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Yoshizaki K, Frias DP, Maier K, Smelan J, Correia AT, Oliveira LMDS, Amato-Lourenço LF, Santillo BT, Prado CM, Oshiro TM, Barbuto JAM, Mauad T, Macchione M. Exposure of cinnamyl alcohol in co-culture of BEAS-2B and dendritic cells: Interaction between CYP450 and cytokines. J Appl Toxicol 2024; 44:1317-1328. [PMID: 38715282 DOI: 10.1002/jat.4623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/18/2024] [Accepted: 04/19/2024] [Indexed: 08/16/2024]
Abstract
The prevalence of fragrances in various hygiene products contributes to their sensorial allure. However, fragrances can induce sensitization in the skin or respiratory system, and the mechanisms involved in this process are incompletely understood. This study investigated the intricate mechanisms underlying the fragrance's effects on sensitization response, focusing on the interplay between CYP450 enzymes, a class of drug-metabolizing enzymes, and the adaptive immune system. Specifically, we assessed the expression of CYP450 enzymes and cytokine profiles in culture of BEAS-2B and mature dendritic cells (mDC) alone or in co-culture stimulated with 2 mM of a common fragrance, cinnamyl alcohol (CA) for 20 h. CYP1A1, CYP1A2, CYP1B1, CYP2A6, and CYP2A13 were analyzed by RT-PCR and IL-10, IL-12p70, IL-18, IL-33, and thymic stromal lymphopoietin (TSLP) by Cytometric Bead Array (CBA). Through RT-PCR analysis, we observed that CA increased CYP1A2 and CYP1B1 expression in BEAS-2B, with a further increased in BEAS-2B-mDC co-culture. Additionally, exposure to CA increased IL-12p70 levels in mDC rather than in BEAS-2B-mDC co-culture. In regards to IL-18, level was higher in BEAS-2B than in BEAS-2B-mDC co-culture. A positive correlation between the levels of IL-10 and CYP1B1 was found in mDC-CA-exposed and between IL-12p70 and CYP1A1 was found in BEAS-2B after CA exposure. However, IL-12p70 and CYP1A2 as well as IL-18, IL-33, and CYP1A1 levels were negative, correlated mainly in co-culture control. These correlations highlight potential immunomodulatory interactions and complex regulatory relationships. Overall, exposure to CA enhances CYP450 expression, suggesting that CA can influence immune responses by degrading ligands on xenosensitive transcription factors.
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Affiliation(s)
- Kelly Yoshizaki
- Laboratory of Experimental Environmental Pathology, Department of Pathology, São Paulo University Medical School, São Paulo, Brazil
| | - Daniela Perroni Frias
- Laboratory of Experimental Environmental Pathology, Department of Pathology, São Paulo University Medical School, São Paulo, Brazil
| | - Kevin Maier
- Laboratory of Experimental Environmental Pathology, Department of Pathology, São Paulo University Medical School, São Paulo, Brazil
| | - Juliana Smelan
- Laboratory of Experimental Environmental Pathology, Department of Pathology, São Paulo University Medical School, São Paulo, Brazil
| | - Aristides Tadeu Correia
- Thoracic Surgery Division, Department of Cardiopneumology, InCor, Clinics Hospital, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Luanda Mara da Silva Oliveira
- Laboratory of Medical Investigation in Dermatology and Immunodeficiences, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Luís Fernando Amato-Lourenço
- Laboratory of Experimental Environmental Pathology, Department of Pathology, São Paulo University Medical School, São Paulo, Brazil
- Institute of Advanced Studies (IEA) Global Cities Program, University of São Paulo, São Paulo, Brazil
| | - Bruna Tereso Santillo
- Laboratory of Medical Investigation in Dermatology and Immunodeficiences, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Telma Miyuki Oshiro
- Laboratory of Medical Investigation in Dermatology and Immunodeficiences, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Jose Alexandre M Barbuto
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Thais Mauad
- Laboratory of Experimental Environmental Pathology, Department of Pathology, São Paulo University Medical School, São Paulo, Brazil
| | - Mariangela Macchione
- Laboratory of Experimental Environmental Pathology, Department of Pathology, São Paulo University Medical School, São Paulo, Brazil
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2
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Mwanga HH, Dumas O, Migueres N, Le Moual N, Jeebhay MF. Airway Diseases Related to the Use of Cleaning Agents in Occupational Settings. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1974-1986. [PMID: 38432401 DOI: 10.1016/j.jaip.2024.02.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 02/13/2024] [Accepted: 02/19/2024] [Indexed: 03/05/2024]
Abstract
Exposure to disinfectants and cleaning products (DCPs) is now a well-established risk factor for work-related asthma (WRA). However, questions remain on the specific causal agents and pathophysiological mechanisms. Few studies have also reported an association between DCPs and rhinitis or chronic obstructive pulmonary disease. This review discusses the recent evidence pertaining to airway diseases attributable to occupational exposure to DCPs. In contrast to other agents, the incidence of WRA due to DCPs has increased over time. The use of DCPs in spray form has clearly been identified as an added risk factor. The mechanisms for WRA associated with DCPs remain poorly studied; however, both allergic and nonallergic responses have been described, with irritant mechanisms thought to play a major role. An early diagnostic workup based on clinical assessment accompanied by evaluation of lung function and immunological and airway inflammatory markers is important to guide optimal care and exposure avoidance to the implicated agent. Future research should focus on the effects of "green" products, pathophysiological mechanisms, and quantitative exposure assessment including the use of barcode-based methods to identify specific agents. There is an urgent need to strengthen preventive measures and interventions to reduce the burden of airway diseases associated with DCPs.
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Affiliation(s)
- Hussein H Mwanga
- Department of Environmental and Occupational Health, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Division of Occupational Medicine and Centre for Environmental & Occupational Health Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Orianne Dumas
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie Respiratoire Intégrative, CESP, Villejuif, France
| | - Nicolas Migueres
- Division of Pulmonology, Department of Chest Diseases, University Hospital of Strasbourg and Fédération de Médecine translationnelle, Strasbourg University, Strasbourg, France; UMR 7357 Laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie ICUBE, Strasbourg, France
| | - Nicole Le Moual
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie Respiratoire Intégrative, CESP, Villejuif, France.
| | - Mohamed F Jeebhay
- Division of Occupational Medicine and Centre for Environmental & Occupational Health Research, School of Public Health, University of Cape Town, Cape Town, South Africa.
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3
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Aggarwal J, Shendell DG, Nguyen KT, Rehman M, Campbell ML. Newer New Jersey work-based learning teachers during the COVID-19 pandemic: school safety regarding ventilation, trainings, and awareness of government agencies resources. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2024:1-10. [PMID: 39003756 DOI: 10.1080/09603123.2024.2378097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 07/05/2024] [Indexed: 07/16/2024]
Abstract
New Jersey (NJ) Safe Schools Program (NJSS) provides code-required trainings for NJ teachers supervising students in work-based learning (WBL) experiences. During the COVID-19 pandemic, increased use of chemical cleaning, sanitization, and disinfectant products (CSDPs) led to ventilation and other health concerns. NJSS conducted two surveys of newer NJ WBL teachers between October 2021 and June 2023, with a follow-up in fall 2022 for those who completed initial surveys before summer 2022. This study focused on questions regarding workspace ventilation; respirator and CSDPs trainings; awareness of government resources for safety and health (S&H); and demographics. Over 65% of participant classrooms have operable windows or ventilation systems, while 13% of school salons have ceiling fans. Half of participants didn't receive training on handling CSDPs, although 90% were aware of government S&H resources. Data suggested teachers have well-ventilated workspaces and are aware of different resources available, which is important to continue post COVID-19.
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Affiliation(s)
- Juhi Aggarwal
- Rutgers School of Public Health (SPH), NJ Safe Schools Program, Rutgers University, Piscataway, NJ, USA
| | - Derek G Shendell
- Rutgers School of Public Health (SPH), NJ Safe Schools Program, Rutgers University, Piscataway, NJ, USA
- Department of Environmental & Occupational Health & Justice, Rutgers School of Public Health (SPH), Piscataway, NJ, USA
- Environmental & Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ, USA
| | - Kimberly T Nguyen
- Rutgers School of Public Health (SPH), NJ Safe Schools Program, Rutgers University, Piscataway, NJ, USA
| | - Midhat Rehman
- Rutgers School of Public Health (SPH), NJ Safe Schools Program, Rutgers University, Piscataway, NJ, USA
| | - Maryanne L Campbell
- Rutgers School of Public Health (SPH), NJ Safe Schools Program, Rutgers University, Piscataway, NJ, USA
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4
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Dumas O, Le Moual N. Correspondence to "The impact of indoor pollution on asthma-related outcomes: A systematic review for the EAACI guidelines on environmental science for allergic diseases and asthma". Allergy 2024. [PMID: 38972003 DOI: 10.1111/all.16224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 06/17/2024] [Accepted: 06/28/2024] [Indexed: 07/08/2024]
Affiliation(s)
- Orianne Dumas
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, Villejuif, France
| | - Nicole Le Moual
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie respiratoire intégrative, CESP, Villejuif, France
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5
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Ozdemir C, Kucuksezer UC, Ogulur I, Pat Y, Yazici D, Ardicli S, Akdis M, Nadeau K, Akdis CA. Lifestyle Changes and Industrialization in the Development of Allergic Diseases. Curr Allergy Asthma Rep 2024; 24:331-345. [PMID: 38884832 PMCID: PMC11233349 DOI: 10.1007/s11882-024-01149-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2024] [Indexed: 06/18/2024]
Abstract
PURPOSE OF REVIEW Modernization and Westernization in industrialized and developing nations is associated with a substantial increase in chronic noncommunicable diseases. This transformation has far-reaching effects on lifestyles, impacting areas such as economics, politics, social life, and culture, all of which, in turn, have diverse influences on public health. Loss of contact with nature, alternations in the microbiota, processed food consumption, exposure to environmental pollutants including chemicals, increased stress and decreased physical activity jointly result in increases in the frequency of inflammatory disorders including allergies and many autoimmune and neuropsychiatric diseases. This review aims to investigate the relationship between Western lifestyle and inflammatory disorders. RECENT FINDINGS Several hypotheses have been put forth trying to explain the observed increases in these diseases, such as 'Hygiene Hypothesis', 'Old Friends', and 'Biodiversity and Dysbiosis'. The recently introduced 'Epithelial Barrier Theory' incorporates these former hypotheses and suggests that toxic substances in cleaning agents, laundry and dishwasher detergents, shampoos, toothpastes, as well as microplastic, packaged food and air pollution damage the epithelium of our skin, lungs and gastrointestinal system. Epithelial barrier disruption leads to decreased biodiversity of the microbiome and the development of opportunistic pathogen colonization, which upon interaction with the immune system, initiates local and systemic inflammation. Gaining a deeper comprehension of the interplay between the environment, microbiome and the immune system provides the data to assist with legally regulating the usage of toxic substances, to enable nontoxic alternatives and to mitigate these environmental challenges essential for fostering a harmonious and healthy global environment.
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Affiliation(s)
- Cevdet Ozdemir
- Institute of Child Health, Department of Pediatric Basic Sciences, Istanbul University, Istanbul, Türkiye
- Istanbul Faculty of Medicine, Department of Pediatrics, Division of Pediatric Allergy and Immunology, Istanbul University, Istanbul, Türkiye
| | - Umut Can Kucuksezer
- Department of Immunology, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Türkiye
| | - Ismail Ogulur
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Yagiz Pat
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Duygu Yazici
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Sena Ardicli
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
- Department of Genetics, Faculty of Veterinary Medicine, Bursa Uludag University, Bursa, Türkiye
| | - Mubeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Kari Nadeau
- Department of Environmental Studies, Harvard T.H. Chan School of Public Health, Cambridge, MA, USA
| | - Cezmi A Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland.
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6
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Salonen H, Salthammer T, Castagnoli E, Täubel M, Morawska L. Cleaning products: Their chemistry, effects on indoor air quality, and implications for human health. ENVIRONMENT INTERNATIONAL 2024; 190:108836. [PMID: 38917624 DOI: 10.1016/j.envint.2024.108836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 06/09/2024] [Accepted: 06/18/2024] [Indexed: 06/27/2024]
Abstract
The use of cleaning and disinfecting products both at work and at home increased during the COVID-19 pandemic. Those products often include surfactants, acids/bases, carcinogens such as chloroform, and endocrine-disrupting chemicals, such as cyclosiloxanes, phthalates, and synthetic fragrances, which may cause harmful health effects among professional cleaners as well as among people exposed at home or in their workplaces. The aim of this study was to synthesize the effects of the commonly used chemical, surface cleaning and disinfecting products on indoor air quality, focusing on chemical and particulate matter pollutants, exposure, and human health in residential and public buildings. We also provide a summary of recommendations to avoid harmful exposure and suggest future research directions. PubMed, Google Scholar, Scopus, and Web of Science (WoS) were used to search the literature. Analysis of the literature revealed that the use of cleaning products and disinfectants increase occupants' exposure to a variety of harmful chemical air contaminants and to particulate matter. Occupational exposure to cleaning and disinfectant products has been linked to an increased risk of asthma and rhinitis. Residential exposure to cleaning products has been shown to have an adverse effect on respiratory health, particularly on asthma onset, and on the occurrence of asthma(-like) symptoms among children and adults. Efforts to reduce occupants' exposure to cleaning chemicals will require lowering the content of hazardous substances in cleaning products and improving ventilation during and after cleaning. Experimentally examined, best cleaning practices as well as careful selection of cleaning products can minimize the burden of harmful air pollutant exposure indoors. In addition, indirect ways to reduce exposure include increasing people's awareness of the harmfulness of cleaning chemicals and of safe cleaning practices, as well as clear labelling of cleaning and disinfecting products.
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Affiliation(s)
- Heidi Salonen
- Aalto University (Aalto), Department of Civil Engineering, PO Box 12100, FI-00076 Aalto, Finland; Queensland University of Technology (QUT), International Laboratory for Air Quality and Health (WHO CC for Air Quality and Health), 2 George Street, Brisbane, QLD 4000, Australia.
| | - Tunga Salthammer
- Queensland University of Technology (QUT), International Laboratory for Air Quality and Health (WHO CC for Air Quality and Health), 2 George Street, Brisbane, QLD 4000, Australia; Fraunhofer WKI, Department of Material Analysis and Indoor Chemistry, 38108 Braunschweig, Germany.
| | - Emmanuelle Castagnoli
- Aalto University (Aalto), Department of Civil Engineering, PO Box 12100, FI-00076 Aalto, Finland
| | - Martin Täubel
- Finnish Institute for Health and Welfare, Department Health Security, Environmental Health Unit, PO Box 95, FIN-70701 Kuopio, Finland
| | - Lidia Morawska
- Queensland University of Technology (QUT), International Laboratory for Air Quality and Health (WHO CC for Air Quality and Health), 2 George Street, Brisbane, QLD 4000, Australia
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Kim M, Jeon S, Chung IY, Park K, Kim JH. Evaluation of inhalation risk during quarantine work with quaternary ammonium compounds-based disinfectant. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 929:172488. [PMID: 38631625 DOI: 10.1016/j.scitotenv.2024.172488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 04/01/2024] [Accepted: 04/12/2024] [Indexed: 04/19/2024]
Abstract
Quarantine work is widely recognized as an indispensable endeavor in curbing the propagation of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Furthermore, the heavy workload places workers at a heightened risk of chemical exposure and respiratory damage. Consequently, it is paramount to systematically perform health risk assessments and meticulously oversee the work by wearing personal protective equipment to minimize these risks. To assess the inhalation exposure, this study examined data on disinfectant exposure from quarantine professional users who utilized disinfectants containing quaternary ammonium compounds. Through a survey of 6,199 cases conducted by 300 quarantine professional users who actively engaged in quarantine work, we assembled a database of exposure factors derived from their utilization of spray-type disinfectants for quarantine purposes. Based on these data, we formulated an inhalation exposure algorithm, which considers the time-weighted average (TWA) air concentrations. The test results demonstrated that the industrial-grade respirator mask could prevent a minimum of 68.3 % of particles, reducing respiratory exposure. Consequently, the hazard quotient (HQ) due to disinfectant exposure also decreased. This research is essential in safeguarding the safety and health of professional users engaged in quarantine-related tasks. By implementing strict measures like health risk assessments and personal protective equipment, individuals with quarantine experience can safely carry out their quarantine work. The results of this study are expected to serve as a framework for improving policies and regulations concerning quarantine work and safeguarding the health of professional users.
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Affiliation(s)
- Minji Kim
- Division of Chemical Research, National Institute of Environmental Research, Hwangyeong-ro 42, Seo-gu, Incheon 22689, South Korea.
| | - Sohyun Jeon
- Division of Chemical Research, National Institute of Environmental Research, Hwangyeong-ro 42, Seo-gu, Incheon 22689, South Korea
| | - In-Young Chung
- Division of Chemical Research, National Institute of Environmental Research, Hwangyeong-ro 42, Seo-gu, Incheon 22689, South Korea
| | - Kyunghwa Park
- Division of Chemical Research, National Institute of Environmental Research, Hwangyeong-ro 42, Seo-gu, Incheon 22689, South Korea
| | - Joo-Hyon Kim
- Division of Chemical Research, National Institute of Environmental Research, Hwangyeong-ro 42, Seo-gu, Incheon 22689, South Korea.
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Mihaicuta S, Udrescu L, Militaru A, Nadasan V, Tiotiu A, Bikov A, Ursoniu S, Birza R, Popa AM, Frent S. Multivariate analysis and data mining help predict asthma exacerbations. J Asthma 2024; 61:608-618. [PMID: 38112563 DOI: 10.1080/02770903.2023.2297366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 12/16/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Work-related asthma has become a highly prevalent occupational lung disorder. OBJECTIVE Our study aims to evaluate occupational exposure as a predictor for asthma exacerbation. METHOD We performed a retrospective evaluation of 584 consecutive patients diagnosed and treated for asthma between October 2017 and December 2019 in four clinics from Western Romania. We evaluated the enrolled patients for their asthma control level by employing the Asthma Control Test (ACT < 20 represents uncontrolled asthma), the medical record of asthma exacerbations, occupational exposure, and lung function (i.e. spirometry). Then, we used statistical and data mining methods to explore the most important predictors for asthma exacerbations. RESULTS We identified essential predictors by calculating the odds ratios (OR) for the exacerbation in a logistic regression model. The average age was 45.42 ± 11.74 years (19-85 years), and 422 (72.26%) participants were females. 42.97% of participants had exacerbations in the past year, and 31.16% had a history of occupational exposure. In a multivariate model analysis adjusted for age and gender, the most important predictors for exacerbation were uncontrolled asthma (OR 4.79, p < .001), occupational exposure (OR 4.65, p < .001), and lung function impairment (FEV1 < 80%) (OR 1.15, p = .011). The ensemble machine learning experiments on combined patient features harnessed by our data mining approach reveal that the best predictor is professional exposure, followed by ACT. CONCLUSIONS Machine learning ensemble methods and statistical analysis concordantly indicate that occupational exposure and ACT < 20 are strong predictors for asthma exacerbation.
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Affiliation(s)
- Stefan Mihaicuta
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, Department of Pulmonology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Lucretia Udrescu
- Department I-Drug Analysis, Faculty of Pharmacy, "Victor Babes" University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Adrian Militaru
- Department of Computer and Information Technology, Politehnica University Timisoara, Timisoara, Romania
| | - Valentin Nadasan
- Department of Hygiene, "G.E. Palade" University of Medicine, Pharmacy, Science and Technology of Targu Mures, Targu Mures, Romania
| | - Angelica Tiotiu
- Department of Pulmonology, Nancy University Hospital, Nancy, France
| | - Andras Bikov
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Division of Infection, Immunity & Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Sorin Ursoniu
- Department of Public Health and Health Management, "Victor Babes" University of Medicine and Pharmacy Timisoara, Timisoara, Romania
- Center for Translational Research and Systems Medicine, Timisoara, Romania
| | - Romina Birza
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, Department of Pulmonology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Alina Mirela Popa
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, Department of Pulmonology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Stefan Frent
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, Department of Pulmonology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Timisoara, Romania
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Rinaldi AO, Li M, Barletta E, D'Avino P, Yazici D, Pat Y, Ward S, Burla D, Tan G, Askary N, Larsson R, Bost J, Babayev H, Dhir R, Gaudenzio N, Akdis M, Nadeau K, Akdis CA, Mitamura Y. Household laundry detergents disrupt barrier integrity and induce inflammation in mouse and human skin. Allergy 2024; 79:128-141. [PMID: 37766519 DOI: 10.1111/all.15891] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/15/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Epithelial barrier impairment is associated with many skin and mucosal inflammatory disorders. Laundry detergents have been demonstrated to affect epithelial barrier function in vitro using air-liquid interface cultures of human epithelial cells. METHODS Back skin of C57BL/6 mice was treated with two household laundry detergents at several dilutions. Barrier function was assessed by electric impedance spectroscopy (EIS) and transepidermal water loss (TEWL) measurements after the 4 h of treatments with detergents. RNA sequencing (RNA-seq) and targeted multiplex proteomics analyses in skin biopsy samples were performed. The 6-h treatment effect of laundry detergent and sodium dodecyl sulfate (SDS) was investigated on ex vivo human skin. RESULTS Detergent-treated skin showed a significant EIS reduction and TEWL increase compared to untreated skin, with a relatively higher sensitivity and dose-response in EIS. The RNA-seq showed the reduction of the expression of several genes essential for skin barrier integrity, such as tight junctions and adherens junction proteins. In contrast, keratinization, lipid metabolic processes, and epidermal cell differentiation were upregulated. Proteomics analysis showed that the detergents treatment generally downregulated cell adhesion-related proteins, such as epithelial cell adhesion molecule and contactin-1, and upregulated proinflammatory proteins, such as interleukin 6 and interleukin 1 beta. Both detergent and SDS led to a significant decrease in EIS values in the ex vivo human skin model. CONCLUSION The present study demonstrated that laundry detergents and its main component, SDS impaired the epidermal barrier in vivo and ex vivo human skin. Daily detergent exposure may cause skin barrier disruption and may contribute to the development of atopic diseases.
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Affiliation(s)
- Arturo O Rinaldi
- Swiss Institute of Allergy and Asthma Research (SIAF), University Zurich, Davos, Switzerland
| | - Manru Li
- Swiss Institute of Allergy and Asthma Research (SIAF), University Zurich, Davos, Switzerland
| | - Elena Barletta
- Swiss Institute of Allergy and Asthma Research (SIAF), University Zurich, Davos, Switzerland
| | - Paolo D'Avino
- Swiss Institute of Allergy and Asthma Research (SIAF), University Zurich, Davos, Switzerland
| | - Duygu Yazici
- Swiss Institute of Allergy and Asthma Research (SIAF), University Zurich, Davos, Switzerland
| | - Yagiz Pat
- Swiss Institute of Allergy and Asthma Research (SIAF), University Zurich, Davos, Switzerland
| | - Siobhan Ward
- Swiss Institute of Allergy and Asthma Research (SIAF), University Zurich, Davos, Switzerland
- Christine Kühne - Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
| | - Daniel Burla
- Swiss Institute of Allergy and Asthma Research (SIAF), University Zurich, Davos, Switzerland
| | - Ge Tan
- Swiss Institute of Allergy and Asthma Research (SIAF), University Zurich, Davos, Switzerland
| | | | | | | | - Huseyn Babayev
- Swiss Institute of Allergy and Asthma Research (SIAF), University Zurich, Davos, Switzerland
| | - Raja Dhir
- SEED, Inc, Co, Los Angeles, California, USA
| | - Nicolas Gaudenzio
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), INSERM UMR1291, CNRS UMR5051, University Toulouse III, Toulouse, France
- Genoskin SAS, Toulouse, France
| | - Mubeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University Zurich, Davos, Switzerland
| | - Kari Nadeau
- Department of Environmental Studies, Harvard T.H. Chan School of Public Health, Cambridge, Massachusetts, USA
| | - Cezmi A Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University Zurich, Davos, Switzerland
- Christine Kühne - Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
| | - Yasutaka Mitamura
- Swiss Institute of Allergy and Asthma Research (SIAF), University Zurich, Davos, Switzerland
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10
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Patel J, Gimeno Ruiz de Porras D, Mitchell LE, Carson A, Whitehead LW, Han I, Pompeii L, Conway S, Zock JP, Henneberger PK, Patel R, De Los Reyes J, Delclos GL. Cleaning Tasks and Products and Asthma Among Health Care Professionals. J Occup Environ Med 2024; 66:28-34. [PMID: 37801602 PMCID: PMC10841035 DOI: 10.1097/jom.0000000000002990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
OBJECTIVE Health care workers are at risk for work-related asthma, which may be affected by changes in cleaning practices. We examined associations of cleaning tasks and products with work-related asthma in health care workers in 2016, comparing them with prior results from 2003. METHODS We estimated asthma prevalence by professional group and explored associations of self-reported asthma with job-exposure matrix-based cleaning tasks/products in a representative Texas sample of 9914 physicians, nurses, respiratory/occupational therapists, and nurse aides. RESULTS Response rate was 34.8% (n = 2421). The weighted prevalence rates of physician-diagnosed (15.3%), work-exacerbated (4.1%), and new-onset asthma (6.7%) and bronchial hyperresponsiveness symptoms (31.1%) were similar to 2003. New-onset asthma was associated with building surface cleaning (odds ratio [OR], 1.91; 95% confidence interval [CI], 1.10-3.33), use of ortho-phthalaldehyde (OR, 1.77; 95% CI, 1.15-2.72), bleach/quaternary compounds (OR, 1.91; 95% CI, 1.10-3.33), and sprays (OR, 1.97; 95% CI, 1.12-3.47). CONCLUSION Prevalence of asthma/bronchial hyperresponsiveness seems unchanged, whereas associations of new-onset asthma with exposures to surface cleaning remained, and decreased for instrument cleaning.
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Affiliation(s)
- Jenil Patel
- Southwest Center for Occupational and Environmental Health, Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth Houston) School of Public Health, Houston, TX, USA
- Center for Pediatric Population Health, Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth Houston), Dallas, TX, USA
| | - David Gimeno Ruiz de Porras
- Southwest Center for Occupational and Environmental Health, Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health in San Antonio, The University of Texas Health Science Center at Houston (UTHealth Houston), San Antonio, TX, USA
- Center for Research in Occupational Health, Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Laura E. Mitchell
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth Houston) School of Public Health, Houston, TX, USA
| | - Arch Carson
- Southwest Center for Occupational and Environmental Health, Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth Houston) School of Public Health, Houston, TX, USA
| | - Lawrence W. Whitehead
- Southwest Center for Occupational and Environmental Health, Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth Houston) School of Public Health, Houston, TX, USA
| | - Inkyu Han
- Department of Epidemiology and Biostatistics, Temple University College of Public Health, Philadelphia, PA, USA
| | - Lisa Pompeii
- Research in Patient Services, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | | | - Jan-Paul Zock
- Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
| | - Paul K. Henneberger
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Riddhi Patel
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth Houston) School of Public Health, Houston, TX, USA
| | - Joy De Los Reyes
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston (UTHealth Houston) School of Public Health, Houston, TX, USA
| | - George L. Delclos
- Southwest Center for Occupational and Environmental Health, Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth Houston) School of Public Health, Houston, TX, USA
- Center for Research in Occupational Health, Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Madrid, Spain
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11
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Yazici D, Ogulur I, Pat Y, Babayev H, Barletta E, Ardicli S, Bel Imam M, Huang M, Koch J, Li M, Maurer D, Radzikowska U, Satitsuksanoa P, Schneider SR, Sun N, Traidl S, Wallimann A, Wawrocki S, Zhakparov D, Fehr D, Ziadlou R, Mitamura Y, Brüggen MC, van de Veen W, Sokolowska M, Baerenfaller K, Nadeau K, Akdis M, Akdis CA. The epithelial barrier: The gateway to allergic, autoimmune, and metabolic diseases and chronic neuropsychiatric conditions. Semin Immunol 2023; 70:101846. [PMID: 37801907 DOI: 10.1016/j.smim.2023.101846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 09/27/2023] [Indexed: 10/08/2023]
Abstract
Since the 1960 s, our health has been compromised by exposure to over 350,000 newly introduced toxic substances, contributing to the current pandemic in allergic, autoimmune and metabolic diseases. The "Epithelial Barrier Theory" postulates that these diseases are exacerbated by persistent periepithelial inflammation (epithelitis) triggered by exposure to a wide range of epithelial barrier-damaging substances as well as genetic susceptibility. The epithelial barrier serves as the body's primary physical, chemical, and immunological barrier against external stimuli. A leaky epithelial barrier facilitates the translocation of the microbiome from the surface of the afflicted tissues to interepithelial and even deeper subepithelial locations. In turn, opportunistic bacterial colonization, microbiota dysbiosis, local inflammation and impaired tissue regeneration and remodelling follow. Migration of inflammatory cells to susceptible tissues contributes to damage and inflammation, initiating and aggravating many chronic inflammatory diseases. The objective of this review is to highlight and evaluate recent studies on epithelial physiology and its role in the pathogenesis of chronic diseases in light of the epithelial barrier theory.
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Affiliation(s)
- Duygu Yazici
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Ismail Ogulur
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Yagiz Pat
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Huseyn Babayev
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Elena Barletta
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland; Swiss Institute of Bioinformatics (SIB), Davos, Switzerland
| | - Sena Ardicli
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Manal Bel Imam
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Mengting Huang
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Jana Koch
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland; Swiss Institute of Bioinformatics (SIB), Davos, Switzerland
| | - Manru Li
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Debbie Maurer
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Urszula Radzikowska
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland; Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland
| | | | - Stephan R Schneider
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Na Sun
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland; National Engineering Research Center of Seafood, School of Food Science and Technology, Dalian Polytechnic University, Dalian 116034, PR China
| | - Stephan Traidl
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland; Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - Alexandra Wallimann
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Sebastian Wawrocki
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Damir Zhakparov
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Danielle Fehr
- Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland; Faculty of Medicine, University of Zurich, Zurich, Switzerland; Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Reihane Ziadlou
- Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland; Faculty of Medicine, University of Zurich, Zurich, Switzerland; Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Yasutaka Mitamura
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Marie-Charlotte Brüggen
- Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland; Faculty of Medicine, University of Zurich, Zurich, Switzerland; Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Willem van de Veen
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland; Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland
| | - Milena Sokolowska
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland; Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland
| | - Katja Baerenfaller
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland; Swiss Institute of Bioinformatics (SIB), Davos, Switzerland
| | - Kari Nadeau
- Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Mubeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Cezmi A Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland; Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland.
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12
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Pat Y, Ogulur I, Yazici D, Mitamura Y, Cevhertas L, Küçükkase OC, Mesisser SS, Akdis M, Nadeau K, Akdis CA. Effect of altered human exposome on the skin and mucosal epithelial barrier integrity. Tissue Barriers 2023; 11:2133877. [PMID: 36262078 PMCID: PMC10606824 DOI: 10.1080/21688370.2022.2133877] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/23/2022] [Accepted: 08/27/2022] [Indexed: 10/24/2022] Open
Abstract
Pollution in the world and exposure of humans and nature to toxic substances is continuously worsening at a rapid pace. In the last 60 years, human and domestic animal health has been challenged by continuous exposure to toxic substances and pollutants because of uncontrolled growth, modernization, and industrialization. More than 350,000 new chemicals have been introduced to our lives, mostly without any reasonable control of their health effects and toxicity. A plethora of studies show exposure to these harmful substances during this period with their implications on the skin and mucosal epithelial barrier and increasing prevalence of allergic and autoimmune diseases in the context of the "epithelial barrier hypothesis". Exposure to these substances causes an epithelial injury with peri-epithelial inflammation, microbial dysbiosis and bacterial translocation to sub-epithelial areas, and immune response to dysbiotic bacteria. Here, we provide scientific evidence on the altered human exposome and its impact on epithelial barriers.
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Affiliation(s)
- Yagiz Pat
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
- Department of Medical Microbiology, Faculty of Medicine, Aydin Menderes University, Turkey
| | - Ismail Ogulur
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Duygu Yazici
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Yasutaka Mitamura
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Lacin Cevhertas
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
- Department of Medical Immunology, Institute of Health Sciences, Bursa Uludag University, Turkey
| | - Ozan C Küçükkase
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Sanne S Mesisser
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Mübeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Kari Nadeau
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University and Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University, Stanford, CA, USA
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Cezmi A Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
- Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland
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13
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Suleiman AM. Comparison of ConsExpo estimated exposure levels to glycol ethers during professional cleaning work to existing regulatory occupational exposure limit values. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2023; 29:604-612. [PMID: 35363595 DOI: 10.1080/10803548.2022.2061150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objectives. Researchers have shown that cleaning workers have an increased risk of asthma and rhinitis, mainly due to exposure to chemical substances present in the cleaning products they use. Among the important substances are glycol ethers, increasingly used as components in cleaning products. This study aimed to assess exposure levels of glycol ether in professional cleaning products and compare them to existing regulatory exposure limit values. Methods. Information from safety data sheets of the products is used to identify the glycol ethers present in the cleaning products and their respective concentrations. Other sources were used to obtain the relevant data required for use in the tool to generate exposure assessments. Exposure levels for various cleaning work exposure scenarios were estimated using the ConsExpo Web tool. Results. The estimated exposure values are significantly lower than the existing regulatory occupational exposure limit (OEL) values for the different glycol ethers. Conclusions. The study showed that the risk of exposure to glycol ethers by inhalation from professional cleaning products is minimal as exposure estimates were much below the regulatory OEL values.
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14
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Pacheco Da Silva E, Ngutuka M, Dumas O, Orsi L, Ait-Hadad W, Lemire P, Quentin J, Pin I, Varraso R, Siroux V, Le Moual N. Longitudinal associations of household use of cleaning agents and asthma symptoms in women: the EGEA study. Occup Environ Med 2023; 80:218-224. [PMID: 36746618 DOI: 10.1136/oemed-2022-108513] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 01/19/2023] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To evaluate the associations between the evolution of household use of cleaning products with the asthma symptom score and its evolution over 8 years. METHODS Our study is based on 509 women participating in the last two surveys of the Epidemiological study on the Genetics and Environment of Asthma (EGEA) study (EGEA2: 2003-2007 (44 years, 19% current smokers) and EGEA3: 2011-2013). We assessed an asthma symptom score and the use of household cleaning products through standardised questionnaires. We studied longitudinal associations of the evolution of weekly use of irritant or spayed cleaning products with (1) the asthma symptom score at EGEA3 and a stable symptom score between EGEA2-EGEA3 (negative binomial models) and (2) the incidence/evolution of asthma symptoms between EGEA2-EGEA3 (logistic/polytomous logistic regressions). Models accounted for familial dependence and were adjusted for age, smoking status, body mass index and occupational exposure to asthmagens. RESULTS Persistent and increased (40% and 16%, respectively) weekly use of irritants or sprays were associated with a higher risk of asthma symptoms at EGEA3 (Mean Score Ratio (MSR)=1.51 (95% CI 1.06 to 2.14) and 1.33 (95% CI 0.85 to 2.08), respectively). A decreased use (19%) was associated with a lower risk of symptoms at EGEA3, compared with a persistent use (MSR=0.59 (95% CI 0.39 to 0.88)). We also observed an association between an increased use of sprays and the incidence of asthma symptoms (OR=2.30 (95% CI 1.08 to 4.91)), compared with no weekly use of irritants/sprays. CONCLUSIONS This longitudinal study, with repeated assessment of exposure and respiratory health, supports the hypothesis that a persistent or increased weekly use of sprayed cleaning products over time may have an adverse effect on the evolution of asthma symptoms.
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Affiliation(s)
- Emilie Pacheco Da Silva
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie Respiratoire Intégrative, CESP, 94807 Villejuif, France
| | - Mélanie Ngutuka
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie Respiratoire Intégrative, CESP, 94807 Villejuif, France
| | - Orianne Dumas
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie Respiratoire Intégrative, CESP, 94807 Villejuif, France
| | - Laurent Orsi
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie Respiratoire Intégrative, CESP, 94807 Villejuif, France
| | - Wassila Ait-Hadad
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie Respiratoire Intégrative, CESP, 94807 Villejuif, France
| | - Pierre Lemire
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie Respiratoire Intégrative, CESP, 94807 Villejuif, France
| | - Joane Quentin
- IAB, Team of Environmental Epidemiology Applied to Development and Respiratory Health, INSERM U1209, University of Grenoble-Alpes, CHU de Grenoble, Grenoble, France
| | - Isabelle Pin
- IAB, Team of Environmental Epidemiology Applied to Development and Respiratory Health, INSERM U1209, University of Grenoble-Alpes, CHU de Grenoble, Grenoble, France
| | - Raphäelle Varraso
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie Respiratoire Intégrative, CESP, 94807 Villejuif, France
| | - Valérie Siroux
- IAB, Team of Environmental Epidemiology Applied to Development and Respiratory Health, INSERM U1209, University of Grenoble-Alpes, CHU de Grenoble, Grenoble, France
| | - Nicole Le Moual
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie Respiratoire Intégrative, CESP, 94807 Villejuif, France
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15
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Wise SK, Damask C, Roland LT, Ebert C, Levy JM, Lin S, Luong A, Rodriguez K, Sedaghat AR, Toskala E, Villwock J, Abdullah B, Akdis C, Alt JA, Ansotegui IJ, Azar A, Baroody F, Benninger MS, Bernstein J, Brook C, Campbell R, Casale T, Chaaban MR, Chew FT, Chambliss J, Cianferoni A, Custovic A, Davis EM, DelGaudio JM, Ellis AK, Flanagan C, Fokkens WJ, Franzese C, Greenhawt M, Gill A, Halderman A, Hohlfeld JM, Incorvaia C, Joe SA, Joshi S, Kuruvilla ME, Kim J, Klein AM, Krouse HJ, Kuan EC, Lang D, Larenas-Linnemann D, Laury AM, Lechner M, Lee SE, Lee VS, Loftus P, Marcus S, Marzouk H, Mattos J, McCoul E, Melen E, Mims JW, Mullol J, Nayak JV, Oppenheimer J, Orlandi RR, Phillips K, Platt M, Ramanathan M, Raymond M, Rhee CS, Reitsma S, Ryan M, Sastre J, Schlosser RJ, Schuman TA, Shaker MS, Sheikh A, Smith KA, Soyka MB, Takashima M, Tang M, Tantilipikorn P, Taw MB, Tversky J, Tyler MA, Veling MC, Wallace D, Wang DY, White A, Zhang L. International consensus statement on allergy and rhinology: Allergic rhinitis - 2023. Int Forum Allergy Rhinol 2023; 13:293-859. [PMID: 36878860 DOI: 10.1002/alr.23090] [Citation(s) in RCA: 79] [Impact Index Per Article: 79.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/11/2022] [Accepted: 09/13/2022] [Indexed: 03/08/2023]
Abstract
BACKGROUND In the 5 years that have passed since the publication of the 2018 International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (ICAR-Allergic Rhinitis 2018), the literature has expanded substantially. The ICAR-Allergic Rhinitis 2023 update presents 144 individual topics on allergic rhinitis (AR), expanded by over 40 topics from the 2018 document. Originally presented topics from 2018 have also been reviewed and updated. The executive summary highlights key evidence-based findings and recommendation from the full document. METHODS ICAR-Allergic Rhinitis 2023 employed established evidence-based review with recommendation (EBRR) methodology to individually evaluate each topic. Stepwise iterative peer review and consensus was performed for each topic. The final document was then collated and includes the results of this work. RESULTS ICAR-Allergic Rhinitis 2023 includes 10 major content areas and 144 individual topics related to AR. For a substantial proportion of topics included, an aggregate grade of evidence is presented, which is determined by collating the levels of evidence for each available study identified in the literature. For topics in which a diagnostic or therapeutic intervention is considered, a recommendation summary is presented, which considers the aggregate grade of evidence, benefit, harm, and cost. CONCLUSION The ICAR-Allergic Rhinitis 2023 update provides a comprehensive evaluation of AR and the currently available evidence. It is this evidence that contributes to our current knowledge base and recommendations for patient evaluation and treatment.
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Affiliation(s)
- Sarah K Wise
- Otolaryngology-HNS, Emory University, Atlanta, Georgia, USA
| | - Cecelia Damask
- Otolaryngology-HNS, Private Practice, University of Central Florida, Lake Mary, Florida, USA
| | - Lauren T Roland
- Otolaryngology-HNS, Washington University, St. Louis, Missouri, USA
| | - Charles Ebert
- Otolaryngology-HNS, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Joshua M Levy
- Otolaryngology-HNS, Emory University, Atlanta, Georgia, USA
| | - Sandra Lin
- Otolaryngology-HNS, University of Wisconsin, Madison, Wisconsin, USA
| | - Amber Luong
- Otolaryngology-HNS, McGovern Medical School of the University of Texas, Houston, Texas, USA
| | - Kenneth Rodriguez
- Otolaryngology-HNS, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Ahmad R Sedaghat
- Otolaryngology-HNS, University of Cincinnati, Cincinnati, Ohio, USA
| | - Elina Toskala
- Otolaryngology-HNS, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Baharudin Abdullah
- Otolaryngology-HNS, Universiti Sains Malaysia, Kubang, Kerian, Kelantan, Malaysia
| | - Cezmi Akdis
- Immunology, Infectious Diseases, Swiss Institute of Allergy and Asthma Research, Davos, Switzerland
| | - Jeremiah A Alt
- Otolaryngology-HNS, University of Utah, Salt Lake City, Utah, USA
| | | | - Antoine Azar
- Allergy/Immunology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Fuad Baroody
- Otolaryngology-HNS, University of Chicago, Chicago, Illinois, USA
| | | | | | - Christopher Brook
- Otolaryngology-HNS, Harvard University, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Raewyn Campbell
- Otolaryngology-HNS, Macquarie University, Sydney, NSW, Australia
| | - Thomas Casale
- Allergy/Immunology, University of South Florida College of Medicine, Tampa, Florida, USA
| | - Mohamad R Chaaban
- Otolaryngology-HNS, Cleveland Clinic, Case Western Reserve University, Cleveland, Ohio, USA
| | - Fook Tim Chew
- Allergy/Immunology, Genetics, National University of Singapore, Singapore, Singapore
| | - Jeffrey Chambliss
- Allergy/Immunology, University of Texas Southwestern, Dallas, Texas, USA
| | - Antonella Cianferoni
- Allergy/Immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | | | | | - Anne K Ellis
- Allergy/Immunology, Queens University, Kingston, ON, Canada
| | | | - Wytske J Fokkens
- Otorhinolaryngology, Amsterdam University Medical Centres, Amsterdam, Netherlands
| | | | - Matthew Greenhawt
- Allergy/Immunology, Pediatrics, University of Colorado, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Amarbir Gill
- Otolaryngology-HNS, University of Michigan, Ann Arbor, Michigan, USA
| | - Ashleigh Halderman
- Otolaryngology-HNS, University of Texas Southwestern, Dallas, Texas, USA
| | - Jens M Hohlfeld
- Respiratory Medicine, Fraunhofer Institute for Toxicology and Experimental Medicine ITEM, Hannover Medical School, German Center for Lung Research, Hannover, Germany
| | | | - Stephanie A Joe
- Otolaryngology-HNS, University of Illinois Chicago, Chicago, Illinois, USA
| | - Shyam Joshi
- Allergy/Immunology, Oregon Health and Science University, Portland, Oregon, USA
| | | | - Jean Kim
- Otolaryngology-HNS, Johns Hopkins University, Baltimore, Maryland, USA
| | - Adam M Klein
- Otolaryngology-HNS, Emory University, Atlanta, Georgia, USA
| | - Helene J Krouse
- Otorhinolaryngology Nursing, University of Texas Rio Grande Valley, Edinburg, Texas, USA
| | - Edward C Kuan
- Otolaryngology-HNS, University of California Irvine, Orange, California, USA
| | - David Lang
- Allergy/Immunology, Cleveland Clinic, Cleveland, Ohio, USA
| | | | | | - Matt Lechner
- Otolaryngology-HNS, University College London, Barts Health NHS Trust, London, UK
| | - Stella E Lee
- Otolaryngology-HNS, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Victoria S Lee
- Otolaryngology-HNS, University of Illinois Chicago, Chicago, Illinois, USA
| | - Patricia Loftus
- Otolaryngology-HNS, University of California San Francisco, San Francisco, California, USA
| | - Sonya Marcus
- Otolaryngology-HNS, Stony Brook University, Stony Brook, New York, USA
| | - Haidy Marzouk
- Otolaryngology-HNS, State University of New York Upstate, Syracuse, New York, USA
| | - Jose Mattos
- Otolaryngology-HNS, University of Virginia, Charlottesville, Virginia, USA
| | - Edward McCoul
- Otolaryngology-HNS, Ochsner Clinic, New Orleans, Louisiana, USA
| | - Erik Melen
- Pediatric Allergy, Karolinska Institutet, Stockholm, Sweden
| | - James W Mims
- Otolaryngology-HNS, Wake Forest University, Winston Salem, North Carolina, USA
| | - Joaquim Mullol
- Otorhinolaryngology, Hospital Clinic Barcelona, Barcelona, Spain
| | - Jayakar V Nayak
- Otolaryngology-HNS, Stanford University, Palo Alto, California, USA
| | - John Oppenheimer
- Allergy/Immunology, Rutgers, State University of New Jersey, Newark, New Jersey, USA
| | | | - Katie Phillips
- Otolaryngology-HNS, University of Cincinnati, Cincinnati, Ohio, USA
| | - Michael Platt
- Otolaryngology-HNS, Boston University, Boston, Massachusetts, USA
| | | | | | - Chae-Seo Rhee
- Rhinology/Allergy, Seoul National University Hospital and College of Medicine, Seoul, Korea
| | - Sietze Reitsma
- Otolaryngology-HNS, University of Amsterdam, Amsterdam, Netherlands
| | - Matthew Ryan
- Otolaryngology-HNS, University of Texas Southwestern, Dallas, Texas, USA
| | - Joaquin Sastre
- Allergy, Fundacion Jiminez Diaz, University Autonoma de Madrid, Madrid, Spain
| | - Rodney J Schlosser
- Otolaryngology-HNS, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Theodore A Schuman
- Otolaryngology-HNS, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Marcus S Shaker
- Allergy/Immunology, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire, USA
| | - Aziz Sheikh
- Primary Care, University of Edinburgh, Edinburgh, Scotland
| | - Kristine A Smith
- Otolaryngology-HNS, University of Utah, Salt Lake City, Utah, USA
| | - Michael B Soyka
- Otolaryngology-HNS, University of Zurich, University Hospital of Zurich, Zurich, Switzerland
| | - Masayoshi Takashima
- Otolaryngology-HNS, Houston Methodist Academic Institute, Houston, Texas, USA
| | - Monica Tang
- Allergy/Immunology, University of California San Francisco, San Francisco, California, USA
| | | | - Malcolm B Taw
- Integrative East-West Medicine, University of California Los Angeles, Westlake Village, California, USA
| | - Jody Tversky
- Allergy/Immunology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Matthew A Tyler
- Otolaryngology-HNS, University of Minnesota, Minneapolis, Minnesota, USA
| | - Maria C Veling
- Otolaryngology-HNS, University of Texas Southwestern, Dallas, Texas, USA
| | - Dana Wallace
- Allergy/Immunology, Nova Southeastern University, Ft. Lauderdale, Florida, USA
| | - De Yun Wang
- Otolaryngology-HNS, National University of Singapore, Singapore, Singapore
| | - Andrew White
- Allergy/Immunology, Scripps Clinic, San Diego, California, USA
| | - Luo Zhang
- Otolaryngology-HNS, Beijing Tongren Hospital, Beijing, China
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16
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Dalbøge A, Albert Kolstad H, Ulrik CS, Sherson DL, Meyer HW, Ebbehøj N, Sigsgaard T, Zock JP, Baur X, Schlünssen V. The Relationship Between Potential Occupational Sensitizing Exposures and Asthma: An Overview of Systematic Reviews. Ann Work Expo Health 2023; 67:163-181. [PMID: 36472234 DOI: 10.1093/annweh/wxac074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 10/05/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES The aim was to identify, appraise, and synthesize the scientific evidence of the relationship between potential occupational sensitizing exposures and the development of asthma based on systematic reviews. METHODS The study was conducted as an overview of systematic reviews. A systematic literature search was conducted for systematic reviews published up to 9 February 2020. Eligibility study criteria included persons in or above the working age, potential occupational sensitizing exposures, and outcomes defined as asthma. Potential occupational sensitizing exposures were divided into 23 main groups comprising both subgroups and specific exposures. Two reviewers independently selected studies, extracted study data, assessed study quality, and evaluated confidence in study results and level of evidence of the relationship between potential occupational sensitizing exposures and asthma. RESULTS Twenty-seven systematic reviews were included covering 1242 studies and 486 potential occupational sensitizing exposures. Overall confidence in study results was rated high in three systematic reviews, moderate in seven reviews, and low in 17 reviews. Strong evidence for the main group of wood dusts and moderate evidence for main groups of mites and fish was found. For subgroups/specific exposures, strong evidence was found for toluene diisocyanates, Aspergillus, Cladosporium, Penicillium, and work tasks involving exposure to laboratory animals, whereas moderate evidence was found for 52 subgroups/specific exposures. CONCLUSIONS This overview identified hundreds of potential occupational sensitizing exposures suspected to cause asthma and evaluated the level of evidence for each exposure. Strong evidence was found for wood dust in general and for toluene diisocyanates, Aspergillus, Cladosporium, Penicillium, and work tasks involving exposure to laboratory animals.
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Affiliation(s)
- Annett Dalbøge
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, 8200 Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark
| | - Henrik Albert Kolstad
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Hvidovre University Hospital, 2650 Hvidovre, Denmark
| | - David Lee Sherson
- Department of Occupational and Environmental Medicine, Odense University Hospital, 5000 Odense, Denmark.,Department of Pulmonary Medicine, Odense University Hospital, 5000 Odense, Denmark
| | - Harald William Meyer
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, 2400 Copenhagen, Denmark
| | - Niels Ebbehøj
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, 2400 Copenhagen, Denmark
| | - Torben Sigsgaard
- Department of Public Health, Environment, Occupation, and Health, Danish Ramazzini Centre, Aarhus University, 8000 Aarhus, Denmark
| | - Jan-Paul Zock
- National Institute for Public Health and the Environment (RIVM), Bilthoven, 3721 MA, The Netherlands
| | - Xaver Baur
- Institut für Arbeitsmedizin, Charité Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Vivi Schlünssen
- National Research Centre for the Working Environment, 2100 Copenhagen, Denmark.,Department of Public Health, Environment, Occupation, and Health, Danish Ramazzini Centre, Aarhus University, 8000 Aarhus, Denmark
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17
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Ogulur I, Pat Y, Aydin T, Yazici D, Rückert B, Peng Y, Kim J, Radzikowska U, Westermann P, Sokolowska M, Dhir R, Akdis M, Nadeau K, Akdis CA. Gut epithelial barrier damage caused by dishwasher detergents and rinse aids. J Allergy Clin Immunol 2023; 151:469-484. [PMID: 36464527 DOI: 10.1016/j.jaci.2022.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND The increased prevalence of many chronic inflammatory diseases linked to gut epithelial barrier leakiness has prompted us to investigate the role of extensive use of dishwasher detergents, among other factors. OBJECTIVE We sought to investigate the effects of professional and household dishwashers, and rinse agents, on cytotoxicity, barrier function, transcriptome, and protein expression in gastrointestinal epithelial cells. METHODS Enterocytic liquid-liquid interfaces were established on permeable supports, and direct cellular cytotoxicity, transepithelial electrical resistance, paracellular flux, immunofluorescence staining, RNA-sequencing transcriptome, and targeted proteomics were performed. RESULTS The observed detergent toxicity was attributed to exposure to rinse aid in a dose-dependent manner up to 1:20,000 v/v dilution. A disrupted epithelial barrier, particularly by rinse aid, was observed in liquid-liquid interface cultures, organoids, and gut-on-a-chip, demonstrating decreased transepithelial electrical resistance, increased paracellular flux, and irregular and heterogeneous tight junction immunostaining. When individual components of the rinse aid were investigated separately, alcohol ethoxylates elicited a strong toxic and barrier-damaging effect. RNA-sequencing transcriptome and proteomics data revealed upregulation in cell death, signaling and communication, development, metabolism, proliferation, and immune and inflammatory responses of epithelial cells. Interestingly, detergent residue from professional dishwashers demonstrated the remnant of a significant amount of cytotoxic and epithelial barrier-damaging rinse aid remaining on washed and ready-to-use dishware. CONCLUSIONS The expression of genes involved in cell survival, epithelial barrier, cytokine signaling, and metabolism was altered by rinse aid in concentrations used in professional dishwashers. The alcohol ethoxylates present in the rinse aid were identified as the culprit component causing the epithelial inflammation and barrier damage.
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Affiliation(s)
- Ismail Ogulur
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland.
| | - Yagiz Pat
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland; Department of Medical Microbiology, Faculty of Medicine, Aydin Adnan Menderes University, Aydin
| | - Tamer Aydin
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Duygu Yazici
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Beate Rückert
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Yaqi Peng
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland; Department of Otolaryngology-Head and Neck Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Juno Kim
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Urszula Radzikowska
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland; Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
| | - Patrick Westermann
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Milena Sokolowska
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland; Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
| | | | - Mubeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Kari Nadeau
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, Calif
| | - Cezmi A Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland; Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
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18
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Dai X, Dharmage SC, Lodge CJ. The relationship of early-life household air pollution with childhood asthma and lung function. Eur Respir Rev 2022; 31:220020. [PMID: 38743526 DOI: 10.1183/16000617.0020-2022] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 06/29/2022] [Indexed: 11/05/2022] Open
Abstract
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.
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Affiliation(s)
- Xin Dai
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Caroline J Lodge
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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19
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Ahmed S, Pinnock H, Dowrick A, Steed L. Generational perspective on asthma self-management in the Bangladeshi and Pakistani community in the United Kingdom: A qualitative study. Health Expect 2022; 25:2534-2547. [PMID: 35999685 PMCID: PMC9615058 DOI: 10.1111/hex.13579] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 07/05/2022] [Accepted: 07/22/2022] [Indexed: 11/27/2022] Open
Abstract
Background Self‐management strategies improve asthma outcomes, although interventions for South Asian populations have been less effective than in White populations. Both self‐management and culture are dynamic, and factors such as acculturation and generation have not always been adequately reflected in existing cultural interventions. We aimed to explore the perspectives of Bangladeshi and Pakistani people in the United Kingdom, across multiple generations (first, second and third/fourth), on how they self‐manage their asthma, with a view to suggesting recommendations for cultural interventions. Methods We purposively recruited Bangladeshi and Pakistani participants, with an active diagnosis of asthma from healthcare settings. Semi‐structured interviews in the participants' choice of language (English, Sylheti, Standard Bengali or Urdu) were conducted, and data were analysed thematically. Results Twenty‐seven participants (13 Bangladeshi and 14 Pakistani) were interviewed. There were generational differences in self‐management, influenced by complex cultural processes experienced by South Asians as part of being an ethnic minority group. Individuals from the first generation used self‐management strategies congruent to traditional beliefs such as ‘sweating’ and often chose to travel to South Asian countries. Generations born and raised in the United Kingdom learnt and experimented with self‐management based on their fused identities and modified their approach depending on whether they were in familial or peer settings. Acculturative stress, which was typically higher in first generations who had migration‐related stressors, influenced the priority given to asthma self‐management throughout generations. The amount and type of available asthma information as well as social discussions within the community and with healthcare professionals also shaped asthma self‐management. Conclusions Recognizing cultural diversity and its influence of asthma self‐management can help develop effective interventions tailored to the lives of South Asian people. Patient or Public Contribution Patient and Public Involvement colleagues were consulted throughout to ensure that the study and its materials were fit for purpose.
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Affiliation(s)
- Salina Ahmed
- Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary University of London, London, UK.,School of Health Sciences, University of Greenwich, London, UK
| | - Hilary Pinnock
- Usher Institute, College of Medicine and Veterinary Science, The University of Edinburgh, Edinburgh, UK
| | - Anna Dowrick
- Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary University of London, London, UK.,Nuffield Department of Primary Care Health Sciences, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Liz Steed
- Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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20
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Celebi Sozener Z, Özbey Yücel Ü, Altiner S, Ozdel Oztürk B, Cerci P, Türk M, Gorgülü Akin B, Akdis M, Yilmaz I, Ozdemir C, Mungan D, Akdis CA. The External Exposome and Allergies: From the Perspective of the Epithelial Barrier Hypothesis. FRONTIERS IN ALLERGY 2022; 3:887672. [PMID: 35873598 PMCID: PMC9304993 DOI: 10.3389/falgy.2022.887672] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/29/2022] [Indexed: 01/04/2023] Open
Abstract
Introduction In the last decades, we have seen a rapid increase in the prevalence of allergic diseases such as asthma, allergic rhinitis, atopic dermatitis, and food allergies. The environmental changes caused by industrialization, urbanization and modernization, including dramatic increases in air pollutants such as particulate matter (PM), diesel exhaust, nitrogen dioxide (NO2), ozone (O3), alarming effects of global warming, change and loss of biodiversity, affect both human health and the entire ecosystem. Objective In this review, we aimed to discuss the effects of the external exposome on epithelial barriers and its relationship with the development of allergic diseases by considering the changes in all stakeholders of the outer exposome together, in the light of the recently proposed epithelial barrier hypothesis. Method To reach current, prominent, and comprehensive studies on the subject, PubMed databases were searched. We included the more resounding articles with reliable and strong results. Results Exposure to altered environmental factors such as increased pollution, microplastics, nanoparticles, tobacco smoke, food emulsifiers, detergents, and household cleaners, and climate change, loss and change in microbial biodiversity, modifications in the consumption of dietary fatty acids, the use of emulsifiers, preservatives and the decrease in the antioxidant content of the widely consumed western diet may disrupt the epithelial barriers of the skin, respiratory and gastrointestinal tracts, making us more vulnerable to exogeneous allergens and microbes. Epithelial cell activation, microbial dysbiosis and bacterial translocation disrupt the immune balance and a chronic Th2 inflammation ensues. Conclusion Dramatic increases in air pollution, worrisome effects of global warming, dysbiosis, changing dietary habits and the complex interactions of all these factors affect the epithelial barriers and local and systemic inflammation. We want to draw attention to the emerging health effects of environmental changes and to motivate the public to influence government policies for the well-being of humans and the nature of the earth and the well-being of future generations.
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Affiliation(s)
- Zeynep Celebi Sozener
- Clinic of Immunology and Allergic Diseases, Ankara City Hospital, Ankara, Turkey
- *Correspondence: Zeynep Celebi Sozener ; orcid.org/0000-0003-4188-0959
| | - Ümüs Özbey Yücel
- Department of Nutrition and Diet, Ankara University, Ankara, Turkey
| | - Seda Altiner
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, School of Medicine, Ankara University, Ankara, Turkey
| | - Betül Ozdel Oztürk
- Division of Immunology and Allergic Diseases, Department of Chest Diseases, School of Medicine, Ankara University, Ankara, Turkey
| | - Pamir Cerci
- Clinic of Immunology and Allergic Diseases, Eskisehir City Hospital, Eskisehir, Turkey
| | - Murat Türk
- Clinic of Immunology and Allergic Diseases, Kayseri City Hospital, Kayseri, Turkey
| | - Begüm Gorgülü Akin
- Clinic of Immunology and Allergic Diseases, Ankara City Hospital, Ankara, Turkey
| | - Mübeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Insu Yilmaz
- Division of Immunology and Allergic Diseases, Department of Chest Diseases, Erciyes University, Kayseri, Turkey
| | - Cevdet Ozdemir
- Department of Pediatric Basic Sciences, Institute of Child Health, Istanbul University, Istanbul, Turkey
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Dilsad Mungan
- Division of Immunology and Allergic Diseases, Department of Chest Diseases, School of Medicine, Ankara University, Ankara, Turkey
| | - Cezmi A. Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
- Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
- Cezmi A. Akdis ; orcid.org/0000-0001-8020-019X
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21
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Pacheco Da Silva E, Sit G, Goldberg M, Leynaert B, Nadif R, Ribet C, Roche N, Zins M, Varraso R, Dumas O, Le Moual N. Household use of green and homemade cleaning products, wipe application mode, and asthma among French adults from the CONSTANCES cohort. INDOOR AIR 2022; 32:e13078. [PMID: 35904383 PMCID: PMC9545541 DOI: 10.1111/ina.13078] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 06/13/2022] [Accepted: 06/30/2022] [Indexed: 06/15/2023]
Abstract
While exposure to irritant and sprayed cleaning products at home is known to have a harmful role in asthma, the potential health effect of other categories or forms has not been investigated. We studied the associations of household use of cleaning products, including green, homemade products, and disinfecting wipes, with asthma based on data from the large French population-based CONSTANCES cohort. Participants completed standardized questionnaires on respiratory health and household use of cleaning products. Cross-sectional associations of cleaning products with current asthma, adjusted for gender, age, smoking status, BMI, and educational level, were evaluated by logistic regressions. Analyses were conducted in 41 570 participants (mean age: 47 years, 56% women, weekly use of the six specific products/forms studied varied from 11% to 37%). Weekly use of irritants (OR = 1.23 [1.13-1.35]), scented (OR = 1.15 [1.06-1.26]), green (OR = 1.09 [1.00-1.20]), and homemade products (OR = 1.19 [1.06-1.34]), as well as sprays (OR = 1.18 [1.08-1.29]), disinfecting wipes (OR = 1.21 [1.09-1.34]) were significantly associated with asthma, with significant trends according to the frequency of use. When they were not co-used with irritants/sprays, associations were reduced and persisted only for disinfecting wipes. Weekly use of disinfecting wipes at home was associated with current asthma, but fewer risks were observed for the use of green and homemade products.
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Affiliation(s)
- Emilie Pacheco Da Silva
- Université Paris‐Saclay, UVSQ, Univ. Paris‐Sud, InsermÉquipe d'Épidémiologie Respiratoire Intégrative, CESPVillejuifFrance
| | - Guillaume Sit
- Université Paris‐Saclay, UVSQ, Univ. Paris‐Sud, InsermÉquipe d'Épidémiologie Respiratoire Intégrative, CESPVillejuifFrance
| | - Marcel Goldberg
- Université de Paris, Unité "Cohortes en Population" INSERMUniversité Paris Saclay, UVSQ, UMSParisFrance
| | - Bénédicte Leynaert
- Université Paris‐Saclay, UVSQ, Univ. Paris‐Sud, InsermÉquipe d'Épidémiologie Respiratoire Intégrative, CESPVillejuifFrance
| | - Rachel Nadif
- Université Paris‐Saclay, UVSQ, Univ. Paris‐Sud, InsermÉquipe d'Épidémiologie Respiratoire Intégrative, CESPVillejuifFrance
| | - Céline Ribet
- Université de Paris, Unité "Cohortes en Population" INSERMUniversité Paris Saclay, UVSQ, UMSParisFrance
| | - Nicolas Roche
- Pneumologie, Hôpital CochinAPHP.Centre – Université de ParisParisFrance
| | - Marie Zins
- Université de Paris, Unité "Cohortes en Population" INSERMUniversité Paris Saclay, UVSQ, UMSParisFrance
| | - Raphaëlle Varraso
- Université Paris‐Saclay, UVSQ, Univ. Paris‐Sud, InsermÉquipe d'Épidémiologie Respiratoire Intégrative, CESPVillejuifFrance
| | - Orianne Dumas
- Université Paris‐Saclay, UVSQ, Univ. Paris‐Sud, InsermÉquipe d'Épidémiologie Respiratoire Intégrative, CESPVillejuifFrance
| | - Nicole Le Moual
- Université Paris‐Saclay, UVSQ, Univ. Paris‐Sud, InsermÉquipe d'Épidémiologie Respiratoire Intégrative, CESPVillejuifFrance
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22
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Hicks A, Hicks P. Disinfection in the time of COVID: Safe solutions are critical for schools. Paediatr Child Health 2022; 27:324-326. [PMID: 36193162 PMCID: PMC9384394 DOI: 10.1093/pch/pxac060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 05/15/2022] [Indexed: 12/04/2022] Open
Abstract
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.
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Affiliation(s)
- Anne Hicks
- Department of Pediatrics, University of Alberta , Edmonton , Canada
| | - Patrick Hicks
- Department of Kinesiology, University of Alberta , Edmonton , Canada
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23
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Paciência I, Cavaleiro Rufo J, Moreira A. Environmental inequality: Air pollution and asthma in children. Pediatr Allergy Immunol 2022; 33. [PMID: 35754123 DOI: 10.1111/pai.13818] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 05/26/2022] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Whether you benefit from high-quality urban environments, such as those rich in green and blue spaces, that may offer benefits to allergic and respiratory health depends on where you live and work. Environmental inequality, therefore, results from the unequal distribution of the risks and benefits that stem from interactions with our environment. METHODS Within this perspective, this article reviews the evidence for an association between air pollution caused by industrial activities, traffic, disinfection-by-products, and tobacco/e-cigarettes, and asthma in children. We also discuss the proposed mechanisms by which air pollution increases asthma risk, including environmental epigenetic regulations, oxidative stress, and damage, disrupted barrier integrity, inflammatory pathways, and enhancement of respiratory sensitization to aeroallergens. RESULTS AND CONCLUSIONS Environmental air pollution is a major determinant of childhood asthma, but the magnitude of effect is not shared equally across the population, regions, and settings where people live, work, and spend their time. Improvement of the exposure assessment, a better understanding of critical exposure time windows, underlying mechanisms, and drivers of heterogeneity may improve the risk estimates. Urban conditions and air quality are not only important features for national and local authorities to shape healthy cities and protect their citizens from environmental and health risks, but they also provide opportunities to mitigate inequalities in the most deprived areas where the environmental burden is highest. Actions to avoid exposure to indoor and outdoor air pollutants should be complementary at different levels-individual, local, and national levels-to take effective measures to protect children who have little or no control over the air they breathe.
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Affiliation(s)
- Inês Paciência
- EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal.,Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal.,Center for Environmental and Respiratory Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - João Cavaleiro Rufo
- EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal.,Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
| | - André Moreira
- EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal.,Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal.,Serviço de Imunoalergologia, Centro Hospitalar Universitário São João, Porto, Portugal.,Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
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24
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Celebi Sozener Z, Ozdel Ozturk B, Cerci P, Turk M, Gorgulu Akin B, Akdis M, Altiner S, Ozbey U, Ogulur I, Mitamura Y, Yilmaz I, Nadeau K, Ozdemir C, Mungan D, Akdis CA. Epithelial barrier hypothesis: Effect of the external exposome on the microbiome and epithelial barriers in allergic disease. Allergy 2022; 77:1418-1449. [PMID: 35108405 PMCID: PMC9306534 DOI: 10.1111/all.15240] [Citation(s) in RCA: 133] [Impact Index Per Article: 66.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 01/25/2022] [Accepted: 01/29/2022] [Indexed: 12/11/2022]
Abstract
Environmental exposure plays a major role in the development of allergic diseases. The exposome can be classified into internal (e.g., aging, hormones, and metabolic processes), specific external (e.g., chemical pollutants or lifestyle factors), and general external (e.g., broader socioeconomic and psychological contexts) domains, all of which are interrelated. All the factors we are exposed to, from the moment of conception to death, are part of the external exposome. Several hundreds of thousands of new chemicals have been introduced in modern life without our having a full understanding of their toxic health effects and ways to mitigate these effects. Climate change, air pollution, microplastics, tobacco smoke, changes and loss of biodiversity, alterations in dietary habits, and the microbiome due to modernization, urbanization, and globalization constitute our surrounding environment and external exposome. Some of these factors disrupt the epithelial barriers of the skin and mucosal surfaces, and these disruptions have been linked in the last few decades to the increasing prevalence and severity of allergic and inflammatory diseases such as atopic dermatitis, food allergy, allergic rhinitis, chronic rhinosinusitis, eosinophilic esophagitis, and asthma. The epithelial barrier hypothesis provides a mechanistic explanation of how these factors can explain the rapid increase in allergic and autoimmune diseases. In this review, we discuss factors affecting the planet's health in the context of the 'epithelial barrier hypothesis,' including climate change, pollution, changes and loss of biodiversity, and emphasize the changes in the external exposome in the last few decades and their effects on allergic diseases. In addition, the roles of increased dietary fatty acid consumption and environmental substances (detergents, airborne pollen, ozone, microplastics, nanoparticles, and tobacco) affecting epithelial barriers are discussed. Considering the emerging data from recent studies, we suggest stringent governmental regulations, global policy adjustments, patient education, and the establishment of individualized control measures to mitigate environmental threats and decrease allergic disease.
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Affiliation(s)
| | - Betul Ozdel Ozturk
- School of MedicineDepartment of Chest DiseasesDivision of Immunology and Allergic DiseasesAnkara UniversityAnkaraTurkey
| | - Pamir Cerci
- Clinic of Immunology and Allergic DiseasesEskisehir City HospitalEskisehirTurkey
| | - Murat Turk
- Clinic of Immunology and Allergic DiseasesKayseri City HospitalKayseriTurkey
| | - Begum Gorgulu Akin
- Clinic of Immunology and Allergic DiseasesAnkara City HospitalAnkaraTurkey
| | - Mubeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF)University of ZurichDavosSwitzerland
| | - Seda Altiner
- Clinic of Internal Medicine Division of Immunology and Allergic DiseasesKahramanmaras Necip Fazil City HospitalKahramanmarasTurkey
| | - Umus Ozbey
- Department of Nutrition and DietAnkara UniversityAnkaraTurkey
| | - Ismail Ogulur
- Swiss Institute of Allergy and Asthma Research (SIAF)University of ZurichDavosSwitzerland
| | - Yasutaka Mitamura
- Swiss Institute of Allergy and Asthma Research (SIAF)University of ZurichDavosSwitzerland
| | - Insu Yilmaz
- Department of Chest DiseasesDivision of Immunology and Allergic DiseasesErciyes UniversityKayseriTurkey
| | - Kari Nadeau
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University School of MedicineDivision of Pulmonary and Critical Care MedicineDepartment of MedicineStanford UniversityStanfordCaliforniaUSA
| | - Cevdet Ozdemir
- Institute of Child HealthDepartment of Pediatric Basic SciencesIstanbul UniversityIstanbulTurkey
- Istanbul Faculty of MedicineDepartment of PediatricsDivision of Pediatric Allergy and ImmunologyIstanbul UniversityIstanbulTurkey
| | - Dilsad Mungan
- School of MedicineDepartment of Chest DiseasesDivision of Immunology and Allergic DiseasesAnkara UniversityAnkaraTurkey
| | - Cezmi A. Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF)University of ZurichDavosSwitzerland
- Christine Kühne‐Center for Allergy Research and Education (CK‐CARE)DavosSwitzerland
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Ahmed AS, Ibrahim DA, Hassan TH, Abd-El-Azem WG. Prevalence and predictors of occupational asthma among workers in detergent and cleaning products industry and its impact on quality of life in El Asher Men Ramadan, Egypt. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:33901-33908. [PMID: 35034305 PMCID: PMC8761047 DOI: 10.1007/s11356-022-18558-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 01/04/2022] [Indexed: 06/14/2023]
Abstract
Cleaning products are mixtures of many chemical ingredients that are known to contain sensitizers, disinfectants, and fragrances, as well as strong airway irritants which associated with lower respiratory tract and asthma symptoms. The aim of this study is to assess the prevalence and possible risk factors of occupational asthma and its effect on quality of life among workers in detergent and cleaning products industries in El Asher men Ramadan city. This cross-sectional study was conducted on 780 workers. All participants were personally interviewed at their workplaces and were subjected to a questionnaire regarding sociodemographic, work characteristics and asthma symptoms, clinical examination, chest X-ray, spirometer, and bronchodilator test. The prevalence of occupational asthma among the studied workers was 35.4%. Multivariate logistic regression analysis revealed that female gender [odds ratio 1.397; 95% CI 1.09-1.96], manually working participants [odds ratio 3.067; 95% CI 1.72-5.46], and history of atopy [odds ratio 1.596; 95% CI 1.09-2.33] were risk factors for development of occupational asthma. The total mean score of asthma-specific quality of life was significantly lower in asthmatic (5.10 ± 0.49) than non-asthmatic workers (5.89 ± 0.46) (P < 0.01) indicating impairment of quality of life among asthmatic group. Workers in detergent and cleaning products industry are at higher risk for developing occupational asthma that adversely affects their general health and quality of life.
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Affiliation(s)
- Amani Shawki Ahmed
- Community, Environmental and Occupational Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
| | - Dalia Anas Ibrahim
- Chest Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Tarek Hamdy Hassan
- Chest Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Wael Galal Abd-El-Azem
- Community, Environmental and Occupational Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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De Troeyer K, De Man J, Vandebroek E, Vanoirbeek JA, Hoet PH, Nemery B, Vanroelen C, Casas L, Ronsmans S. Identifying cleaning products associated with short-term work-related respiratory symptoms: A workforce-based study in domestic cleaners. ENVIRONMENT INTERNATIONAL 2022; 162:107170. [PMID: 35272140 DOI: 10.1016/j.envint.2022.107170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 06/14/2023]
Abstract
Domestic cleaners have an increased risk of asthma-like and other respiratory symptoms and conditions. Uncertainty exists about which products are most hazardous. We aimed to investigate, among professional domestic cleaners, the associations of ocular/respiratory outcomes with using specific types of products at work and with the ability to choose their own products. Among domestic cleaners employed by "service vouchers" companies in Belgium, we administered an online questionnaire on ocular/respiratory symptoms (frequency and time relation to workdays), frequency of use of 40 types of products, and ability to choose one's own products. Work-relatedness was defined as symptoms improving/disappearing on days off-work. We studied associations between frequency of product-use with work-related outcomes (eye irritation, rhinitis symptoms, sore throat, laryngeal symptoms, asthma symptoms, cough) and with chronic bronchitis, using multivariable logistic and elastic net regression. Adjusted odds ratios (OR) with 95%-confidence intervals were obtained per time a product was used per week. Among 1,586 domestic cleaners (99% women), the number of times sprays were used (median 13/week) was significantly associated with all outcomes (ORs between 1.012 and 1.024 per time sprays were used per week). Bleach/disinfectant-containing liquid products were associated with all outcomes, except for laryngeal symptoms (ORs 1.086 to 1.150); ammonia with work-related upper airway symptoms and chronic bronchitis. Cleaners able to choose their own products had fewer work-related eye symptoms (OR 0.728;0.556-0.954), rhinitis (OR 0.735;0.571-0.946) and cough (OR 0.671;0.520-0.865). Using elastic net regression, work-related rhinitis was most strongly associated with mould removal spray (OR 1.108;1.006-1.248), carpet/seat/curtain spray (OR 1.099;1.001-1.304) and ammonia (OR 1.081;1.002-1.372); work-related asthma with carpet/seat/curtain spray (OR 1.103;1.017-1.322), mould removal spray (OR 1.029;0.995-1.199) and drain cleaner (OR 1.023;0.979-1.302). In a large group of domestic cleaners, we documented that cleaning products have a range of adverse respiratory effects. Empowering cleaners to choose their products may reduce the burden of symptoms.
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Affiliation(s)
- Katrien De Troeyer
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium; Epidemiology and Health Policy, Department of Family Medicine and Population Health, University of Antwerp, Wilrijk, Belgium
| | - Jeroen De Man
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Eline Vandebroek
- Clinic for Occupational and Environmental Medicine, Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium; Premed, External Service for Prevention and Protection at Work, Leuven, Belgium
| | - Jeroen A Vanoirbeek
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Peter Hm Hoet
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Benoit Nemery
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium; Clinic for Occupational and Environmental Medicine, Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Christophe Vanroelen
- Interface Demography, Sociology Department, Vrije Universiteit Brussel, Brussels, Belgium
| | - Lidia Casas
- Epidemiology and Health Policy, Department of Family Medicine and Population Health, University of Antwerp, Wilrijk, Belgium
| | - Steven Ronsmans
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium; Clinic for Occupational and Environmental Medicine, Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium.
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27
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Jenkins CR, Boulet LP, Lavoie KL, Raherison-Semjen C, Singh D. Personalized Treatment of Asthma: The Importance of Sex and Gender Differences. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:963-971.e3. [PMID: 35150902 DOI: 10.1016/j.jaip.2022.02.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/18/2022] [Accepted: 02/03/2022] [Indexed: 12/19/2022]
Abstract
An individual's sex (nominally male or female, based on biological attributes) and gender (a complex term referring to socially constructed roles, behaviors, and expressions of identity) influence the clinical course of asthma in several ways. The physiologic development of the lungs and effects of sex hormones may explain why more boys than girls have asthma, and after puberty, more women than men have asthma. Female sex hormones have an impact throughout the life span and are associated with poor asthma control. Gender may influence exposure to asthma triggers, and sex and gender can influence the prevalence of comorbidities and interactions with health care professionals. Despite widely reported sex- and gender-based differences in asthma and asthma management, these issues frequently are not considered by health care professionals. There is also inconsistency regarding the use of "sex" and "gender" in scientific discourse; research is needed to define sex- and gender-based differences better and how they might interact to influence asthma outcomes. This review outlines the impact an individual's sex and gender can have on the pathogenesis, clinical course, diagnosis, treatment, and management of asthma.
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Affiliation(s)
| | | | - Kim L Lavoie
- Department of Psychology, University of Québec at Montreal and Montreal Behavioural Medicine Centre, CIUSSS-NIM, Hôpital du Sacré-Cœur de Montréal, Montreal, Canada
| | - Chantal Raherison-Semjen
- Centre Hospitalier Universitaire de Guadeloupe, Guadeloupe, France; INSERM U1219, EpiCene Team, University of Bordeaux, Bordeaux, France
| | - Dave Singh
- University of Manchester, Manchester University NHS Foundation Trust, Manchester, United Kingdom
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Rafiee A, Delgado-Saborit JM, Sly PD, Amiri H, Mosalaei S, Hoseini M. Health consequences of disinfection against SARS-CoV-2: Exploring oxidative stress damage using a biomonitoring approach. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 814:152832. [PMID: 34986424 PMCID: PMC8720300 DOI: 10.1016/j.scitotenv.2021.152832] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 12/13/2021] [Accepted: 12/28/2021] [Indexed: 05/13/2023]
Abstract
Individuals who get involved in the disinfection of public settings using sodium hypochlorite might suffer adverse health effects. However, scarce information is available on the potential oxidative stress damage caused at low concentrations typically used for disinfection. We aimed to assess whether exposure to sodium hypochlorite during the COVID-19 pandemic causes oxidative stress damage in workers engaged in disinfection tasks. 75 operators engaged in the disinfection of public places were recruited as the case group, and 60 individuals who were not exposed to disinfectant were chosen as the control group. Spot urine samples were collected before (BE) and after exposure (AE) to disinfectants in the case group. Likewise, controls provided two spot urine samples in the same way as the case group. Urinary malondialdehyde (MDA) levels were quantified by forming thiobarbituric acid reactive substances in the urine. In addition, the concentration of 8-hydroxy-2'-deoxyguanosine (8-OHdG) in the urine was determined using an ELISA kit. Results showed significant differences in the urinary levels of oxidative stress markers, where median 8-OHdG (AE case: 3.84 ± 2.89 μg/g creatinine vs AE control 2.54 ± 1.21 μg/g creatinine) and MDA (AE case: 169 ± 89 μg/g creatinine vs AE control 121 ± 47 μg/g creatinine) levels in case group AE samples were 1.55 and 1.35-times higher than the control group AE samples (P < 0.05), respectively. Besides, urinary levels of oxidative stress markers in AE samples of the case group were significantly higher than in BE samples (8-OHdG BE 3.40 ± 1.95 μg/g creatinine, MDA BE 136 ± 51.3 μg/g creatinine, P < 0.05). Our results indicated that exposure to even low levels of sodium hypochlorite used in disinfection practices might cause oxidative stress related damage. With this in mind, implementing robust protective measures, such as specific respirators, is crucial to reduce the health burdens of exposure to disinfectants.
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Affiliation(s)
- Ata Rafiee
- Department of Medicine, University of Alberta, Edmonton, AB, Canada.
| | - Juana Maria Delgado-Saborit
- Universitat Jaume I, Perinatal Epidemiology, Environmental Health and Clinical Research, School of Medicine, Castellon, Spain; ISGlobal Barcelona Institute for Global Health, Barcelona Biomedical Research Park, Barcelona, Spain; Environmental Research Group, MRC Centre for Environment and Health, Imperial College London, United Kingdom; Division of Environmental Health & Risk Management, School of Geography, Earth & Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Peter D Sly
- Children's Health and Environment Program, Child Health Research Center, The University of Queensland, South Brisbane, Australia
| | - Hoda Amiri
- Environmental Health Engineering Research Center, Kerman University of Medical Sciences, Kerman, Iran; Department of Environmental Health Engineering, Faculty of Public Health, Kerman University of Medical Sciences, Kerman, Iran.
| | - Shamim Mosalaei
- Department of Environmental Health, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hoseini
- Research Center for Health Sciences, Institute of Health, Department of Environmental Health, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran.
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29
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The Impact of Ambient Environmental and Occupational Pollution on Respiratory Diseases. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052788. [PMID: 35270479 PMCID: PMC8910713 DOI: 10.3390/ijerph19052788] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/22/2022] [Accepted: 02/25/2022] [Indexed: 11/16/2022]
Abstract
Ambient pollutants and occupational pollutants may cause and exacerbate various lung and respiratory diseases. This review describes lung and respiratory diseases in relation to ambient pollutants, particularly particulate matter (PM2.5), and occupational air pollutants, excluding communicable diseases and indoor pollutants, including tobacco smoke exposure. PM2.5 produced by combustion is an important ambient pollutant. PM2.5 can cause asthma attacks and exacerbations of chronic obstructive pulmonary disease in the short term. Further, it not only carries a risk of lung cancer and death, but also hinders the development of lung function in children in the long term. It has recently been suggested that air pollution, such as PM2.5, is a risk factor for severe coronavirus disease (COVID-19). Asbestos, which causes asbestosis, lung cancer, and malignant mesothelioma, and crystalline silica, which cause silicosis, are well-known traditional occupational pollutants leading to pneumoconiosis. While work-related asthma (WRA) is the most common occupational lung disease in recent years, many different agents cause WRA, including natural and synthetic chemicals and irritant gases. Primary preventive interventions that increase awareness of pollutants and reduce the development and exacerbation of diseases caused by air pollutants are paramount to addressing ambient and occupational pollution.
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30
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Oyer-Peterson K, Ruiz de Porras DG, Han I, Delclos GL, Brooks EG, Afshar M, Whitworth KW. A pilot study of total personal exposure to volatile organic compounds among Hispanic female domestic cleaners. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2022; 19:1-11. [PMID: 34731075 PMCID: PMC8813894 DOI: 10.1080/15459624.2021.2000615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Cleaners have an elevated risk for the development or exacerbation of asthma and other respiratory conditions, possibly due to exposure to cleaning products containing volatile organic compounds (VOCs) leading to inflammation and oxidative stress. This pilot study aimed to quantify total personal exposure to VOCs and to assess biomarkers of inflammation and pulmonary oxidative stress in 15 predominantly Hispanic women working as domestic cleaners in San Antonio, Texas, between November 2019 and July 2020. In partnership with a community organization, Domésticas Unidas, recruited women were invited to attend a training session where they were provided 3M 3500 passive organic vapor monitors (badges) and began a 72-hr sampling period during which they were instructed to wear one badge during the entire period ("AT," for All the Time), a second badge only while they were inside their home ("INS," for INSide), and a third badge only when they were outside their home ("OUT," for OUTside). At the end of the sampling period, women returned the badges and provided blood and exhaled breath condensate (EBC) samples. From the badges, 30 individual VOCs were measured and summed to inform total VOC (TVOC) concentrations, as well as concentrations of the following VOC groups: aromatic hydrocarbons, alkanes, halogenated hydrocarbons, and terpenes. From the blood and EBC samples, concentrations of serum C-reactive protein (CRP) and EBC 8-isoprostane (8-ISP) and pH were quantified. Data analyses included descriptive statistics. The 72-hr average of personal exposure to TVOC was 34.4 ppb and ranged from 9.2 to 219.5 ppb. The most prevalent class of VOC exposures for most women (66.7%) was terpenes, specifically d-limonene. Overall, most women also experienced higher TVOC concentrations while outside their home (86.7%) as compared to inside their home. Serum CRP concentrations ranged from 0.3 to 20.3 mg/dL; 8-ISP concentrations ranged from 9.5 to 44.1 pg/mL; and EBC pH ranged from 7.1 to 8.6. Overall, this pilot study demonstrated personal VOC exposure among Hispanic domestic cleaners, particularly to d-limonene, which may result from the use of scented cleaning products.
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Affiliation(s)
- Kelly Oyer-Peterson
- Southwest Center for Occupational and Environmental Health (SWCOEH), Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in San Antonio, San Antonio, TX, USA
| | - David Gimeno Ruiz de Porras
- Southwest Center for Occupational and Environmental Health (SWCOEH), Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in San Antonio, San Antonio, TX, USA
- CIBER Epidemiología y Salud Pública, Madrid, 28029, Spain
- Center for Research in Occupational Health (CISAL), Universitat Pompeu Fabra, Barcelona, 08003, Spain
| | - Inkyu Han
- Department of Epidemiology and Biostatistics, Temple University College of Public Health, Philadelphia, PA, USA
| | - George L. Delclos
- CIBER Epidemiología y Salud Pública, Madrid, 28029, Spain
- Center for Research in Occupational Health (CISAL), Universitat Pompeu Fabra, Barcelona, 08003, Spain
- Southwest Center for Occupational and Environmental Health (SWCOEH), Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health, Houston, TX, USA
| | - Edward G. Brooks
- The University of Texas Health Science Center at San Antonio (UT Health San Antonio), Long School of Medicine, Department of Microbiology, Immunology & Molecular Genetics, San Antonio, TX, USA
| | - Masoud Afshar
- Southwest Center for Occupational and Environmental Health (SWCOEH), Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health, Houston, TX, USA
| | - Kristina W. Whitworth
- Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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31
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Does the epithelial barrier hypothesis explain the increase in allergy, autoimmunity and other chronic conditions? Nat Rev Immunol 2021; 21:739-751. [PMID: 33846604 DOI: 10.1038/s41577-021-00538-7] [Citation(s) in RCA: 413] [Impact Index Per Article: 137.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 02/07/2023]
Abstract
There has been a steep increase in allergic and autoimmune diseases, reaching epidemic proportions and now affecting more than one billion people worldwide. These diseases are more common in industrialized countries, and their prevalence continues to rise in developing countries in parallel to urbanization and industrialization. Intact skin and mucosal barriers are crucial for the maintenance of tissue homeostasis as they protect host tissues from infections, environmental toxins, pollutants and allergens. A defective epithelial barrier has been demonstrated in allergic and autoimmune conditions such as asthma, atopic dermatitis, allergic rhinitis, chronic rhinosinusitis, eosinophilic esophagitis, coeliac disease and inflammatory bowel disease. In addition, leakiness of the gut epithelium is also implicated in systemic autoimmune and metabolic conditions such as diabetes, obesity, multiple sclerosis, rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis and autoimmune hepatitis. Finally, distant inflammatory responses due to a 'leaky gut' and microbiome changes are suspected in Alzheimer disease, Parkinson disease, chronic depression and autism spectrum disorders. This article introduces an extended 'epithelial barrier hypothesis', which proposes that the increase in epithelial barrier-damaging agents linked to industrialization, urbanization and modern life underlies the rise in allergic, autoimmune and other chronic conditions. Furthermore, it discusses how the immune responses to dysbiotic microbiota that cross the damaged barrier may be involved in the development of these diseases.
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Mwanga HH, Baatjies R, Singh T, Jeebhay MF. Asthma Phenotypes and Host Risk Factors Associated With Various Asthma-Related Outcomes in Health Workers. FRONTIERS IN ALLERGY 2021; 2:747566. [PMID: 35386991 PMCID: PMC8974710 DOI: 10.3389/falgy.2021.747566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/21/2021] [Indexed: 12/11/2022] Open
Abstract
Background: Work-related asthma phenotypes in health workers (HWs) exposed to cleaning agents have not been investigated extensively as other occupational exposures. This study aimed to describe asthma phenotypes and to identify important host risk factors associated with various asthma-related outcomes. Methods: A cross-sectional study of 699 HWs was conducted in two large tertiary hospitals. A total of 697 HWs completed questionnaire interviews. Sera collected from 682 HWs were analyzed for atopy (Phadiatop) and IgE to occupational allergens (NRL—Hev b5, Hev b6.02; chlorhexidine and ortho-phthalaldehyde—OPA). Methacholine (MCT), bronchodilator challenge (BDR) and fractional exhaled nitric oxide (FeNO) were performed. An asthma symptom score (ASS) used five asthma-related symptoms reported in the past 12 months. Current asthma was based on use of asthma medication or an asthma attack or being woken up by an attack of shortness of breath in the past 12 months. Nonspecific bronchial hyperresponsiveness (NSBH) was defined as having either a positive MCT or a significant bronchodilator response. Two continuous indices of NSBH [continuous index of responsiveness (CIR) and dose-response slope (DRS)] were calculated. Results: The prevalence of current asthma was 10%, atopic asthma (6%) and non-atopic asthma (4%). Overall, 2% of subjects had work-related asthma. There was a weak positive association between NSBH and FeNO [CIR: Beta coefficient (β) = 0.12; CI: 0.03–0.22 and DRS: β = 0.07; CI: 0.03–0.12]. Combining FeNO ≥ 50 ppb with a BDR [mean ratio (MR) = 5.89; CI: 1.02–34.14] or with NSBH (MR = 4.62; CI: 1.16–18.46) correlated better with ASS than FeNO alone (MR = 2.23; CI: 1.30–3.85). HWs with current asthma were twice as likely to be atopic. FeNO was positively associated with atopy (OR = 3.19; CI: 1.59–6.39) but negatively associated with smoking status (GMR = 0.76; CI: 0.62–0.94). Most HWs sensitized to occupational allergens were atopic. Conclusion: Atopic asthma was more prevalent than non-atopic asthma in HWs. Most asthma-related outcomes were positively associated with allergic predictors suggesting a dominant role for IgE mechanisms for work-related symptoms and asthma associated with sensitization to OPA or chlorhexidine.
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Affiliation(s)
- Hussein H. Mwanga
- Division of Occupational Medicine and Center for Environmental & Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Department of Environmental and Occupational Health, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Roslynn Baatjies
- Division of Occupational Medicine and Center for Environmental & Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Department of Environmental and Occupational Studies, Faculty of Applied Sciences, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Tanusha Singh
- National Institute for Occupational Health, National Health Laboratory Services, Johannesburg, South Africa
- Department of Clinical Microbiology and Infectious Diseases, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
- Department of Environmental Health, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Mohamed F. Jeebhay
- Division of Occupational Medicine and Center for Environmental & Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- *Correspondence: Mohamed F. Jeebhay
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33
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Tjalvin G, Svanes Ø, Igland J, Bertelsen RJ, Benediktsdóttir B, Dharmage S, Forsberg B, Holm M, Janson C, Jõgi NO, Johannessen A, Malinovschi A, Pape K, Real FG, Sigsgaard T, Torén K, Vindenes HK, Zock JP, Schlünssen V, Svanes C. Maternal preconception occupational exposure to cleaning products and disinfectants and offspring asthma. J Allergy Clin Immunol 2021; 149:422-431.e5. [PMID: 34674855 DOI: 10.1016/j.jaci.2021.08.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 07/08/2021] [Accepted: 08/31/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Emerging research suggests health effects in offspring after parental chemical exposures before conception. Many future mothers are exposed to potent chemicals at work, but potential offspring health effects are hardly investigated. OBJECTIVE We sought to investigate childhood asthma in relation to mother's occupational exposure to cleaning products and disinfectants before conception. METHODS The multicenter Respiratory Health In Northern Europe/Respiratory Health In Northern Europe, Spain and Australia generation study investigated asthma and wheeze starting at age less than 10 years in 3318 mother-offspring pairs. From an asthma-specific Job-Exposure Matrix and mothers' occupational history, we defined maternal occupational exposure to indoor cleaning agents (cleaning products/detergents and disinfectants) starting before conception, in the 2-year period around conception and pregnancy, or after birth. Never-employed mothers were excluded. Exposed groups include cleaners, health care workers, cooks, and so forth. Associations were analyzed using mixed-effects logistic regression and ordinary logistic regression with clustered robust SEs and adjustment for maternal education. RESULTS Maternal occupational exposure to indoor cleaning starting preconception and continuing (n = 610) was associated with offspring's childhood asthma: odds ratio 1.56 (95% CI, 1.05-2.31), childhood asthma with nasal allergies: 1.77 (1.13-2.77), and childhood wheeze and/or asthma: 1.71 (95% CI, 1.19-2.44). Exposure starting around conception and pregnancy (n = 77) was associated with increased childhood wheeze and/or asthma: 2.25 (95% CI, 1.03-4.91). Exposure starting after birth was not associated with asthma outcomes (1.13 [95% CI, 0.71-1.80], 1.15 [95% CI, 0.67-1.97], 1.08 [95% CI, 0.69-1.67]). CONCLUSIONS Mother's occupational exposure to indoor cleaning agents starting before conception, or around conception and pregnancy, was associated with more childhood asthma and wheeze in offspring. Considering potential implications for vast numbers of women in childbearing age using cleaning agents, and their children, further research is imperative.
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Affiliation(s)
- Gro Tjalvin
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway.
| | - Øistein Svanes
- Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Jannicke Igland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Department of Health and Caring Sciences, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Randi Jacobsen Bertelsen
- Department of Clinical Science, University of Bergen, Bergen, Norway; Oral Health Center of Expertise in Western Norway, Bergen, Norway
| | - Bryndís Benediktsdóttir
- Medical Faculty, University of Iceland, Reykjavík, Iceland; Department of Sleep, Landspitali University Hospital Reykjavík, Reykjavík, Iceland
| | - Shyamali Dharmage
- Allergy and Lung Health Unit, University of Melbourne, Melbourne, Australia
| | - Bertil Forsberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Mathias Holm
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Christer Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Nils Oskar Jõgi
- Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway; Tartu University Lung Clinic, Tartu, Estonia
| | - Ane Johannessen
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Andrei Malinovschi
- Department of Medical Sciences: Clinical Physiology, Uppsala University, Uppsala, Sweden
| | - Kathrine Pape
- National Research Centre for the Working Environment, Aarhus, Denmark; Department of Public Health, Aarhus University, Environment, Work and Health, Danish Ramazzini Centre, Aarhus, Denmark
| | - Francisco Gomez Real
- Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - Torben Sigsgaard
- Department of Public Health, Aarhus University, Environment, Work and Health, Danish Ramazzini Centre, Aarhus, Denmark
| | - Kjell Torén
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hilde Kristin Vindenes
- Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Jan-Paul Zock
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Vivi Schlünssen
- National Research Centre for the Working Environment, Aarhus, Denmark; Department of Public Health, Aarhus University, Environment, Work and Health, Danish Ramazzini Centre, Aarhus, Denmark
| | - Cecilie Svanes
- Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway; Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Yuksel H, Ocalan M, Yilmaz O. E-Cadherin: An Important Functional Molecule at Respiratory Barrier Between Defence and Dysfunction. Front Physiol 2021; 12:720227. [PMID: 34671272 PMCID: PMC8521047 DOI: 10.3389/fphys.2021.720227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 08/31/2021] [Indexed: 12/16/2022] Open
Abstract
While breathing, many microorganisms, harmful environmental particles, allergens, and environmental pollutants enter the human airways. The human respiratory tract is lined with epithelial cells that act as a functional barrier to these harmful factors and provide homeostasis between external and internal environment. Intercellular epithelial junctional proteins play a role in the formation of the barrier. E-cadherin is a calcium-dependent adhesion molecule and one of the most important molecules involved in intercellular epithelial barier formation. E-cadherin is not only physical barrier element but also regulates cell proliferation, differentiation and the immune response to environmental noxious agents through various transcription factors. In this study, we aimed to review the role of E-cadherin in the formation of airway epithelial barier, its status as a result of exposure to various environmental triggers, and respiratory diseases associated with its dysfunction. Moreover, the situations in which its abnormal activation can be noxious would be discussed.
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Affiliation(s)
- Hasan Yuksel
- Department of Pediatric Allergy and Pulmonology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Merve Ocalan
- Department of Pediatric Allergy and Immunology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Ozge Yilmaz
- Department of Pediatric Allergy and Pulmonology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
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Roio LCD, Mizutani RF, Pinto RC, Terra-Filho M, Santos UP. Work-related asthma. ACTA ACUST UNITED AC 2021; 47:e20200577. [PMID: 34406224 PMCID: PMC8352763 DOI: 10.36416/1806-3756/e20200577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 04/05/2021] [Indexed: 11/17/2022]
Abstract
Work-related asthma (WRA) is highly prevalent in the adult population. WRA includes occupational asthma (OA), which is asthma caused by workplace exposures, and work-exacerbated asthma (WEA), also known as work-aggravated asthma, which is preexisting or concurrent asthma worsened by workplace conditions. In adults, the estimated prevalence of OA is 16.0%, whereas that of WEA is 21.5%. An increasing number of chemicals used in industrial production, households, and services are associated with the incidence of adult-onset asthma attributable to exposure to chemicals. This review article summarizes the different types of WRA and describes diagnostic procedures, treatment, prevention, and approaches to patient management. It is not always easy to distinguish between OA and WEA. It is important to establish a diagnosis (of sensitizer-/irritant-induced OA or WEA) in order to prevent worsening of symptoms, as well as to prevent other workers from being exposed, by providing early treatment and counseling on social security and work-related issues.
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Affiliation(s)
- Lavinia Clara Del Roio
- . Programa de Pós-Graduação em Pneumologia, Faculdade de Medicina, Universidade de São Paulo - FMUSP - São Paulo (SP) Brasil
| | - Rafael Futoshi Mizutani
- . Grupo de Doenças Respiratórias Ocupacionais, Ambientais e de Cessação de Tabagismo, Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - FMUSP - São Paulo (SP) Brasil
| | - Regina Carvalho Pinto
- . Grupo de Doenças Obstrutivas, Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - FMUSP - São Paulo (SP) Brasil
| | - Mário Terra-Filho
- . Disciplina de Pneumologia, Faculdade de Medicina, Universidade de São Paulo - FMUSP - São Paulo (SP) Brasil
| | - Ubiratan Paula Santos
- . Grupo de Doenças Respiratórias Ocupacionais, Ambientais e de Cessação de Tabagismo, Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - FMUSP - São Paulo (SP) Brasil
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Occupational Respiratory Allergy: Risk Factors, Diagnosis, and Management. Handb Exp Pharmacol 2021; 268:213-225. [PMID: 34031758 DOI: 10.1007/164_2021_472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Occupational allergies are among the most common recorded occupational diseases. The skin and the upper and lower respiratory tract are the classical manifestation organs. More than 400 occupational agents are currently documented as being potential "respiratory sensitizers" and new reported causative agents are reported each year. These agents may induce occupational rhinitis (OR) or occupational asthma (OA) and can be divided into high-molecular weight (HMW) and low-molecular weight (LMW) agents. The most common occupational HMW agents are (glycol)proteins found in flour and grains, enzymes, laboratory animals, fish and seafood, molds, and Hevea brasiliensis latex. Typical LMW substances are isocyanates, metals, quaternary ammonium persulfate, acid anhydrides, and cleaning products/disinfectants. Diagnosis of occupational respiratory allergy is made by a combination of medical history, physical examination, positive methacholine challenge result or bronchodilator responsiveness, determination of IgE-mediated sensitization, and specific inhalation challenge tests as the gold standard. Accurate diagnosis of asthma is the first step to managing OA as shown above. Removal from the causative agent is of central importance for the management of OA. The best strategy to avoid OA is primary prevention, ideally by avoiding the use of and exposure to the sensitizer or substituting safer substances for these agents.
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Romero Starke K, Friedrich S, Schubert M, Kämpf D, Girbig M, Pretzsch A, Nienhaus A, Seidler A. Are Healthcare Workers at an Increased Risk for Obstructive Respiratory Diseases Due to Cleaning and Disinfection Agents? A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105159. [PMID: 34068014 PMCID: PMC8152277 DOI: 10.3390/ijerph18105159] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 11/16/2022]
Abstract
Several reviews have reported an increased risk of obstructive respiratory diseases in workers exposed to cleaning or disinfection agents, but they have focused mainly on professional cleaners. Cleaning and disinfecting are frequently performed activities by healthcare workers. We conducted a systematic review with meta-analysis to quantify the risk of obstructive respiratory diseases in healthcare workers exposed to cleaning and disinfection agents. We searched the Medline and Embase databases until 4 February 2021 to find adequate primary studies. Two independent reviewers screened the titles/abstracts and the full texts of the studies, as well as performing data extraction and quality assessment. The literature search yielded 9432 records, and 8 studies were found through a hand search. After screening, 14 studies were included in the review. All had a high risk of bias, and most studies dealt with nurses, asthma, and hyperresponsiveness (BHR)-related symptoms. Only one study investigated COPD. The meta-analysis estimated an increased risk of new-onset asthma for nurses (Effect size (ES) = 1.67; 95% CI 1.11–2.50) compared with other occupations and found an increase in the risk of new-onset asthma for nurses exposed to cleaning and disinfecting surfaces (ES = 1.43; 95% CI 1.09–1.89) and instruments (ES = 1.34; 95% CI 1.09–1.65). Exposure to specific chemicals such as bleach and glutaraldehyde (GA) increased the risk of asthma in nurses (bleach ES = 2.44; 95% CI 1.56–3.82; GA ES = 1.91, 95% CI 1.35–2.70). A higher risk for BHR-related symptoms was observed for nurses exposed to cleaning surfaces (ES = 1.44; 95% CI 1.18–1.78). Although the overall evidence was rated as low, the limitations found in this review hint at a potential underestimation of the real risk. These findings highlight the need for reinforced prevention practices with regard to healthcare workers. Similar research investigating these associations among other healthcare workers such as rescue service and nursing home personnel is needed.
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Affiliation(s)
- Karla Romero Starke
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (S.F.); (M.S.); (D.K.); (M.G.); (A.P.); (A.S.)
- Institute of Sociology, Faculty of Behavioral and Social Sciences, Chemnitz University of Technology, Thüringer Weg 9, 09126 Chemnitz, Germany
- Correspondence:
| | - Sophie Friedrich
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (S.F.); (M.S.); (D.K.); (M.G.); (A.P.); (A.S.)
| | - Melanie Schubert
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (S.F.); (M.S.); (D.K.); (M.G.); (A.P.); (A.S.)
| | - Daniel Kämpf
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (S.F.); (M.S.); (D.K.); (M.G.); (A.P.); (A.S.)
| | - Maria Girbig
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (S.F.); (M.S.); (D.K.); (M.G.); (A.P.); (A.S.)
| | - Anna Pretzsch
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (S.F.); (M.S.); (D.K.); (M.G.); (A.P.); (A.S.)
| | - Albert Nienhaus
- Department of Occupational Medicine, Toxic Substances and Health Research, Institution for Statutory Social Accident Insurance and Prevention in the Health Care and Welfare Services (BGW), 22089 Hamburg, Germany;
- Competence Centre for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), Institute for Health Service Research in Dermatology and Nursing (IVDP), University Medical Centre Hamburg-Eppendorf (UKE), 20251 Hamburg, Germany
| | - Andreas Seidler
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (S.F.); (M.S.); (D.K.); (M.G.); (A.P.); (A.S.)
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Sheha DS, Abdel-Rehim AS, Abdel-Latif OM, Abdelkader MA, Raafat RH, Sallam SA, Mostafa NS. Level of asthma control and mental health of asthma patients during lockdown for COVID-19: a cross-sectional survey. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2021. [PMCID: PMC7903366 DOI: 10.1186/s43168-021-00058-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Lockdown has been enforced globally to curb the spread of SARS-CoV-2. Patients with uncontrolled asthma are at risk of severe illness from COVID-19, highlighting the priority of adequate asthma control during the pandemic. Staying indoors exposes asthmatics to indoor asthma triggers, including disinfectants used for limiting the virus spread, in addition to psychological stresses of the pandemic which represent crucial contributors to loss of asthma control. Elective medical care, curtailed by the lockdown procedures, compromises adequate asthma follow up. The current study evaluated the effect of COVID-19 lockdown on the level of asthma control and mental health of bronchial asthma patients. The study included 264 bronchial asthma patients, aged 12 years and older, who responded to an online questionnaire including the asthma control test to evaluate asthma control in the preceding 4 weeks. Anxiety and depression scores and the impact of event scale were also provided. Results Seventy percent of asthmatics had uncontrolled asthma, and disinfectant use was associated with perceived increase in asthma symptoms in 77.7%. Anxiety and depression were associated with uncontrolled asthma in 50% of participants, suggesting a possible psychological impact on asthma patients. Conclusions During lockdown, asthma patients participating in the study had significantly uncontrolled disease and associated anxiety and depression. Since regular follow-up of asthma patients is cornerstone to adequate asthma control, alternative methods of medical care for asthma patients during lockdown are warranted, and particular need for mental health support ought to be provided as a continuum to adequate asthma control.
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Celebi Sözener Z, Cevhertas L, Nadeau K, Akdis M, Akdis CA. Environmental factors in epithelial barrier dysfunction. J Allergy Clin Immunol 2021; 145:1517-1528. [PMID: 32507229 DOI: 10.1016/j.jaci.2020.04.024] [Citation(s) in RCA: 162] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/17/2020] [Accepted: 04/22/2020] [Indexed: 12/11/2022]
Abstract
The main interfaces controlling and attempting to homeostatically balance communications between the host and the environment are the epithelial barriers of the skin, gastrointestinal system, and airways. The epithelial barrier constitutes the first line of physical, chemical, and immunologic defenses and provides a protective wall against environmental factors. Following the industrial revolution in the 19th century, urbanization and socioeconomic development have led to an increase in energy consumption, and waste discharge, leading to increased exposure to air pollution and chemical hazards. Particularly after the 1960s, biological and chemical insults from the surrounding environment-the exposome-have been disrupting the physical integrity of the barrier by degrading the intercellular barrier proteins at tight and adherens junctions, triggering epithelial alarmin cytokine responses such as IL-25, IL-33, and thymic stromal lymphopoietin, and increasing the epithelial barrier permeability. A typical type 2 immune response develops in affected organs in asthma, rhinitis, chronic rhinosinusitis, eosinophilic esophagitis, food allergy, and atopic dermatitis. The aim of this article was to discuss the effects of environmental factors such as protease enzymes of allergens, detergents, tobacco, ozone, particulate matter, diesel exhaust, nanoparticles, and microplastic on the integrity of the epithelial barriers in the context of epithelial barrier hypothesis.
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Affiliation(s)
- Zeynep Celebi Sözener
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Herman-Burchard Strasse 9, Davos, Switzerland; Department of Chest Diseases, Division of Allergy and Immunology, Ankara University School of Medicine, Ankara, Turkey
| | - Lacin Cevhertas
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Herman-Burchard Strasse 9, Davos, Switzerland; Department of Medical Immunology, Institute of Health Sciences, Bursa Uludag University, Bursa, Turkey; Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
| | - Kari Nadeau
- the Naddisy Foundation, Sean Parker Asthma and Allergy Center, Stanford University, Stanford, Calif
| | - Mübeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Herman-Burchard Strasse 9, Davos, Switzerland
| | - Cezmi A Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Herman-Burchard Strasse 9, Davos, Switzerland; Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland.
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De Matteis S, Ronsmans S, Nemery B. Respiratory Health Effects of Exposure to Cleaning Products. Clin Chest Med 2021; 41:641-650. [PMID: 33153684 DOI: 10.1016/j.ccm.2020.08.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
There is consistent and growing evidence of an epidemic of "asthma-like" symptoms among professional cleaners. Questions include how big is this problem worldwide, which cleaning agents are dangerous, how do they affect the lungs, and is it really asthma? This issue is important to public health because of the increasing number of professional cleaners, many from vulnerable categories. There are implications for anybody exposed to cleaning products during housekeeping, including children. This article uses available evidence to give a broad but concise overview on what we know so far and how we can prevent the cleaning-associated respiratory public health burden.
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Affiliation(s)
- Sara De Matteis
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; NHLI, Imperial College London, London, United Kingdom.
| | - Steven Ronsmans
- Clinic for Occupational and Environmental Medicine, Department of Pulmonary Medicine, University Hospitals Leuven, Leuven, Belgium; Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Benoit Nemery
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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Low-dose chlorine exposure impairs lung function, inflammation and oxidative stress in mice. Life Sci 2020; 267:118912. [PMID: 33338503 DOI: 10.1016/j.lfs.2020.118912] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 12/04/2020] [Accepted: 12/09/2020] [Indexed: 12/11/2022]
Abstract
AIM To explore the different consequences of acute and chronic exposure to chlorine gas (Cl2) on the functional and histological parameters of health mice. MAIN METHODS Firstly, male BALB/c mice were acute exposed to 3.3 or 33.3 or 70.5 mg/m3 Cl2. We analyzed the lung function, the inflammatory cells in the bronchoalveolar lavage, cell influx in the peribrochoalveolar space and mucus production. In a second phase, mice were chronic exposed to 70.5 mg/m3 Cl2. Besides the first phase analyses, we also evaluated the epithelial cells thickness, collagen deposition in the airways, immunohistochemistry stain for IL-1β, iNOS, IL-17 and ROCK-2 and the levels of IL-5, IL-13, IL-17, IL-1β and TNF-α in lung homogenate. KEY FINDINGS Acute exposure to chlorine impaired the lung function, increased the number of inflammatory cells in the BALF and in the airways, also increased the mucus production. Furthermore, when chlorine was exposed chronically, increased the airway remodeling with collagen deposition and epithelial cells thickness, positive cells for IL-1β, iNOS, IL-17 in the airways and in the alveolar walls and ROCK-2 in the alveolar walls, lung inflammation with increased levels of IL-5, IL-13, IL-1β and TNF-α in the lung homogenate, and also, induced the acid mucus production by the nasal epithelium. SIGNIFICANCE Acute and chronic exposure to low dose of chlorine gas worsens lung function, induces oxidative stress activation and mucus production and contributes to augmenting inflammation in health mice.
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Proceedings from the CIH LMU occupational safety and health symposium 2019 "Protecting workers' health: global challenges and opportunities in work-related respiratory diseases". BMC Proc 2020; 14:14. [PMID: 33292237 PMCID: PMC7709215 DOI: 10.1186/s12919-020-00197-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2020] [Indexed: 11/10/2022] Open
Abstract
The international CIHLMU Occupational Safety and Health Symposium 2019 was held on 16th March, 2019 at the Ludwig-Maximilians-Universität Munich, Germany. About 60 participants from around the world representing occupational health and safety professionals, students, instructors from several institutions in Germany and abroad, attended the symposium. The main objective of the symposium was to create awareness on global challenges and opportunities in work-related respiratory diseases. One keynote lecture and six presentations were made. While the keynote lecture addressed issues on occupational diseases in the twenty-first century, the six presentations were centered on: Prevention and control of work-related respiratory diseases, considerations; Occupational health and safety in Mining: Respiratory diseases; The prevention of TB among health workers is our collective responsibility; Compensation and prevention of occupational diseases and discussion on how artificial intelligence can support them: Overview of international approaches; Work-related Asthma: Evidence from high-income countries; and The role of imaging in the diagnosis of work- related respiratory diseases. A panel discussion was conducted following the presentations on the importance and challenges of data acquisition which is needed to have a realistic picture of the occupational safety and health status of workers at different levels. The current summary is an attempt to share the proceedings of the symposium.
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Archangelidi O, Sathiyajit S, Consonni D, Jarvis D, De Matteis S. Cleaning products and respiratory health outcomes in occupational cleaners: a systematic review and meta-analysis. Occup Environ Med 2020; 78:oemed-2020-106776. [PMID: 33234692 DOI: 10.1136/oemed-2020-106776] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/25/2020] [Accepted: 10/30/2020] [Indexed: 01/07/2023]
Abstract
There is consistent evidence of increased respiratory symptoms in occupational cleaners; however, uncertainty remains on type of respiratory health effects, underlying causal agents, mechanisms and respiratory phenotypes. We aimed to conduct a systematic review and if possible, a meta-analysis of the available literature to characterise and quantify the cleaning-related respiratory health effects. We searched MEDLINE and EMBASE databases and included studies that evaluated the association of any respiratory health outcome with exposure to cleaning occupation or products in occupational cleaners. A modified GRADE was used to appraise the quality of included studies. We retrieved 1124 articles, and after applying our inclusion criteria, 39 were selected for the systematic review. We performed a meta-analysis of the 21 studies evaluating asthma which showed a 50% increased pooled relative risk in cleaners (meta-relative risk (RR)=1.50; 95% CI 1.44 to 1.56). Population-based cross-sectional studies showed more stable associations with asthma risk. No evidence of atopic asthma as dominant phenotype emerged. Also, we estimated a 43% increased risk (meta-RR=1.43; 95% CI 1.31 to 1.56) of chronic obstructive pulmonary disease. Evidence for associations with bronchial-hyper-responsiveness, lung function decline, rhinitis, upper and lower respiratory tract symptoms was weaker. In our systematic review and meta-analysis, we found that working as a cleaner is associated with an increased risk of reversible and even irreversible obstructive airway diseases. All studies lacked quantitative exposure assessment to cleaning products; this would help elucidate underlying causal agents and mechanisms. Exposure control and respiratory surveillance among cleaners is warranted to prevent the associated respiratory health burden. Trial registration number: CRD4201705915.
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Affiliation(s)
| | | | - Dario Consonni
- Epidemiology Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Sara De Matteis
- NHLI, Imperial College London, London, UK
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Sardegna, Italy
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Moscato G, Apfelbacher C, Brockow K, Eberle C, Genuneit J, Mortz CG, Quecchia C, Quirce S, Siracusa A, Tarlo SM, Kampen V, Walusiak‐Skorupa J, Raulf M. Gender and occupational allergy: Report from the task force of the EAACI Environmental and Occupational Allergy Interest Group. Allergy 2020; 75:2753-2763. [PMID: 32279350 DOI: 10.1111/all.14317] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 03/18/2020] [Accepted: 04/01/2020] [Indexed: 12/14/2022]
Abstract
Women's work has traditionally been considered less hazardous to health in comparison with men's work. The increased women's participation in the workforce has led to an increased attention to women's working conditions. Women and men are unequally represented in individual professions or sectors (horizontal segregation), with women also under-represented in leadership positions (vertical segregation). The selection of specific occupations can result in differences between types and levels of occupational exposures among women and men and can affect prevalence of occupational allergy. Gender distribution of work-related asthma appears to vary across countries without clear global difference. Occupational rhinitis tends to be higher in women, although is not clear if this is related to a sex/gender effect or to differences in work exposure. Women are more likely to have occupational contact dermatitis, mainly due to wet work. No clear effects of gender on rates of hypersensitivity pneumonitis have been shown. Besides variation in exposures, physical and physiological characteristics, different behaviours and health consciousness have an impact on the occupational health hazards of women and men. Occupational allergy health promotion strategies need to consider approaches for women and men adjusted by gender, and legislative actions similarly could be implemented in a more gender-sensitive way.
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Affiliation(s)
- Gianna Moscato
- Specialization School in Occupational Medicine Department of Public Health, Forensic and Experimental Medicine University of Pavia Pavia Italy
| | - Christian Apfelbacher
- Institute of Social Medicine and Health Economics Otto von Guericke University Magdeburg Magdeburg Germany
| | - Knut Brockow
- Department of Dermatology and Allergy Biederstein School of Medicine Technical University of Munich Munich Germany
| | - Chiara Eberle
- Institute of Social Medicine and Health Economics Otto von Guericke University Magdeburg Magdeburg Germany
| | - Jon Genuneit
- Pediatric Epidemiology Department of Pediatrics University Medicine Leipzig Germany
| | - Charlotte G. Mortz
- Department of Dermatology and Allergy Centre ORCA (Odense Research Center for Anaphylaxis) Odense University Hospital Odense Denmark
| | - Cristina Quecchia
- Io e l'Asma” Center Ospedale dei Bambini ASST Spedali Civili Brescia Italy
| | - Santiago Quirce
- Department of Allergy Hospital La Paz Institute for Health Research (IdIPAZ) Madrid Spain
- CIBER of Respiratory Diseases CIBERES Madrid Spain
| | - Andrea Siracusa
- Formerly Professor of Occupational Medicine University of Perugia Perugia Italy
| | - Susan Mary Tarlo
- Department of Medicine and Dalla Lana School of Public Health University of Toronto Toronto ON Canada
- Respiratory Division Toronto Western Hospital University Health Network Toronto ON Canada
| | - Vera Kampen
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance Institute of the Ruhr‐University Bochum (IPA) Bochum Germany
| | - Jolanta Walusiak‐Skorupa
- Department of Occupational Diseases and Environmental Health Nofer Institute of Occupational Medicine Lodz Poland
| | - Monika Raulf
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance Institute of the Ruhr‐University Bochum (IPA) Bochum Germany
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Lemire P, Dumas O, Chanoine S, Temam S, Severi G, Boutron-Ruault MC, Zock JP, Siroux V, Varraso R, Le Moual N. Domestic exposure to irritant cleaning agents and asthma in women. ENVIRONMENT INTERNATIONAL 2020; 144:106017. [PMID: 32829252 DOI: 10.1016/j.envint.2020.106017] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 07/26/2020] [Indexed: 06/11/2023]
Abstract
An adverse role of frequent domestic use of cleaning agents, especially in spray form, on asthma has been reported. However, sparse studies have investigated respiratory health effects of chronic domestic exposure to irritant cleaning agents. This study aims to investigate associations between weekly use of irritant domestic cleaning products and current allergic and non-allergic asthma in a large cohort of elderly women. We used data from the Asthma-E3N nested case-control study on asthma (n = 19,404 women, response rate: 91%, 2011), in which participants completed standardized questionnaires on asthma and on the use of domestic cleaning products including irritants (bleach, ammonia, solvents and acids). Allergic multimorbidity in asthma was assessed from allergic-related medications recorded in drug refunds database. The association between use of irritants and current asthma was estimated by logistic regression (current vs. never asthma) and multinomial logistic regression (never asthma, non-allergic asthma, allergic asthma) adjusted on age, smoking status and body mass index (BMI). In the 12,758 women included in the analysis (mean age: 70 years, current smokers: 4%, BMI ≥ 25 kg/m2: 32%, low education: 11%, current asthma: 23%), 47% reported weekly use of at least one irritant cleaning product at home. Weekly use of irritant products was associated with a higher risk of current asthma (adjusted Odds-Ratio: 1.17, 1.07-1.27). A statistically significant dose-response association was reported (p trend < 0.0001), with both the number of irritant products used weekly (1 irritant: 1.12, 1.02-1.23; 2 irritants: 1.21, 1.05-1.39; 3 irritants or more: 2.08, 1.57-2.75) and the frequency of use (1-3 days/week: 1.12, 1.02-1.23; 4-7 days/week: 1.41,1.22-1.64). A dose-response association was observed with the frequency of products used (p trend < 0.05), for both non-allergic (4-7 days/week: 1.27, 1.02-1.57) and allergic asthma (1.52, 1.27-1.82). In conclusion, weekly use of common cleaning irritants was associated with an increased risk of current asthma, whatever the allergic status.
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Affiliation(s)
- Pierre Lemire
- Université Paris-Saclay, UVSQ, Inserm, CESP, Equipe d'Epidémiologie Respiratoire Intégrative, 94807 Villejuif, France
| | - Orianne Dumas
- Université Paris-Saclay, UVSQ, Inserm, CESP, Equipe d'Epidémiologie Respiratoire Intégrative, 94807 Villejuif, France
| | - Sébastien Chanoine
- IAB, Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, INSERM U1209, University of Grenoble-Alpes, CHU de Grenoble, Grenoble, France
| | - Sofia Temam
- Université Paris-Saclay, UVSQ, Inserm, CESP, Equipe d'Epidémiologie Respiratoire Intégrative, 94807 Villejuif, France; MGEN Foundation for Public Health (FESP-MGEN), 75748 Paris, France
| | - Gianluca Severi
- Université Paris-Saclay, UVSQ, Inserm, CESP, Equipe Générations et Santé, 94805 Villejuif, France
| | | | - Jan-Paul Zock
- Barcelona Institute of Global Health (ISGlobal), Universitat Pompeu Fabra (UPF), Barcelone, Spain
| | - Valérie Siroux
- IAB, Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, INSERM U1209, University of Grenoble-Alpes, CHU de Grenoble, Grenoble, France
| | - Raphaëlle Varraso
- Université Paris-Saclay, UVSQ, Inserm, CESP, Equipe d'Epidémiologie Respiratoire Intégrative, 94807 Villejuif, France
| | - Nicole Le Moual
- Université Paris-Saclay, UVSQ, Inserm, CESP, Equipe d'Epidémiologie Respiratoire Intégrative, 94807 Villejuif, France
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van Eck D, Dobusch L, van den Brink M. The organizational inclusion turn and its exclusion of low-wage labor. ORGANIZATION 2020. [DOI: 10.1177/1350508420966743] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
As most scholarly work on the conceptualization of organizational inclusion seems to be implicitly based on contexts of high-wage labor, this article investigates whether the common themes of organizational inclusion as identified by Shore et al. (2018) also align with the low-wage labor context. Our respective analysis identifies several mismatches between the current conceptualizations of organizational inclusion and the needs and interests of low-wage workers. Consequently, we offer suggestions for adapting these conceptualizations: by paying attention to (1) material and physical safety next to psychological safety, (2) opportunities of non-task-oriented involvement in the workgroup and (3) the recognition and accommodation of low-wage workers’ voices and needs. Furthermore, we argue to extend the scope of scholarly work on organizational inclusion by taking into account the broader (historical) social order and different stakeholders who influence the organizational processes of inclusion and exclusion. By engaging with the current “inclusion turn” and providing adaptations, this article contributes to a less “exclusive” conception of organizational inclusion as well as outlines where the organizational inclusion approach might come up against its own limits.
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Association Between Occupational Exposure to Disinfectants and Asthma in Young Adults Working in Cleaning or Health Services: Results From a Cross-Sectional Analysis in Germany. J Occup Environ Med 2020; 61:754-759. [PMID: 31233007 DOI: 10.1097/jom.0000000000001655] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To analyze the association of occupational disinfectants use with asthma and wheezing in young professionals. METHODS Three hundred sixty-five participants from the German Study on Occupational Allergy Risks II aged 20 to 24 years and working in cleaning or health services answered a questionnaire on respiratory health, occupational exposure to disinfectants, and potential confounders. By logistic regression, we calculated the association between duration of occupational disinfectants exposure and doctor-diagnosed asthma, current asthma, and current wheezing. RESULTS Individuals exposed to disinfectants for more than 12 months had almost three times the odds of doctor-diagnosed asthma compared with those not exposed (odds ratio [OR]: 2.99, 95% confidence interval [CI]: 1.36-6.55). CONCLUSIONS Our findings provide some further evidence for an association between occupational exposure to disinfectants and asthma, indicating that this association can be seen already after the first year of exposure.
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Rosenman KD, Reilly MJ, Wang L. Calls to a State Poison Center Concerning Cleaners and Disinfectants From the Onset of the COVID-19 Pandemic Through April 2020. Public Health Rep 2020; 136:27-31. [PMID: 33059533 PMCID: PMC7856373 DOI: 10.1177/0033354920962437] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
An increased use of disinfectants during the coronavirus disease 2019 (COVID-19) pandemic may increase the number of adverse health effects among people who apply them or among those who are in the area being disinfected. For the 3-month period from January 1 to March 30, 2020, the number of calls about exposure to cleaners and disinfectants made to US poison centers in all states increased 20.4%, and the number of calls about exposure to disinfectants increased 16.4%. We examined calls about cleaners and disinfectants to the Michigan Poison Center (MiPC) since the onset of the COVID-19 pandemic. We compared all calls related to exposure to cleaners or disinfectants, calls with symptoms, and calls in which a health care provider was seen during the first quarters of 2019 and 2020 and in relationship to key COVID-19 dates. From 2019 to 2020, the number of all disinfectant calls increased by 42.8%, the number of calls with symptoms increased by 57.3%, the average number of calls per day doubled after the first Michigan COVID-19 case, from 4.8 to 9.0, and the proportion of calls about disinfectants among all exposure calls to the MiPC increased from 3.5% to 5.0% (P < .001). Calls for exposure to cleaners did not increase significantly. Exposure occurred at home for 94.8%97.1% of calls, and ingestion was the exposure route for 59.7% of calls. Information about the adverse health effects of disinfectants and ways to minimize exposure should be included in COVID-19 pandemic educational materials.
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Affiliation(s)
- Kenneth D. Rosenman
- Division of Occupational and Environmental Medicine, Department of Medicine, College of Human Medicine, Michigan State University, East Lansing, MI, USA,Kenneth D. Rosenman, MD, Michigan State University, Division of Occupational and Environmental Medicine, 909 Wilson Rd, Room 117 West Fee, East Lansing, MI 48824, USA;
| | - Mary Jo Reilly
- Division of Occupational and Environmental Medicine, Department of Medicine, College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Ling Wang
- Division of Occupational and Environmental Medicine, Department of Medicine, College of Human Medicine, Michigan State University, East Lansing, MI, USA
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Parks J, Takaro TK. Exposure to cleaning products and childhood asthma: more than just a link? Expert Rev Respir Med 2020; 14:1185-1188. [PMID: 32990115 DOI: 10.1080/17476348.2020.1813572] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Jaclyn Parks
- Faculty of Health Sciences, Simon Fraser University , Burnaby, BC, Canada
| | - Tim K Takaro
- Faculty of Health Sciences, Simon Fraser University , Burnaby, BC, Canada
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Chemicals inhaled from spray cleaning and disinfection products and their respiratory effects. A comprehensive review. Int J Hyg Environ Health 2020; 229:113592. [PMID: 32810683 DOI: 10.1016/j.ijheh.2020.113592] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/20/2020] [Accepted: 07/03/2020] [Indexed: 12/13/2022]
Abstract
Spray cleaning and disinfection products have been associated with adverse respiratory effects in professional cleaners and among residents doing domestic cleaning. This review combines information about use of spray products from epidemiological and clinical studies, in vivo and in vitro toxicological studies of cleaning chemicals, as well as human and field exposure studies. The most frequent chemicals in spray cleaning and disinfection products were compiled, based on registrations in the Danish Product Registry. The chemicals were divided into acids, bases, disinfectants, fragrances, organic solvents, propellants, and tensides. In addition, an assessment of selected cleaning and disinfectant chemicals in spray products was carried out. Chemicals of concern regarding respiratory effects (e.g. asthma) are corrosive chemicals such as strong acids and bases (including ammonia and hypochlorite) and quaternary ammonium compounds (QACs). However, the evidence for respiratory effects after inhalation of QACs is ambiguous. Common fragrances are generally not considered to be of concern following inhalation. Solvents including glycols and glycol ethers as well as propellants are generally weak airway irritants and not expected to induce sensitization in the airways. Mixing of certain cleaning products can produce corrosive airborne chemicals. We discuss different hypotheses for the mechanisms behind the development of respiratory effects of inhalation of chemicals in cleaning agents. An integrative assessment is needed to understand how these chemicals can cause the various respiratory effects.
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