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Lopez DJ, Lodge CJ, Bui DS, Waidyatillake NT, Su JC, Perret JL, Knibbs LD, Erbas B, Thomas PS, Hamilton GS, Thompson BR, Abramson MJ, Walters EH, Dharmage SC, Bowatte G, Lowe AJ. Association between ambient air pollution and development and persistence of atopic and non-atopic eczema in a cohort of adults. Allergy 2021; 76:2524-2534. [PMID: 33598994 DOI: 10.1111/all.14783] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 12/07/2020] [Accepted: 01/04/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND There is limited information on risk factors for eczema in adults. Recent evidence suggests that air pollution may be associated with increased incidence of eczema in adults. We aimed to assess this possible association. METHODS Ambient air pollution exposures (distance from a major road, nitrogen dioxide [NO2 ], fine particulate matter with an aerodynamic diameter ≤2.5 µm [PM2.5 ]) were assessed for the residential address of Tasmanian Longitudinal Health Study participants at ages 43 and 53 years. Eczema incidence (onset after age 43 years), prevalence (at 53 years), and persistence were assessed from surveys, while IgE sensitization was assessed using skin prick tests. The presence or absence of eczema and sensitization was classified into four groups: no atopy or eczema, atopy alone, non-atopic eczema, and atopic eczema. Adjusted logistic and multinomial regression models were fitted to estimate associations between ambient air pollution and eczema, and interaction by sex was assessed. RESULTS Of 3153 participants in both follow-ups, 2369 had valid skin prick tests. For males, a 2.3 ppb increase in baselineNO2 was associated with increased odds of prevalent eczema (OR = 1.15 [95% CI 0.98-1.36]) and prevalent atopic eczema (OR = 1.26 [1.00-1.59]). These associations were not seen in females (p for interaction = 0.08, <0.01). For both sexes, a 1.6 µg/m3 increase in PM2.5 exposure at follow-up was associated with increased odds of aeroallergen sensitization (OR = 1.15 [1.03-1.30]). CONCLUSION Increased exposure to residential ambient air pollutants was associated with an increased odds of eczema, only in males, and aeroallergen sensitization in both genders.
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Affiliation(s)
- Diego J. Lopez
- Allergy and Lung Health Unit The University of Melbourne Melbourne Vic Australia
| | - Caroline J. Lodge
- Allergy and Lung Health Unit The University of Melbourne Melbourne Vic Australia
| | - Dinh S. Bui
- Allergy and Lung Health Unit The University of Melbourne Melbourne Vic Australia
| | | | - John C. Su
- Department of Dermatology Eastern Health and the Population allergy group Monash University Clayton Vic Australia
- Murdoch Children's Research InstituteUniversity of Melbourne Melbourne Vic Australia
| | - Jenny L. Perret
- Allergy and Lung Health Unit The University of Melbourne Melbourne Vic Australia
| | - Luke D. Knibbs
- Faculty of Medicine School of Public Health The University of Queensland Herston Qld Australia
| | - Bircan Erbas
- School of Psychology and Public Health La Trobe University Melbourne Vic Australia
| | - Paul S. Thomas
- Prince of Wales' Clinical School, and Mechanisms of Disease and Translational Research Faculty of Medicine UNSW and Prince of Wales' Hospital Sydney NSW Australia
| | - Garun S. Hamilton
- Department of Lung and Sleep Medicine Monash Health Melbourne Vic Australia
- School of Clinical Sciences Monash University Melbourne Vic Australia
| | - Bruce R. Thompson
- School of Heath Sciences Swinburne University of Technology Melbourne Vic Australia
| | - Michael J. Abramson
- School of Public Health & Preventive Medicine Monash University Melbourne Vic Australia
| | - E. Haydn Walters
- Allergy and Lung Health Unit The University of Melbourne Melbourne Vic Australia
- Medicine University of Tasmania Hobart TAS Australia
| | - Shyamali C. Dharmage
- Allergy and Lung Health Unit The University of Melbourne Melbourne Vic Australia
| | - Gayan Bowatte
- Allergy and Lung Health Unit The University of Melbourne Melbourne Vic Australia
| | - Adrian J. Lowe
- Allergy and Lung Health Unit The University of Melbourne Melbourne Vic Australia
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Model choice for estimating the association between exposure to chemical mixtures and health outcomes: A simulation study. PLoS One 2021; 16:e0249236. [PMID: 33765068 PMCID: PMC7993848 DOI: 10.1371/journal.pone.0249236] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 03/13/2021] [Indexed: 11/26/2022] Open
Abstract
Challenges arise in researching health effects associated with chemical mixtures. Several methods have recently been proposed for estimating the association between health outcomes and exposure to chemical mixtures, but a formal simulation study comparing broad-ranging methods is lacking. We select five recently developed methods and evaluate their performance in estimating the exposure-response function, identifying active mixture components, and identifying interactions in a simulation study. Bayesian kernel machine regression (BKMR) and nonparametric Bayes shrinkage (NPB) were top-performing methods in our simulation study. BKMR and NPB outperformed other contemporary methods and traditional linear models in estimating the exposure-response function and identifying active mixture components. BKMR and NPB produced similar results in a data analysis of the effects of multipollutant exposure on lung function in children with asthma.
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Castañeda AR, Vogel CFA, Bein KJ, Hughes HK, Smiley‐Jewell S, Pinkerton KE. Ambient particulate matter enhances the pulmonary allergic immune response to house dust mite in a BALB/c mouse model by augmenting Th2- and Th17-immune responses. Physiol Rep 2018; 6:e13827. [PMID: 30230272 PMCID: PMC6144457 DOI: 10.14814/phy2.13827] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 07/08/2018] [Accepted: 07/10/2018] [Indexed: 12/16/2022] Open
Abstract
Ambient particulate matter (PM) exacerbates airway inflammation and hyper-reactivity in asthmatic patients. Studies show that PM has adjuvant-like properties that enhance the allergic inflammatory response; however, the mechanisms through which PM enhances these processes remain elusive. The objective of the study was to examine how ambient PM enhances the allergic immune response. Eight-week-old BALB/c mice were sensitized with house dust mite (HDM) or HDM and ambient particulate matter (PM, 2.5 μm; Sacramento, CA) to assess how PM modulates the development of adaptive immune responses against allergens. Both groups were challenged with HDM only. Bronchoalveolar lavage (BAL) was analyzed for extent of airway inflammation. Lung tissue was used for histological analysis, mucosubstance quantification, and heme oxygenase-1 (HO-1) localization/quantification. Gene expression was analyzed in whole lung to characterize immune markers of inflammation: cytokines, chemokines, antioxidant enzymes, and transcription factors. Cytokine and chemokine protein levels were quantified in whole lung to confirm gene expression patterns. Compared to HDM-only sensitization, exposure to PM during HDM sensitization led to significant immune cell recruitment into the airway subepithelium, IgE gene expression, mucosubstance production, and Th2-associated cytokine expression. HO-1 levels were not significantly different between the treatment groups. Gene expression profiles suggest that polycyclic aromatic hydrocarbon (PAH) content in PM activated the aryl hydrocarbon receptor (AhR) and enhanced Th17-responses in the mice that received HDM and PM compared to mice that received HDM-only. The findings suggest that PM enhances allergic sensitization via enhancement of Th2-mediated inflammation and that AhR activation by PAHs in PM promotes Th17-immune responses.
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Affiliation(s)
| | - Christoph F. A. Vogel
- Center for Health and the EnvironmentUniversity of CaliforniaDavisCalifornia
- Department of Environmental ToxicologyUniversity of CaliforniaDavisCalifornia
| | - Keith J. Bein
- Center for Health and the EnvironmentUniversity of CaliforniaDavisCalifornia
- Air Quality Research CenterUniversity of CaliforniaDavisCalifornia
| | | | | | - Kent E. Pinkerton
- Center for Health and the EnvironmentUniversity of CaliforniaDavisCalifornia
- Department of PediatricsSchool of MedicineUniversity of CaliforniaDavisCalifornia
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Castañeda AR, Pinkerton KE, Bein KJ, Magaña-Méndez A, Yang HT, Ashwood P, Vogel CFA. Ambient particulate matter activates the aryl hydrocarbon receptor in dendritic cells and enhances Th17 polarization. Toxicol Lett 2018; 292:85-96. [PMID: 29689377 PMCID: PMC5971007 DOI: 10.1016/j.toxlet.2018.04.020] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 03/01/2018] [Accepted: 04/18/2018] [Indexed: 02/02/2023]
Abstract
The objective of this study was to explore the role of the aryl hydrocarbon receptor (AhR) in ambient particulate matter (PM)-mediated activation of dendritic cells (DCs) and Th17-immune responses in vitro. To assess the potential role of the AhR in PM-mediated activation of DCs, co-stimulation, and cytokine expression, bone marrow (BM)-derived macrophages and DCs from C57BL/6 wildtype or AhR knockout (AhR-/-) mice were treated with PM. Th17 differentiation was assessed via co-cultures of wildtype or AhR-/- BMDCs with autologous naive T cells. PM2.5 significantly induced AhR DNA binding activity to dioxin responsive elements (DRE) and expression of the AhR repressor (AhRR), cytochrome P450 (CYP) 1A1, and CYP1B1, indicating activation of the AhR. In activated (OVA sensitized) BMDCs, PM2.5 induced interleukin (IL)-1β, CD80, CD86, and MHC class II, suggesting enhanced DC activation, co-stimulation, and antigen presentation; responses that were abolished in AhR deficient DCs. DC-T cell co-cultures treated with PM and lipopolysaccharide (LPS) led to elevated IL-17A and IL-22 expression at the mRNA level, which is mediated by the AhR. PM-treated DCs were essential in endowing T cells with a Th17-phenotype, which was associated with enhanced expression of MHC class II and cyclooxygenase (COX)-2. In conclusion, PM enhances DC activation that primes naive T cell differentiation towards a Th17-like phenotype in an AhR-dependent manner.
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Affiliation(s)
| | - Kent E Pinkerton
- Center for Health and the Environment, University of California, Davis, 95616, USA; Department of Pediatrics, School of Medicine, University of California, Davis, 95817, USA
| | - Keith J Bein
- Center for Health and the Environment, University of California, Davis, 95616, USA; Air Quality Research Center, University of California, Davis, CA, 95616, USA
| | - Alfonso Magaña-Méndez
- Escuela de Ciencias de la Salud, Universidad Autónoma de Baja California, Ensenada, C.P. 22860, Mexico
| | - Houa T Yang
- M.I.N.D. Institute, University of California, Davis, 95817, USA
| | - Paul Ashwood
- M.I.N.D. Institute, University of California, Davis, 95817, USA
| | - Christoph F A Vogel
- Center for Health and the Environment, University of California, Davis, 95616, USA; Department of Environmental Toxicology, University of California, Davis, 95616, USA.
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Ren S, Haynes E, Hall E, Hossain M, Chen A, Muglia L, Lu L, DeFranco E. Periconception Exposure to Air Pollution and Risk of Congenital Malformations. J Pediatr 2018; 193:76-84.e6. [PMID: 29237538 PMCID: PMC5794608 DOI: 10.1016/j.jpeds.2017.09.076] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 08/21/2017] [Accepted: 09/27/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the association between increased exposure to airborne fine particulate matter (PM2.5) during the periconception period with risk of congenital anomalies. STUDY DESIGN Using birth certificate data from the Ohio Department of Health (2006-2010) and PM2.5 data from the US Environmental Protection Agency's 57 monitoring stations located throughout Ohio, the geographic coordinates of the mother's residence for each birth were linked to the nearest PM2.5 monitoring station and monthly exposure averages were calculated. The association between congenital anomalies and increased PM2.5 levels was estimated, with adjustment for coexistent risk factors. RESULTS After adjustment for coexisting risk factors, exposure to increased levels of PM2.5 in the air during the periconception period was modestly associated with risk of congenital anomalies. Compared with other periconception exposure windows, increased exposure during the 1 month before conception was associated with the highest risk increase at lesser distances from monitoring stations. The strongest influences of PM2.5 on individual malformations were found with abdominal wall defects and hypospadias, especially during the 1-month preconception. CONCLUSIONS Increased exposure to PM2.5 in the periconception period is associated with some modest risk increases for congenital malformations. The most susceptible time of exposure appears to be the 1 month before and after conception. Although the increased risk with PM2.5 exposure is modest, the potential impact on a population basis is noteworthy because all pregnant women have some degree of exposure.
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Affiliation(s)
- Sheng Ren
- Department of Mathematics, University of Cincinnati, Cincinnati, OH; Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Erin Haynes
- Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Eric Hall
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Monir Hossain
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Aimin Chen
- Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Louis Muglia
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Long Lu
- Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Emily DeFranco
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH
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Castañeda AR, Bein KJ, Smiley-Jewell S, Pinkerton KE. Fine particulate matter (PM 2.5) enhances allergic sensitization in BALB/c mice. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2017; 80:197-207. [PMID: 28494199 PMCID: PMC6159927 DOI: 10.1080/15287394.2016.1222920] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Ambient particulate matter (PM), a component of air pollution, exacerbates airway inflammation and hyperreactivity in asthmatic patients. Studies showed that PM possesses adjuvant-like properties that enhance the allergic inflammatory response; however, the mechanism (or mechanisms) by which PM enhances the allergic response remains to be determined. The aim of this study was to assess how exposure to fine PM collected from Sacramento, CA, shapes the allergic airway immune response in BALB/c mice undergoing sensitization and challenge with ovalbumin (OVA). Eight-week-old BALB/c male mice were sensitized/challenged with phosphate-buffered saline (PBS/PBS; n = 6), PM/PBS (n = 6), OVA/OVA (n = 6), or OVA + PM/OVA (n = 6). Lung tissue, bronchoalveolar lavage fluid (BALF), and plasma were analyzed for cellular inflammation, cytokines, immunoglobulin E, and heme oxygenase-1 (HO-1) expression. Mice in the OVA + PM/OVA group displayed significantly increased airway inflammation compared to OVA/OVA animals. Total cells, macrophages, and eosinophils recovered in BALF were significantly elevated in the OVA + PM/OVA compared to OVA/OVA group. Histopathological grading indicated that OVA + PM/OVA treatment induced significant inflammation compared to OVA/OVA. Both immunoglobulin (Ig) E and tumor necrosis factor (TNF) α levels were significantly increased in OVA/OVA and OVA + PM /OVA groups compared to PBS/PBS control. The number of HO-1 positive alveolar macrophages was significantly elevated in lungs of mice treated with OVA + PM /OVA compared to OVA/OVA. Our findings suggest that fine PM enhances allergic inflammatory response in pulmonary tissue through mechanisms involving increased oxidative stress.
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Affiliation(s)
- Alejandro R Castañeda
- a Center for Health and the Environment, University of California , Davis , California , USA
| | - Keith J Bein
- a Center for Health and the Environment, University of California , Davis , California , USA
- b Air Quality Research Center, University of California , Davis , California , USA
| | - Suzette Smiley-Jewell
- a Center for Health and the Environment, University of California , Davis , California , USA
| | - Kent E Pinkerton
- a Center for Health and the Environment, University of California , Davis , California , USA
- c Department of Pediatrics , University of California , Davis , California , USA
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Wang IJ, Tung TH, Tang CS, Zhao ZH. Allergens, air pollutants, and childhood allergic diseases. Int J Hyg Environ Health 2015; 219:66-71. [PMID: 26404109 DOI: 10.1016/j.ijheh.2015.09.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 08/03/2015] [Accepted: 09/09/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The synergistic effect of allergens and air pollutants on the risk of allergic diseases is unclear. OBJECTIVE To evaluate the joint effect of outdoor pollutants and indoor allergens on the risk of allergic diseases. METHODS We enrolled 2661 kindergarten children from the CEAS cohort. Data on allergic diseases and environmental exposure were collected. Skin prick tests were performed. Individual exposure to air pollution was estimated using a geographic information system with the mean concentration of air pollutants. Multiple logistic regression analysis was performed to estimate the association between air pollutants, allergen exposure and the risk of allergic diseases with adjustments for potential confounders. RESULTS Overall, 12.6% of the children had asthma, 30.0% had allergic rhinitis (AR), and 14.4% had atopic dermatitis (AD). Mite sensitization significantly increased the risk of AD, AR, and asthma (OR (95%CI) 2.15 (1.53-3.03), 1.94 (1.46-2.58), and 2.31 (1.63-3.29), respectively). Exposure to PM10, PM(2.5), CO, and O(3) was associated with asthma (OR (95% CI) 1.39 (1.03-1.87), 1.45 (1.07-1.97), 1.36 (1.01-1.83), and 0.68 (0.51-0.92), respectively). PM(2.5) may have increased the risk of AR (OR (95% CI) 1.54 (1.03-2.32). Mite sensitization showed a synergistic effect with PM(2.5) on the development of asthma (p < 0.001). Moreover, mite allergens may modify the effect of air pollutants on allergic diseases. CONCLUSION Dust mites and PM(2.5) play an important role on the risk of asthma and AR. Exposure to PM(2.5) and mite allergens had a synergistic effect on the development of asthma. Avoiding co-exposure to allergens and air pollutants is important.
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Affiliation(s)
- I-Jen Wang
- Department of Pediatrics, Taipei Hospital, Ministry of Health and Welfare, Taipei, Taiwan; Institute of Environmental and Occupational Health Sciences, College of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Health Risk Management, China Medical University, Taichung, Taiwan.
| | - Tao-Hsin Tung
- College of Public Health, Fu Jen Catholic University, Taipei, Taiwan; Department of Medical Research and Education, Cheng-Hsin General Hospital, Taiwan
| | - Chin-Sheng Tang
- College of Public Health, Fu Jen Catholic University, Taipei, Taiwan
| | - Zi-Hao Zhao
- College of Public Health, Fu Jen Catholic University, Taipei, Taiwan
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Sbihi H, Allen RW, Becker A, Brook JR, Mandhane P, Scott JA, Sears MR, Subbarao P, Takaro TK, Turvey SE, Brauer M. Perinatal Exposure to Traffic-Related Air Pollution and Atopy at 1 Year of Age in a Multi-Center Canadian Birth Cohort Study. ENVIRONMENTAL HEALTH PERSPECTIVES 2015; 123:902-8. [PMID: 25826816 PMCID: PMC4559953 DOI: 10.1289/ehp.1408700] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 03/26/2015] [Indexed: 05/22/2023]
Abstract
BACKGROUND The role of traffic-related air pollution (TRAP) exposure in the development of allergic sensitization in children is unclear, and few birth cohort studies have incorporated spatiotemporal exposure assessment. OBJECTIVES We aimed to examine the association between TRAP and atopy in 1-year-old children from an ongoing national birth cohort study in four Canadian cities. METHODS We identified 2,477 children of approximately 1 year of age with assessment of atopy for inhalant (Alternaria, Der p, Der f, cat, dog, cockroach) and food-related (milk, eggs, peanuts, soy) allergens. Exposure to nitrogen dioxide (NO2) was estimated from city-specific land use regression models accounting for residential mobility and temporal variability in ambient concentrations. We used mixed models to examine associations between atopy and exposure during pregnancy and the first year of life, including adjustment for covariates (maternal atopy, socioeconomic status, pets, mold, nutrition). We also conducted analyses stratified by time-location patterns, daycare attendance, and modeled home ventilation. RESULTS Following spatiotemporal adjustment, TRAP exposure after birth increased the risk for development of atopy to any allergens [adjusted odds ratio (aOR) per 10 μg/m3 NO2 = 1.16; 95% CI: 1.00, 1.41], but not during pregnancy (aOR = 1.02; 95% CI: 0.86, 1.22). This association was stronger among children not attending daycare (aOR = 1.61; 95% CI: 1.28, 2.01) compared with daycare attendees (aOR = 1.05; 95% CI: 0.81, 1.28). Trends to increased risk were also found for food (aOR = 1.17; 95% CI: 0.95, 1.47) and inhalant allergens (aOR = 1.28; 95% CI: 0.93, 1.76). CONCLUSION Using refined exposure estimates that incorporated temporal variability and residential mobility, we found that traffic-related air pollution during the first year of life was associated with atopy. CITATION Sbihi H, Allen RW, Becker A, Brook JR, Mandhane P, Scott JA, Sears MR, Subbarao P, Takaro TK, Turvey SE, Brauer M. 2015. Perinatal exposure to traffic-related air pollution and atopy at 1 year of age in a multi-center Canadian birth cohort study. Environ Health Perspect 123:902-908; http://dx.doi.org/10.1289/ehp.1408700.
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Affiliation(s)
- Hind Sbihi
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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9
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Weir CH, Yeatts KB, Sarnat JA, Vizuete W, Salo PM, Jaramillo R, Cohn RD, Chu H, Zeldin DC, London SJ. Nitrogen dioxide and allergic sensitization in the 2005-2006 National Health and Nutrition Examination Survey. Respir Med 2013; 107:1763-72. [PMID: 24045117 DOI: 10.1016/j.rmed.2013.08.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 07/30/2013] [Accepted: 08/14/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Allergic sensitization is a risk factor for asthma and allergic diseases. The relationship between ambient air pollution and allergic sensitization is unclear. OBJECTIVE To investigate the relationship between ambient air pollution and allergic sensitization in a nationally representative sample of the US population. METHODS We linked annual average concentrations of nitrogen dioxide (NO2), particulate matter ≤10 μm (PM10), particulate matter ≤2.5 μm (PM2.5), and summer concentrations of ozone (O3), to allergen-specific immunoglobulin E (IgE) data for participants in the 2005-2006 National Health and Nutrition Examination Survey (NHANES). In addition to the monitor-based air pollution estimates, we used the Community Multiscale Air Quality (CMAQ) model to increase the representation of rural participants in our sample. Logistic regression with population-based sampling weights was used to calculate adjusted prevalence odds ratios per 10 ppb increase in O3 and NO2, per 10 μg/m(3) increase in PM10, and per 5 μg/m(3) increase in PM2.5 adjusting for race, gender, age, socioeconomic status, smoking, and urban/rural status. RESULTS Using CMAQ data, increased levels of NO2 were associated with positive IgE to any (OR 1.15, 95% CI 1.04, 1.27), inhalant (OR 1.17, 95% CI 1.02, 1.33), and indoor (OR 1.16, 95% CI 1.03, 1.31) allergens. Higher PM2.5 levels were associated with positivity to indoor allergen-specific IgE (OR 1.24, 95% CI 1.13, 1.36). Effect estimates were similar using monitored data. CONCLUSIONS Increased ambient NO2 was consistently associated with increased prevalence of allergic sensitization.
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Affiliation(s)
- Charles H Weir
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
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10
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Su HJ, Chang CH, Chen HL. Effects of vitamin C and E intake on peak expiratory flow rate of asthmatic children exposed to atmospheric particulate matter. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2013; 68:80-6. [PMID: 23428057 DOI: 10.1080/19338244.2011.646360] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
One hundred eighty-four asthmatic children were selected from 8 schools in Tainan City (high PM(10) [particulate matter with aerodynamic diameter <10 μm] exposure) and Hualien County (low PM(10) exposure) in Taiwan, and completed records of dietary consumption, daily peak expiratory flow rate (PEFR), and daily respiratory symptoms for 1 week. The higher prevalence of PEFR less than 80% predicted was found in children of high-exposure district than of low-exposure one, as well as in subjects with high intake of vitamin E than those who took less vitamin E. Furthermore, the risk of declining PEFR appeared to significantly decrease for subjects with both high intake of vitamins C and E and residing in area of low PM(10) levels as compared with those with low intake of vitamins C and E and residing in high-exposure area. The beneficiary effect of vitamin C and E intake on PEFR improvement for asthmatic children with low air pollution is suggested.
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Affiliation(s)
- Huey-Jen Su
- Department of Environmental and Occupational Health, Medical College, National Cheng Kung University, Tainan, Taiwan
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Savage JH, Matsui EC, Wood RA, Keet CA. Urinary levels of triclosan and parabens are associated with aeroallergen and food sensitization. J Allergy Clin Immunol 2012; 130:453-60.e7. [PMID: 22704536 DOI: 10.1016/j.jaci.2012.05.006] [Citation(s) in RCA: 151] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Revised: 04/17/2012] [Accepted: 05/04/2012] [Indexed: 12/29/2022]
Abstract
BACKGROUND Endocrine-disrupting compounds (EDCs) have immune-modulating effects. We were interested in determining their association with allergic sensitization. OBJECTIVE We sought to determine the association between EDCs and allergic sensitization and whether this relationship depends on the antimicrobial properties of the EDCs, sex, or both. METHODS Data were obtained from the 2005-2006 National Health and Nutrition Examination Survey in which urinary bisphenol A; triclosan; benzophenone-3; propyl, methyl, butyl, and ethyl parabens; and specific IgE levels were available for 860 children. Aeroallergen and food sensitizations were defined as having at least 1 positive (≥ 0.35 kU/L) specific IgE level to an aeroallergen or a food. Logistic regression was used to determine the association of EDCs and sensitization. Analyses were adjusted for urinary creatinine level, age, sex, ethnicity, and poverty index ratio. RESULTS The odds of aeroallergen sensitization significantly increased with the level of the antimicrobial EDCs triclosan and propyl and butyl parabens (P ≤ .04). The odds of food sensitization significantly increased with the level of urinary triclosan among male subjects (odds ratio for third vs first tertiles, 3.9; P= .02 for trend). There was a significant interaction between sex and triclosan level, with male subjects being more likely to be food sensitized with exposure (P= .03). Similar associations were not identified for the nonantimicrobial EDCs bisphenol A and benzophenone-3 (P > .2). CONCLUSIONS As a group, EDCs are not associated with allergen sensitization. However, levels of the antimicrobial EDCs triclosan and parabens were significantly associated with allergic sensitization. The potential role of antimicrobial EDCs in allergic disease warrants further study because they are commonly used in Western society.
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Affiliation(s)
- Jessica H Savage
- Johns Hopkins Division of Allergy and Clinical Immunology, Baltimore, MD 21224, USA.
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Braga M, Schiavone C, Di Gioacchino G, De Angelis I, Cavallucci E, Lazzarin F, Petrarca C, Di Gioacchino M. Environment and T regulatory cells in allergy. THE SCIENCE OF THE TOTAL ENVIRONMENT 2012; 423:193-201. [PMID: 20825978 DOI: 10.1016/j.scitotenv.2010.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Revised: 08/09/2010] [Accepted: 08/09/2010] [Indexed: 05/29/2023]
Abstract
The central role of T regulatory cells in the responses against harmless environmental antigens has been confirmed by many studies. Impaired T regulatory cell function is implicated in many pathological conditions, particularly allergic diseases. The "hygiene hypothesis" suggests that infections and infestations may play a protective role for allergy, whereas environmental pollutants favor the development of allergic diseases. Developing countries suffer from a variety of infections and are also facing an increasing diffusion of environmental pollutants. In these countries allergies increase in relation to the spreading use of xenobiotics (pesticides, herbicides, pollution, etc.) with a rate similar to those of developed countries, overcoming the protective effects of infections. We review here the main mechanisms of non-self tolerance, with particular regard to relations between T regulatory cell activity, infections and infestations such as helminthiasis, and exposure to environmental xenobiotics with relevant diffusion in developing countries.
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Affiliation(s)
- M Braga
- Allergy Unit, Spedali Civili, Piazzale Spedali Civili, 25123 Brescia, Italy.
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Patel MM, Quinn JW, Jung KH, Hoepner L, Diaz D, Perzanowski M, Rundle A, Kinney PL, Perera FP, Miller RL. Traffic density and stationary sources of air pollution associated with wheeze, asthma, and immunoglobulin E from birth to age 5 years among New York City children. ENVIRONMENTAL RESEARCH 2011; 111:1222-9. [PMID: 21855059 PMCID: PMC3210909 DOI: 10.1016/j.envres.2011.08.004] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Revised: 07/06/2011] [Accepted: 08/02/2011] [Indexed: 05/21/2023]
Abstract
Exposures to ambient air traffic-related pollutants and their sources have been associated with respiratory and asthma morbidity in children. However, longitudinal investigation of the effects of traffic-related exposures during early childhood is limited. We examined associations of residential proximity and density of traffic and stationary sources of air pollution with wheeze, asthma, and immunoglobulin (Ig) E among New York City children between birth and age 5 years. Subjects included 593 Dominican and African American participants from the Columbia Center for Children's Environmental Health cohort. Prenatally, through age 5 years, residential and respiratory health data were collected every 3-6 months. At ages 2, 3, and 5 years, serum IgE was measured. Spatial data on the proximity and density of roadways and built environment were collected for a 250 m buffer around subjects' homes. Associations of wheeze, asthma, total IgE, and allergen-specific IgE with prenatal, earlier childhood, and concurrent exposures to air pollution sources were analyzed using generalized estimating equations or logistic regression. In repeated measures analyses, concurrent residential density of four-way intersections was associated significantly with wheeze (odds ratio: 1.26; 95% confidence interval [CI]: 1.01, 1.57). Age 1 exposures also were associated with wheeze at subsequent ages. Concurrent proximity to highway was associated more strongly with total IgE (ratio of the geometric mean levels: 1.25; 95% CI: 1.09, 1.42) than were prenatal or earlier childhood exposures. Positive associations also were observed between percent commercial building area and asthma, wheeze, and IgE and between proximity to stationary sources of air pollution and asthma. Longitudinal investigation suggests that among Dominican and African American children living in Northern Manhattan and South Bronx during ages 0-5 years, residence in neighborhoods with high density of traffic and industrial facilities may contribute to chronic respiratory morbidity, and concurrent, prenatal, and earlier childhood exposures may be important. These findings may have broad implications for other urban populations that commonly have high asthma prevalence and exposure to a high density of traffic and stationary air pollution sources.
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Affiliation(s)
- Molini M. Patel
- Division of Pulmonary, Allergy and Critical Care Medicine, PH8E, Columbia University College of Physicians and Surgeons, 630 W. 168 St, New York, NY 10032, U.S.A
| | - James W. Quinn
- The Institute for Social and Economic Research and Policy, Columbia University, 420 W. 118 St, New York, NY 10027, U.S.A
| | - Kyung Hwa Jung
- Division of Pulmonary, Allergy and Critical Care Medicine, PH8E, Columbia University College of Physicians and Surgeons, 630 W. 168 St, New York, NY 10032, U.S.A
| | - Lori Hoepner
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722 W. 168 St, New York, NY 10032, U.S.A
| | - Diurka Diaz
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722 W. 168 St, New York, NY 10032, U.S.A
| | - Matthew Perzanowski
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722 W. 168 St, New York, NY 10032, U.S.A
| | - Andrew Rundle
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W. 168 St, New York, NY 10032, U.S.A
| | - Patrick L. Kinney
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722 W. 168 St, New York, NY 10032, U.S.A
| | - Frederica P. Perera
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722 W. 168 St, New York, NY 10032, U.S.A
| | - Rachel L. Miller
- Division of Pulmonary, Allergy and Critical Care Medicine, PH8E, Columbia University College of Physicians and Surgeons, 630 W. 168 St, New York, NY 10032, U.S.A
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722 W. 168 St, New York, NY 10032, U.S.A
- Department of Pediatrics, Columbia University Medical Center, PH8E, 630 W. 168 St, New York, NY 10032, U.S.A
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Esplugues A, Ballester F, Estarlich M, Llop S, Fuentes-Leonarte V, Mantilla E, Vioque J, Iñiguez C. Outdoor, but not indoor, nitrogen dioxide exposure is associated with persistent cough during the first year of life. THE SCIENCE OF THE TOTAL ENVIRONMENT 2011; 409:4667-73. [PMID: 21889786 DOI: 10.1016/j.scitotenv.2011.08.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Revised: 07/29/2011] [Accepted: 08/03/2011] [Indexed: 04/13/2023]
Abstract
BACKGROUND AND AIMS Because their lungs and immune system are not completely developed, children are more susceptible to respiratory disease and more vulnerable to ambient pollution. We assessed the relation between prenatal and postnatal nitrogen dioxide (NO(2)) levels and the development of lower respiratory tract infections (LRTI), wheezing and persistent cough during the first year of life. METHODS The study population consisted of 352 children from a birth cohort in Valencia, Spain. Prenatal exposure to NO(2), a marker of traffic related air pollution was measured at 93 sampling sites spread over the study area during four different sampling periods of 7 days each. It was modeled for each residential address through land use regression using the empirical measurements and data from geographic information systems. Postnatal exposure was measured once inside and outside each home using passive samplers for a period of 14 days. Outcomes studied were any episode of LRTI during the child's first year of life diagnosed by a doctor (bronchitis, bronchiolitis or pneumonia), wheezing (defined as whistling sounds coming from the chest), and persistent cough (more than three consecutive weeks). Outcomes and potential confounders were obtained from structured questionnaires. Multiple logistic regression was used to identify associations. RESULTS The cumulative incidence (CI) at first year of life was 30.4% for LRTI (23.0% bronchiolitis, 11.9% bronchitis and 1.4% pneumonia), 26.1% for wheezing and 6.3% for persistent cough. The adjusted odds ratio (95% confidence interval) per 10μg/m(3) increment in postnatal outdoor NO(2) concentration was 1.40 (1.02-1.92) for persistent cough. We also found some pattern of association with LRTI, bronchiolitis, bronchitis, wheezing and persistent cough in different prenatal periods, although it was not statistically significant. CONCLUSIONS Our results indicate that exposure to outdoor, but not indoor, NO(2) during the first year of life increases the risk of persistent cough.
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Rosa MJ, Jung KH, Perzanowski MS, Kelvin EA, Darling KW, Camann DE, Chillrud SN, Whyatt RM, Kinney PL, Perera FP, Miller RL. Prenatal exposure to polycyclic aromatic hydrocarbons, environmental tobacco smoke and asthma. Respir Med 2011; 105:869-76. [PMID: 21163637 PMCID: PMC3081952 DOI: 10.1016/j.rmed.2010.11.022] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Revised: 11/17/2010] [Accepted: 11/19/2010] [Indexed: 01/25/2023]
Abstract
BACKGROUND Previously, we reported that prenatal exposures to polycyclic aromatic hydrocarbons (PAH) and postnatal environmental tobacco smoke (ETS) in combination were associated with respiratory symptoms at ages 1 and 2 years. Here, we hypothesized that children exposed to both prenatal PAH and ETS may be at greater risk of asthma and seroatopy at ages 5-6 years, after controlling for current pollution exposure. METHODS Prenatal PAH exposure was measured by personal air monitoring over 48 h. ETS exposure, respiratory symptoms and asthma at ages 5-6 years were assessed through questionnaire. Immunoglobulin (Ig) E was measured by Immunocap. RESULTS A significant interaction between prenatal PAH and prenatal (but not postnatal) ETS exposure on asthma (p < 0.05), but not IgE, was detected. Among children exposed to prenatal ETS, a positive nonsignificant association was found between prenatal PAH exposure and asthma (OR 1.96, 95% CI [0.95-4.05]). Among children without exposure to prenatal ETS, a negative nonsignificant association was found between prenatal PAH exposure and asthma (OR 0.65, 95% CI [0.41-1.01]). Prenatal PAH exposure was not associated with asthma or IgE at age 5-6 years. CONCLUSIONS Combined prenatal exposure to PAH and ETS appears to be associated with asthma but not seroatopy at age 5-6. Exposure to PAH alone does not appear associated with either asthma or seroatopy at age 5-6 years. Discerning the differential effects between ETS exposed and ETS nonexposed children requires further study.
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Affiliation(s)
- Maria José Rosa
- Division of Pulmonary, Allergy, Critical Care Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons, NY 10032, USA.
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Lisciandro JG, van den Biggelaar AHJ. Neonatal immune function and inflammatory illnesses in later life: lessons to be learnt from the developing world? Clin Exp Allergy 2010; 40:1719-31. [PMID: 20964742 DOI: 10.1111/j.1365-2222.2010.03629.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
With the emergence of allergic and autoimmune diseases in populations that have started to transit to a western lifestyle, there has been an increasing interest in the role of environmental factors modulating early immune function. Yet, most of the information concerning neonatal immune function has been derived from studies in westernized countries. We postulate that comparative studies of early immune development in children born under conditions that are typical for a westernized vs. that of a still more traditional setting will provide a crucial insight into the environmental-driven immunological mechanisms that are responsible for the world-wide rise in inflammatory disorders. In this review, we summarize the current understanding of early-life immune function in humans in general and the literature on some major lifestyle factors that may influence neonatal immune function and potentially the risk for disease in later life. An understanding of the mechanisms of 'prenatal/early-life programming' in populations living in traditional compared with modern societies is crucial to develop strategies to prevent a further rise in 'western diseases' such as allergic disorders. Indications exist that prenatal conditioning of the innate immune system by low-grade inflammatory responses is key to inducing more tightly regulated postnatal adaptive immune responses.
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Affiliation(s)
- J G Lisciandro
- Centre for Child Health Research, Telethon Institute for Child Health Research, The University of Western Australia, Perth, Australia.
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Yang KD, Chang JC, Chuang H, Liang HM, Kuo HC, Lee YS, Hsu TY, Ou CY. Gene-gene and gene-environment interactions on IgE production in prenatal stage. Allergy 2010; 65:731-9. [PMID: 19968631 DOI: 10.1111/j.1398-9995.2009.02260.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Prevalence of allergic diseases in children has increased worldwide over the past decades. Allergy sensitization may occur in fetal life. This study investigated whether gene-gene and gene-environment interactions affected cord blood IgE (CBIgE) levels. METHODS A total of 575 cord blood DNA samples were subjected to a multiplex microarray for 384 single nucleotide polymorphisms (SNPs) in 159 allergy candidate genes. Genetic association was initially assessed by univariate and multivariate analyses. Multifactor dimensionality reduction (MDR) was used to identify gene-gene and gene-environment interactions. Environmental factors for analysis included maternal atopy, paternal atopy, parental smoking, gender, and prematurity. RESULTS Twenty-one SNPs in 14 genes were associated with CBIgE elevation (>or =0.5 KU/l) in univariate analysis. Multivariate analysis identified eleven genes (IL13, IL17A, IL2RA, CCL17, CXCL1, PDGFRA, FGF1, HAVCR1, GNAQ, C11orf72, and ADAM33) which were significantly associated with CBIgE elevation. MDR analyses of gene-gene interactions identified IL13 interacted with IL17A and/or redox genes on CBIgE elevation with the prediction accuracy of 62.52%. Analyses of gene-environment interactions identified that maternal atopy combined with IL13, rs1800925 and CCL22, rs170359 SNPs had the highest prediction accuracy of 67.15%. All the high and low risk classifications on gene-gene and gene-environment interactions by MDR analyses could be validated by Chi-square test. CONCLUSIONS Gene-gene (e.g. immune and redox genes) and gene-environment (e.g. maternal atopy and FGF1or redox genes) interactions on IgE production begin in prenatal stage, suggesting that prevention of IgE-mediated diseases may be made possible by control of maternal atopy and redox responses in prenatal stage.
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Affiliation(s)
- K D Yang
- Department of Pediatrics, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University, No. 123 Ta-Pei Road, Kaohsiung, Taiwan
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Current world literature. Curr Opin Allergy Clin Immunol 2009; 9:482-8. [PMID: 19690478 DOI: 10.1097/aci.0b013e3283312f84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Brunekreef B, Stewart AW, Anderson HR, Lai CKW, Strachan DP, Pearce N. Self-reported truck traffic on the street of residence and symptoms of asthma and allergic disease: a global relationship in ISAAC phase 3. ENVIRONMENTAL HEALTH PERSPECTIVES 2009; 117:1791-8. [PMID: 20049134 PMCID: PMC2801184 DOI: 10.1289/ehp.0800467] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2008] [Accepted: 07/20/2009] [Indexed: 05/12/2023]
Abstract
BACKGROUND Associations between traffic pollution on the street of residence and a range of respiratory and allergic outcomes in children have been reported in developed countries, but little is known about such associations in developing countries. METHODS The third phase of the International Study of Asthma and Allergies in Childhood (ISAAC) was carried out in 13- to 14-year-old and 6- to 7-year-old children across the world. A question about frequency of truck traffic on the street of residence was included in an additional questionnaire. We investigated the association between self-reported truck traffic on the street of residence and symptoms of asthma, rhinoconjunctivitis, and eczema with logistic regression. Adjustments were made for sex, region of the world, language, gross national income, and 10 other subject-specific covariates. RESULTS Frequency of truck traffic on the street of residence was positively associated with the prevalence of symptoms of asthma, rhinoconjunctivitis, and eczema with an exposure-response relationship. Odds ratios (95% confidence intervals) for "current wheeze" and "almost the whole day" versus "never" truck traffic were 1.35 (1.23-1.49) for 13- to 14-year-olds and 1.35 (1.22-1.48) for 6- to 7-year-olds. CONCLUSIONS Higher exposure to self-reported truck traffic on the street of residence is associated with increased reports of symptoms of asthma, rhinitis, and eczema in many locations in the world. These findings require further investigation in view of increasing exposure of the world's children to traffic.
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Affiliation(s)
- Bert Brunekreef
- Institute for Risk Assessment Sciences and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
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Ritz SA. Air pollution as a potential contributor to the 'epidemic' of autoimmune disease. Med Hypotheses 2009; 74:110-7. [PMID: 19665849 DOI: 10.1016/j.mehy.2009.07.033] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Accepted: 07/16/2009] [Indexed: 12/14/2022]
Abstract
There has been remarkable progress over the past 20 years in pushing forward our understanding of many facets of autoimmune disease. Indeed, knowledge of the genetic basis of autoimmunity and the molecular and cellular pathways involved in its pathogenesis has reached an unprecedented level. Yet this knowledge has not served to prevent autoimmune disease nor to curtail the dramatic rise in its incidence over the same interval. Population-level genetic changes cannot explain this trend; thus, environmental factors are strongly implicated. Among the possible environmental contributors to autoimmune disease, air pollution exposure has received very little attention. Although there is only a small amount of published data directly examining a possible causal relationship between air pollution exposure and autoimmunity, data from related fields suggests that it could facilitate autoimmunity as well. If correct, this hypothesis could prove to have sizeable public health implications.
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Affiliation(s)
- Stacey A Ritz
- Medical Sciences Division, Northern Ontario School of Medicine, East Campus - Laurentian University, 935 Ramsey Lake Road, Sudbury, ON, Canada.
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