
2.2.5 Dampness Associated Respiratory Symptoms- studies that include more 100,000 persons in several countries demonstrate consistent correlations between damp environments and or fungal growth in dwellings and the occurrence of respiratory symptoms.
2.2.6 Infections Derived From Building Related Sources: to include opportunistic pathogens, i.e. infections which may occur in immunocompromised persons and maybe caused by bacteria, fungi viruses or parasites. Histoplazmosis infects the lung.
2.2.7 Mycotoxicosis– looks at the role of mycotoxins in a building as a cause of symptoms.
2.2.8 Allergic Bronchoplumonary Aspergillosis and Allergic Fungal Rhinosinusitis
- American Journal of Industrial Medicine (25:41-42)( DOI: 10.1002/ajim.4700250110) deals with clinical experience with patients suffering from a chronic fatigue like syndrome and related upper respiratory infections in relation to airborne microbial contaminants.
- Environmental Mold and Mycotoxin Exposures Elicit Specific Cytokine and Chemokine Responses- A research study which was conducted by the Molecular and Integrative Physiological Sciences Program, Department of Environmental Health, Hebrew Senior Life Institute for Aging Research and Harvard Medical School. These findings demonstrate that chronic mold exposures induced changes in inflammatory and immune system responses to specific mold and mycotoxin challenges. These responses can differentiate mold-exposed patients from unexposed controls. (Ref 26).
- Numerous medical researchers have proven the links between water damaged buildings, microbial contamination and ” CIRS” (chronic Inflammatory response syndrome), a leader in this field is Dr Ritchie Shoemaker who is a leader and pioneer in patient care, research and education in the field of inflammatory illness caused by exposure to biologically produced toxins (biotoxins). A major focus of his work is chronic illness due to the toxins produced in a water-damaged building where microbial contamination has been shown to be a serious health and safety issue. Dr Shoemaker has been able to show that inflammatory markers related to microbial exposure can be reduced but quickly increase during re-exposure in the affected building. NeuroQuant testing can also identify levels of mould related inflammation in the brain and monitor its reduction during treatment and or re-exposure.
- After floods, water damage to buildings may cause mould contamination, particularly as mould tends to grow best in warm, damp environments (Brandt et al. 2006). This may be dangerous to people with impaired immune systems or pre-existing allergies. The strongest health associations with mould are found for upper and lower respiratory tract conditions (such as the exacerbation of asthma and allergic rhinitis or by causing hypersensitivity pneumonitis) (Committee on Damp Indoor Spaces and Health 2004; Brandt et al. 2006). (Health and the environment- Australian Institute of Health and Welfare –ref 18 )
The published literature agrees that a water damaged building can have an impact on the health of some occupants, what this means is that “guessology” should not be used by insurance companies or their representatives, building owners or management of government owned buildings as to the contamination within a building after a water damage or from ongoing moisture issues.
Attachment 2- ERMI/qPCR Identification
This identification process (qPCR) is being used in medical facilities where species identification is of paramount importance i.e. to complement donor selection and tissue processing, rapid and reliable detection, discrimination, and quantification of fungal pathogens are extremely important for tissues destined to be implanted into humans(Cell Tissue Bank. 2008 Jun;9(2):75-82. Epub 2007 Nov 23).
Identification of the causative agents of invasive fungal infections (IFI) is critical for guiding antifungal therapy. Cultures remain negative in a substantial number of IFI cases so that qPCR allows both identification and quantification of the infection (BMC Infectious Diseases 2011, 11:202 doi: 10.1186/1471-2334-11-202).
Quantative polymerase chain reaction is “Real Molecular Science” allowing repeatable Identification and Quantification of fungal species.
One of the major recommendations espoused by the Institutes of Medicine report (IOM 2004) regarding mould, moisture and health was the need for the development of a molecular-based method of mould analysis. The development of an alternative DNA-based analysis, mould specific quantitative PCR (MSQPCR) (Haugland and Vesper, 2002) did provide the required analysis.
The Department of Housing and Urban Development, United States (HUD) in its Report to Congress described the resulting situation succinctly (HUD 2005). Traditional approaches to mould sampling, identification/ quantification techniques are time consuming and require considerable technical expertise. There are situations where reliable test methods are needed, including the identification of hidden mould problems and to better define mould-related hazards based on significant association with adverse health effects in residents.
Bob Brandy sent the same set of four slides to seven AIHA certified laboratories. Not only were there significant variation in the counts produced by the different labs but even the identification at the genus level was inconsistent. He summarized the results of the overall study by noting that, “there is so much variance in this data that little statistically useful information can be gained” (Brandys, 2007). Another study of 10 commercial, AIHA credited laboratories evaluated the variability of total spore/particle counts and culturable mould sample concentrations (Godish and Godish, 2006). The authors summarized their findings by noting that “as a general rule, total mould spore/particle concentrations reported by commercial laboratories may not be reliable indicators of total airborne mould spore/particle levels and thus potential human exposures.”
qPCR (Quantative polymer Chain Reaction) test is extremely accurate. In other words, every little scrap of mold in the form of spores, chunks of the mold hyphae (fibers), and the like are all measured and counted. There’s no way to figure out what part of the total DNA found is from each of the parts of mold. So the EPA developed a way to figure out how much DNA you’d get from the average spore of each particular mold species and then converted the total DNA found, into an equivalent number of spores of that mold – Spore Equivalents.
You have to remember those fragments of moulds are PAMPS (pathogen associated microbial patterns) and can cause inflammatory issues, so simply knowing the total spores, does not show you the total exposure within a contaminated building. (Ref 34, 35 )
High ERMI values were associated with homes of asthmatic children in three widely dispersed cities in the United States (Ref 36) and decreased Pulmonary Function Measured in Children Exposed to High Environmental Relative Moldiness Index Homes (Ref 37)
This simply means that ERMI will identify the mould species whether it’s dead or alive (total exposure) and we know that PAMPs from moulds whether they be viable or non-viable can cause an inflammatory response. The only way you can identify to a species level with mould which is dead and fragmented is with qPCR. I.e. what the total level of PAMPs may be. Should you have elevated levels of C3a, C4a or C5a’s it’s the total level of PAMP exposure that you would want to know about if you can reduce your exposure.
Just how important is it to use qPCR against culture based methods .In “Quantitative PCR analysis of house dust can reveal abnormal mold conditions” from the National Exposure Research Laboratory, US Environmental Protection Agency and Department of Internal Medicine, University of Cincinnati have shown that Culturing underestimated the concentrations of Aspergillus ochraceus, A. penicillioides, A. unguis, A. versicolor by 2 to 3 orders of magnitude compared to QPCR. Simply put qPCR has been shown to far more definite than culture based methods and this can see in the works completed by the above group.
USA
So which identification is more informative, simply put if you dismiss those who claim what makes them money, then you would have to say that would be qPCR but one should also recognise the value of viable reporting, bio tape analysis, as these are all tools which can assist in determining what is a current exposure within a building. Remember that bacteria levels are extremely important and doing only qPCR may miss what is a bacterial contamination, PAMPs from bacteria include endotoxins. (Ref 38)
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Queensland, Australia-Australian Antarctic Division, Department of Sustainability, Environment, Water, Populations and Communities, Kingston, Tasmania, Australia
Centre for Applications in Natural Resource Mathematics, School of Mathematics and Physics, The University of Queensland, St Lucia, Queensland, Australia-Environmental Decisions Group, School of Biological Sciences, The University of Queensland, Brisbane, Queensland, Australia.
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After reading the above report even though there will have been onsite discussions, should you or your treating physician have any questions please don’t hesitate to email, please do not feel that this is an intrusion as assisting you to provide a healthier and safe home is our main concern.
Sincerely,
Vince Neil
Investigative Microbial Consultant and Research
Mycotox Pty Ltd
Professional Member – Global Indoor Health Network
Member of CASANZ- Clean Air Society of Australia and New Zealand
http://globalindoorhealthnetwork.com/
Ph: 0418 491 507