Does environmental endotoxin exposure prevent asthma?

Update on the role of genetic factors, environmental factors and allergens in canine atopic dermatitis

BACKGROUND

Canine atopic dermatitis (cAD) is a common, complex and multifactorial disease involving, among others, genetic predisposition, environmental factors and allergic sensitisation.

OBJECTIVE

This review summarises the current evidence on the role of genetic and environmental factors and allergic sensitisation in the pathogenesis of cAD since the last review by ICADA in 2015.

MATERIALS AND METHODS

Online citation databases and proceedings from international meetings on genetic factors, environmental factors and allergens relevant to cAD that had been published between 2015 and 2022 were reviewed.

RESULTS

Despite intensive research efforts, the detailed genetic background predisposing to cAD and the effect of a wide range of environmental factors still need more clarification. Genome-wide association studies and investigations on genetic biomarkers, such as microRNAs, have provided some new information. Environmental factors appear to play a major role. Lifestyle, especially during puppyhood, appears to have an important impact on the developing immune system. Factors such as growing up in a rural environment, large size of family, contact with other animals, and a nonprocessed meat-based diet may reduce the risk for subsequent development of cAD. It appears that Toxocara canis infection may have a protective effect against Dermatophagoides farinae-induced cAD. House dust mites (D. farinae and D. pteronyssinus) remain the most common allergen group to which atopic dogs react. Currently, the major allergens related to D. farinae in dogs include Der f 2, Der f 15, Der f 18 and Zen 1.

CONCLUSIONS AND CLINICAL RELEVANCE

Canine atopic dermatitis remains a complex, genetically heterogeneous disease that is influenced by multiple environmental factors. Further, well-designed studies are necessary to shed more light on the role of genetics, environmental factors and major allergens in the pathogenesis of cAD.

Radiation-Detoxified Form of Endotoxin Effectively Activates Th1 Responses and Attenuates Ragweed-Induced Th2-Type Airway Inflammation in Mice

Urbanization with reduced microbial exposure is associated with an increased burden of asthma and atopic symptoms. Conversely, environmental exposure to endotoxins in childhood can protect against the development of allergies. Our study aimed to investigate whether the renaturation of the indoor environment with aerosolized radiation-detoxified lipopolysaccharide (RD-LPS) has a preventative effect against the development of ragweed-induced Th2-type airway inflammation. To explore this, cages of six-week-old BALB/c mice were treated daily with aerosolized native LPS (N-LPS) or RD-LPS. After a 10-week treatment period, mice were sensitized and challenged with ragweed pollen extract, and inflammatory cell infiltration into the airways was observed. As dendritic cells (DCs) play a crucial role in the polarization of T-cell responses, in our in vitro experiments, the effects of N-LPS and RD-LPS were compared on human monocyte-derived DCs (moDCs). Mice in RD-LPS-rich milieu developed significantly less allergic airway inflammation than mice in N-LPS-rich or common environments. The results of our in vitro experiments demonstrate that RD-LPS-exposed moDCs have a higher Th1-polarizing capacity than moDCs exposed to N-LPS. Consequently, we suppose that the aerosolized, non-toxic RD-LPS applied in early life for the renaturation of urban indoors may be suitable for the prevention of Th2-mediated allergies in childhood.

Respiratory symptoms and pulmonary function impairment among textile industry workers in Alexandria, Egypt

Occupational exposure to cotton dust is still an important cause of respiratory problems in textile workers particularly in less developed countries like Egypt. Evaluate respiratory symptoms and diseases, and pulmonary function pattern among Egyptian textile workers. Cross sectional comparative study was conducted from December 2019 to September 2020 in a textile factory in Egypt; 364 male workers (184 cotton dust exposed workers, and 180 unexposed workers) were included. Participants were subjected to an interviewing questionnaire, British Medical Research Council questionnaire, anthropometric measurements, pulmonary function tests, and byssinosis grading format. Descriptive and analytic statistics were conducted. Chronic cough, phlegm production, and shortness of breath grade I, II and III were more reported in cotton dust exposed workers than unexposed workers (P#x003C;0.01, P#x003C;0.01, and P=0.02, respectively). Prevalence of chronic bronchitis was significantly higher among cotton dust exposed workers (12%) than unexposed workers (3.9%) (P#x003C;0.01). The mean percent predicted values of lung function indices reflecting large-1irway function (VC, FVC, FEV1, FEV1%, PEFR, and FEF75) were significantly lower in cotton dust exposed workers (P#x003C;0.01). Prevalence of byssinosis was 22.8%. Workers with byssinosis had significantly higher prevalence of respiratory symptoms, chronic bronchitis, cross-shift reduction in PEFR and significant decrease in mean percent predicted values of FVC, FEV1, PEFR, FEF75, and FEF50 than workers without byssinosis. This study revealed a substantial association between cotton dust exposure at work and respiratory symptoms and morbidity. Regular measurement of cross shift change in PEFR is recommended among exposed workers for early diagnosis of byssinosis.

Laboratory mice with a wild microbiota generate strong allergic immune responses

Allergic disorders are caused by a combination of hereditary and environmental factors. The hygiene hypothesis postulates that early-life microbial exposures impede the development of subsequent allergic disease. Recently developed "wildling" mice are genetically identical to standard laboratory specific pathogen-free (SPF) mice but are housed under seminatural conditions and have rich microbial exposures from birth. Thus, by comparing conventional SPF mice with wildlings, we can uncouple the impact of lifelong microbial exposures from genetic factors on the allergic immune response. We found that wildlings developed larger populations of antigen-experienced T cells than conventional SPF mice, which included interleukin-10-producing CD4 T cells specific for commensal Lactobacilli strains and allergy-promoting T helper 2 (TH2) cells. In models of airway exposure to house dust mite (HDM), recombinant interleukin-33, or Alternaria alternata, wildlings developed strong allergic inflammation, characterized by eosinophil recruitment, goblet cell metaplasia, and antigen-specific immunoglobulin G1 (IgG1) and IgE responses. Wildlings developed robust de novo TH2 cell responses to incoming allergens, whereas preexisting TH2 cells could also be recruited into the allergic immune response in a cytokine-driven and TCR-independent fashion. Thus, wildling mice, which experience diverse and lifelong microbial exposures, were not protected from developing pathological allergic immune responses. Instead, wildlings mounted robust allergic responses to incoming allergens, shedding new light on the hygiene hypothesis.

Characterizing Inflammatory Cell Asthma Associated Phenotypes in Dental Health Workers Using Cytokine Profiling

Cytokines elicit a pro-inflammatory response by modifying the airway microenvironment in patients with acute or chronic asthma. The expression pattern of several distinct cytokines could be a useful discriminator in asthma. This study aimed to identify asthma subject groupings based on common inflammatory patterns and to determine the relationship between these identified patterns and asthma-associated clinical indices. A sub-group of 76 dental healthcare workers (HCWs) identified from a larger cross-sectional study of 454 dental HCWs in five dental institutions were evaluated further. A self-administered questionnaire elicited the health and employment history of subjects. Sera were analyzed for atopic status, latex sensitization, and 12 cytokines (IL-1β, 3, 4, 5, 6, 7, 8, 10, 12p70, eotaxin, GM-CSF, TNF-α). Pre and post-bronchodilator spirometry was performed on all HCWs. Data clustering and factor analysis were used to identify inflammatory cluster patterns of cytokines. Associations between the cytokine cluster groupings and relevant asthma-associated clinical indices were determined using multivariate logistic regression. The classification of asthma subtype based on cytokine patterns demonstrated both eosinophilic and neutrophilic inflammatory responses. Four phenotypically distinct subgroups relating to the severity of inflammation (acute or chronic) of the cell types were identified. Cytokine determinants for the neutrophilic subtype included IL-1β, 6, 8, 10, 12p70, and TNF-α whereas for the eosinophilic subtype these included IL-3, 4, 5, 7, eotaxin, and GM-CSF. The multivariate models showed a significant association between work-related chest symptoms and all four inflammatory patterns. However, stronger associations were observed for the acute neutrophilic (OR = 6.00, p < 0.05) compared to acute and chronic eosinophilic responses (OR = 4.30, p < 0.05; OR = 4.93, p < 0.05), respectively. Subjects with airway obstruction were more likely to have a mixed cellular infiltrate. The odds of work-exacerbated asthma were increased in acute or chronic eosinophilia (OR = 7.75 and 8.12; p < 0.05), respectively as well as with acute neutrophilia (OR = 6) sub-type. This study demonstrated that neutrophilic inflammatory cell asthma phenotypes coexist with eosinophilic inflammatory phenotypes suggesting a possible dual pathway for asthma in dental health workers, probably due to mixed exposures to high molecular weight (e.g., latex) and low molecular weight (e.g., acrylates) agents.

Associations between household airborne culturable fungi and allergies and airway illnesses in childhood in Shanghai, China

Associations of household airborne fungi with allergies in childhood were inconsistent in the epidemiologic studies. During 2013-2014, we conducted a case-control study (phase two), which was nested in a cross-sectional study (phase one) during 2011-2012 in Shanghai, China. We inspected indoor air quality of 454 residences for 5-10 years old children. We defined cases as those children who were reported illnesses in the questionnaire of phase one or phase two and defined controls as those children who were not reported illnesses in both phases. A total of 436 living rooms and 445 bedrooms had valid data of household airborne fungi, and their mean concentrations were 301 cfu/m³ and 310 cfu/m³, respectively. In the multiple logistic regression analyses with adjusting for potential confounders, most associations of 16 studied illnesses with airborne fungi concentration were not statistically significant. Taking children in the 1st quartile that was stratified according to airborne fungi concentration in the living room as reference, only children in the 3rd quartile were significantly associated with a higher odd of lifetime-ever ear infections (adjusted OR, 95% CI 3.05, 1.29-7.21), and children in the 4th quartile were significantly associated with a higher odd of lifetime-ever wheeze (2.72, 1.28-5.75); but children in the 3rd quartile (0.33, 0.17-0.68) and in the 4th quartile (0.47, 0.23-0.97) were significantly associated with a lower odd of rhinitis in the past 12 months prior to the home inspection. Our results indicate that exposures to indoor airborne fungi in low concentrations seemingly have no significant impacts on the risks of most allergic and airway illnesses in childhood. Since families with sick participants might pay more attention to improve indoor air quality, effects of "avoidance behavior" on associations between indoor pollutants and childhood health should be considered in the data analysis and design of the nested case-control study.

TLR2 favors OVA-induced allergic airway inflammation in mice through JNK signaling pathway with activation of autophagy

AIMS

Numerous studies indicate that toll-like receptor 2 (TLR2) led to divergent effects in asthma. The occurrence of autophagy in asthma pathogenesis is still incompletely understood. Here, we aimed to investigate the role of TLR2 and the underlying mechanisms in allergic airway inflammation and autophagy activation.

MAIN METHODS

C57BL/6 and TLR2 knockout (TLR2^-/-) mice were subjected to an ovalbumin (OVA)-immunized allergic airway model, and were treated with SP600125. Differential cell counts in bronchoalveolar lavage fluid were determined by Wright's staining. Histological analysis of airway inflammation was determined by haematoxylin and eosin (H&E) and periodic acid-Schiff (PAS) staining. The levels of OVA-specific immunoglobulin E (IgE), tumor necrosis factor α (TNF-α) and interleukin 10 (IL-10) were detected by enzyme-linked immunosorbent assay (ELISA). Proteins expression in lung tissues was detected by western blot, expression of TLR2 was further observed by immunofluorescence. Autophagy activation was determined by western blot and transmission electron microscopy (TEM).

KEY FINDINGS

TLR2 expression was increased upon OVA challenge, and TLR2 deficiency was associated with decreased allergic airway inflammation. Meanwhile, TLR2 deficiency weakened autophagy activation. Moreover, inhibition of c-Jun N-terminal kinase (JNK) by SP600125 also suppressed OVA-induced allergic airway inflammation and autophagy activation. Interestingly, treating TLR2^-/- mice with SP600125 showed similar OVA-induced allergic airway inflammation and autophagy activation compared to that in vehicle-treated TLR2^-/- mice.

SIGNIFICANCE

TLR2 might contribute to the maintenance of allergic airway inflammation through JNK signaling pathway accompanying with autophagy activation. These findings may provide a novel signal target for prevention of allergic airway inflammation.

Relationships between Exposure to Bioaerosols, Moldy Surface and Symptoms in French Mold-Damaged Homes

Air quality in homes is a major concern in Europe, where people spend most of their time indoors. According to the World Health Organization, numerous houses are subject to dampness that can lead to mold growth, with associated health and economic consequences. Our goal was to characterize the human exposure to bioaerosols in French mold-damaged houses but also to study the effects of these bioaerosols as suffered by the inhabitants of these houses. A global approach including both field study and laboratory experimentation was used to investigate 48 mold-damaged homes. Among a wide fungal diversity, 101 viable species, Aspergillus versicolor, Penicillium chrysogenum and P. crustosum were observed as recurrent species and could be used as microbial indicators of indoor air quality. Statistical analyses highlighted a relationship between the concentrations of these recurrent molds and the levels of surface contamination by molds in homes. Fever, cough, dyspnea, flu-like symptoms were observed with several fungal strains (A. versicolor, P. chrysogenum and P. crustosum) or in relation to moldy odor. Relationships between particles of 2 to 15 µm diameter and headaches and dizziness were also observed. In our study, we identified a cutaneous effect (itching) in relationship to the airborne concentration of A. versicolor.

On the interpretation of bioaerosol exposure measurements and impacts on health

Bioaerosols are recognized as one of the main transmission routes for infectious diseases and are responsible for other various types of health effects through inhalation and potential ingestion. Associating exposure with bioaerosol and health problems is challenging, and adequate exposure monitoring is a top priority for aerosol scientists. The multiple factors affecting bioaerosol content, the variability in the focus of each bioaerosol exposure study, and the variations in experimental design and the standardization of methods make bioaerosol exposure studies very difficult. Therefore, the health impacts of bioaerosol exposure are still poorly understood. This paper presents a brief description of a state-of-the-art development in bioaerosol exposure studies supported by studies on several related subjects. The main objective of this paper is to propose new considerations for bioaerosol exposure guidelines and the development of tools and study designs to better interpret bioaerosol data. The principal observations and findings are the discrepancy of the applicable methods in bioaerosol studies that makes result comparison impossible. Furthermore, the silo mentality helps in creating a bigger gap in the knowledge accumulated about bioaerosol exposure. Innovative and original ideas are presented for aerosol scientists and health scientists to consider and discuss. Although many examples cited herein are from occupational exposure, the discussion has relevance to any human environment. This work gives concrete suggestions for how to design a full bioaerosol study that includes all of the key elements necessary to help understand the real impacts of bioaerosol exposure in the short term. The creation of the proposed bioaerosol public database could give crucial information to control the public health. Implications: How can we move toward a bioaerosol exposure guidelines? The creation of the bioaerosol public database will help accumulate information for long-term association studies and help determine specific exposure biomarkers to bioaerosols. The implementation of such work will lead to a deeper understanding and more efficient utilization of bioaerosol studies to prevent public health hazards.

Occupational Animal Allergy

PURPOSE OF REVIEW

This review explores animal allergen exposure in research laboratories and other work settings, focusing on causes and prevention.

RECENT FINDINGS

(1) Consistent with the hygiene hypothesis, there is new evidence that early childhood exposure to pets produces changes in the gut microbiome that likely lead to a lower risk of allergy. (2) Anaphylaxis from laboratory animal bites occurs more frequently than suggested by prior literature. (3) Animal allergens represent an occupational hazard in a wide variety of work settings ranging from fields that work with animals to public settings like schools and public transportation where allergens are brought into or are present in the workplace. Exposure to animal allergens can result in allergy, asthma, and anaphylaxis. Animal allergy has been most studied in the research laboratory setting, where exposure reduction can prevent the development of allergy. Similar prevention approaches need to be considered for other animal work environments and in all settings where animal allergens are present.

Relationship of environmental disturbances and the infectious potential of fungi

Fungi are critical organisms for the environment and offer many benefits to modern society through their application in the pharmaceutical, beverage and food industries. In contrast, fungal pathogens are emerging threats to humans, animals, plants and insects with potential to cause devastating mortality, morbidity and economic loss. Outbreaks associated with anthropogenic alterations of the environment, including climate change-related events such as natural disasters, are responsible for human, animal and plant disease. Similarly, fungi and their metabolites also have a negative impact in agriculture, posing a serious threat to our food supplies. Here, we describe the existing knowledge and importance of understanding the relationship of fungi and the environment in the context of human, animal and plant disease. Our goal is to encourage communication between scientists and the general public to create informed awareness about the impact of fungi in their daily lives and their environment.

[House Dust and Its Adverse Health Effects]

In this review, we examine house dust and its effect on inhabitants' health. Residential house dust includes components from plants, pollens, microorganisms, insects, skin flakes, hairs and fibers. It also includes materials contaminated with chemicals from combustion, furniture, interior materials, electronics, cleaning agents, personal care products. Nowadays, most people spend their time indoors. Thus, dust is an important medium of exposure to pollutions. According to United States Environmental Protection Agency Exposure Factors Handbook, the estimated amount of dust ingestion is 30 mg/day for adults, and 60 mg/day for children over 1 year of age. Since 2003, we have been conducting epidemiological studies to find the association between the indoor environment and the inhabitants' health. The levels of mite allergens, endotoxins, and β-1,3-d-glucan in house dust were measured as biological factors. Semi volatile organic compounds (SVOC) such as phthalates and phosphate flame retardants (PFRs) in dust were also analyzed. As a result, we found that the ORs (95%CI) of nasal and optical symptoms of sick building syndrome (SBS) were 1.45 (1.01-2.10) and 1.47 (1.14-1.88), respectively, when there was a 10-fold increase in the levels of mite allergens. There was no association of mite allergens with allergies. Endotoxins and β-1,3-d-glucan did not show any association with SBS. Regarding SVOC, increased levels of phthalates and PFR increased the risk of allergies. The association between phthalates and increased risk of allergies was clearer among children than adults. There were no gold standards of dust sampling and pretreatment methods. Thus, caution is needed when comparing findings of various studies. Methods should accurately reflect exposure levels.

Density assessment and mapping of microorganisms around a biocomposting plant in Sanandaj, Iran

Exposure to microorganisms can cause various diseases or exacerbate the excitatory responses, inflammation, dry cough and shortness of breath, reduced lung function, chronic obstructive pulmonary disease, and allergic response or allergic immune. The aim of the present study was to investigate the density of microorganisms around the air of processing facilities of a biocomposting plant. Each experiment was carried out according to ASTM E884-82 (2001) method. The samples were collected from inhaled air in four locations of the plant, which had a high traffic of workers and employees, including screen, conveyor belt, aerated compost pile, and static compost pile. The sampling was repeated five times for each location selected. The wind speed and its direction were measured using an anemometer. Temperature and humidity were also recorded at the time of sampling. The multistage impactor used for sampling was equipped with a solidified medium (agar) and a pump (with a flow rate of 28.3 l/m) for passing air through the media. It was found that the mean density of total bacteria was >1.7 × 10³ cfu/m³ in the study area. Moreover, the mean densities of fungi, intestinal bacteria (Klebsiella), and Staphylococcus aureus were 5.9 × 10³, 3.3 × 10³, and 4.1 × 10³ cfu/m³, respectively. In conclusion, according to the findings, the density of bacteria and fungi per cubic meter of air in the samples collected around the processing facilities of the biocomposting plant in Sanandaj City was higher than the microbial standard for inhaled air.

Association of macrophage migration inhibitory factor promoter polymorphism -173G/C with susceptibility to childhood asthma

Introduction

Macrophage migration inhibitory factor (MIF) is a proinflammatory cytokine that plays an important role in the pathogenesis of asthma. Polymorphisms associated with inflammatory diseases exist in the promoter region of MIF, which alter its expression. We aimed to study the association of MIF promoter polymorphism –173G/C with childhood asthma.

Material and methods

In this case-control study, we recruited 60 pediatric patients with bronchial asthma and 90 age- and sex-matched healthy controls. MIF-173G/C was genotyped using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP).

Results

Genotype distribution between cases and healthy controls was statistically evaluated. Our results revealed that the frequency of the MIF-173C allele was significantly higher in children with asthma than in the control group (p = 0.002, odds ratio [OR] = 3.61, 95% confidence interval [CI] = 1.63-7.97). The frequency of the MIF-173CC genotype was higher in the asthmatic children than in the controls (p = 0.028, OR = 6.24, 95% CI = 1.24-31.29). Comparing carriage of the MIF-173C allele in pediatric patients with asthma with that observed in healthy controls (GC + CC vs. GG) revealed a positive association with the disease (p = 0.019, OR = 3.12, 95% CI = 1.22-7.99).

Conclusions

These results suggest that MIF-173G/C polymorphism confers an increased risk of susceptibility to the development of childhood asthma in an Egyptian population.

Systemic and bronchial inflammation following LPS inhalation in asthmatic and healthy subjects

Background: Inhaled endotoxin is known to induce airway inflammation, causing bronchial hyper-reactivity.

Objective: We characterized the response to lipopolysaccharide-inhalation by measuring exhaled nitric oxide (eNO) and inflammatory mediators.

Patients and Methods : A total of 43 adult volunteers (13 asthmatics, 30 healthy controls) inhaled stepwise LPS every 30 min up to a cumulative dose of 100 µg (2.5, 10.5, 42, 45 µg). After each provocation and up to 24 h later, FEV1 was determined; the procedure was stopped when FEV1 declined more than 12.5%. We measured eNO, leucocytes, eosinophils, polymorphonuclear neutrophils (PMNs), C-reactive protein (CrP), lipopolysaccharide binding protein (LBP), eosinophilic cationic protein (ECP), leucotriene B4 (LTB4), thromboxane B2 (TXB2), and body temperature.

Results: Initial eNO values were higher in asthmatics ( P < 0.01), but only increased in an asthmatic subgroup. Marked differences were observed in the systemic response to LPS inhalation. Significant increases were found for CrP, LBP, and PMNs. There was no correlation between FEV1 decrease and basal eNO levels.

Conclusions: Inhalation of endotoxin was followed by clinical and laboratory signs of systemic inflammation, with asthmatics responding to the challenge similar as healthy subjects. Bronchial eNO increased only temporarily in asthmatics.

The association of residential mold exposure and adenotonsillar hypertrophy in children living in damp environments

BACKGROUND

There are many consequences of mold exposure related to respiratory system health of children This retrospective cohort study aims to find the association between adenoid hypertrophy and mold exposure in children living in damp environments.

METHODS

Children with history of recurrent respiratory tract infections were enrolled in the study between June 2012 and June 2013 and were followed up for adenoid hypertrophy from June 2013 to June 2016. One hundred and forty two children were residents of moldy houses and 242 were living in normal houses. Skin prick test results for 60 common allergens, vitamin D levels, IgE levels, age, presence of comorbidities such as urticaria, atopic dermatitis, allergic conjunctivitis, allergic rhinitis, asthma, frequency of upper respiratory tract infections and lower respiratory tract infections, were evaluated in both groups.

RESULTS

A total of 384 children (mean age ± standard deviation = 53.37 ± 36 months; 198 males and 186 females) were included. The children were classified into 2 groups (1)Children living normal houses (n = 242) (2); Children living in damp houses (n = 142) according to mold exposure. Children with adenoid hypertrophy (p < 0,001) and higher IgE levels (p < 0,001) were more common in mold exposed group. Lower respiratory tract infections were more common in children with mold exposure (p < 0,05). Bivariate correlation analysis showed no significant association between IgE levels and adenoid hypertrophy. Multiple linear regression analysis was performed to evaluate IgE levels, vitamin D levels, and presence of adenoid as independent variables; age as dependent variable among two groups and was found statistically significant (p < 0,001). Dermatophagoid sensitive group living in damp houses had a significant increase in adenoid hypertrophy (p = 0,01). Housedustmite sensitive children with recurrent lower respiratory tract infection and upper respiratory tract infection were mainly residents of damp houses (p < 0,001). Allergic comorbidities were significantly more in damp environment group (p < 0,001), but there was no significant increase in any of the subgroups.

CONCLUSIONS

Children with mold exposure had significantly increased adenoid hypertrophy regardless of their atopic nature, however, they may have become more sensitized due to other environmental triggers and genetic factors. In damp environments, sensitization to dermatophagoids, was significantly increased in children with adenoid hypertrophy. During the period of infancy, when children were mostly vitamin D supplemented, they were not sensitized and had normal adenoids. As children with recurrent respiratory tract infections grow, they tend to have lower vitamin D levels, become more atopic and tend to have adenoid hypertrophy.

CD14 polymorphisms, microbial exposure and allergic diseases: a systematic review of gene-environment interactions

Asthma and allergy may develop as a result of interactions between environmental factors and the genetic characteristics of an individual. This review aims to summarize the available evidence for, and potential effects of, an interaction between polymorphisms of the CD14 gene and exposure to microbes on the risk of asthma and allergic diseases. We searched PubMed, MEDLINE and Global Health databases, finding 12 articles which met inclusion criteria. Most studies reported a significant interaction between CD14 polymorphisms and microbial exposure. When stratified by age at microbial exposure (early life vs adult life), there was evidence of a protective effect of gene-environment interaction against atopy in children, but not adults. We also found different effects of interaction depending on the type of microbial exposures. There was no strong evidence for asthma and eczema. Future studies should consider a three-way interaction between CD14 gene polymorphisms, microbial exposures and the age of exposure.

Epidemiology of Respiratory Allergies and Asthma

Asthma has puzzled and confused physicians from the time of Hippocrates to the present day. The word “asthma” comes from a Greek word meaning “panting” (Keeney 1964), but reference to asthma can also be found in ancient Egyptian, Hebrew, and Indian medical writings (Ellul-Micallef 1976; Unger and Harris 1974). There were clear observations of patients experiencing attacks of asthma in the second century and evidence of disordered anatomy in the lung as far back as the seventeenth century (Dring et al. 1689).

The hygiene hypothesis in allergy and asthma: an update

PURPOSE OF REVIEW

It has been hypothesized that increased cleanliness, reduced family size, and subsequent decreased microbial exposure could explain the increases in global asthma prevalence. This review considers the recent evidence for and against the 'hygiene hypothesis'.

RECENT FINDINGS

Recent evidence does not provide unequivocal support for the hygiene hypothesis: the hygiene hypothesis specifically relates to atopic asthma, but some of the protective effects (e.g. farm exposures) appear to apply to both atopic and nonatopic asthma; asthma prevalence has begun to decline in some western countries, but there is little evidence that they have become less clean; Latin American countries with high infection rates have high asthma prevalence and the hygiene hypothesis relates to early-life exposures, but exposures throughout life may be important.

SUMMARY

There is a considerable body of evidence which warrants scepticism about the hygiene hypothesis. However, these anomalies contradict the 'narrow' version of it in which microbial pressure early in life protects against atopic asthma by suppressing T-helper 2 immune responses. It is possible that a more general version of the hygiene hypothesis is still valid, but the aetiologic mechanisms involved are currently unclear.

The pathophysiology of the hygiene hypothesis

There has been a considerable increase in the diagnosis of allergic diseases over the last decades. Prevalence of allergies in high-income countries and urban areas appears higher than in rural environments. While environmental factors like pollution or nutrition can be important, it is more likely that in the end they have a small association with allergies. Childhood infections and exposure to certain microbial antigens on the other hand seem to present a strong negative correlation with allergies, and therefore the increase of the allergic burden in the Western world has been frequently related to a decline of childhood infections giving birth to the "Hygiene Hypothesis". We address the issue with emphasis on the associated pathophysiology tightrope walking between the skepticism of the critics, which cast doubt on it, and the pilgrims' belief of having discovered allergy's Holy Grail.

Research at the interface between human and veterinary health

Epidemiology is currently undergoing changes in its underlying philosophy and approach, as a result of the rapid global changes which are transforming the world in which epidemiologists live and work. This necessitates a multidisciplinary "population approach" involving "multilevel thinking" about the determinants of disease. These issues are of relevance to the interface between human and animal epidemiology, which has received considerable attention in recent years, particularly as a result of the arrival of H1N1 influenza, and the increasingly obvious need for coordinated systems of surveillance for human and animal infectious diseases. However, the need for coordination between human and veterinary epidemiology is broader than that, and there is no need to restrict the "one world one health" concept to communicable disease. In the current paper we will therefore consider the interface between human and animal health for the study of non-communicable disease, particularly those involving occupational and environmental risk factors. These issues are illustrated with two examples: one involving environmental health (asthma); and one involving occupational health (cancer). We will also discuss the potential to use animal health data as indicators for human environmental health risks.

Risk factors associated with asthma phenotypes in dental healthcare workers

BACKGROUND

Exposure in the dental environment can increase the risk of respiratory disease in dental healthcare workers (HCWs). This study investigated the prevalence of asthma phenotypes in dental HCWs and associated risk factors.

METHODS

A cross-sectional study of 454 dental HCWs in five dental institutions in South Africa was conducted. A self-administered questionnaire elicited the health and employment history of subjects. Sera was analyzed for atopic status and latex sensitization. Pre- and post-bronchodilator spirometry was performed.

RESULTS

The prevalence of atopic asthma was 6.9%, non-atopic asthma 5.9% and work-exacerbated asthma (WEA) 4.0%. Atopy and work-related ocular-nasal symptoms were strong predictors of WEA (OR: 3.4; 95% CI: 1.07-10.8; OR: 6.7, 95% CI: 2.4-19.1), respectively. Regular use of personal protective equipment (PPE) was associated with a protective affect (OR: 0.23, 95% CI: 0.1-0.7) among non-atopic asthmatics, while glove use and respiratory protection was protective among atopic asthmatics (OR: 0.39, 95% CI: 0.17-0.89).

CONCLUSION

Identification of risk factors associated with specific asthma phenotypes in dental HCWs can be used to focus preventive strategies for asthmatics.

The Head-off Environmental Asthma in Louisiana (HEAL) study--methods and study population

BACKGROUND

In the city of New Orleans, Louisiana, and surrounding parishes (NOLA), children with asthma were perilously impacted by Hurricane Katrina as a result of disrupted health care, high home mold and allergen levels, and high stress.

OBJECTIVES

The Head-off Environmental Asthma in Louisiana (HEAL) study was conducted to examine relationships between the post-Katrina environment and childhood asthma in NOLA and assess a novel asthma counselor intervention that provided case management and guidance for reducing home mold and allergen levels.

METHODS

Children (4-12 years old) with moderate-to-severe asthma were recruited from NOLA schools. Over 1 year, they received two clinical evaluations, three home environmental evaluations, and the asthma intervention. Quarterly end points included symptom days, medication use, and unscheduled emergency department or clinic visits. A community advisory group was assembled and informed HEAL at all phases.

RESULTS

Of the children (n = 182) enrolled in HEAL, 67% were African American, and 25% came from households with annual incomes < $15,000. HEAL children were symptomatic, averaging 6.6 symptom days in the 2 weeks before baseline, and had frequent unscheduled visits to clinics or emergency departments (76% had at least one unscheduled visit in the preceding 3 months). In this report, we describe study design and baseline characteristics of HEAL children.

CONCLUSIONS

Despite numerous challenges faced by investigators, study staff, and participants, including destroyed infrastructure, disrupted lives, and lost jobs, HEAL was successful in terms of recruitment and retention, the high quality of data collected that will provide insight into asthma-allergen relationships, and the asthma intervention. This success was attributable to using an adaptive approach and refining processes as needed.

Leukocytes from wheezing infants release lower amounts of IL-12 and IFN-γ compared to non-wheezing infants

OBJECTIVE

This study investigated environmental endotoxin exposure during early life, sensitization to aeroallergens, the production of cytokines by LPS-stimulated leukocytes, and the development of a wheezing phenotype in a prospective cohort of infants with high risk of developing allergic diseases.

MATERIALS AND METHODS

Eighty-four infants were followed from birth until 30 months of age. We assessed endotoxin concentration in house dust of their homes during the first 6 months of life. At age 30 months they were clinically evaluated to determine the development of wheezing and other clinical events, were skin prick tested, and had blood samples collected for the evaluation of cytokine release by LPS-stimulated peripheral blood mononuclear cells (PBMC).

RESULTS

The level of endotoxin exposure during early life was not associated with development of a wheezing phenotype. On the other hand a higher incidence of respiratory infections occurred among recurrent wheezing (RW) infants. PBMC from RW children exposed to higher levels of environmental endotoxin (above 50 EU/mg) released less Interleukin (IL)-12p70 and IFN-γ compared to the non-RW group. TNF-α, IL-10, IL-4, IL-5, and IL17 production by LPS-stimulated PBMC from RW and non-RW children was equivalent in both groups of environmental endotoxin exposure.

CONCLUSION

In this prospective cohort of infants with high risk of developing allergic diseases we observed that RW and non-RW children were exposed to similar levels of endotoxin early in life. LPS-stimulated PBMC from RW infants exposed to higher levels of endotoxin released significantly less IL-12 and IFN-γ compared to non-RW infants.

Indoor environmental exposures for children with asthma enrolled in the HEAL study, post-Katrina New Orleans

BACKGROUND

Rain and flooding from Hurricane Katrina resulted in widespread growth of mold and bacteria and production of allergens in New Orleans, Louisiana, which may have led to increased exposures and morbidity in children with asthma.

OBJECTIVES

The goal of the Head-off Environmental Asthma in Louisiana (HEAL) study was to characterize post-Katrina exposures to mold and allergens in children with asthma.

METHODS

The homes of 182 children with asthma in New Orleans and surrounding parishes were evaluated by visual inspection, temperature and moisture measurements, and air and dust sampling. Air was collected using vacuum-pump spore traps and analyzed for > 30 mold taxa using bright field microscopy. Dust was collected from the children's beds and bedroom floors and analyzed for mouse (Mus m 1), dust mite (Der p 1), cockroach (Bla g 1), and mold (Alternaria mix) allergens using ELISA.

RESULTS

More than half (62%) of the children were living in homes that had been damaged by rain, flooding, or both. Geometric mean indoor and outdoor airborne mold levels were 501 and 3,958 spores/m3, respectively. Alternaria antigen was detected in dust from 98% of homes, with 58% having concentrations > 10 µg/g. Mus m 1, Der p 1, and Bla g 1 were detected in 60%, 35%, and 20% of homes, respectively, at low mean concentrations.

CONCLUSIONS

Except for Alternaria antigen in dust, concentrations of airborne mold (ratio of indoor to outdoor mold) and dust allergens in the homes of HEAL children were lower than measurements found in other studies, possibly because of extensive post-Katrina mold remediation and renovations, or because children moved into cleaner homes upon returning to New Orleans.

Exposure assessment of residential mould, fungi and microbial components in relation to children's health: achievements and challenges

Each day we are exposed to a complex mixture of microbial agents and components in indoor environments. A major part of this mixture derives from fungal and bacterial origin. The impact between those microbial agents in the home environment in relation to respiratory health in children is still a major issue in research. There is little known about the causal agents that provoke or arrest the development of allergic respiratory disorders in children. Identification is complicated by the biodiversity and variability of microbial components in indoor air as well as the lack of validated and standardized exposure assessment methods. In this review, we aim to consider all important aspects in terms of research which may encounter an epidemiological study. Apart from the need for standardized exposure assessment methods which consider cost, handling and effort, especially for the participants, we suggest that a combination of different analysis methods such as chemical and molecular methods may have the potential to best describe the microbial milieu in indoor environments at present. Further, the impact of mould and moisture remediation activities on health is still heavily under investigated, especially in larger prospective cohorts of children and should be a topic of future research. Moreover, the exposure to mould and microbial agents might be embedded in a broader spectrum of children's health such as behavior and cognitive development.

Do indoor environments influence asthma and asthma-related symptoms among adults in homes?: a review of the literature

This review summarizes the results of epidemiological studies focusing on the detrimental effects of home environmental factors on asthma morbidity in adults. We reviewed the literature on indoor air quality (IAQ), physical and sociodemographic factors, and asthma morbidity in homes, and identified commonly reported asthma, allergic, and respiratory symptoms involving the home environment. Reported IAQ and asthma morbidity data strongly indicated positive associations between indoor air pollution and adverse health effects in most studies. Indoor factors most consistently associated with asthma and asthma-related symptoms in adults included fuel combustion, mold growth, and environmental tobacco smoke. Environmental exposure may increase an adult's risk of developing asthma and also may increase the risk of asthma exacerbations. Evaluation of present IAQ levels, exposure characteristics, and the role of exposure to these factors in relation to asthma morbidity is important for improving our understanding, identifying the burden, and for developing and implementing interventions aimed at reducing asthma morbidity.

Indoor air pollution and childhood asthma: variations between urban and rural areas

Health effects of indoor pollution have been investigated overall in urban areas. To compare the potential effect of home air pollutants on asthma in urban and rural houses, two case-control populations, composed of children living in the city (32 asthmatics and 31 controls) and in the countryside (24 asthmatics and 27 controls) were included. During 1 week, nitrogen dioxide, fine particles, and volatile organic compounds (formaldehyde, acetaldehyde, benzene, toluene, ethylbenzene, and xylenes) were assessed at home. Urban dwellings were found to be more polluted than rural ones, with concentrations up to two times higher. In the whole population, exposure to acetaldehyde and toluene was significantly associated with a higher risk of asthma. In the urban population, the association with toluene was significant in children studied during winter, and with toluene, xylenes, and ethylbenzene when cases were restricted to current asthmatics. In rural settings, a relationship between asthma and formaldehyde exposure was observed (OR = 10.7; 95% CI 1.69-67.61). Our findings suggest that daily continuous exposures to pollutants may be implicated in asthma, even in the case of low exposure, as those found in rural areas. Our results could also indicate a specific effect of indoor pollution in the rural environment.

PRACTICAL IMPLICATIONS

Everyday exposure to indoor pollution was associated with a higher risk of childhood asthma. These findings suggest that even at low concentrations, pollutants could be implicated in asthma and reinforce the importance of establishing guideline values to improve indoor air quality by limiting sources or by optimizing ventilation. Specific effects could occur in rural environments where pollution differs from urban area.

Environmental epigenetics of asthma: an update

Asthma, a chronic inflammatory disorder of the airway, is influenced by interplay between genetic and environmental factors now known to be mediated by epigenetics. Aberrant DNA methylation, altered histone modifications, specific microRNA expression, and other chromatin alterations orchestrate a complex early-life reprogramming of immune T-cell response, dendritic cell function, macrophage activation, and a breach of airway epithelial barrier that dictates asthma risk and severity in later life. Adult-onset asthma is under analogous regulation. The sharp increase in asthma prevalence over the past 2 or 3 decades and the large variations among populations of similar racial/ethnic background but different environmental exposures favors a strong contribution of environmental factors. This review addresses the fundamental question of whether environmental influences on asthma risk, severity, and steroid resistance are partly due to differential epigenetic modulations. Current knowledge on the epigenetic effects of tobacco smoke, microbial allergens, oxidants, airborne particulate matter, diesel exhaust particles, polycyclic aromatic hydrocarbons, dietary methyl donors and other nutritional factors, and dust mites is discussed. Exciting findings have been generated by rapid technological advances and well-designed experimental and population studies. The discovery and validation of epigenetic biomarkers linked to exposure, asthma, or both might lead to better epigenotyping of risk, prognosis, treatment prediction, and development of novel therapies.

What has the ECRHS told us about the childhood risks of asthma, allergy and lung function?

Few studies investigate how environmental factors in childhood may influence adult respiratory health. The European Community Respiratory Health Survey (ECRHS) is a longitudinal multi-centre study of Western world adults, including retrospective assessment of early life factors. Analyses of the ECRHS showed both beneficial and harmful long-term effects of childhood factors on adult asthma, allergy and lung function. Childhood pets were associated with less adult atopy and hay fever; beneficial effects were also indicated for growing up on a farm and for early exposure to other children. The findings have contributed to further development of the hygiene hypothesis and further understanding of the mechanisms relating microbial stimulation to allergy; however, the public health consequences may be limited. Harmful effects of early life factors on adult asthma and lung function were indicated for severe respiratory infections early in life, parental smoking and long-term dog keeping. Intervention with regard to parental smoking and vaccination against common lower airways infections may improve respiratory health in the population. Thus, early life environment had permanent beneficial and adverse effects on adult respiratory health. The multi-centre structure of the ECRHS, the large sample size, the extensive information about each participant and follow-up until the age of 56 years, have given the basis for convincing conclusions, and made possible publication of unsuspected findings in spite of the problems related to adult recall of childhood events. The ECRHS have contributed substantially to increased knowledge about the early life origins of allergy and obstructive pulmonary disease, providing a basis for prevention.

Modeling human health risks of airborne endotoxin in homes during the winter and summer seasons

Endotoxin, a component of gram-negative bacterial cell walls, is a pro-inflammatory agent that induces local and systemic inflammatory responses in normal subjects which can contribute to the risk of developing asthma and chronic obstructive lung diseases. A probabilistic approach linking models of exposure, internal dosimetry, and health effects was carried out to quantitatively assess the potential inhalation risk of airborne endotoxin in homes during the winter and summer seasons. Combining empirical data and modeling results, we show that the half-maximum effect of the endotoxin dose (ED50) was estimated to be 707.9 (95% confidence interval (CI): 308.8-1287.0) endotoxin units (EU) for body temperature change, 481.8 (95% CI: 333.2-630.3) EU for elevation of neutrophils, and 1174.5 (95% CI: 816.0-1532.9) EU for elevation of the cytokine, interleukin-6. Our study also suggests that airborne endotoxin in homes may pose potential risks, and a higher risk for elevation of neutrophils and cytokine interleukin-6 appeared in winter season than in summer. Our study offers a risk-management framework for discussion of future studies of human respiratory exposure to airborne endotoxin.

Asthmatic symptoms after exposure to ethylenebisdithiocarbamates and other pesticides in the Europit field studies

We conducted a multicenter prospective study to assess the effects of occupational exposure to ethylenebisdithiocarbamate fungicides and/or other pesticides on self-reported asthma and asthmatic symptoms. This multicenter study was conducted among 248 workers exposed to pesticides and 231 non-exposed workers from five field studies. The five field studies were carried out in The Netherlands, Italy, Finland, and two studies in Bulgaria. Subjects constituting this cohort completed a self-administered questionnaire at baseline (before the start of exposure). Ethylenethiourea in urine was determined to assess exposure to ethylenebisdithiocarbamates. In multivariate analyses adjusted for all potential confounders (age, education, residence, smoking, gender, and field study), we found inverse associations, all not statistically significant, between occupational exposure to pesticides and asthma diagnosis (OR 0.41; 95% CI 0.15-1.11), complains of chest tightness (OR 0.60; 95% CI 0.36-1.02), wheeze (OR 0.56; 95% CI 0.32-0.98), asthma attack (OR 0.52; 95% CI 0.12-2.25), and asthma medication (OR 0.79; 95% CI 0.25-2.53). Furthermore, we reported null associations for multivariate analysis using ethylenethiourea as determinant for exposure. Although exposure to pesticides remains a potential health risk, our results do not suggest an association between exposure to ethylenebisdithiocarbamates and/or other pesticides used in our study on asthma and asthmatic symptoms.

CD14 and toll-like receptor gene polymorphisms, country living, and asthma in adults

RATIONALE

It has been shown that country living protects against asthma, which may be explained by microbial exposures.

OBJECTIVES

To study whether single nucleotide polymorphisms (SNPs) in CD14 and Toll-like receptor (TLR) 2, TLR4 and TLR9 genes are associated with asthma in adults, and whether these SNPs modify associations between country living and asthma.

METHODS

Twenty-five SNPs in CD14, TLR2, TLR4, and TLR9 genes were genotyped in adult subjects from the French Epidemiological study on the Genetics and Environment of Asthma, Bronchial Hyperresponsiveness, and Atopy (EGEA). We conducted a case-control analysis on unrelated subjects (239 with asthma and 596 without asthma), and a family-based association test (FBAT) in 192 families ascertained through probands with asthma.

MEASUREMENTS AND MAIN RESULTS

The TLR2/+596 C allele was associated with an increased risk for asthma in both case-control and family-based analyses (under a dominant model, odds ratio [OR] 1.91 and 95% confidence interval [CI] 1.34-2.72, P = 0.0003; Z statistics from FBAT = 2.48, P = 0.01). In skin prick test (SPT) positive subjects, the CD14/-260 C allele was negatively associated with asthma (additive model, OR 0.66; CI 0.48-0.91). Significant gene-environment interactions between variation in CD14 and TLR genes and country living during childhood were found for ten SNPs. In SPT positive subjects carrying CD14/-260 CC, country living protected against asthma (OR, 0.32; 95% CI, 0.12-0.85), whereas country living was not associated with asthma in subjects who were atopic and carrying CD14/-260 T (OR, 1.11; 95% CI, 0.65-1.90) (gene-environment interaction, P < 0.05).

CONCLUSIONS

TLR2 and CD14 SNPs were associated with asthma and atopic asthma respectively. In addition, CD14, TLR2, TLR4, and TLR9 SNPs modified associations between country living and asthma.

Innate immunity in asthma

Asthma is a complex disorder and evidence now suggests that it is not solely attributable either to allergy or eosinophilia. Non-eosinophilic asthma accounts for up to one half of all cases and a large proportion have a non-allergic aetiology. The innate immune system responds to a variety of triggers, including viral and bacterial components which are known non-allergic triggers of asthma. The innate immune response may be involved in both the development of and protection against asthma. Factors which are likely to determine the nature of the response include the timing of the exposure (childhood or adulthood), baseline asthma inflammatory subtype (eosinophilic or non-eosinophilic) and the dose of the exposure. Gene-environment interactions are likely to modify the response. Further research is required to elucidate the specific mechanisms involved in the innate immune response in asthma and will be important in the identification of new targets for therapy and management.

The role of infection in asthma

This paper reviews the impact of infections on the onset and clinical course of bronchial asthma. A just emphasis is given to the role viral infections, particularly rhinovirus infections, play in exacerbations, and that played by respiratory syncytial virus, suspected of triggering the asthmatic syndrome. The mechanisms of the immune response to virus attacks are explained, highlighting the asthmatic and allergic patient's weakened response, particularly in the perinatal period. Further stressed is a potentiating effect of viral aggression on the allergic response. The hygiene hypothesis and its lack of scientific consistency is detailed, at least as far as the role it seeks to confer on an unproven antagonism of the Th1 and Th2 lymphocyte responses. The current importance of research not into bacteria, but into bacterial products, including endotoxins, on the modulation of asthma and allergy is noted. Studies which, along these lines, show an environmental impact on genetic secretion in the phenotype are underlined. Also discussed in passing are several mechanisms which go towards explaining neutrophilic asthma - for many a contradiction, given eosinophilia's stranglehold on asthmatic inflammation.

Infecção na modulaçâo da asma11Trabalho apresentado no XXIII Congresso de Pneumologia da SPP – Guarda, Novembro 2007 / Paper presented at the XXIII Congresso de Pneumologia da SPP / PSP Pulmonology Congress, Guarda, November 2007

Faz-se uma revisão da influência das infecções no aparecimento e na clínica da asma brônquica. Dá-se o relevo que merece à intervenção virusal, sobretudo ao rinovírus, pela sua influência nas exacerbações, e ao vírus sincicial respiratório, sobre o qual recai a suspeita de poder ser causa determinante no aparecimento da síndroma asmática. Tentam-se esclarecer os mecanismos da resposta imune à agressão virusal em função das debilidades da resposta do asmático e do atópico, sobretudo no período perinatal, salientando-se, ainda, um efeito de potenciação da agressão virusal sobre a resposta atópica. Aborda-se a hipótese higiénica e a sua falta de consistência científica, pelo menos no papel que pretende atribuir a um não demonstrado antagonismo das respostas linfocitárias Th₁ e Th_2, apontando-se a importância actual da investigação, não das bactérias mas dos produtos bacterianos, como as endotoxinas, na modulação da asma e da atopia, dando-se relevo aos estudos que, a partir deste modelo, demonstram uma influência do ambiente na secreção génica e, consequentemente, no fenótipo. Invocam-se, nas entrelinhas, vários mecanismos que podem explicar a asma neutrofílica que, para muitos, é um paradoxo perante o consagrado domínio do eosinófilo na inflamação asmática.

Rev Port Pneumol 2008; XIV (5): 647-675

Occupational exposures and ovarian cancer in textile workers

BACKGROUND

Occupational risk factors for ovarian cancer have been investigated only to a limited extent. We conducted a case-cohort study to examine associations between occupational exposures and ovarian cancer in the textile industry.

METHODS

We compared 261 incident ovarian cancer cases diagnosed between 1989 and 1998 with an age-stratified reference subcohort (n = 3199) from a cohort of 267,400 textile workers in Shanghai, China. Occupational exposures were assessed by job-exposure matrices designed for the textile industry, and estimates of quantitative cotton dust and endotoxin. We calculated hazard ratios (HRs) and 95% confidence intervals (CIs) with Cox proportional hazards modeling adapted for the case-cohort design.

RESULTS

A decreased risk of ovarian cancer was associated with ever having worked in cotton manufacturing production (HR = 0.7; 95% CI = 0.4-1.0). An increased risk was associated with ever having worked in textile finishing (2.1; 0.9-5.0). We found an increasing risk of ovarian cancer associated with cumulative exposure to silica dust (for <10 years exposure, HR = 6.8 [CI = 0.6-76]; for > or =10 years, 5.6 [1.3-23.6]), although these results are based on only 8 exposed subcohort women (0.3%) and 4 cases (1.3%). We also detected inverse risk gradients for cumulative exposures to endotoxin when exposures were lagged by 20 years (in highest quartile, HR = 0.6 [CI = 0.4-1.1]).

CONCLUSION

Silica dust may increase the risk of ovarian cancer, and cotton dust and endotoxin may reduce risk.

A EuroPrevall review of factors affecting incidence of peanut allergy: priorities for research and policy

Peanuts are extensively cultivated around the world, providing a foodstuff that is both cheap to produce and nutritious. However, allergy to peanuts is of growing global concern, particularly given the severity of peanut-allergic reactions, which can include anaphylaxis and death. Consequently, it is important to understand the factors related to the prevalence of peanut allergy in order to inform efforts to ameliorate or pre-empt the condition. In this article we review evidence for the relevance of factors hypothesized to have some association with allergy prevalence, including both genetic and environmental factors. Although our analysis does indicate some empirical support for the importance of a number of factors, the key finding is that there are significant data gaps in the literature that undermine our ability to provide firm conclusions. We highlight these gaps, indicating questions that need to be addressed by future research.

Lifelong farm exposure may strongly reduce the risk of asthma in adults

BACKGROUND

Farm exposures may protect against childhood asthma, hay fever and eczema. Whether farm exposures also confer protection in adult farmers remains unclear. Moreover, little is known about the role of timing of exposure. We assessed the effects of current and childhood farm exposures on asthma, hay fever and eczema in farmers and a rural nonfarming control population.

METHODS

We conducted a cross-sectional questionnaire survey in 2509 farming families (response rate 78%) and 1001 nonfarming families (response rate 67%), which included 4288 farmers and 1328 nonfarmers.

RESULTS

Farmers were less likely to have asthma symptoms, hay fever and eczema; no significant differences were observed among dairy, sheep and beef, and horticulture farmers. A combination of current and childhood exposure was more strongly associated with shortness of breath (OR 0.50, CL 0.39-0.66), wheeze (OR 0.60, CL 0.49-0.73), asthma medication (OR 0.48, CL 0.37-0.63); and asthma ever (OR 0.56, CL 0.46-0.68) than current exposure alone (OR 0.63, CL 0.47-0.84; OR 0.80, CL 0.65-0.99; OR 0.68, CL 0.51-0.9; OR 0.69, CL 0.56-0.85 respectively) or childhood exposure alone (OR 0.97, CL0.65-1.44; OR 1.01, CL 0.75-1.34; OR 0.78, CL 0.51-1.19; OR 0.87, CL 0.63-1.19 respectively). Moreover, the combined number of years of farm exposure in childhood and adulthood showed a dose-dependent inverse association with symptom prevalence.

CONCLUSIONS

Although both current and childhood farm exposures may play a role in the observed low prevalence of asthma symptoms in adult farmers, continued long-term exposure may be required to maintain optimal protection.

Chronic asthma-induced airway remodeling is prevented by toll-like receptor-7/8 ligand S28463

RATIONALE

Allergic asthma is a heterogeneous disease, the pathology of which is a result of improper immune responses to innocuous antigens. We and others have previously shown that one of the Toll-like receptor (TLR)-7/8 ligands, the synthetic compound S28463 (resiquimod, R-848), is able to inhibit acute allergic asthma in mice.

OBJECTIVES

Given that the efficiency of this pharmacologic compound against the smooth muscle mass increase and goblet cell hyperplasia that are characteristic of chronic allergic asthma has not been previously assessed, we investigated the ability of this compound to prevent these aspects of chronic airway remodeling.

METHODS

The impact of S28463 treatment was assessed in a Brown Norway rat model of chronic asthma by histologic, morphometric, and molecular techniques.

MEASUREMENTS AND MAIN RESULTS

We demonstrate that treatment with S28463 is able to prevent the development of goblet cell hyperplasia and increases in airway smooth muscle mass, and that this effect is at least partially mediated by inhibiting proliferation of goblet and smooth muscle cells, respectively. Furthermore, we show that the abrogation of airway remodeling is preceded by inhibition of the inflammatory reaction normally occurring in response to allergen challenge in sensitized animals. This inhibition was associated with a reduction of both helper T cell type 1 and type 2 cytokine protein expression in the lungs, demonstrating the potent antiinflammatory effect of this pharmaceutical compound in the context of allergic reactions.

CONCLUSIONS

Taken together, our results indicate great potential for the use of S28463 as an antiinflammatory therapeutic agent for the management of chronic asthma.

Health effects of airborne exposures from concentrated animal feeding operations

Toxic gases, vapors, and particles are emitted from concentrated animal feeding operations (CAFOs) into the general environment. These include ammonia, hydrogen sulfide, carbon dioxide, malodorous vapors, and particles contaminated with a wide range of microorganisms. Little is known about the health risks of exposure to these agents for people living in the surrounding areas. Malodor is one of the predominant concerns, and there is evidence that psychophysiologic changes may occur as a result of exposure to malodorous compounds. There is a paucity of data regarding community adverse health effects related to low-level gas and particulate emissions. Most information comes from studies among workers in CAFO installations. Research over the last decades has shown that microbial exposures, especially endotoxin exposure, are related to deleterious respiratory health effects, of which cross-shift lung function decline and accelerated decline over time are the most pronounced effects. Studies in naïve subjects and workers have shown respiratory inflammatory responses related to the microbial load. This working group, which was part of the Conference on Environmental Health Impacts of Concentrated Animal Feeding Operations: Anticipating Hazards-Searching for Solutions, concluded that there is a great need to evaluate health effects from exposures to the toxic gases, vapors, and particles emitted into the general environment by CAFOs. Research should focus not only on nuisance and odors but also on potential health effects from microbial exposures, concentrating on susceptible subgroups, especially asthmatic children and the elderly, since these exposures have been shown to be related to respiratory health effects among workers in CAFOs.

Hay fever and asthma symptoms in conventional and organic farmers in The Netherlands

BACKGROUND

Farming has been associated with respiratory symptoms and with protection against atopy. To date, effects of organic farming on respiratory health have not been studied.

AIMS

To (1) compare hay fever and asthma-like symptoms in organic and conventional farmers and (2) assess associations between current and childhood farm exposures and respiratory health effects by conducting a survey.

METHODS

Questionnaire data from 1205 conventional and 593 organic farmers were evaluated. Associations between health effects and farm exposures were assessed by logistic regression analyses.

RESULTS

Organic farmers reported less wheezing with shortness of breath and slightly more hay fever than conventional farmers. However, organic farming was not an independent determinant of hay fever when adjusted for farming practices and potential confounders. Livestock farmers who grew up on a farm had a threefold lower prevalence of hay fever than crop farmers without a farm childhood (odds ratio (OR) 0.3, 95% confidence interval (CI) 0.1 to 0.5). Both crop farmers who grew up on a farm and livestock farmers who did not grow up on a farm had a reduced prevalence, although less pronounced and not statistically significant. Use of disinfectants containing quaternary ammonium compounds was positively related to hay fever (OR 2.1, 95% CI 1 to 4.4). No effects of farming practices were found for asthma.

CONCLUSIONS

Our study adds to the evidence that a farm childhood in combination with current livestock farming protects against allergic disorders. This effect was found for both organic and conventional farmers.

Specific fungal exposures, allergic sensitization, and rhinitis in infants

Indoor air quality has become increasingly important as we live in a society where the majority of our time is spent indoors. Specific attention has been drawn to airborne fungal spores as a factor affecting indoor air quality. This study targeted shortcomings of other studies by utilizing long-term air sampling and total fungal spore enumeration to determine associations between health outcomes and fungal spore concentrations. Infants (n = 144) were clinically evaluated and had skin prick tests (SPT) for 17 allergens. Airborne fungal spores were collected using a Button Personal Inhalable Sampler (SKC Inc.) for 48 h at a flow rate of 4 l/min. Sampling was conducted in the spring (March-May) or fall (August-October) in 2003-2004. Fungal spores were analyzed using microscopy-based total counting and identified to the genus/group level. Total spore and individual genus concentrations were analyzed for associations with rhinitis and positive SPT results. Overall, concentrations varied widely, between <2 and 2294 spores/m(3). While no relationship was observed between SPT(+) and total fungal counts, several significant associations were found when analysis was conducted on the various fungal genera and health outcomes. Positive associations were obtained between: Basidiospores and rhinitis (p < 0.01), Penicillium/Aspergillus and SPT(+) to any allergen (p < 0.01), and Alternaria and SPT(+) to any allergen (p < 0.01). Inverse associations were found between: Cladosporium and SPT(+) to any allergen (p < 0.05), and Cladosporium and SPT(+) to aeroallergens (p < 0.05). This study indicates that health outcome may vary by fungal genera; some fungal types may have sensitizing effects while others may have a beneficial role.