No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Association of use of cleaning products with respiratory health in a Canadian birth cohort
Abstract
Background:
Comprehensive longitudinal studies are important for understanding the complex risk factors, pathways, exposures and interactions that lead to the development and persistence of asthma. We aimed to examine associations between use of household cleaning products in early life and childhood respiratory and allergic disease using data from the Canadian Healthy Infant Longitudinal Development (CHILD) Cohort Study.
Methods:
We summed responses from parental questionnaires that indicated the frequency of use of 26 household cleaning products in the homes of 2022 children from this birth cohort when they were 3-4 months of age to create a cumulative Frequency of Use Score (FUS). We used multivariable logistic regression models to assess whether frequent compared with less frequent use was associated with recurrent wheeze, atopy or asthma diagnosis, as defined by the questionnaire and clinical assessments at age 3 years. Data were collected between 2008 and 2015.
Results:
Children in homes with a higher frequency of use of cleaning products in infancy, as determined by an interquartile range increase, had higher odds of recurrent wheeze (adjusted odds ratio [OR] 1.35, 95% confidence interval [CI] 1.11-1.64), recurrent wheeze with atopy (adjusted OR 1.49, 95% CI 1.02-2.16) and asthma diagnosis (adjusted OR 1.37, 95% CI 1.09-1.70), but no increase in the odds of atopy at age 3 years (adjusted OR 1.14, 95% CI 0.96-1.35). Compared with the lowest tertile of FUS exposure, infants in the highest tertile had higher odds of acquiring asthma. Stratification of the results showed that females had higher ORs than males for all outcomes, although the p values for this sex difference did not reach statistical significance.
Interpretation:
Frequent use of household cleaning products in early life was associated with an increased risk for childhood wheeze and asthma but not atopy at age 3 years. Our findings add to the understanding of how early life exposures to cleaning products may be associated with the development of allergic airway disease and help to identify household behaviours as a potential area for intervention.
... They can react with ozone and form secondary pollutants such as formaldehyde, which is an irritant to the respiratory system and can increase the severity of pediatric asthma (Robroeks et al. 2013;Nurmatov et al. 2015;David and Niculescu 2021;Lin et al. 2021). The pediatric populations are more vulnerable to the side effects of these substances due to a developing immune system, higher respiratory rate, and spending most of their time indoors (Parks et al. 2020). Additionally, they tend to spend more time on floors and near areas where cleaning agents are frequently used. ...
... studies, which includes Sweden (Choi et al. 2010(Choi et al. , 2017, one (6.25%) study each reported from United Kingdom (UK) (Sherriff et al. 2005), Belgium (Nickmilder et al. 2007), Spain (Casas et al. 2013 (Johnson et al. 2008;Baroni et al. 2023), which reported 2 (12.5%) studies and one study (6.25%) from Canada (Parks et al. 2020). Furthermore, varied study designs were followed to perform these studies. ...
... Among these designs, cross-sectional study design was found most followed design 6 (37.5%) (Garrett et al. 1999;Nickmilder et al. 2007;Choi et al. 2010;Hong et al. 2014;Bukalasa et al. 2019;Bably et al. 2021), case-control was the second most followed design by 3 (18.75%) studies (Rumchev et al. 2002(Rumchev et al. , 2004Choi et al. 2017) followed by prospective by 4 (25%) studies (Sherriff et al. 2005;Casas et al. 2013;Parks et al. 2020;Baroni et al. 2023). RCT and retrospective study design each was followed by one study (6.25%) (Johnson et al. 2008;Zhou et al. 2024). ...
Background: Household cleaning agents promote hygiene along with causing respiratory effects, especially pediatric asthma. This systematic review quantified the association between exposure to household cleaning agents and pediatric asthma. Method: Five databases were searched. Data were analyzed qualitatively and quantitatively. RevMan 5.4 calculated odds ratios (OR) with 95% confidence intervals (CI), and a funnel plot assessed publication bias. The Mixed Methods Appraisal Tool (MMAT) and GRADE framework assessed methodological quality and certainty respectively. Results: Sixteen studies met the eligibility criteria. Meta-analysis showed a significant association between the use of household cleaning agents and pediatric asthma (OR 2.90 (95% CI: 2.13-3.95; p < 0.01, I 2 = 98%). Exposure stages also showed significant (p < 0.01) association with household cleaning agents (OR 2.92 (95% CI: 2.12-4.03, I 2 = 98%). No publication bias or high risk of bias was found. Conclusion: A strong association between exposure to household cleaning agents and an increased risk of pediatric asthma was found. .
... It is also important to investigate the association of cleaning product use with recurrent wheezing (a risk factor for asthma) as opposed to transient wheezing symptoms (Casas et al. 2022). While several studies consistently found associations with increased risk of various types of wheezing (Casas et al. 2013a;Herr et al. 2012;Henderson et al. 2008;Sherriff et al. 2005;Mikeš et al. 2019), only one study (Parks et al. 2020) investigated specifically recurrent wheeze in children as an outcome. In addition, the findings are inconsistent for childhood asthma as an outcome (Mikeš et al. 2019;Nickmilder et al. 2007;Parks et al. 2020). ...
... While several studies consistently found associations with increased risk of various types of wheezing (Casas et al. 2013a;Herr et al. 2012;Henderson et al. 2008;Sherriff et al. 2005;Mikeš et al. 2019), only one study (Parks et al. 2020) investigated specifically recurrent wheeze in children as an outcome. In addition, the findings are inconsistent for childhood asthma as an outcome (Mikeš et al. 2019;Nickmilder et al. 2007;Parks et al. 2020). ...
... Previous studies examining wheezing outcomes were quite consistent for an association with early life exposure to cleaning products, regardless of the wheezing phenotype analyzed (Casas et al. 2013a(Casas et al. , 2022Herr et al. 2012;Henderson et al. 2008;Sherriff et al. 2005;Mikeš et al. 2019;Parks et al. 2020). Our study, however, specifically examined the outcome recurrent wheezing, with the aim to distinguish children with high risk of developing asthma from children with transient wheezing symptoms, which may explain discrepancies with previous literature studying more common wheezing phenotypes (Casas et al. 2022). ...
Household chemicals may act as irritants in the lungs; however, their association with recurrent wheeze and asthma in children remains controversial. We aimed to investigate if household cleaning product exposure in infancy is associated with recurrent wheezing and asthma development in children.
We analyzed data from two cohorts: MARC-35 consisting of 815 children with history of severe bronchiolitis in infancy, and MARC-43 consisting of 525 healthy children in infancy. Frequency of use of cleaning product at the child’s home during infancy was collected via telephone interview with parents. Outcomes were recurrent wheezing by age 3 years and asthma diagnosis at age 6 years.
In MARC-35, there was no association between cleaning product exposure in infancy and recurrent wheeze (adjusted HR = 1.01 [95% CI 0.66–1.54] for 4–7 days/week exposure frequency), nor asthma (adjusted OR = 0.91 [95% CI 0.51–1.63]). In MARC-43, there was also no association between cleaning product exposure in infancy and recurrent wheeze (adjusted HR = 0.69 [95% CI 0.29–1.67] for 4–7 days/week exposure frequency).
We found no association between household cleaning product exposure in infancy and later development of recurrent wheeze or asthma, even among children who are at high risk for asthma due to history of severe bronchiolitis.
... The link between cleaning product use and worsened respiratory health is largely based on occupational exposure in adults [2][3][4]. Recent cohort studies show that these risks are not exclusive to workers, and that household exposures carry risk for the development of airways disease in young children as well [5][6][7]. Young children spend at least 80-90% of their time indoors, have an increased respiration rate, hand-to-mouth behaviors, breath closer to the ground where airborne concentrations of the ingredients are higher, and are still developing their immune and respiratory systems [8,9]. This makes them especially vulnerable and reinforces the need to identify modifiable risk factors of asthma in early life. ...
... In the UK, the ALSPAC study found the frequent use of chemical cleaning products during pregnancy was associated with persistent wheeze in children [5], and that a maternal composite household chemical exposure score was positively associated with early and intermediate persistent, and lateonset wheezing in children who were not atopic [6,10]. A recent study from a Canadian birth cohort found an increased frequency of household cleaning product use measured at 3-months of age to be associated with an increased risk of developing asthma and recurrent wheeze in early childhood [7]. A Dutch study of adolescents found living in a home with higher cleaning product use was not associated with asthma, rhinitis, or eczema risk, differing from the previous studies by focussing on an age group with a more developed and therefore less sensitive respiratory and immune system when compared to children and infants [11]. ...
... The products ingredients and their delivery mechanism appear to be important determinants of risk from cleaning products, particularly liquid or solid air fresheners, spray air fresheners, plug-in deodorizers, dusting spray, glass cleaners, anti-microbial hand sanitizers, and oven cleaners [7]. Many of these products have been previously identified in occupational studies be associated with increased risk for asthma [1,2,12]. ...
... The risk to health from ambient and indoor air pollution has come into sharp focus with the COVID-19 pandemic [37][38][39]. Here, we report the added concern by participants of repeated exposure to odors from disinfectants that may trigger symptoms and may lead to an increase in sensitivity to chemicals, akin to the dose-response relationship between exposure to disinfectants and increased risk of asthma in adults and children [40]. ...
... Our study has important public health implications since, to our knowledge, it is the first study examining the impact of public health measures to counter the COVID-19 pandemic on the daily lives of people experiencing MCS. This study highlights a new context that people experiencing MCS must navigate in terms of their sensitivities to antimicrobial products and supports an emerging body of literature describing the risks associated with the overexposure or misuse of products used to control the COVID-19 pandemic [40,60]. Moving forward, it would be crucial to increase awareness of the chemicals contained in disinfectants and their health effects by clearly labeling the full list of ingredients and using only effective yet least toxic and fragrance-free products. ...
Background
Multiple chemical sensitivity (MCS) develops in response to repeated small-level chemical exposures or a major exposure in a subset of people, who then experience symptoms that can range from mild to debilitating when exposed to chemicals. The arrival of the COVID-19 pandemic and the stringent health measures put in place may have increased the burden for those living with MCS, as it became more challenging to avoid chemicals that trigger their condition.
Objective
This study aimed to better understand the lived experience of Canadians living with MCS during the first year of the COVID-19 pandemic.
Methods
An online questionnaire was created to ask participants to compare daily living during the pandemic to before March 11, 2020. Data were collected in January and February 2021. Three areas were investigated: (1) environmental exposures to chemical triggers from ambient air (pollution from industry, farming, and traffic) and indoor air (the smell of cleaning products, cooking odors, and smoke); (2) access to, and satisfaction with, health care visits; and (3) how people experiencing MCS rated contact with their social network.
Results
In all, 119 Canadians who had lived with MCS for more than a year completed the questionnaire. The participant sample was mostly female (86.6%, n=103) and highly educated, with 57.1% (n=68) having a university degree. Slightly more than half (57.1%, n=68) were older than 55 years. McNemar chi-square and Wilcoxon signed rank tests were used to evaluate if there were statistically significant changes before (“prepandemic period”) and after (“postpandemic period”) March 11, 2020. Perceived exposure to pollution from a highway or a road was significantly decreased from the prepandemic to postpandemic period (z=–3.347; P<.001). Analysis of industry or power plants also suggested a significant decrease in the perceived exposure from the prepandemic to postpandemic period (z=–2.152; P=.04). Participants reported an increase in exposure to odors from disinfectants or sanitizers that entered their living environment (P<.001). There was a significant decrease between prepandemic and postpandemic levels of satisfaction when attending in-person meetings with a physician (z=–2.048; P=.04), yet there were no significant differences between prepandemic and postpandemic levels of satisfaction for online or telephone meetings with a physician. Although people with MCS experienced increased social isolation (P<.001), they also reported an increase in understanding from family (P=.03) and a decrease in stigma for wearing personal protective equipment (P<.001).
Conclusions
During the first year of the COVID-19 pandemic, people with MCS were impacted by inaccessibility, loss of social support, and barriers to accessing health care. This study highlights unique challenges and possible benefits associated with the COVID-19 pandemic public health measures for individuals living with MCS. These findings can guide decision makers to improve policies on accessibility through appropriate accommodation measures.
... Cleaning agents and indoor pesticides cause mucous epithelial damage and may initiate or aggravate pre-existing asthma through different mechanisms, however their clinical relevance is still yet to be proven. [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] The aim of this systematic review (SR) and meta-analysis is to synthesize and update the current scientific evidence of the on the risk of developing asthma upon exposure to specific indoor pollutants and their impact on asthma-related outcomes. This ...
... 29 Similarly, the Canadian Healthy Infant Longitudinal Development Cohort Study showed that frequent use of household cleaning products in early life was associated with an increased risk for childhood wheeze and asthma but not atopy at age 3 years. 30 These pivotal trials published after our SR was performed showed the importance of good quality data from longitudinal well characterized cohorts and provide hope for the next appraisal of the literature on exposure to cleaning agents, which is planned for the upcoming EAACI guidelines update in 2028. 129 The difference in effect size may be attributed to less extensive damage or damage of shorter duration. ...
Systematic review using GRADE of the impact of exposure to volatile organic compounds (VOCs), cleaning agents, mould/damp, pesticides on the risk of (i) new‐onset asthma (incidence) and (ii) adverse asthma‐related outcomes (impact). MEDLINE, EMBASE and Web of Science were searched for indoor pollutant exposure studies reporting on new‐onset asthma and critical and important asthma‐related outcomes. Ninety four studies were included: 11 for VOCs (7 for incidenceand 4 for impact), 25 for cleaning agents (7 for incidenceand 8 for impact), 48 for damp/mould (26 for incidence and 22 for impact) and 10 for pesticides (8 for incidence and 2 for impact). Exposure to damp/mould increases the risk of new‐onset wheeze (moderate certainty evidence). Exposure to cleaning agents may be associated with a higher risk of new‐onset asthma and with asthma severity (low level of certainty). Exposure to pesticides and VOCs may increase the risk of new‐onset asthma (very low certainty evidence). The impact on asthma‐related outcomes of all major indoor pollutants is uncertain. As the level of certainty is low or very low for most of the available evidence on the impact of indoor pollutants on asthma‐related outcomes more rigorous research in the field is warranted.
... As well as clean air, mask use and immunization, in spite of evidence that COVID-19 transmission is predominantly airborne, surface cleaning, disinfection and hand hygiene are strategies that are widely employed to decrease school-based spread of COVID-19 (2). Unfortunately, many commonly used disinfectants are respiratory irritants implicated in the incidence and prevalence of asthma (3)(4)(5)(6)(7), posing a potential risk to all children in school with disproportionate impacts on children with respiratory diseases such as asthma. ...
... Chronic exposure to some commonly used disinfectants increases the incidence of asthma and, with acute exposure, its prevalence (3)(4)(5)(8)(9)(10). While most reports focus on adults involved in cleaning as a profession (4,(8)(9)(10) or who use disinfectants frequently at home (5), similar observations have been made for children exposed at home (3,7). Pandemic-level school disinfection routines have increased children's exposure to these chemicals at school. ...
Surface disinfection is part of school protocols designed to decrease the risk of students and staff contracting COVID-19. However, exposure to disinfectants can have short- and long-term health consequences. Given that the risks are well-described and safer products are readily available, it is critical that schools consciously employ safer disinfection strategies.
... The rapid increase in prevalence observed between the mid 1950's and the early part of this century cannot be explained by genetics alone. This has led to an increased focus on environmental factors (Asher et al., 2012), including exposure to chemicals from products and materials indoors (Parks et al., 2020), due to the increased use of synthetic materials and products in recent decades (US EPA 2017). Among those chemicals examined are phthalates, which are a group of chemicals found in a wide variety of consumer products including vinyl flooring, plastic toys, food packaging, and personal care products (Godwin 2017;Schettler 2006). ...
... Phthalate concentrations were categorized into quartiles, defined based on the distribution observed in the random subcohort, to examine doseresponse relationships which were assessed using the Cochrane-Armitage exact trend test. All models were adjusted for study site due to differences in risk factors for asthma by city observed in the CHILD cohort (Miliku et al., 2019;Parks et al., 2020), and by income because of differences in phthalate exposure previously reported in the CHILD cohort (Navaranjan et al., 2020). Several other potential confounders were assessed including sex, parental history of asthma reported at recruitment, smoking inside the home at 3 months, housing characteristics including flooring type and period the home was built. ...
(word count = 349)
BACKGROUND
Studies have demonstrated an association between phthalate exposure and childhood asthma, although results have been inconsistent. No epidemiological studies have examined exposure during the first year of life.
OBJECTIVE
To investigate the association between phthalate exposures in the home environment during the first year of life, and subsequent development of childhood asthma and related symptoms.
METHODS
This study used a case-cohort design including 436 randomly selected children and all additional cases of asthma at 5 years (ntotal=129) and recurrent wheeze between 2 to 5 years (ntotal=332) within the CHILD Cohort Study, a general population Canadian birth cohort of 3455 children. Phthalate exposure was assessed using house dust samples collected during a standardized home visit when children were 3 months of age. All children were assessed by specialist clinicians for asthma and allergy at 1, 3 and 5 years. Logistic regression was used to assess the association between exposure to five phthalates and asthma diagnosis at 5 years, and recurrent wheeze between 2 to 5 years, with further stratification by wheeze subtypes (late onset, persistent, transient) based on the timing of onset and persistence of wheeze symptoms.
RESULTS
Di(2-ethyl-hexyl) phthalate (DEHP) had the highest concentration in dust (mediansubcohort=217 μg/g), followed by benzyl butyl phthalate (BzBP) (20 μg/g). A nearly four-fold increase in risk of developing asthma was associated with the highest concentration quartile of DEHP (OR=3.92, 95% CI: 1.87-8.24) including a positive dose-response relationship. A two-fold increase in risk of recurrent wheeze was observed across all quartiles compared to the lowest quartile of DEHP concentrations. Compared to other wheeze subtypes, stronger associations for DEHP were observed with the late onset wheezing subtype, while stronger associations for di-iso-butyl phthalate (DiBP) and BzBP were observed with the transient subtype.
DISCUSSION
DEHP exposure at 3 months, at concentrations lower than other studies that reported an association, were associated with increased risks of asthma and recurrent wheeze among children at 5 years. These findings suggest the need to assess whether more stringent regulations are required to protect children’s health, which can be informed by future work exploring the main sources of DEHP exposure.
... In linked research, Parks and colleagues describe an association between use of household cleaning products early in life and risk of childhood wheeze and asthma at age 3 years, using data from the Canadian Healthy Infant Longitudinal De velopment (CHILD) Cohort Study. 4 This longitudinal prospective birth cohort of 3455 participants notes that children had a higher odds of recurrent wheeze, recurrent wheeze with atopy and asthma diagnosis if living in homes with a higher frequency of use of cleaning products during their infancy. Several studies have identified household cleaning products to be associated with elevated risk of asthma or wheeze in adolescents, in adults and in association with occupational exposures, 5 and the linked study adds to this by showing an association in young children. ...
... The linked study points to small preventive changes that could be considered, especially among families of children at risk of asthma. 4 Given the accumulating evidence, 5 the American Lung Association recommends using only cleaning products that "don't have volatile organic compounds, fragrances, irritants or flammable ingredients" and that air fresheners should be avoided altogether. 6 However, currently, manufacturers in Canada and the United States are not required to list all ingredients in consumer household cleaning products, and even products labelled as "environmentally friendly" or "green" may contain harmful substances, as such claims are largely unregulated. ...
... We aim to determine these preliminary hypothesis in future research. No beneficial effects, but rather the opposite, have been evidenced for exposure to the xenobiotic chemicals or the Stachybotrys metabolites detected in airborne indoor urban dusts (Bornehag et al., 2005;Salonen et al., 2024;Weschler, 2009;Parks et al., 2020;Wang et al., 2019). ...
... In the present study, we assessed the regular exposure to products containing phthalates, and results showed that the more frequent use of personal care products was a significant predictor of asthma. 55, 56 . ...
Background: Phthalates, which are diesters of phthalic acid, are commonly used as plasticizers and additives in various consumer products. Several phthalates have been identified as substances of high concern. Exposure to phthalate esters (PAEs) has been linked to asthma in children, but the specific impacts of PAEs on asthmatic children were not well understood. Objective: The objective of this study was to compare urinary phthalate concentrations in asthmatic and non-asthmatic children and to identify potential sources of exposure as risk factors for asthma. Methods: A case control study was conducted for 100 Egyptian children aged 8-16 years (50 asthmatics and 50 healthy controls). Asthma was identified using GINA guidelines. Socio-demographic and probable risk factors were assessed, in addition to measuring phthalate levels in urine samples using high-performance liquid chromatography. Results and conclusion: Mean urinary Mono-methyl as well as Mono-benzyl levels were highly significant in asthmatic children compared to control group (895.26ng/ mL vs 548.55 ng/mL and 13.5 ng/mL vs 2.07 ng/mL respectively) (p= 0.001). The number of asthmatic children living in houses painted with non-plastic paint was significantly lower (P<0.05) than children living in houses painted with other paints. No association between floor type and asthma was reported. The frequent use of personal care products and plastic painting of walls were identified by multiple logistic regression analysis as the highly significant predictors of asthma in the studied subjects. The declared higher levels of urinary phthalate metabolites (Mono-methyl and Mono-benzyl) in Egyptian asthmatic children may reveal the probable risk of phthalate exposure in triggering bronchial asthma.
... Casas et al. (2013) and Mikeš et al. (2019) found an association between exposure to cleaning products during either pregnancy or the first years of life and persistent wheezing in early childhood. In a Canadian birth cohort study (Parks et al., (2020), exposure to frequent use of household cleaning products in early life was associated with an increased risk of childhood wheezing and asthma but not atopy at 3 years of age. Liu et al. (2016) found an increase in the odds of rhinitis in Chinese primary school children. ...
... Exposure to cleaning products also harms children's health. Frequent household use of cleaning products during infancy, especially use of scented spray products, was associated with a higher risk of childhood asthma and wheezing (Bably et al., 2021;Parks et al., 2020). Similarly, exposure to cleaning products daily during infancy or pregnancy was associated with persistent wheezing in early childhood and increased lower respiratory tract infections (Casas et al., 2013;Herr et al., 2012;Sherriff et al., 2005). ...
... Estos hallazgos contribuyen a la comprensión de cómo las exposiciones tempranas a los productos de limpieza pueden estar asociadas con el desarrollo de enfermedades alérgicas. 20 Jiménez Boraita et al., describieron que los adolescentes que vivían en zonas rurales tenían mejor calidad de vida relacionada a salud y mayor bienestar psicológico, mayor acceso al medioambiente natural, exposición a menor densidad poblacional, estrés y aislamiento social, al ser comparados con los adolescentes de las zonas urbanas. 16,21 Al contrario de lo descripto por Jiménez Boraita et al., las familias de las zonas rurales, en nuestro estudio, reportaron mayor exposición a productos químicos debido a sus actividades. ...
... Chronic exposure to irritants found in cleaning products, however, has been linked to an increased risk of asthma. These irritants induce chronic inflammation by damaging the respiratory epithelium and inducing an innate immune-mediated response [67]. ...
Purpose of Review
This review aims to assess the prevalence of common allergen exposures and environmental risk factors for asthma in schools, examine the underlying mechanisms of these environmental risk factors, and explore possible prevention strategies.
Recent Findings
Cockroach, mouse, dust mites, fungi, viral infections, ozone pollution, and cleaning products are common allergen exposures and environmental risk factors in schools which may affect asthma morbidity. Novel modifiable environmental risk factors in schools are also being investigated to identify potential associations with increased asthma morbidity.
Summary
While several studies have investigated the benefit of environmental remediation strategies in schools and their impact on asthma morbidity, future studies are warranted to further define the effects of modifiable risk factors in schools and determine whether school mitigation strategies may help improve asthma symptoms in students with asthma.
... These findings help to understand how an early exposure to cleaning products may be associated with the development of allergies. 20 Jiménez Boraita et al., described that adolescents living in rural areas had a better health-related quality of life and a greater psychological well-being, a greater access to the natural environment, exposure to a lower population density, stress and social isolation, compared to adolescents living in urban areas. 16,21 Contrary to what was described by Jiménez Boraita et al., in our study, the families living in rural areas reported a higher exposure to chemical substances due to their activities. ...
Introduction. Children's environmental health studies the influence of the environment on health and disease in children. Global environmental exposures pose a serious threat to health, warranting further research and action. Objective. To assess the environmental health of a sample of children living in urban and rural areas in Uruguaiana, Brazil. Population and methods. We included parents/legal guardians (n = 714) of children seen at Policlinica Infantil de Uruguaiana between January and October 2021, who completed the environmental historytaking in pediatrics (Brazilian Society of Pediatrics). Collected data were analyzed based on place of residence (urban or rural) or household income. Results. The comparison between inhabitants of the urban area (n = 660) and the rural area (n = 54) established that, among those living in the rural area, activity with chemical substances (15% versus 32.7%; p = 0.004), living near a plantation (7.5% versus 74.5%; p < 0.001) or near a source of contamination (4.8% versus 32.7%; p < 0.001), having a dog (62% versus 87.3%; p < 0.001), using pesticides (0.6% versus 32.7%; p < 0.001), and exposure to chemical contamination (2.6% versus 18.2%; p < 0.001) were significantly higher. In the urban area, exposure to vehicle traffic near the house (85% versus 48.1%; p < 0.001), an average income below 3 minimum wages (90%), and a low level of education predominated. Conclusion. Environmental history-taking is critical for the detection of environmental threats present in the areas where children and adolescents live, learn, play, and study.
... However, there are studies showing that using N95 or KF94 masks increases the risk for chronic disease patients with impaired pulmonary function and that frequent disinfectant usage may affect the respiratory tract of newborns, increasing the risk of pediatric asthma. 37 Zok et al 38 showed that weekly usage of air fresheners may also be a risk factor of severe asthma onset. Considering the fact that 60-80% of allergic asthma cases involve pulmonary asthma, minimizing exposure to allergens should be the most effective method to control asthma. ...
not available DS (Child) H J 2021; 37(2): 87-92
... These disinfection products can be incredibly effective in their purpose, are widely used and yet they are one of the least understood aspects of indoor air chemistry and health (Weschler et al. 2006). A few studies have significantly correlated usage of caustic cleaners in the home to adverse health effects such as asthma and wheezing in children (Quirce and Barranco 2010;Parks et al. 2020). Conversely, some studies showed no significant connection between cleaners and respiratory issues with the possible differences in conclusions being due to the age of subjects, location or other unknown factors (Bukalasa et al. 2019). ...
Environmental context
The chemistry that occurs in indoor environments and the role that indoor surfaces play have recently received increased attention in the scientific community. Here we have investigated the chemistry of chlorine-based cleaning products and their interactions with indoor relevant surfaces and find that these surfaces react with these cleaning products to yield surface adsorbed chlorine oxides and other surface-bound species.
Rationale
Indoor chemistry has recently received increased attention in the scientific community due to the fact that there is relatively little known given its unique environment including point combustion sources (candles, gas stoves, etc.) resulting in high aerosol concentrations, high surface to volume ratios and the impact of humans on indoor air quality. Recently, surface-initiated reactions during chlorine cleaning events have been proposed.
Methodology
In this study, we probe the interaction of bleach headspace gas with high surface area silica as a proxy for window glass – an ‘inert’ and impervious surface – using attenuated total reflectance Fourier Transform infrared (ATR-FTIR) spectroscopy, atomic force microscopy photothermal infrared (AFM-PTIR) spectroscopy and transmission electron microscopy (TEM) to observe surface chemical and physical changes.
Results
The results suggest chemical transformations occur at the silica surface forming surface adsorbed chlorine oxides (ClOx). Conductivity and ion chromatography methods support the presence of adsorbed chloride after surfaces have been exposed to bleach and HOCl.
Discussion
Interactions between HOCl and indoor surfaces have not been previously studied with molecular based techniques. The possibility of surface-mediated reactions has been relatively unexplored on indoor surfaces and this study shows the chemistry of chlorine-containing cleaning products on indoor relevant surfaces.
... [121]. The use of household chemicals and other cleaning products may also have a role in respiratory outcomes, but the evidence is still scant [122,123]. ...
Wheezing at preschool age (i.e., before the age of six) is common, occurring in about 30% of children before the age of three. In terms of health care burden, preschool children with wheeze show double the rate of access to the emergency department and five times the rate of hospital admissions compared with school-age asthmatics. The consensus document aims to analyse the underlying mechanisms involved in the pathogenesis of preschool wheezing and define the risk factors (i.e., allergy, atopy, infection, bronchiolitis, genetics, indoor and outdoor pollution, tobacco smoke exposure, obesity, prematurity) and the protective factors (i.e., probiotics, breastfeeding, vitamin D, influenza vaccination, non-specific immunomodulators) associated with the development of the disease in the young child. A multidisciplinary panel of experts from the Emilia-Romagna Region, Italy, addressed twelve key questions regarding managing preschool wheezing. Clinical questions have been formulated by the expert panel using the PICO format (Patients, Intervention, Comparison, Outcomes). Systematic reviews have been conducted on PubMed to answer these specific questions and formulate recommendations. The GRADE approach has been used for each selected paper to assess the quality of the evidence and the degree of Citation: Grandinetti, R.; Fainardi, V.; Caffarelli, C.; Capoferri, G.; Lazzara, A.; Tornesello, M.; Meoli, A.; Bergamini, B.M.; Bertelli, L.; Biserna, L.; et al. Risk Factors Affecting Development and
... In general, detergent products are highly alkaline and destructive to our exposed body cells. Overexposure to detergents is associated with different side effects, such as irritant contact dermatitis, respiratory problems, namely allergies, asthma aggravation, damage to epithelial cells, and optical problems (corneal irritation and damage) [56][57][58][59]. Furthermore, the entering of dishwashing liquids or other detergents into the stomach and their residues can lead to gastrointestinal disorders, diarrhea, and tissue damage in epithelium cells [60]. ...
To control and prevent the spread of the infectious agents in the environment and body, various measures have been taken, including the use of disinfectants for hands and surfaces, use of detergents, self-medication by herbal concoctions, and dietary supplements. Although these actions may have a therapeutic effect or reduce the viral load, incorrect use (abuse or overuse) could have negative health repercussions. Therefore, public awareness in this context is essential. The purpose of this narrative review was to evaluate the health consequences of overexposure to disinfectants and self-medication against infectious agents, specially SARS-CoV-2. The literature search for this review was conducted using related keywords in PubMed, Web of Science (WOS), and Scopus databases. This review found a significant number of reported poisoning cases during the pandemic as a result of the overuse of alcoholic hand sanitizers, household bleach products, and detergents. This paper also provides an integrated systemic overview of the possible toxic effects of self-medication, alcohol consumption, and self-administration of dietary supplements and herbs during the COVID-19 pandemic. The present review indicated that the main adverse effects associated with the overuse of popular preventative actions against contagious respiratory illnesses specially COVID-19 and Influenza (flu) were methanol intoxication, skin damage, respiratory problems, gastrointestinal ulcers, nausea, vomiting, epigastric pain, and liver injury. Due to the significant increase in the use of these preventative measures, it is essential to raise public awareness of the side effects of their excessive and unnecessary use.
... In the past decade, increasing evidence has suggested that exposure to cleaning products may cause airway irritation and chronic inflammation, subsequently leading to asthma symptoms [81][82][83] and reduced lung function [84,85]. A longitudinal prospective birth cohort of 3455 children in Canada observed increased risk of recurrent wheeze and physician-diagnosed asthma at 3 years in children living in homes with a higher frequency of use of cleaning products during infancy [86]. This Canadian study raised concerns about irritative effects of cleaning products on the respiratory system during early life. ...
The increase in childhood asthma over the past few decades has made it an important public health issue. Poor lung function growth associated with some phenotypes of asthma compounds its long-term impact on the individual. Exposure to early-life household risk factors is believed to be linked with respiratory health while infants’ lungs are still developing. This review summarises epidemiological studies and mechanistic evidence focusing on the detrimental effects of early-life household air exposures on the respiratory health of children, in particular effects on asthma and lung function. Many early-life household air exposures, including tobacco smoke, gases from heating and cooking, mould/dampness and cleaning products are associated with childhood asthma development and lung function growth. These exposures may alter structural and mechanical characteristics of infants’ lungs and contribute to deficits in later life. In addition, some risk factors, including tobacco smoke and cleaning products, can transmit effects across generations to increase the risk of asthma in subsequent generations. This review supports the hypothesis that risks of asthma and accelerated lung ageing are established in early life. The timing of exposure may be critical in the pathogenesis of respiratory diseases, in terms of future risk of asthma and reduced lung function in adults.
... Health effects associated with migraine (Silva-Néto et al. 2014;Steinemann and Nematollahi 2020), asthma attacks, exacerbations (Zock et al., 2007;Weinberg et al., 2017;Steinemann and Goodman 2019), childhood wheeze (Sherriff et al. 2005;Parks et al., 2020), neurological, respiratory, gastrointestinal, dermatological, and immune systems disorder (Steinemann 2019). VOCs emitted by building materials are suspected cause of Sick building syndrome (SBS) (Herberth et al. 2009;Mori and Todaka 2011;Heinrich 2011;Kim et al. 2012;Azuma et al. 2016). ...
Response surface methodology (RSM) and principal component analyses (PCA) modelling tools have been used in this study to quantitatively describe the interaction effects of more than one factor on system response for the modelling and optimization of experimental data. In Nigeria, there are no stringent policies in place by the government on paint production and this has led to unregulated paint products by producers in the commercial markets. Water-based paints currently available in Nigerian market were sampled. Experimental data of Metals (As, Ca, Cd, Cr, Cu, Fe, Mg, and Pb) and Ethylene glycol butyl ether (Volatile organic compounds (VOC)) measured using Inductively Coupled Plasma-Optical Emission Spectrometer (ICP-OES) and Gas Chromatography-Flame Ionisation Detector (GC-FID), respectively was used to develop a mathematical model. The principal component analyses were explained with a cumulative variance of 82% for the VOC and 76% for metals based on manufacturers. Estimated responses were compared with the experimentally determined responses and prediction capabilities of Response Surface Methodology. In the RSM, the 2 developed model had R value of 0.9569, with optimized value at 0.10 % (1000ppm) of Ethylene glycol butyl ether and concentration (ppm) ranges of As (383.0-1,930.0), Ca (614.0-10,400.0), Cd (98.0-2,000.0), Cr (10.3- 225.0), Cu (133.0-1,840.0), Fe 742.0-2,910.0, Mg (4,000.0-99,510.0), Pb (170.0-3,230.0). The correlation and optimization study employed are applicable for assessing the impact of hazardous air pollutants on indoor air quality and a good applicability in paint industries to produce products within the set limit of international standards. For the purpose of reducing sick building syndrome and protecting public health, it was important to investigate paints and sealers extensively. Keywords: VOCs; Paint; metals; Ethylene glycol butyl ether; Response Surface Method
... However, there are studies showing that using N95 or KF94 masks increases the risk for chronic disease patients with impaired pulmonary function 6 and that frequent disinfectant usage may affect the respiratory tract of newborns, increasing the risk of pediatric asthma. 7 Zok et al showed that weekly usage of air fresheners may also be a risk factor of severe asthma onset. 8 Considering the fact that 60-80% of allergic asthma cases involve pulmonary asthma, 9 minimizing exposure to allergens should be the most effective method to control asthma. ...
Background
To tackle the COVID-19 pandemic and mitigate viral transmission, mainland China has implemented various disease prevention measures and arrangements. We hypothesize that these measures may be pose challenges to the management of pediatric asthma. Here, we studied the situation of pediatric asthma in Chengdu during the COVID-19 pandemic and compared the pediatric asthma situation before so as to provide a reference for designing effective management plan for pediatric asthma patients in the future facing the outbreak of epidemic.
Methods
An observational study was done to compare the pediatric asthma situation in Chengdu from 2017 to 2019 to the situation under COVID-19 pandemic. Asthma incidence, severe asthma attack, air quality, temperature, and patient follow-up were examined.
Results
The number of monthly asthma cases decreased significantly in February 2020. The number of asthma cases in 2017–2019 positively correlated with levels of particulate matter PM 2.5 (p = 0.006) and PM10 (p = 0.005), while it negatively correlated with temperature (p = 0.048). No correlation was identified in 2020. A higher rate of severe asthma attack cases (9.69%) was observed among asthma patients in 2020 (p = 0.014). Differences were identified between the monthly severe asthma attack during the period 2017–2020 (p<0.001). The rate of severe asthma attack cases peaked in June and September 2020. The percentage of patients who failed to undergo pulmonary function tests was 34.5% in 2020, remarkably higher than in the previous 3 years (p<0.001).
Conclusion
The situation and management of pediatric asthma during the 2020 COVID-19 pandemic differed from those in previous years, with more emphasis placed on disease prevention practices and facilities. To design future pediatric asthma management practice, the environmental and psychological impact on asthma management should also be considered. Local areas should make good use of telemedicine to manage pediatric asthma effectively.
... These include improvements in immune health (Li, 2010;Rook, 2013), mental health (Birch et al., 2020;Callaghan et al., 2020), and cardiovascular health (Yeager et al., 2020). In the alternative direction (i.e., spending more time in natural environments which may help to establish more positive attitudes toward microbes), we can hypothesize that our positive attitudes toward microbes could conceivably reduce the likelihood that we carry out mass (non-targeted) sterilization of our local environments, which could also have important implications for our health (Jun et al., 2018;Parks et al., 2020;Prescott, 2020;Renz and Skevaki, 2020). This hypothesis requires further research and would benefit from the collection of data on people's actions (e.g., related to environmental avoidance and sterilization). ...
Germaphobia – a pathological aversion to microorganisms – could be contributing to an explosion in human immune-related disorders via mass sterilization of surfaces and reduced exposure to biodiversity. Loss of biodiversity and people’s weaker connection to nature, along with poor microbial literacy may be augmenting the negative consequences of germaphobia on ecosystem health. In this study, we created an online questionnaire to acquire data on attitudes toward, and knowledge of microbes. We collected data on nature connectedness and interactions with nature and explored the relationships between these variables. Although the study had an international reach (n = 1,184), the majority of responses came from England, United Kingdom (n = 993). We found a significant association between attitudes toward microbes and both duration and frequency of visits to natural environments. A higher frequency of visits to nature per week, and a longer duration spent in nature per visit, was significantly associated with positive attitudes toward microbes. We found no association between nature connectedness and attitudes toward microbes. We found a significant relationship between knowledge of “lesser known” microbial groups (e.g., identifying that fungi, algae, protozoa, and archaea are microbes) and positive attitudes toward microbes. However, we also found that people who identified viruses as being microbes expressed less positive views of microbes overall–this could potentially be attributed to a “COVID-19 effect.” Our results suggest that basic microbial literacy and nature engagement may be important in reducing/preventing germaphobia-associated attitudes. The results also suggest that a virus-centric phenomenon (e.g., COVID-19) could increase broader germaphobia-associated attitudes. As the rise of immune-related disorders and mental health conditions have been linked to germaphobia, reduced biodiversity, and non-targeted sterilization, our findings point to a feasible strategy to potentially help ameliorate these negative consequences. Further research is needed, but greater emphasis on microbial literacy and promoting time spent in nature could potentially be useful in promoting resilience in human health and more positive/constructive attitudes toward the foundations of our ecosystems—the microorganisms.
... Bleach was the most commonly used cleaning agent; other investigators have also observed its common use (32% reported monthly, weekly, or daily use) (Parks et al., 2020). Soap and water, vinegar, and "Green" cleaners were rarely used. ...
We examined mold cleanup practices in the U.S. in a general population that was not selected on a history of natural disaster. We used a population-based survey (n = 3,624) to assess associations between 1) sociodemographic, housing, and respiratory health variables and 2) mold cleanup, personal protective equipment (PPE) use, and cleaning agent use. Bleach was the most commonly used cleaning agent, with approximately 90% of residents reporting using bleach alone or with other agents. More respondents used gloves (76%) than any other PPE. The use of PPE varied: 42% of bleach users wore a facemask/respirator compared with only 19% of soap and water users. Hispanic populations frequently reported mold cleanup. Bleach use was less likely in the Western region of the country and among Asians. Although green products were rarely used, Asians were more likely to use them. Bleach was the most commonly used cleaning agent for mold and PPE use was common when using bleach, which supports the need for current Centers for Disease Control and Prevention safe-use recommendations. © 2020, National Environmental Health Association. All rights reserved.
... To reduce the risk of misuse and overuse of cleaning and disinfectant products, there is a critical need for public health to communicate these messages to the public. Public health communication during the COVID-19 pandemic should follow several basic principles to effectively communicate core messages to the target audiences (Vraga & Jacobsen, 2020 Folletti et al., 2014;Shrem et al., 2014;Takaro & Parks, 2020). ...
... Nazaroff and Weschler (2004) synthesize evidence of adverse health outcomes linked to chemical exposures from the use of cleaning products and air fresheners. In addition, use of fragranced cleaning products and air disinfectants has been associated with migraine headaches (e.g., Silva-Néto et al. 2014;Steinemann and Nematollahi 2020), asthma attacks and exacerbations (e.g., Zock et al. 2007;Weinberg et al. 2017;Steinemann and Goodman 2019), childhood wheeze (e.g., Parks et al., 2020;Sherriff et al. 2005), and additional health problems related to neurological, gastrointestinal, respiratory, dermatological, and immune systems (e.g., Steinemann 2019a). ...
The recent pandemic (COVID-19) has seen a sweeping and surging use of products intended to clean and disinfect, such as air sprays, hand sanitizers, and surface cleaners, many of which contain fragrance. However, exposure to fragranced cleaning products has been associated with adverse effects on human health. Products can emit a range of volatile chemicals, including some classified as hazardous, but relatively few ingredients are disclosed to the public. Thus, relatively little is known about the specific emissions from these products. This study investigates the volatile organic compounds (VOCs) emitted from “pandemic products” that are being used frequently and extensively in society. In addition, among these emissions, this study identifies potentially hazardous compounds, compares so-called green and regular versions of products, and examines whether ingredients are disclosed to the public. Using gas chromatography/mass spectrometry, 26 commonly used pandemic products, including 13 regular and 13 so-called green versions, were analyzed for their volatile emissions. Product types included hand sanitizers, air disinfectants, multipurpose cleaners, and handwashing soap. All products were fragranced. The analyses found the products collectively emitted 399 VOCs with 127 VOCs classified as potentially hazardous. All products emitted potentially hazardous compounds. Comparing regular products and green products, no significant difference was found in the emissions of the most prevalent compounds. Further, among the 399 compounds emitted, only 4% of all VOCs and 11% of potentially hazardous VOCs were disclosed on any product label or safety data sheet. This study reveals that pandemic products can generate volatile emissions that could pose risks to health, that could be unrecognized, and that could be reduced, such as by using fragrance-free versions of products.
Background
Intensified cleaning protocols to maintain a safe environment during the pandemic caused an increase in the use of disinfectants. The use of cleaning products in safer conditions by mothers is one of the important practices that will reduce the risk of household accidents.
Objective
The aim of research was determine the practices of mothers about the safe use of cleaning and disinfectant products in the COVID-19.
Methods
Data were collected by online survey among 255 mothers of the children 0-6 age from April and July 2021. Percentage, mean and chi-square tests were used to evaluate the data.
Results
It was reported that the amount of cleaning product usage (69%) increased significantly, 26.3% of the mothers store the products in a locked cabinet and 29.4% use the product in the recommended amount. It was detected 28.7% of the mothers use disinfectants close to children. It was detected that 37.6% of the families were exposed to cleaning and disinfectant products. There was not significant difference between exposure situations and maternal age, education, employment status.
Conclusions
It can be suggested that health workers should organize screening and training programs for the community about safe cleaning and disinfection practices.
Introduction:
Epidemiological studies demonstrated that cleaning work and frequent use of cleaning products are risk factors for asthma. Laundry detergents have been reported to have epithelial barrier-opening effects. However, whether laundry detergents directly induce airway inflammation and its mechanisms in vivo remain to be elucidated.
Methods:
Two commercial laundry detergents and two commonly-used surfactants for cleaning and cosmetics (sodium lauryl sulfate and sodium dodecyl benzene sulfonate) were intranasally administered to mice. Lungs were analyzed using flow cytometry, histology, ELISA, and quantitative PCR. Human bronchial epithelial cells were stimulated with laundry detergents and analyzed using quantitative PCR and western blotting. Involvement of oxidative stress was assessed using an antioxidant. Dust samples from homes were analyzed to determine their detergent content by measuring their critical micelle concentration (CMC).
Results:
The administered laundry detergents and surfactants induced eosinophilic airway inflammation accompanied by increased IL-33 expression and activation of group 2 innate lymphoid cells (ILC2s). Detergent-induced eosinophilic airway inflammation was significantly attenuated in Rag2-/- Il2rg-/- , Il33-/- mice, and also in wild-type mice treated with NAC. Detergent-induced IL-33 expression in airways was attenuated by NAC treatment, both in vivo and in vitro. CMCs were found in all of the tested dust extracts, and they differed significantly among the homes.
Conclusion:
The laundry detergents and surfactants induced eosinophilic airway inflammation in vivo through epithelial cell and ILC2 activation. They induced IL-33 expression in airway epithelial cells through oxidative stress. Furthermore, detergent residues were present in house dust and are presumably inhaled into the airway in daily life.
Background: Asthma is a leading cause of childhood morbidity in the U.S. and a significant public health concern. The prenatal period is a critical window during which environmental influences, including maternal occupational exposures, can shape child respiratory health. Cleaning chemicals are commonly encountered in occupational settings, yet few studies have examined the potential link between prenatal occupational exposures to cleaning chemicals and risk of childhood wheeze and asthma.
Methods: We evaluated the potential influence of maternal occupational exposure to cleaning chemicals during pregnancy on pediatric asthma and wheeze at child age 4–6 years in 453 mother-child pairs from two longitudinal pregnancy cohorts, TIDES and GAPPS, part of the ECHO prenatal and early childhood pathways to health (ECHO-PATHWAYS) consortium. Maternal occupational exposure to cleaning chemicals was defined based on reported occupation and frequency of occupational use of chemicals during pregnancy. Child current wheeze and asthma outcomes were defined by parental responses to a widely-used, standardized respiratory outcomes questionnaire administered at child age 4–6 years. Multivariable Poisson regression with robust standard errors was used to estimate relative risk (RR) of asthma in models adjusted for confounding. Effect modification by child sex was assessed using product interaction terms.
Results: Overall, 116 mothers (25.6%) reported occupational exposure to cleaning chemicals during pregnancy, 11.7% of children had current wheeze, and 10.2% had current asthma. We did not identify associations between prenatal exposure to cleaning chemicals and current wheeze [RRadjusted 1.03, 95% confidence interval (CI): 0.56, 1.90] or current asthma (RRadjusted 0.89, CI: 0.46, 1.74) in the overall sample. Analyses of effect modification suggested an adverse association among females for current wheeze (RR 1.82, CI: 0.76, 4.37), compared to males (RR 0.68, CI: 0.29, 1.58), though the interaction p-value was >0.05.
Conclusion: We did not observe evidence of associations between maternal prenatal occupational exposure to cleaning chemicals and childhood wheeze or asthma in the multi-site ECHO-PATHWAYS consortium. We leveraged longitudinal U.S. pregnancy cohorts with rich data characterization to expand on limited and mixed literature. Ongoing research is needed to more precisely characterize maternal occupational chemical exposures and impacts on child health in larger studies.
Various indoor irritants and allergens may be associated with asthma. Some volatile and semivolatile organic compounds (VOCs and SVOCs) in indoor environments are respiratory irritants that may increase the risk of asthma and respiratory symptoms. Indoor VOCs are originated from multiple sources, including cleaning products. Results of studies focusing on the occupational use of cleaning products provide strong evidence of their adverse respiratory health effects. More recent studies show that domestic use of cleaning products is also a risk factor for asthma and asthma symptoms, not only among active users (adults) but also among children. This chapter summarizes methods for exposure assessment used in epidemiology and provides an overview of the respiratory health effects of nonoccupational exposure to chemicals occurring in indoor environments, focusing on the exposure to VOCs and SVOCs and the domestic use of cleaning products.
The frequency of surface disinfectant use has increased over the last several years in public settings such as schools, especially during the COVID‐19 pandemic. Although these products are important for infection control and prevention, their increased use may intensify the exposure to both persons applying the disinfection product as well as bystanders. Safety assessments have demonstrated that these products, when used as intended, are considered safe for use and effective; however, point‐of‐contact effects (such as respiratory or dermal irritation) may still occur. Additionally, relative exposures may vary significantly due to the wide variation in disinfectant formulation and application methods. Quantitative estimations of exposures to two commonly used active ingredients, quaternary ammonium compounds (QACs) and ethanol, are not well characterized during product use and application scenarios. To assess the potential for health risks attributable to increased use in classroom settings, as well as to quantitatively evaluate the potential exposure to both ethanol and QACs, student and adult bystander surface and air measurements were collected in a K‐8 school setting in Ohio, United States, over a three‐day period. Direct‐reading instruments were utilized to collect real‐time air samples that characterized mass fraction concentrations following the use of the QAC‐ and ethanol‐based disinfectants. Furthermore, surface and air sampling of microbial species were conducted to establish the overall bioburden and effectiveness of each disinfectant to inform the comparative risk and health effect impacts from the tested products use scenario. Both tested products were approximately equally effective at reducing bioburdens on desk surfaces. In some classrooms, concentrations of QAC congeners were significantly increased on desk surfaces following the application of the disinfectant spray; however, the magnitude of the change in concentration was small. Ethanol was not measured on surfaces due to its volatility. Airborne concentrations increased immediately following spray of each disinfectant product but rapidly returned to baseline. Each of the QAC congeners listed in the product safety data sheets were detected and measurable on desk surfaces; however, air concentrations were generally below the limit of detection. The 15‐min time‐weighted averages (TWAs) of both QACs and ethanol in the air were below respective health effects benchmarks, and therefore, the negative impact on health outcomes is considered to be minimal from short‐term, repeated use of ethanol‐ or QAC‐based spray products in a school setting when the products are used as directed.
Background
Modern environmental health research extensively focuses on outdoor air pollutants and their effects on public health. However, research on monitoring and enhancing individual indoor air quality is lacking. The field of exposomics encompasses the totality of human environmental exposures and its effects on health. A subset of this exposome deals with atmospheric exposure, termed the “atmosome.” The atmosome plays a pivotal role in health and has significant effects on DNA, metabolism, skin integrity, and lung health.
Objective
The aim of this work is to develop a low-cost, comprehensive measurement system for collecting and analyzing atmosomic factors. The research explores the significance of the atmosome in personalized and preventive care for public health.
Methods
An internet of things microcontroller-based system is introduced and demonstrated. The system collects real-time indoor air quality data and posts it to the cloud for immediate access.
Results
The experimental results yield air quality measurements with an accuracy of 90% when compared with precalibrated commercial devices and demonstrate a direct correlation between lifestyle and air quality.
Conclusions
Quantifying the individual atmosome is a monumental step in advancing personalized health, medical research, and epidemiological research. The 2 main goals in this work are to present the atmosome as a measurable concept and to demonstrate how to implement it using low-cost electronics. By enabling atmosome measurements at a communal scale, this work also opens up potential new directions for public health research. Researchers will now have the data to model the impact of indoor air pollutants on the health of individuals, communities, and specific demographics, leading to novel approaches for predicting and preventing diseases.
Little is known about the environmental health-related policies and practices of early care and education (ECE) programs that contribute to childhood asthma, particularly in Oklahoma where child asthma rates (9.8%) and rates of uncontrolled asthma among children with asthma (60.0%) surpass national rates (8.1% and 50.3%, respectively). We conducted a cross-sectional survey with directors of Oklahoma-licensed ECE programs to assess policies and practices related to asthma control and to evaluate potential differences between Centers and Family Childcare Homes (FCCHs). Surveyed ECEs (n = 476) included Centers (56.7%), FCCHs (40.6%), and other program types (2.7%). Almost half (47.2%) of directors reported never receiving any asthma training. More Center directors were asthma-trained than FCCH directors (61.0% versus 42.0%, p < 0.0001). Most ECEs used asthma triggers, including bleach (88.5%) and air fresheners (73.6%). Centers were more likely to use bleach daily than were FCCHs (75.6% versus 66.8%, p = 0.04). FCCHs used air fresheners more than did Centers (79.0% versus 61.0%, p < 0.0001). The majority of ECEs (74.8%) used pesticides indoors. Centers applied indoor pesticides more frequently (i.e., monthly or more often) than did FCCHs (86.0% versus 58.0%, p < 0.0001). Policy, educational, and technical assistance interventions are needed to reduce asthma triggers and improve asthma control in Oklahoma ECEs.
We investigated the association between exposure to 29 organophosphate esters (OPEs) and the onset of childhood asthma and recurrent wheeze. Using a case-cohort design nested in the Canadian CHILD Cohort Study, we included a random sample of children (n = 429), all children with asthma at 5 years (n = 128), and all children with recurrent wheeze between 2 and 5 years (n = 331). The association between 14 highly detected OPEs measured in house dust vacuumed when children were 3–4 months of age, including the child’s sleeping environment, and asthma at 5 years and recurrent wheeze between 2 and 5 years was assessed using logistic regression. The most abundant OPEs were TBOEP (median: 45730 ng/g) ≫ TCiPP (6065 ng/g) > TCEP (5260 ng/g) > TPhP (4440 ng/g) > EHDPP (1750 ng/g). Concentrations were higher than those in most other studies worldwide, potentially due to the inclusion of dust from the child’s sleeping area. A 2–4-fold increased odds of asthma was observed across all quartiles of exposure to TBOEP compared to the lowest quartile, including a positive dose–response relationship. Inverse relationships (p < 0.05) were observed with the odds of asthma and recurrent wheeze for 24DiPPDPP, B4tBPPP, tri-m-cresyl phosphate (TmCP), and EHDPP, and between 4tBPDPP and odds of asthma.
Objective
To present an update of birth cohort study designs and their contributions to allergic risk.
Data Sources
The PubMed database was used to search for relevant articles.
Study
Selections Peer-reviewed prospective and retrospective studies involving the assessment of allergy using human birth cohorts between 2014-2021 were examined.
Results
Parental history of allergic diseases, especially in cases involving both parents, is associated with increased risk of allergy. Exposure to prenatal and postnatal smoking and limited diet diversity were associated with increased allergic burden. The impact of early life infections and antibiotics on disease development may be associated with the onset of asthma, though this remains debated. Cohort studies also revealed that the mode of delivery and breastfeeding duration impacts the odds ratio of asthma and eczema development. Household exposures, including pets, house dust mites, and scented aeroallergens may confer protective effects, while high air pollution exposure and low socioeconomic status may be risk-enhancing. Exposure to antibiotics during early-life may be associated with increased asthma risk while viral infections may lead to disease protection, though the impact of the coronavirus disease 2019 (COVID-19) pandemic on allergic risk is yet to be understood.
Conclusion
While assessing risk of allergic disease development is complex, clinicians can apply these insights on the multi-factorial nature of atopy to better understand and potentially mitigate disease development.
The immune system requires data inputs, especially in early life. A lack of these inputs contributes to increases in immunoregulatory disorders such as those in which the immune system attacks inappropriate targets (harmless allergens, self-components, or gut contents) or fails to switch off unnecessary background inflammation (resulting in chronically raised biomarkers of inflammation, and cardiovascular, metabolic, and psychiatric disorders). We can use an evolutionary approach to identify inputs that the immune systems of evolving humans inevitably received, because these are the inputs on which we may be in a state of “evolved dependence”. The maternal microbiota is clearly one major source of data for the developing immune system, and we now understand that caesarean deliveries, lack of breastfeeding, unvaried diets, and misuse of antibiotics are distorting mother-to-child transmission of the microbiota. However, the main focus of this essay is the crucial role of inputs from the natural environment, which have received much less attention despite the fact that epidemiology reveals strong health benefits of contact with nature. These inputs from nature, received via the airways, gut, and skin, provide crucial signals that set up immunoregulatory circuits. The natural environment also provides other inputs including epitopes to guide retention and expansion of useful lymphocyte clones, information about the microbiota of the environment into which the individual is born, signals that drive background activation of the innate immune system, spores of gut-adapted strains that can replace those lost because of antibiotics or poor diet, bacteriophages that modulate the microbiota, and DNA via horizontal gene transfer that increases metabolic flexibility of the gut microbiota. By analysing these microbial inputs and their mechanisms of action, while also identifying the lifestyle changes that are disrupting them, we can expect to discover novel prophylactic and therapeutic strategies.
Public health measures necessary to counteract the coronavirus disease 2019 (COVID-19) pandemic have resulted in dramatic changes in the physical and social environments within which children grow and develop. As our understanding of the pathways for viral exposure and associated health outcomes in children evolves, it is critical to consider how changes in the social, cultural, economic, and physical environments resulting from the pandemic could affect the development of children. This review article considers the environments and settings that create the backdrop for children's health in the United States during the COVID-19 pandemic, including current threats to child development that stem from: A) change in exposures to environmental contaminants such as heavy metals, pesticides, disinfectants, air pollution and the built environment; B) changes in food environments resulting from adverse economic repercussion of the pandemic and limited reach of existing safety nets; C) limited access to children's educational and developmental resources; D) changes in the social environments at the individual and household levels, and their interplay with family stressors and mental health; E) social injustice and racism. The environmental changes due to COVID-19 are overlaid onto existing environmental and social disparities. This results in disproportionate effects among children in low-income settings and among populations experiencing the effects of structural racism. This article draws attention to many environments that should be considered in current and future policy responses to protect children's health amid pandemics.
Introduction: Occupational use of cleaning chemicals has been related to asthma in adults. However, little information is available on the effect of non-occupational use of cleaning products during pregnancy on childhood asthma. This study examines the association between prenatal exposure to cleaning and scented products with childhood asthma, asthma symptoms, and mental and developmental comorbidities among low-income families in Karachi, Pakistan.
Methods: Four hundred children from the Koohi Goth Women’s Hospital were included in the study. Parents’ or guardians reported current asthma, asthma-related symptoms, mental health problems, and behavioral problems among the children. Multivariable logistic regression analysis was used to examine the association between the use of cleaning and scented products during pregnancy and seven different outcome variables.
Results: The odds of nocturnal cough were significantly elevated among children whose mothers reported the use of cleaning products (OR: 2.23, 95% CI: 1.15–4.31) or scented products (OR: 2.15, 95% CI: 1.22–3.77) during pregnancy. Mental health comorbidities were threefold elevated (OR: 3.05, 95% CI: 1.74–5.35) among children whose mothers reported using scented products during pregnancy. There was no statistically significant association of the prenatal use of cleaning or scented products with current asthma status or nocturnal symptoms of wheezing, shortness of breath, and chest tightness among children.
Conclusions: The study results indicate prenatal exposure to cleaning and scented products is associated with nocturnal cough among children. The study also suggests an association between prenatal use of scented products and mental health comorbidities among children.
Gut microbial diversity changes throughout the human life span and is known to be associated with host sex. We investigated the association of age, sex, and gut bacterial alpha diversity in three large cohorts of adults from four geographical regions: subjects from the United States and United Kingdom in the Amer-ican Gut Project (AGP) citizen-science initiative and two independent cohorts of Co-lombians and Chinese. In three of the four cohorts, we observed a strong positive association between age and alpha diversity in young adults that plateaued after age 40 years. We also found sex-dependent differences that were more pronounced in younger adults than in middle-aged adults, with women having higher alpha diversity than men. In contrast to the other three cohorts, no association of alpha diversity with age or sex was observed in the Chinese cohort. The association of alpha diversity with age and sex remained after adjusting for cardiometabolic parameters in the Colombian cohort and antibiotic usage in the AGP cohort. We further attempted to predict the microbiota age in individuals using a machine-learning approach for the men and women in each cohort. Consistent with our alpha-diversity-based findings, U.S. and U.K. women had a significantly higher predicted microbiota age than men, with a reduced difference being seen above age 40 years. This difference was not observed in the Colombian cohort and was observed only in middle-aged Chinese adults. Together, our results provide new insights into the influence of age and sex on the biodiversity of the human gut microbiota during adulthood while highlighting similarities and differences across diverse cohorts.
Humans carry numerous symbiotic microorganisms in their body, most of which are present in the gut. Although recent technological advances have produced extensive research data on gut microbiota, there are various confounding factors (e.g., diet, race, medications) to consider. Sex is one of the important variables affecting the gut microbiota, but the association has not yet been sufficiently investigated. Although the results are inconsistent, several animal and human studies have shown sex differences in gut microbiota. Herein, we review these studies to discuss the sex-dependent differences as well as the possible mechanisms involved.
There is good evidence for gender-specific differences in asthma regarding all affected areas, from intra- to extra-cellular mediators to the whole organ structure und functioning of the lung. These result from complex, in parts synergistic, in other parts opposing, effects — especially of female sex hormones, and rather protective effects of male hormones against asthma, which include effects on the cellular immune system. Additionally, there are gender differences of sociocultural origin, regarding presentation, doctor’s diagnosis and treatment of asthma symptoms, as well as the undertaken coping strategies concerning the female or male patient’s complaints. Taking into account gender-specific differences in asthma would contribute to improved individual diagnosis and therapies.
Objectives:
We scrutinised the association of private use of household sprays and disinfectants with asthma incidence in young adults in the transition from school to working life.
Methods:
Between 2007 and 2009,2051 young adults aged 19-24 years living in two major German cities took part in the Study on Occupational Allergy Risks II. Self-reported exposure to household sprays and disinfectants was characterised according to a composite score for frequency of use as no use (score=0), low use (score between 1 and the median), medium use (score between the median and the 90th percentile) and high use (score above the 90th percentile). Two outcome variables (current asthma and current wheezing) with four mutually exclusive categories (never, incident, persistent and remittent) were used for the risk analyses. Multinomial logistic regression models examined the association between the frequency of using household sprays and disinfectants with asthma and wheezing adjusting for potential confounders.
Results:
Compared with no use, high use of disinfectants was associated with a more than twofold increased odds of incident asthma (OR 2.79, 95% CI 1.14 to 6.83). In addition, low/medium use of disinfectants was associated with remittent asthma (OR 2.39, 95% CI 1.29 to 4.47). The evidence for an association between high usage of household sprays and asthma incidence was weak (OR 2.79, 95% CI 0.84 to 9.20).
Conclusion:
Our results support the hypothesis of an association between the use of cleaning products and elevated risks for asthma and wheezing in young adults at the start of working life.
In recent years, the bidirectional communication between the gut microbiome and the brain has emerged as a factor that influences immunity, metabolism, neurodevelopment and behaviour. Cross-talk between the gut and brain begins early in life immediately following the transition from a sterile in utero environment to one that is exposed to a changing and complex microbial milieu over a lifetime. Once established, communication between the gut and brain integrates information from the autonomic and enteric nervous systems, neuroendocrine and neuroimmune signals, and peripheral immune and metabolic signals. Importantly, the composition and functional potential of the gut microbiome undergoes many transitions that parallel dynamic periods of brain development and maturation for which distinct sex differences have been identified. Here, we discuss the sexually dimorphic development, maturation and maintenance of the gut microbiome–brain axis, and the sex differences therein important in disease risk and resilience throughout the lifespan.
The Canadian Healthy Infant Longitudinal Development birth cohort was designed to elucidate interactions between environment and genetics underlying development of asthma and allergy. Over 3600 pregnant mothers were recruited from the general population in four provinces with diverse environments. The child is followed to age 5 years, with prospective characterization of diverse exposures during this critical period. Key exposure domains include indoor and outdoor air pollutants, inhalation, ingestion and dermal uptake of chemicals, mold, dampness, biological allergens, pets and pests, housing structure, and living behavior, together with infections, nutrition, psychosocial environment, and medications. Assessments of early life exposures are focused on those linked to inflammatory responses driven by the acquired and innate immune systems. Mothers complete extensive environmental questionnaires including time-activity behavior at recruitment and when the child is 3, 6, 12, 24, 30, 36, 48, and 60 months old. House dust collected during a thorough home assessment at 3-4 months, and biological specimens obtained for multiple exposure-related measurements, are archived for analyses. Geo-locations of homes and daycares and land-use regression for estimating traffic-related air pollution complement time-activity-behavior data to provide comprehensive individual exposure profiles. Several analytical frameworks are proposed to address the many interacting exposure variables and potential issues of co-linearity in this complex data set.Journal of Exposure Science and Environmental Epidemiology advance online publication, 25 March 2015; doi:10.1038/jes.2015.7.
The hygiene hypothesis stipulates that microbial exposure during early life induces immunologic tolerance via immune stimulation, and hence reduces the risk of allergy development. Several common lifestyle factors and household practices, such as dishwashing methods, may increase microbial exposure. The aim of this study was to investigate if such lifestyle factors are associated with allergy prevalence.
Questionnaire-based study of 1029 children aged 7 to 8 years from Kiruna, in the north of Sweden, and Mölndal, in the Gothenburg area on the southwest coast of Sweden. Questions on asthma, eczema, and rhinoconjunctivitis were taken from the International Study of Asthma and Allergies in Childhood questionnaire.
Hand dishwashing was associated with a reduced risk of allergic disease development (multivariate analysis, odds ratio 0.57; 95% confidence interval: 0.37-0.85). The risk was further reduced in a dose-response pattern if the children were also served fermented food and if the family bought food directly from farms.
In families who use hand dishwashing, allergic diseases in children are less common than in children from families who use machine dishwashing. We speculate that a less-efficient dishwashing method may induce tolerance via increased microbial exposure.
Copyright © 2015 by the American Academy of Pediatrics.
Professional and domestic cleaning is associated with work-related asthma (WRA). This position paper reviews the literature linking exposure to cleaning products and the risk of asthma and focuses on prevention. Increased risk of asthma has been shown in many epidemiological and surveillance studies, and several case reports describe the relationship between exposure to one or more cleaning agents and WRA. Cleaning sprays, bleach, ammonia, disinfectants, mixing products, and specific job tasks have been identified as specific causes and/or triggers of asthma. Because research conclusions and policy suggestions have remained unheeded by manufactures, vendors, and commercial cleaning companies, it is time for a multifaceted intervention. Possible preventive measures encompass the following: substitution of cleaning sprays, bleach, and ammonia; minimizing the use of disinfectants; avoidance of mixing products; use of respiratory protective devices; and worker education. Moreover, we suggest the education of unions, consumer, and public interest groups to encourage safer products. In addition, information activities for the general population with the purpose of improving the knowledge of professional and domestic cleaners regarding risks and available preventive measures and to promote strict collaboration between scientific communities and safety and health agencies are urgently needed.
Background
The risk of indoor exposure to volatile organic compounds (VOCs) on allergic airway diseases in children remains unknown.
Objective
We examined the residential concentrations of VOCs, emitted from building materials, paints, furniture, and other lifestyle practices and the risks of multiple allergic diseases as well as the IgE-sensitization in pre-school age children in Sweden.
Methods
In a case-control investigation (198 case children with asthma and allergy and 202 healthy controls), air samples were collected in the room where the child slept. The air samples were analyzed for the levels of eight classes of VOCs.
Results
A natural-log unit of summed propylene glycol and glycol ethers (PGEs) in bedroom air (equal to interquartile range, or 3.43 – 15.65 µg/m3) was associated with 1.5-fold greater likelihood of being a case (95% CI, 1.1 – 2.1), 1.5-fold greater likelihood of asthma (95% CI, 1.0 – 2.3), 2.8-fold greater likelihood of rhinitis (95% CI, 1.6 – 4.7), and 1.6-fold greater likelihood of eczema (95% CI, 1.1 – 2.3), accounting for gender, secondhand smoke, allergies in both parents, wet cleaning with chemical agents, construction period of the building, limonene, cat and dog allergens, butyl benzyl phthalate (BBzP), and di(2-ethylhexyl)phthalate (DEHP). When the analysis was restricted to the cases, the same unit concentration was associated with 1.8-fold greater likelihood of IgE-sensitization (95% CI, 1.1 – 2.8) compared to the non-IgE sensitized cases. No similar associations were found for the other classes of VOCs.
Conclusion
We propose a novel hypothesis that PGEs in indoor air exacerbate and/or induce the multiple allergic symptoms, asthma, rhinitis and eczema, as well as IgE sensitization respectively.
Although cleaners represent a significant part of the working population worldwide, they remain a relatively understudied occupational group. Epidemiological studies have shown an association between cleaning work and asthma, but the risk factors are uncertain. Cleaning workers are exposed to a large variety of cleaning products containing both irritants and sensitizers, as well as to common indoor allergens and pollutants. Thus, the onset or aggravation of asthma in this group could be related to an irritant-induced mechanism or to specific sensitization. The main sensitizers contained in cleaning products are disinfectants, quaternary ammonium compounds (such as benzalkonium chloride), amine compounds, and fragrances.The strongest airway irritants in cleaning products are bleach (sodium hypochlorite), hydrochloric acid, and alkaline agents (ammonia and sodium hydroxide), which are commonly mixed together. Exposure to the ingredients of cleaning products may give rise to both new-onset asthma, with or without a latency period, and work-exacerbated asthma. High-level exposure to irritants may induce reactive airways dysfunction syndrome. Cleaning workers may also have a greater relative risk of developing asthma due to prolonged low-to-moderate exposure to respiratory irritants. In addition, asthma-like symptoms without confirmed asthma are also common after exposure to cleaning agents. In many cleaners, airway symptoms induced by chemicals and odors cannot be explained by allergic or asthmatic reactions. These patients may have increased sensitivity to inhaled capsaicin, which is known to reflect sensory reactivity, and this condition is termed airway sensory hyperreactivity.
The number of female smokers developing chronic obstructive pulmonary disease (COPD) is rapidly increasing, but whether or not there exists a differential susceptibility by gender remains controversial.
How smoking behaviour and subsequent lung function reduction differed by gender was examined in a study including 954 subjects with COPD and 955 subjects without COPD. The study focused on two subgroups: subjects with COPD <60 years of age (early-onset group, n=316) and subjects with COPD with <20 pack-years of smoking (low exposure group, n=241).
In the low exposure group, female subjects with COPD had lower forced expiratory volume in 1 s (FEV(1)) % predicted (48.7% vs 55.8%, p=0.001) and more severe disease (50.4% vs 35.6%, p=0.020, in GOLD (Global Initiative for Chronic Obstructive Lung Disease) stage 3 and 4) than male subjects with COPD. Females also had lower FEV(1)% predicted (50.6% vs 56.0%, p=0.006) and more severe COPD (41.7% vs 31.1% in GOLD stage 3 and 4, p=0.050) in the early-onset group. Using multivariate regression, female gender was associated with 5.7% lower FEV(1)% predicted in the low exposure group (p=0.012) and a similar trend was observed in the early-onset group (p=0.057). The number of pack-years was not significantly associated with lung function in female subjects with COPD in this study, and the dose-response relationship between smoking and lung function differed by gender at lower levels of smoking exposure. Interaction analysis suggested that the effect of smoking on lung function might be different by gender (p=0.027 in all subjects with COPD).
Female gender was associated with lung function reduction and more severe disease in subjects with COPD with early onset of disease or low smoking exposure. The findings may suggest a gender difference in susceptibility to the lung-damaging effects of cigarette smoking, but alternative explanations should be considered.
Household cleaning products often contain potential allergens and irritants but allergic contact dermatitis from these products in general consumers is rarely reported in the literature.
The purpose of this study was to evaluate the presence of irritants and allergens as indicated on the labels or on the product information found on the website of household cleaning products marketed in Italy.
We examined the labels and the product information of 291 liquid household washing and cleaning products, including 43 washing-up liquids, 63 laundry detergents, 61 fabric conditioners, 47 spray detergents, and 77 hard surface cleaning products. We obtained the data from the product information found on the websites for 263 products and directly on the product packages for 28 products. For each product we specifically recorded the presence of surfactants, preservatives, and fragrances listed in Annex III of Directive 76/768/EEC.
The websites of two Italian brands do not respect EU regulations as they provide product information only with bar codes of the products. Preservatives and fragrances are the main allergens declared in the label of household cleaning products with methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) listed in 35.7% and limonene in 43.6% of the products. Surfactants were listed in 16.5% of the studied products.
Our study shows that household cleaning products in Italian market contain several allergens, particularly preservatives and fragrances. For consumers, at least in Italy, it may not be easy to retrieve product information from the website for two widely sold brands. The information had to be taken from the actual package.
There is a paucity of detailed longitudinal data on wheeze in early childhood. Not all children who wheeze in early infancy will continue to wheeze into childhood and beyond. This study aims to investigate possible risk factors for different patterns of wheeze in the pre-school years.
Study participants were part of the Avon Longitudinal Study of Parents and Children (ALSPAC). Maternal reports of child wheeze between birth and 6 months and again between 30 and 42 months were gathered prospectively. Children were categorized into early wheeze, persistent wheeze or late onset wheeze. A large number of risk factors were assessed for each wheezing phenotype using multivariable logistic regression models.
Over 70% of children who wheezed in the first 6 months did not wheeze 3 years later. Wheezing between 0-6 months was independently associated with the presence of older siblings, male sex, delivery between April and December, bottle feeding, young maternal age, prenatal tobacco smoke exposure, atopy and parental history of asthma. From within this group of early wheezers, risk factors for wheeze that persisted beyond 6 months included pre-term delivery, young maternal age, living in rented local authority housing, atopy and a maternal (not paternal) history of asthma. Atopy and a family history of asthma emerged as the main predictors of wheeze that developed after 6 months of age.
It is clear that a number of wheezing syndromes exist by 3(1/2) years, albeit with some degree of overlap. Detailed follow-up of this cohort is underway to determine whether risk factor associations determined in the first 3(1/2) years have long-term significance for the clinical entity termed 'asthma'.
In the UK and other developed countries the prevalence of asthma symptoms has increased in recent years. This is likely to be the result of increased exposure to environmental factors. A study was undertaken to investigate the association between maternal use of chemical based products in the prenatal period and patterns of wheeze in early childhood.
In the population based Avon Longitudinal Study of Parents and Children (ALSPAC), the frequency of use of 11 chemical based domestic products was determined from questionnaires completed by women during pregnancy and a total chemical burden (TCB) score was derived. Four mutually exclusive wheezing patterns were defined for the period from birth to 42 months based on parental questionnaire responses (never wheezed, transient early wheeze, persistent wheeze, and late onset wheeze). Multinomial logistic regression models were used to assess the relationship between these wheezing outcomes and TCB exposure while accounting for numerous potential confounding variables. Complete data for analysis was available for 7019 of 13, 971 (50%) children.
The mean (SD) TCB score was 9.4 (4.1), range 0-30. Increased use of domestic chemical based products was associated with persistent wheezing during early childhood (adjusted odds ratio (OR) per unit increase of TCB 1.06 (95% confidence interval (CI) 1.03 to 1.09)) but not with transient early wheeze or late onset wheeze. Children whose mothers had high TCB scores (>90th centile) were more than twice as likely to wheeze persistently throughout early childhood than children whose mothers had a low TCB score (<10th centile) (adjusted OR 2.3 (95% CI 1.2 to 4.4)).
These findings suggest that frequent use of chemical based products in the prenatal period is associated with persistent wheezing in young children. Follow up of this cohort is underway to determine whether TCB is associated with wheezing, asthma, and atopy at later stages in childhood.
There is scant information pertaining to airborne ammonia exposures from either spills or common household uses of ammonia-containing floor and tile cleaners or from spray-on glass cleaners. We assessed instantaneous and event-specific time-weighted average (TWA) exposures to airborne ammonia during spills and use (per label directions) of a household floor and tile cleaner and two spray-on window cleaners. Airborne ammonia levels measured at breathing zone height (BZH) above the spilled floor and tile cleaner product reached 500 p.p.m. within 5 min, while levels for spilled window cleaner were below 8 p.p.m. TWA exposures were assessed while tile walls and floors were cleaned in three different bathrooms of a residence, and during use of a spray-on glass cleaner while washing several large windows in an office setting. NIOSH Method 6015 was utilized with concurrent field measurements every 60 s using a Drager PAC III monitor with an electrochemical cell detector. Peak ammonia levels ranged from 16 to 28 p.p.m. and short-term TWA concentrations ranged from 9.4 to 13 p.p.m. during mixing (0.1% ammonia) and cleaning tiles in the three bathrooms. Ammonia exposures while using spray-on window cleaner were over 10-fold lower (TWA=0.65 p.p.m.). Use of the floor and tile cleaner mixed at 0.2% ammonia led to peak airborne ammonia levels within 3-5 min at 36-90 p.p.m., and use of full strength cleaner (3% ammonia) led to peak ammonia levels of 125 to >200 p.p.m. within 2-3 min. Spillage or intentional use of the full strength floor and tile cleaner led to airborne ammonia concentrations that exceed occupational short-term exposure limits, while spillage or use of the spray-on window cleaner did not approach potentially hazardous airborne ammonia levels and likely represents a minimal inhalation health hazard. We conclude that routine household uses of ammonia are unlikely to produce significant exposures when using standard cleaning solutions (0.1-0.2%), but spillage or use of concentrated ammonia solutions (e.g., 3%) in poorly ventilated areas can lead to potentially hazardous airborne ammonia exposures.
The authors have previously reported an increased prevalence of asthma in Estevan, Saskatchewan (21.4%) compared with Swift Current, Saskatchewan (16.2%).
To determine the association between asthma and personal and indoor environmental risk factors in these communities.
A population-based cross-sectional study was conducted in January 2000. A questionnaire was distributed to school children in grades 1 to 6 for completion by a parent. Multivariate logistic regression was used to examine associations between various risk factors and physician-diagnosed asthma.
Asthma was associated with respiratory allergy (adjusted OR [adjOR]=8.85, 95% CI 6.79 to 11.54), early respiratory illness (adjOR=2.81, 95% CI 1.96 to 4.03) and family history of asthma (adjOR=2.37, 95% CI 1.67 to 3.36). Several environmental factors varied with asthma by town. In Estevan, asthma was associated with home mould or dampness (adjOR=1.82, 95% CI 1.23 to 2.69) and was inversely associated with air conditioning (adjOR=0.56, 95% CI 0.37 to 0.85). The risk of asthma was increased if the child had previous exposure to environmental tobacco smoke from the mother in both communities (Swift Current: OR=1.87, 95% CI 1.06 to 3.30; Estevan: OR=2.00, 95% CI 1.17 to 3.43), and there was an inverse association with current exposure to environmental tobacco smoke from the mother in Estevan (OR=0.64, 95% CI 0.40 to 1.00). When multivariate analyses were stratified by sex, the relationship between home mould or dampness and asthma was most prominent in girls in Estevan.
Despite a similar regional location, different risk factors for asthma were identified in each community. Local environmental factors are important to consider when interpreting findings and planning asthma care.
Cleaning work and professional use of certain cleaning products have been associated with asthma, but respiratory effects of nonprofessional home cleaning have rarely been studied.
To investigate the risk of new-onset asthma in relation to the use of common household cleaners.
Within the follow-up of the European Community Respiratory Health Survey in 10 countries, we identified 3,503 persons doing the cleaning in their homes and who were free of asthma at baseline. Frequency of use of 15 types of cleaning products was obtained in a face-to-face interview at follow-up. We studied the incidence of asthma defined as physician diagnosis and as symptoms or medication usage at follow-up. Associations between asthma and the use of cleaning products were evaluated using multivariable Cox proportional hazards or log-binomial regression analysis.
The use of cleaning sprays at least weekly (42% of participants) was associated with the incidence of asthma symptoms or medication (relative risk [RR], 1.49; 95% confidence interval [CI], 1.12-1.99) and wheeze (RR, 1.39; 95% CI, 1.06-1.80). The incidence of physician-diagnosed asthma was higher among those using sprays at least 4 days per week (RR, 2.11; 95% CI, 1.15-3.89). These associations were consistent for subgroups and not modified by atopy. Dose-response relationships (P < 0.05) were apparent for the frequency of use and the number of different sprays. Risks were predominantly found for the commonly used glass-cleaning, furniture, and air-refreshing sprays. Cleaning products not applied in spray form were not associated with asthma.
Frequent use of common household cleaning sprays may be an important risk factor for adult asthma.
The aims of the present study were to assess the effects of maternal use of domestic chemicals during pregnancy on wheezing and lung function in children aged ≤8.5 yrs and to explore the potential modifying effect of atopy.
In the Avon Longitudinal Study of Parents and Children, a cohort study, a maternal composite household chemical exposure (CHCE) score was derived. Wheezing phenotypes from birth to age 7 yrs were assigned on the basis of reported wheeze. Lung function (forced expiratory volume in one second (FEV 1 ), forced vital capacity (FVC), forced midexpiratory flow between 25 and 75% of FVC (FEF 25–75% )) was measured at age 8.5 yrs; and atopy by skin-prick tests at age 7.5 yrs. Multinomial logistic and linear regression models assessed the relationship between wheezing outcomes, lung function and CHCE score, and interactions with atopy.
Increased CHCE score was associated with early- (<18 months) and intermediate- (18–30 months) persistent and late-onset (>30 months) wheezing in nonatopic children (adjusted odds ratio per z-score of CHCE (95% confidence interval) 1.41 (1.13–1.76), 1.43 (1.02–2.13) and 1.69 (1.19–2.41), respectively). Increasing CHCE score was associated with decrements in FEV 1 and FEF 25–75% .
Higher domestic chemical exposure during pregnancy was associated with persistent wheeze and lung function abnormalities in nonatopic children. This may result from pre-natal developmental effects or post-natal irritant effects on the developing airway, but is unlikely to be mediated through increased hygiene in the home.
There is growing evidence that events occurring early in life, both before and after birth, are significantly associated with the risk of asthma, chronic obstructive pulmonary disease, and diminished lung function later in life. In fact, from conception to death, a series of continuous, dynamic gene-environment interactions determine 2 fundamental biological processes, namely, lung development and lung aging. Over 130 birth cohorts have been initiated in the last 30 years. Data from these cohorts have improved our understanding of the inception, progression, and persistency of asthma. In this review, we summarize the main data for the early life events proven to determine later development and persistence of asthma, such as maternal atopy and smoking, preterm birth/bronchopulmonary dysplasia, infections, nutrition, obesity, smoking, and other environmental exposures in childhood and adolescence. While some of these factors are obviously impossible to prevent or eliminate, others have been proven to have a protective role, and current research is aimed optimizing them. Available prophylactic measures are also reviewed. In the case of environmental pollution, large scale political interventions successfully managed to decrease contamination levels, leading to improved lung function and lower asthma prevalence in the respective geographical areas. Future research should focus on better understanding these complex interactions in order to develop and enhance effective preventive therapeutic measures.
Background:
Emerging links between household cleaning products and childhood overweight may involve the gut microbiome. We determined mediating effects of infant gut microbiota on associations between home use of cleaning products and future overweight.
Methods:
From the Canadian Healthy Infant Longitudinal Development (CHILD) birth cohort, we tested associations between maternal report of cleaning product use and overweight at age 3, and whether associations were mediated by microbial profiles of fecal samples in 3- to 4-month-old infants.
Results:
Among 757 infants, the abundance of specific gut microbiota was associated with household cleaning with disinfectants and eco-friendly products in a dose-dependent manner. With more frequent use of disinfectants, Lachnospiraceae increasingly became more abundant (highest v. lowest quintile of use: adjusted odds ratio [AOR] 1.93, 95% confidence interval [CI] 1.08 to 3.45) while genus Haemophilus declined in abundance (highest v. lowest quintile of use: AOR 0.36, 95% CI 0.20 to 0.65). Enterobacteriaceae were successively depleted with greater use of eco-friendly products (AOR 0.45, 95% CI 0.27 to 0.74). Lachnospiraceae abundance significantly mediated associations of the top 30th centile of household disinfectant use with higher body mass index (BMI) z score (p = 0.02) and with increased odds of overweight or obesity (p = 0.04) at age 3. Use of eco-friendly products was associated with decreased odds of overweight or obesity independently of Enterobacteriaceae abundance (AOR 0.44, 95% CI 0.22 to 0.86), with no significant mediation (p = 0.2).
Interpretation:
Exposure to household disinfectants was associated with higher BMI at age 3, mediated by gut microbial composition at age 3-4 months. Although child overweight was less common in households that cleaned with eco-friendly products, the lack of mediation by infant gut microbiota suggests another pathway for this association.
Rationale:
Cleaning tasks may imply exposure to chemical agents with potential harmful effects to the respiratory system, and increased risk of asthma and respiratory symptoms among professional cleaners and in persons cleaning at home has been reported. The long-term consequences of cleaning agents on respiratory health are, however, not well described.
Objectives:
This paper aims to investigate long-term effects of occupational cleaning and cleaning at home on lung function decline and chronic airway obstruction.
Methods:
The ECRHS study has investigated a multi-centre population based cohort at three time points over twenty years. 6230 participants with at least one lung function measurements from 22 study centres, who in ECRHS II responded to questionnaire modules concerning cleaning activities between ECRHS I and ECRHS II were included. The data were analysed with mixed linear models adjusting for potential confounders.
Main results:
As compared to women not engaged in cleaning (FEV1=-18.5 ml/year), FEV1 declined more rapidly in women responsible for cleaning at home (-22.1, p=0.01) and occupational cleaners (-22.4, p=0.03). The same was found for decline in FVC (FVC-=8.8 ml/year; -13.1, p=0.02 and -15.9, p=0.002, respectively). Both cleaning sprays and other cleaning agents were associated with accelerated FEV1 decline (-22.0, p=0.04 and -22.9, p=0.004, respectively). Cleaning was not significantly associated with lung function decline in men or with chronic airway obstruction.
Conclusions:
Women cleaning at home or working as occupational cleaners had accelerated decline in lung function, suggesting that exposures related to cleaning activities may constitute a risk to long-term respiratory health.
Background:
The atopic march describes the progression from atopic dermatitis during infancy to asthma and allergic rhinitis in later childhood. In a Canadian birth cohort we investigated whether concomitant allergic sensitization enhances subsequent development of these allergic diseases at age 3 years.
Methods:
Children completed skin prick testing at age 1 year. Children were considered sensitized if they produced a wheal 2 mm or larger than that elicited by the negative control to any of 10 inhalant or food allergens. Children were also assessed for atopic dermatitis by using the diagnostic criteria of the UK Working Party. At age 3 years, children were assessed for asthma, allergic rhinitis, food allergy, and atopic dermatitis. Data from 2311 children were available.
Results:
Atopic dermatitis without allergic sensitization was not associated with an increased risk of asthma at age 3 years after adjusting for common confounders (relative risk [RR], 0.46; 95% CI, 0.11-1.93). Conversely, atopic dermatitis with allergic sensitization increased the risk of asthma more than 7-fold (RR, 7.04; 95% CI, 4.13-11.99). Atopic dermatitis and allergic sensitization had significant interactions on both the additive (relative excess risk due to interaction, 5.06; 95% CI, 1.33-11.04) and multiplicative (ratio of RRs, 5.80; 95% CI, 1.20-27.83) scales in association with asthma risk. There was also a positive additive interaction between atopic dermatitis and allergic sensitization in their effects on food allergy risk (relative excess risk due to interaction, 15.11; 95% CI, 4.19-35.36).
Conclusions:
Atopic dermatitis without concomitant allergic sensitization was not associated with an increased risk of asthma. In combination, atopic dermatitis and allergic sensitization had strong interactive effects on both asthma and food allergy risk at age 3 years.
To the best of our knowledge, this study represents the first observation of multi-day persistence of an indoor aerosol transformation linked to a kitchen degreaser containing mono-ethanol amine (MEA). MEA remaining on the cleaned surfaces and on a wiping paper towel in a trash can was able to transform ammonium sulfate and ammonium nitrate into (MEA)2SO4 and (MEA)NO3. This influence persisted for at least 60 hours despite a high average ventilation rate. The influence was observed using both offline (filters, impactors, and ion chromatography analysis) and online (compact time-of-flight aerosol mass spectrometer) techniques. Substitution of ammonia in ammonium salts was observed not only in aerosol but also in particles deposited on a filter before the release of MEA. The similar influence of other amines is expected based on literature data. This influence represents a new pathway for MEA exposure of people in an indoor environment. The stabilizing effect on indoor nitrate also causes higher indoor exposure to fine nitrates.
Indoor Environmental Quality (IEQ) and its effect on occupant well-being and comfort is an important area of study. This paper presents a state of the art study through extensive review of the literature, by establishing links between IEQs and occupant well-being and comfort. A range of issues such as sick building syndrome, indoor air quality thermal comfort, visual comfort and acoustic comfort are considered in this paper. The complexity of the relationship between occupant comfort and well-being parameters with IEQ are further exacerbated due to relationships that these parameters have with each other as well. Based on the review of literature in these areas it is established that design of buildings needs to consider occupant well-being parameters right at the beginning. Some good practices in all these different areas have also been highlighted and documented in this paper. The knowledge established as part of this paper would be helpful for researchers, designer, engineers and facilities maintenance engineers. This paper will also be of great benefit to researchers who endeavour to undertake research in this area and could act as a good starting point for them.
Rationale Cleaning work and professional use of certain cleaning products have been associated with asthma, but respiratory effects of nonprofessional home cleaning have rarely been studied. Objectives: To investigate the risk of new-onset asthma in relation to the use of common household cleaners. Methods: Within the follow-up of the European Community Respiratory Health Survey in 10 countries, we identified 3,503 persons doing the cleaning in their homes and who were free of asthma at baseline. Frequency of use of 15 types of cleaning products was obtained in a face-to-face interview at follow-up. We studied the incidence of asthma defined as physician diagnosis and as symptoms or medication usage at follow-up. Associations between asthma and the use of cleaning products were evaluated using multivariable Cox proportional hazards or log-binomial regression analysis. Measurements and Main Results: The use of cleaning sprays at least weekly (42 70 of participants) was associated with the incidence of asthma symptoms or medication (relative risk [RR], 1.49; 95070 confidence interval [Cl], 1.12-1.99) and wheeze (RR, 1.39; 95 % Cl, 1.06-1.80). The incidence of physician-diagnosed asthma was higher among those using sprays at least 4 days per week (RR, 2.11; 95% Cl, 1.15-3.89). These associations were consistent for subgroups and not modified by atopy. Dose-response relationships (P < 0.05) were apparent for the frequency of use and the number of different sprays. Risks were predominantly found for the commonly used glass-cleaning, furniture, and air-refreshing sprays. Cleaning products not applied in spray form were not associated with asthma. Conclusions: Frequent use of common household cleaning sprays may be an important risk factor for adult asthma.
Gender differences in asthma incidence, prevalence and severity have been reported worldwide. After puberty, asthma becomes more prevalent and severe in women, and is highest in women with early menarche or with multiple gestations, suggesting a role for sex hormones in asthma genesis. However, the impact of sex hormones on the pathophysiology of asthma is confounded by and difficult to differentiate from age, obesity, atopy, and other gender associated environmental exposures. There are also gender discrepancies in the perception of asthma symptoms. Understanding gender differences in asthma is important to provide effective education and personalized management plans for asthmatics across the lifecourse.
Background
Exposure to indoor air pollutants is thought to cause allergic inflammation. Volatile organic compounds (VOCs) are one of the aggravating factors of asthma and other allergic diseases. However, the influence of VOCs on development of atopic dermatitis is ambiguous in the clinical field. We therefore investigated the associations of indoor total volatile organic compounds (TVOCs) and development of atopic dermatitis in young Korean children.Methods
From the birth cohort of a MOthers and Children's Environmental Health (MOCEH) study, 257 infants whose parents agreed with the environmental measurement, were enrolled. Total VOCs were measured in infant's bedrooms at the age of 6 month. 105 parents answered a questionnaire at 36 month. Concentrations of TVOCs were divided into 2 groups by third quartile (75th). Associations between the high VOCs exposure group and development of atopic dermatitis at the age of 36 months were estimated by multivariate logistic regression.ResultsThe average concentration of TVOCs was 174.7 ± 115.1 ㎍/m3. We defined the high TVOCs exposure group by those with more than 75 percentile of the distribution (242.1 ㎍/m3). An increased risk of atopic dermatitis was observed in the high TVOCs exposure group, after adjustment for parents history of allergy, household income, breastfeeding longer than 6 month (OR = 3.116, 95% Cl 1.041-9.323). Risk of atopic dermatitis was increased when the family bought new furniture within 1 year.Conclusion
Our results showed that exposure to high concentration of VOCs during infancy, an indoor pollutant, increased the risk of atopic dermatitis at 36 months.This article is protected by copyright. All rights reserved.
The asthma epidemic of the last few decades may have peaked; studies suggest that the incidence and prevalence of asthma has decreased in some countries in the last few years, although other studies suggest continuing small increases in prevalence. Increasing awareness and changing diagnostic habits make precise evaluation of epidemiologic trends difficult in the absence of a gold-standard test for asthma, and on a global basis uncertainty persists. Trends in prevalence in some populations (eg, immigrants, farming communities) suggest both adverse and beneficial effects of specific environmental factors. Although the effects of indoor allergens, dampness, and mold and of outdoor air pollutants, especially traffic related, have traditionally dominated risk-factor research, more recent epidemiologic and clinical studies have focused on metabolic and nutritional factors, including maternal obesity and vitamin D levels, mode of delivery and its effect on the infant microbiome, fetal and infant growth, the psychosocial environment, and medication use by mother and infant. It is likely that changes in incidence and prevalence are due to multiple factors, each contributing a relatively small effect. Longitudinal studies from pregnancy through childhood to adulthood will yield greater insights into the complex pathways leading to asthma.
Cited By (since 1996): 80
,
Export Date: 4 February 2013
,
Source: Scopus
, The following values have no corresponding Zotero field:
Author Address: Atmospheric Sciences Department, Environmental Energy Technologies Division, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, United States
Author Address: Civil and Environmental Engineering Department, University of California, Berkeley, CA 94720-1710, United States
Author Address: Environmental and Occupational Health Sciences Institute, University of Medicine and Dentistry of New Jersey, Rutgers University, Piscataway, NJ 08854, United States
Author Address: International Centre for Indoor Environment and Energy, Technical University of Denmark, Denmark
Unlike other major diseases, mortality for chronic obstructive pulmonary disease (COPD) continues to increase. In recent years, COPD has evolved to increasingly affect women, minorities, and individuals from low socioeconomic groups. In women and African-Americans, evidence exists supporting the earlier development of COPD after less lifetime smoking. This review highlights new information on racial and sex differences in COPD.
Sex and related hormonal changes affect T-cell phenotypes, immunity, and smoking-related metabolism of toxic intermediate metabolites. Alterations in the bronchoalveolar lavage proteome of women, but not of men, have allowed the differentiation of healthy female smokers from smokers with COPD. Sex significantly influences levels of inflammatory cytokines and correlates with different clinical and physiological parameters in female COPD patients. African-Americans with COPD are younger, smoke less, are more likely to currently smoke, and have worse health-related quality of life (QOL). African-Americans are more likely to report hospitalized exacerbations that impact QOL. African-Americans with COPD and asthma are nearly four times more likely to experience exacerbations.
There are sex-specific and race-related differences in the manifestation of COPD. These differences warrant further physiologic, biologic, and genetic investigations.
This study investigated the formation of secondary pollutants resulting from household product use in the presence of ozone. Experiments were conducted in a 50-m3 chamber simulating a residential room. The chamber was operated at conditions relevant to US residences in polluted areas during warm-weather seasons: an air exchange rate of 1.0 h−1 and an inlet ozone concentration of approximately 120 ppb, when included. Three products were used in separate experiments. An orange oil-based degreaser and a pine oil-based general-purpose cleaner were used for surface cleaning applications. A plug-in scented-oil air freshener (AFR) was operated for several days. Cleaning products were applied realistically with quantities scaled to simulate residential use rates. Concentrations of organic gases and secondary organic aerosol from the terpene-containing consumer products were measured with and without ozone introduction. In the absence of reactive chemicals, the chamber ozone level was approximately 60 ppb. Ozone was substantially consumed following cleaning product use, mainly by homogeneous reaction. For the AFR, ozone consumption was weaker and heterogeneous reaction with sorbed AFR-constituent VOCs was of similar magnitude to homogeneous reaction with continuously emitted constituents. Formaldehyde generation resulted from product use with ozone present, increasing indoor levels by the order of 10 ppb. Cleaning product use in the presence of ozone generated substantial fine particle concentrations (more than 100 μg m−3) in some experiments. Ozone consumption and elevated hydroxyl radical concentrations persisted for 10–12 h following brief cleaning events, indicating that secondary pollutant production can persist for extended periods.
Air pollution constitutes a major public health concern because of its ubiquity and of its potential health impact. Because individuals are exposed to many air pollutants at once that are highly correlated with each other, there is a need to consider the multi-pollutant exposure phenomenon. The characteristics of multiple pollutants that make statistical analysis of health-related effects of air pollution complex include the high correlation between pollutants prevents the use of standard statistical methods, the potential existence of interaction between pollutants, the common measurement errors, the importance of the number of pollutants to consider, and the potential nonlinear relationship between exposure and health.
We made a review of statistical methods either used in the literature to study the effect of multiple pollutants or identified as potentially applicable to this problem. We reported the results of investigations that applied such methods.
Eighteen publications have investigated the multi-pollutant effects, 5 on indoor pollution, 10 on outdoor pollution, and 3 on statistical methodology with application on outdoor pollution. Some other publications have only addressed statistical methodology.
The use of Hierarchical Bayesian approach, dimension reduction methods, clustering, recursive partitioning, and logic regression are some potential methods described. Methods that provide figures for risk assessments should be put forward in public health decisions.
Data on the link between atopy and viral wheeze are limited. Aim: To evaluate the association between IgE sensitization and viral infection in wheezing children.
This is an observational study in hospitalized wheezing children (n = 247; median age 1.6 ; interquartile range 1.1, 2.9). Eighteen respiratory viral infections were studied using all available methods. A specific immunoglobulin E (IgE) sensitization for common food and aeroallergens and other atopy-related variables including total IgE, blood and nasal eosinophils, exhaled nitric oxide, eczema and atopic eczema, parental allergy and asthma, number of wheezing episodes, positive asthma predictive index or asthma and use of inhaled corticosteroid were correlated with specific viral etiology.
Atopy was closely associated with sole rhinovirus etiology (n = 58) but not with sole respiratory syncytial virus, sole enterovirus, sole human bocavirus, sole other virus, mixed viral, or virus negative etiology. The number of sensitizations was particularly associated with sole rhinovirus etiology (odds ratio 4.59; 95% confidence interval 1.78, 11.8; adjusted to age and sex), followed by aeroallergen sensitization (respectively; 4.18; 2.00, 8.72), total IgE level (2.06; 1.32, 3.21), food allergen sensitization (2.02; 1.08, 3.78), and nasal eosinophil count (1.52; 1.08, 2.13).
According to our data, allergic sensitization is positively linked to rhinovirus-, but not other virus-, associated wheezing and calls attention for studies to test rhinovirus-associated wheezing as a part of asthma risk indices.
The main goal of the paper was to assess the pattern of risk factors having an impact on the onset of early wheezing phenotypes in the birth cohort of 468 two-year olds and to investigate the severity of respiratory illness in the two-year olds in relation to both wheezing phenotypes, environmental tobacco smoke (ETS) and personal PM(2.5) exposure over pregnancy period (fine particulate matter). The secondary goal of the paper was to assess possible association of early persistent wheezing with the length of the baby at birth. Pregnant women were recruited from ambulatory prenatal clinics in the first and second trimester of pregnancy. Only women 18-35 years of age, who claimed to be non-smokers, with singleton pregnancies, without illicit drug use and HIV infection, free from chronic diseases were eligible for the study. In the statistical analysis of respiratory health of children multinomial logistic regression and zero-inflated Poisson regression models were used. Approximately one third of the children in the study sample experienced wheezing in the first 2 years of life and in about two third of cases (67%) the symptom developed already in the first year of life. The early wheezing was easily reversible and in about 70% of infants with wheezing the symptom receded in the second year of life. The adjusted relative risk ratio (RRR) of persistent wheezing increased with maternal atopy (RRR=3.05; 95%CI: 1.30-7.15), older siblings (RRR=3.05; 95%CI: 1.67-5.58) and prenatal ETS exposure (RRR=1.13; 95%CI: 1.04-1.23), but was inversely associated with the length of baby at birth (RRR=0.88; 95%CI: 0.76-1.01). The adjusted incidence risk ratios (IRR) of coughing, difficult breathing, runny/stuffy nose and pharyngitis/tonsillitis in wheezers were much higher than that observed among non-wheezers and significantly depended on prenatal PM(2.5) exposure, older siblings and maternal atopy. The study shows a clear inverse association between maternal age or maternal education and respiratory illnesses and calls for more research efforts aiming at the explanation of factors hidden behind proxy measures of quality of maternal care of babies. The data support the hypothesis that burden of respiratory symptoms in early childhood and possibly in later life may be programmed already in prenatal period when the respiratory system is completing its growth and maturation.
Cleaning is a large enterprise involving a large fraction of the workforce worldwide. A broad spectrum of cleaning agents has been developed to facilitate dust and dirt removal, for disinfection and surface maintenance. The cleaning agents are used in large quantities throughout the world. Although a complex pattern of exposure to cleaning agents and resulting health problems, such as allergies and asthma, are reported among cleaners, only a few surveys of this type of product have been performed. This paper gives a broad introduction to cleaning agents and the impact of cleaning on cleaners, occupants of indoor environments, and the quality of cleaning. Cleaning agents are usually grouped into different product categories according to their technical functions and the purpose of their use (e.g. disinfectants and surface care products). The paper also indicates the adverse health and comfort effects associated with the use of these agents in connection with the cleaning process. The paper identifies disinfectants as the most hazardous group of cleaning agents. Cleaning agents contain evaporative and non-evaporative substances. The major toxicologically significant constituents of the former are volatile organic compounds (VOCs), defined as substances with boiling points in the range of 0 degree C to about 400 degrees C. Although laboratory emission testing has shown many VOCs with quite different time-concentration profiles, few field studies have been carried out measuring the exposure of cleaners. However, both field studies and emission testing indicate that the use of cleaning agents results in a temporal increase in the overall VOC level. This increase may occur during the cleaning process and thus it can enhance the probability of increased short-term exposure of the cleaners. However, the increased levels can also be present after the cleaning and result in an overall increased VOC level that can possibly affect the indoor air quality (IAQ) perceived by occupants. The variety and duration of the emissions depend inter alia on the use of fragrances and high boiling VOCs. Some building materials appear to increase their VOC emission through wet cleaning and thus may affect the IAQ. Particles and dirt contain a great variety of both volatile and non-volatile substances, including allergens. While the volatile fraction can consist of more than 200 different VOCs including formaldehyde, the non-volatile fraction can contain considerable amounts (> 0.5%) of fatty acid salts and tensides (e.g. linear alkyl benzene sulphonates). The level of these substances can be high immediately after the cleaning process, but few studies have been conducted concerning this problem. The substances partly originate from the use of cleaning agents. Both types are suspected to be airway irritants. Cleaning activities generate dust, mostly by resuspension, but other occupant activities may also resuspend dust over longer periods of time. Personal sampling of VOCs and airborne dust gives higher results than stationary sampling. International bodies have proposed air sampling strategies. A variety of field sampling techniques for VOC and surface particle sampling is listed.
ALSPAC (The Avon Longitudinal Study of Parents and Children, formerly the Avon Longitudinal Study of Pregnancy and Childhood) was specifically designed to determine ways in which the individual's genotype combines with environmental pressures to influence health and development. To date, there are comprehensive data on approximately 10,000 children and their parents, from early pregnancy until the children are aged between 8 and 9. The study aims to continue to collect detailed data on the children as they go through puberty noting, in particular, changes in anthropometry, attitudes and behaviour, fitness and other cardiovascular risk factors, bone mineralisation, allergic symptoms and mental health. The study started early during pregnancy and collected very detailed data from the mother and her partner before the child was born. This not only provided accurate data on concurrent features, especially medication, symptoms, diet and lifestyle, attitudes and behaviour, social and environmental features, but was unbiased by parental knowledge of any problems that the child might develop. From the time of the child's birth many different aspects of the child's environment have been monitored and a wide range of phenotypic data collected. By virtue of being based in one geographic area, linkage to medical and educational records is relatively simple, and hands-on assessments of children and parents using local facilities has the advantage of high quality control. The comprehensiveness of the ALSPAC approach with a total population sample unselected by disease status, and the availability of parental genotypes, provides an adequate sample for statistical analysis and for avoiding spurious results. The study has an open policy in regard to collaboration within strict confidentiality rules.
In longitudinal cohort studies, the relationships between prenatal and postnatal tobacco smoke exposure and infant wheezing illnesses were compared in two geographically defined populations in Avon, UK and Brno and Znojmo in the South Moravian Region of the Czech Republic. Pregnant females living in defined regions and with expected dates of delivery between defined dates were recruited. Females completed self-report questionnaires during pregnancy and when their infant was 6 months old. For this analysis, responses to questions about smoking during pregnancy, environmental tobacco smoke (ETS) exposure and reported wheezing illnesses of infants at 6 months after birth were used. Odds ratios for wheeze in relation to the smoking variables were calculated with adjustment for potential confounding effects. The prevalence of smoking during pregnancy was higher in Avon (17.5%) than the Czech Republic (7.1%). Exposure of infants to ETS during the first 6 months after birth was also reported to be higher in Avon (35.5%) than the Czech Republic (9.7%). The prevalence of reported wheezing by 6 months of age was 21.4% in Avon and 10.3% in Brno and Znojmo. In Avon, there was a significant relationship between infant wheeze and maternal smoking during pregnancy (odds ratio (95% confidence interval) 1.30 (1.09-1.56), p=0.004) but not with environmental exposure after birth (1.11 (0.98-1.25)). In contrast, in Brno and Znojmo in the Czech Republic, there was a significant relationship between infant wheeze and ETS exposure (1.66 (1.17-2.36), p=0.04) but not with maternal smoking during pregnancy (0.99 (0.64-1.55)). This study demonstrated an apparent difference in the associations between prenatal and postnatal tobacco smoke exposure and infant wheezing illnesses in two populations with different smoking prevalence. The relationships were independent of a number of potential confounding variables that have been associated with infant wheezing. Possible explanations of these observations include dose-related effects of prenatal and postnatal tobacco smoke exposure of infants.
Objective:
In a prospective study of children with a family history of asthma, asthma onset by 3 years of age was found previously to be positively associated with variables from the first year of life, including elevated total immunoglobulin E (IgE), frequent respiratory infections, and parenting difficulties. We followed this cohort of genetically at-risk children to investigate the relationship between factors assessed in infancy and asthma, allergy, and psychological status at school age.
Methods:
A cohort of 150 children who were at risk for developing asthma were identified prenatally on the basis of the mothers' having asthma. For 28 children, the father had asthma as well, putting them at bilateral genetic risk. Families primarily were middle and upper middle class Caucasians. Parents came to the clinic during the third trimester of pregnancy for assessments of medical and psychosocial functioning. A home visit took place when the infant was 3 weeks old, when parenting risk was assessed before the onset of any asthma symptoms. Parenting difficulties included problems with infant caregiving as well as components of maternal functioning, such as postpartum depression and inadequate marital support. Blood was drawn for serum IgE at 6 months of age. Parents and offspring subsequently came to the clinic multiple times, with the last clinic visit during the child's sixth year. Follow-up at age 6 involved a clinic visit for allergy and psychosocial evaluations, consisting of interviews and a behavior questionnaire. Seventy-seven children received the allergy and psychosocial evaluation, 26 received the psychosocial evaluation in the clinic, and 30 families received telephone interviews and mailed in questionnaires. Additional monitoring of families by telephone and mail was maintained over the next 2 years, until the children were 8, to ensure accurate characterization of the course of illness. Comprehensive medical records were obtained and reviewed for all health care contacts. Children were designated as having asthma when there was documentation in medical records of physician-diagnosed asthma, observed wheezing, and/or prescription of asthma medications during the time period when the child was between 6 and 8 years of age. Parental reports of the occurrence of asthma corroborated the medical record data.
Results:
Data regarding asthma status were available for 145 children through 8 years of age. Forty (28%) of the children manifested asthma between 6 and 8 years of age. Among variables previously reported to predict asthma onset by age 3, 3 proved to have significant univariate relationships with asthma between ages 6 and 8: elevated IgE levels measured when the children were 6 months of age, global ratings of parenting difficulties measured when infants were 3 weeks old, and higher numbers of respiratory infections in the first year of life. Among these offspring of mothers with asthma, paternal asthma showed a significant association with asthma between ages 6 and 8. Eczema in the first year was not significantly related to later asthma. Multiple logistic regression showed that the model that best predicted asthma at ages 6 to 8 from infancy variables included 2 main effects. The adjusted odds ratio for 6-month IgE was 2.15 (1.51, 3.05) and for parenting difficulties was 2.07 (1.15, 3.71). Although socioeconomic status (SES) was not associated with asthma at ages 6 to 8, families of lower SES were more likely to be rated as having parenting difficulties early in the child's life. The mothers of lower SES breastfed for a shorter period of time and were more likely to smoke during their infant's first year. There were more respiratory infections during the first year of life among infants whose mother was rated as having more parenting difficulties. Mothers who reported smoking breastfed their infants for a shorter length of time. Male gender was significantly associated with higher IgE levels when infants were 6 months of age. Laboratory testing was completed for 77 children at age 6. Total serum IgE levels were significantly higher for the children with asthma between ages 6 and 8. Skin-prick testing showed that the children with asthma had significantly more positive skin test reactions than did the children without asthma. Psychosocial interview data at 6 years of age were available for 103 families, and behavioral questionnaires were available for 133 families. On the basis of 6-year interviews, children with asthma were rated as being at greater psychological risk than were the children without asthma. Mothers' Child Behavior Checklist (CBCL) ratings of their children's behavior indicated higher internalizing scores for the children with asthma as compared with the children without asthma. Like the 6-month IgE, 6-year IgE was higher for boys. IgE levels measured at 6 months of age were significantly correlated with 6-year IgE levels. Parenting difficulties measured at 3 weeks were significantly correlated with 6-year measures of maternal depression, CBCL Internalizing score, and Child Psychological Risk (CPR) score. There also were significant correlations among the psychosocial variables assessed when the children were 6 years of age; maternal depression was significantly associated with child CBCL Internalizing score and CPR score, and the last 2 also were significantly correlated. Multiple logistic regression showed that 2 concurrently measured variables entered the model showing the strongest associations with asthma at ages 6 to 8. The adjusted odds ratio for CPR score was 3.21 (1.29-7.96) and for 6-year IgE was 1.71 (1.04-2.80).
Conclusions:
This study of the natural history of childhood asthma focused on the development of asthma into the school-age years in a genetically at-risk group of children. The relationships between biological and psychosocial variables in the first year and school-age asthma support the formulation of asthma as beginning early in life, with the developing immune system interacting with environmental influences. The data provide support for the possible contribution of psychosocial factors to asthma onset and persistence into childhood.
Delineating asthma subphenotypes is of interest to understand the cause of the disease. Few studies have addressed the interrelationships of quantitative asthma-related traits.
We sought to study the interrelationships of allergy markers and FEV(1) in relation to asthma and sex in children and adults.
Total IgE levels, skin prick test (SPT) positivity, eosinophil counts, and FEV(1) were assessed in 299 asthmatic cases (children and adults) recruited in chest clinics and 309 nonasthmatic population-based control subjects in the French Epidemiological Study on the Genetics and Environment of Asthma, Bronchial Hyperresponsiveness, and Atopy.
Allergy parameters were significantly higher in asthmatic cases than in control subjects for children and adults and for both sexes. Sex and age modified the pattern of concordance of high IgE levels, SPT positivity, and eosinophilia among asthmatic cases, with the greatest overlap in male children (64%) and the lowest in male adults (18%). Patterns of change over the lifespan of IgE levels, eosinophil counts, and FEV(1)/height(2) varied, with the acceleration of FEV(1) decrease being particularly evident in asthmatic adults. In adult cases and control subjects, SPT positivity (particularly to indoor allergens) was significantly related to IgE levels but not to eosinophil counts. The association of eosinophil counts with IgE levels was evident only in children. Environmental factors (smoking, pets, and country living) did not alter the patterns observed.
Each allergy-related phenotype showed a distinct relation with asthma, with the role for eosinophils being different than that for IgE levels and SPT responses.
Taking age and sex into account is essential for understanding the interrelationships of the various allergy-related phenotypes to asthma status.
Chlorine bleach or sodium hypochlorite can inactivate common indoor allergens. In this cross-sectional study we evaluated to what extent regular house cleaning with bleach can influence the risks of respiratory and allergic diseases in children. We studied a group of 234 schoolchildren aged 10-13 yr among whom 78 children were living in a house cleaned with bleach at least once per week. Children examination included a questionnaire, an exercise-induced bronchoconstriction test and the measurement of exhaled nitric oxide (NO) and of serum total and aeroallergen-specific immunoglobulin (Ig)E, Clara cell protein (CC16) and surfactant-associated protein D (SP-D). Children living in a house regularly cleaned with bleach were less likely to have asthma (OR, 0.10; CI, 0.02-0.51), eczema (OR, 0.22; CI, 0.06-0.79) and of being sensitized to indoor aeroallergens (OR, 0.53; CI, 0.27-1.02), especially house dust mite (OR, 0.43; CI, 0.19-0.99). These protective effects were independent of gender, ethnicity, previous respiratory infections, total serum IgE level and of family history of allergic diseases. They were however abolished by parental smoking, which also interacted with the use of bleach to increase the risk of recurrent bronchitis (OR, 2.03; CI, 1.12-3.66). House cleaning with bleach had effect neither on the sensitization to pollen allergens, nor on the levels of exhaled NO and of serum CC16 and SP-D. House cleaning with chlorine bleach appears to protect children from the risks of asthma and of sensitization to indoor allergens while increasing the risk of recurrent bronchitis through apparently an interaction with parental smoking. As chlorine bleach is one of the most effective cleaning agent to be found, these observations argue against the idea conveyed by the hygiene hypothesis that cleanliness per se increases the risk of asthma and allergy.