Blood lead level and risk of asthma

Trophodynamics and health risk assessment of heavy metals in seafood from a tropical estuary in the gulf of Guinea

Seafood is an essential protein source for coastal communities. However, they can accumulate heavy metals from human activities which could pose a potential health risk to consumers. In this study, we investigated the distribution, bioaccumulation, trophic transfer and potential human health risk of heavy metals in sediments, shell and fin fish collected from the Escravos Estuary in southern Nigeria. Heavy metals (Ni, Cd, V, Pb and Cu) in sediments, periwinkles and tongue soles from the two study sites were lower than the permissible limits for fishery products. The metal distribution in fish tissues was in the decreasing order of liver > gills > muscles > gonads > rest of the fish. Moderate to high BSAF (>1) was reported for Cd, Pb and Cu. All the studied metals, except Pb, showed evidence of biomagnification from periwinkle to tongue sole. The estimated daily intake (EDI) and hazard ratio (HR) for metals in periwinkles from both study sites were lower or within the USEPA reference doses (RfD) for the respective daily intake and HR value < 1, except for Cd, V and Pb for children. In contrast, EDI values in the muscle of tongue soles were higher than the RfD values for heavy metals except for Ni and Pb, whereas HR values > 1 except for Ni, Cd and V. In the whole fish, EDI and HR values were disproportionately high in both study sites with higher values reported for children. This study provides the first insights on the trophic transfer and risk assessment of heavy metals from petroleum and gas operations impacting the Escravos Estuary and the implications to public health.

Toxic metals and pediatric clinical immune dysfunction: A systematic review of the epidemiological evidence

BACKGROUND

Children are at high risk for exposure to toxic metals and are vulnerable to their effects. Significant research has been conducted evaluating the role of these metals on immune dysfunction, characterized by biologic and clinical outcomes. However, there are inconsistencies in these studies. The objective of the present review is to critically evaluate the existing literature on the association between toxic metals (lead, mercury, arsenic, and cadmium) and pediatric immune dysfunction.

METHODS

Seven databases (PubMed (NLM), Embase (Elsevier), CINAHL (Ebsco), Web of Science (Clarivate Analytics), ProQuest Public Health Database, and ProQuest Environmental Science Collection) were searched following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in February 2024. Rayaan software identified duplicates and screened by title and abstract in a blinded and independent review process. The remaining full texts were reviewed for content and summarized. Exclusions during the title, abstract, and full-text reviews included: 1) not original research, 2) not epidemiology, 3) did not include toxic metals, 4) did not examine an immune health outcome, or 5) not pediatric (>18 years). This systematic review protocol followed the PRISMA guidelines. Rayaan was used to screen records using title and abstract by two blinded and independent reviewers. This process was repeated for full-text article screening selection.

RESULTS

The search criteria produced 7906 search results; 2456 duplicate articles were removed across search engines. In the final review, 79 studies were included which evaluated the association between toxic metals and outcomes indicative of pediatric immune dysregulation.

CONCLUSIONS

The existing literature suggests an association between toxic metals and pediatric immune dysregulation. Given the imminent threat of infectious diseases demonstrated by the recent COVID-19 epidemic in addition to increases in allergic disease, understanding how ubiquitous exposure to these metals in early life can impact immune response, infection risk, and vaccine response is imperative.

Identification of lead-binding proteins as carriers and potential molecular targets associated with systolic blood pressure

Lead (Pb) exposure is well recognized as a significant environmental factor associated with the high incidence of cardiovascular diseases. However, the carriers and molecular targets of Pb in human blood remain to be understood, especially for a real Pb exposure scenario. In this study, a total of 350 blood samples were collected from the smelting workers and systematically analyzed using metallomics and metalloproteomics approaches. The results showed that the majority of Pb (∼99.4%) could be presented in the blood cells. Pb in the cytoplasm of blood cells accounted for approximately 83.1% of the total blood Pb, with nearly half of Pb being bound to proteins. Pb-binding proteins in the blood of workers were identified as hemoglobin, catalase, haptoglobin, δ-aminolevulinic acid dehydratase, and peroxiredoxin-2. Multiple linear regression analysis demonstrated that higher levels of Pb bound to proteins (Mix-bound Pb and Protein-bound Pb) were positively associated with higher systolic blood pressure (p < 0.05). However, the association between blood lead level, Pb levels in the blood cells and systolic blood pressure was not observed (p > 0.05). This study suggested that Pb bound to proteins could be a suitable biomarker for indicating the potential risk of occupational hypertension.

Impact of Cadmium and Lead Exposure on Camel Testicular Function: Environmental Contamination and Reproductive Health

The free grazing habits of camels from various sources may cause heavy metals to bioaccumulate in their tissues and organs, possibly resulting in higher amounts of these toxic substances in their bodies over time. The aim of this study was to assess the exposure impact of lead (Pb) and cadmium (Cd) on bull camels of the Lassi breed, aged 7 to 8 years, at a site near the industrial area and another two non-industrial sites, to analyze the presence of heavy metals. Samples from three sites were collected from thirty camels (n = 10/each), soil and water (n = 30), and five different plants (n = 15/each) for analysis. Testes were collected for atomic absorption spectrometry (AAS), and hematoxylin-eosin (HE) staining. Serum samples were obtained to measure testosterone levels by radioimmunoassay (RIA). Samples were obtained from plants, soil, water, blood, serum and urine for AAS. According to the results, the testes' weight, length, width, and volume significantly decreased at the industrial site compared with the other two sites as a result of exposure to Cd and Pb. Additionally, blood testosterone concentrations were considerably lower at the industrial site, indicating a detrimental impact on testicular steroidogenesis. The histological investigation of the industrial site indicated structural disturbances, including seminiferous tubule degeneration and shedding, cellular debris in seminiferous tubules, lining epithelium depletion, and vacuolation. Elevated amounts of Cd and Pb were found at the industrial site when analyzed using water, soil, plants, testes, serum, and urine. These findings demonstrate the adverse effects of Pb and Cd exposure on camel testicular function, including decreased weight and altered steroidogenesis. These findings are essential for understanding the impact of exposure to Pb and Cd on camel reproductive function and for developing successful prevention and management plans for these exposures in this species.

Spatial distribution, sources and health risk assessment of heavy metals in topsoil around oil and natural gas drilling sites, Andhra Pradesh, India

Soils are usually the interface between human activity and environmental components that must be conserved and protected. As a result of rising industrialization and urbanization, activities such as exploration and extraction operations lead to the release of heavy metals into the environment. This study presents distribution of six heavy metals (As, Cr, Cu, Ni, Pb and Zn) in 139 top soil samples collected in and around oil and natural gas drilling sites at a sampling density of 1 site/12 km2. The results indicated the concentration ranged from 0.1 to 16 mg/kg for As, 3-707 mg/kg for Cr, 7-2324 mg/kg for Cu, 14-234 mg/kg for Ni, 9-1664 mg/kg for Pb, and 60-962 mg/kg for Zn. The contamination of soil was estimated on the basis of Index of geo accumulation (Igeo), enrichment factor (Ef), and contamination factor (Cf). Further, spatial distribution pattern maps indicated that the pollution levels for Cu, Cr, Zn, and Ni were higher around drilling sites of the study area relative to other regions. Using exposure factors for the local population and references from the USEPA's integrated database, potential ecological risk indices (PERI) and health risk assessments were made. The hazard index (HI) values of Pb (in adults) and Cr, Pb (in children) exceeded the recommended limit of HI = 1, indicating the non-carcinogenic risks. Total carcinogenic risk (TCR) calculations revealed Cr (in adults) and As, Cr (in children) levels in soils exceeded the threshold value of 1.0E - 04, indicating significant carcinogenic risk due to high metal concentrations in the study area. These results may assist in determining the soil's present state and its effect due to extraction strategies used during drilling process and initiate few remedial techniques, particularly for proper management strategies in farming activities to decrease point and non-point source of contamination.

Exposure to Heavy Metals and Allergic Outcomes in Children: a Systematic Review and Meta-analysis

It has been reported that heavy metals have adverse effects on the immune system. However, the relationship between heavy metal exposure and allergic outcomes remains unclear. This systematic review was conducted to examine whether heavy metal exposure is associated with allergic outcomes during childhood. We performed a systematic search of all relevant articles in Web of Science, EMBASE, and PubMed, from inception through to November 2020. We used odds ratio (OR) and the standard mean differences (SMDs) with 95% confidence intervals (CIs) to present estimates from individual studies. In addition, random-effects meta-analysis was used to pool the data. We also conducted the meta-regression and subgroup analysis to explore potential sources of heterogeneity. After duplicate removal, we finally included 35 articles in the systematic review and meta-analysis from an initial 11,181 articles. The overall results showed that copper (Cu) was associated with asthma (pooled SMD = 1.50, 95% CI = 0.13-2.86); in the subgroup analysis, the results indicated that lead (Pb) was associated with asthma (pooled OR = 6.27, 95% CI = 2.24-17.56), and Cu and Pb were connected with atopic dermatitis (SMD =  - 1.05, 95% CI =  - 1.45 to - 0.65; SMD = 5.68, 95% CI = 5.05-6.32), respectively. Mercury (Hg) was associated with atopic dermatitis (pooled OR = 1.13, 95% CI = 1.04-1.22) and wheeze (OR = 1.20, 95% CI = 1.05-1.37). The meta-analysis results indicate that Cu might be connected with childhood asthma, but not with other allergic diseases; Hg and Pb may have no association with allergic diseases during childhood. Given some limits observed in the current studies, more prospective cohort studies are still needed to verify our findings. Review registration: PROSPERO CRD42020222167.

A critical review on microbes-based treatment strategies for mitigation of toxic pollutants

Contamination of the environment through toxic pollutants poses a key risk to the environment due to irreversible environmental damage(s). Industrialization and urbanization produced harmful elements such as petrochemicals, agrochemicals, pharmaceuticals, nanomaterials, and herbicides that are intentionally or unintentionally released into the water system, threatening biodiversity, the health of animals, and humans. Heavy metals (HMs) in water, for example, can exist in a variety of forms that are inclined by climate features like the presence of various types of organic matter, pH, water system hardness, transformation, and bioavailability. Biological treatment is an important tool for removing toxic contaminants from the ecosystem, and it has piqued the concern of investigators over the centuries. In situ bioremediation such as biosparging, bioventing, biostimulation, bioaugmentation, and phytoremediation and ex-situ bioremediation includes composting, land farming, biopiles, and bioreactors. In the last few years, scientific understanding of microbial relations with particular chemicals has aided in the protection of the environment. Despite intensive studies being carried out on the mitigation of toxic pollutants, there have been limited efforts performed to discuss the solutions to tackle the limitations and approaches for the remediation of heavy metals holistically. This paper summarizes the risk assessment of HMs on aquatic creatures, the environment, humans, and animals. The content of this paper highlights the principles and limitations of microbial remediation to address the technological challenges. The coming prospect and tasks of evaluating the impact of different treatment skills for pollutant remediation have been reviewed in detail. Moreover, genetically engineered microbes have emerged as powerful bioremediation capabilities with significant potential for expelling toxic elements. With appropriate examples, current challenging issues and boundaries related to the deployment of genetically engineered microbes as bioremediation on polluted soils are emphasized.

Evaluating the Potential Health Risks of Selected Heavy Metals across Four Wastewater Treatment Water Works in Durban, South Africa

Poor and inadequate sanitation systems have been considered not only a human health issue, but also an environmental threat that instigates climate change. Nine heavy metals-arsenic (As), cadmium (Cd), cobalt (Co), chromium (Cr), iron (Fe), manganese (Mn), nickel (Ni), lead (Pb), and zinc (Zn)-were evaluated in influent and effluent water samples from four wastewater treatment plants in the Durban metropolis, KwaZulu-Natal, South Africa. The results indicate that the mean concentrations of all the heavy metals in the influent samples ranged from 0.122 to 1.808 mg/L, while the effluent samples had a concentration ranging from 0.118 to 0.854 mg/L. Iron was found to be in the highest concentration and the concentration of Co was the lowest across the wastewater treatment plants. The levels for most of the heavy metals in this study were found to be above the recommended maximum concentrations in surface and effluent waters as stipulated by the World Health Organization, United States Environmental Protection Agency, Food and Agriculture Organization, and the Department of Water Affairs and Forestry of South Africa. According to the toxicity effect due to non-carcinogenic risks, As, Pb, Cr, and Cd are considered to be of medium risk in this study, indicating that a probable adverse health risk is very likely to occur. Additionally, the cancer risk (RI) values were lower than 10^-3, which shows that cancer development is very likely in individuals who are exposed. Cancer development associated with dermal absorption is quite negligible; thereby, it does not raise any concerns.

Evaluation of Serum IL-33, IL-5 and Trace Elements Levels among Asthmatic Patients

The precise relationship between interleukins-33 and IL-5, as well as some trace elements and asthma, is unknown. The target of research was to compare and link the above-mentioned serological parameters in asthmatic patients and healthy controls. In 69 asthmatic patients and 35 healthy controls, serum levels of IL-33, IL-5, zinc, copper, iron, total IgE, Forced expiratory volume (FEV) and Forced expiratory volume (FEV) were compared. Spirometry was used to assess the (FEV) and (FVC) in asthmatic patients, as well as their age and body mass index (BMI). When asthmatic patients were matched to controls, mean levels of IL-33, IL-5, and total IgE appeared highly significant difference (p < 0.001). There was a substantial decline in zinc levels in the asthmatic group, but no significant drop in Copper levels. There was also a statistically significant difference in high Iron mean levels among asthmatic patients. In addition, the findings revealed a significant positive correlation between Iron and IgE levels in patients and the levels of (IL-33 and IL-5), plus a significant negative correlation with Zinc levels. Only Copper had no relationship with the interleukins studied. IL-33, also known as IL-5, is a novel inflammatory marker implicated in asthma progression by interacting with IgE, Zinc, Iron, but not Copper levels. As a result, it could be a one-of-a-kind therapeutic target in these patients.

Association between prenatal exposure to metal mixtures and early childhood allergic diseases

The association between prenatal exposure to the metal mixture and allergic diseases is poorly understood. We aimed to explore the individual effect and the combined effect of prenatal exposure to vanadium (V), chromium (Cr), nickel (Ni), arsenic (As), cadmium (Cd), thallium (Tl), and lead (Pb) on early childhood allergic diseases based on a birth cohort study that included 628 mother-infant pairs. Metals were measured in maternal urine samples collected in the first, second, and third trimesters. Children were prospectively followed up at age 4 years to collect information on allergic rhinitis, wheeze, and eczema status. By applying logistic regression models, weighted quantile sum (WQS) regression, and Bayesian kernel machine regression (BKMR), the different statistical analyses revealed urinary metals were only associated with early childhood allergic rhinitis. The averaged prenatal As exposure was significantly associated with an increased OR for allergic rhinitis in both single-metal (OR = 2.04, 95% CI: 1.35, 3.07) and multiple-metal logistic regression models (OR = 1.78, 95% CI: 1.15, 2.78). The WQS index of mixed metal exposure was positively associated with allergic rhinitis (OR = 1.66, 95% CI: 1.26, 2.19), and As and Tl had the largest weights in the WQS index (weighted 0.51 and 0.29, respectively). The BKMR analysis also showed the overall effect of the metal mixture was significantly associated with allergic rhinitis when all the metals were at their 55th percentile or above, compared to their 50th percentile. The effect of As and Tl on the risk of allergic rhinitis was significant when all of the other metals were fixed at the specific percentiles. Our findings suggest that prenatal co-exposure to higher levels of the seven metals increases the risk of allergic rhinitis in children, and As and Tl may contribute most to the combined risk.

Toxic Mechanisms of Five Heavy Metals: Mercury, Lead, Chromium, Cadmium, and Arsenic

The industrial activities of the last century have caused massive increases in human exposure to heavy metals. Mercury, lead, chromium, cadmium, and arsenic have been the most common heavy metals that induced human poisonings. Here, we reviewed the mechanistic action of these heavy metals according to the available animal and human studies. Acute or chronic poisonings may occur following exposure through water, air, and food. Bioaccumulation of these heavy metals leads to a diversity of toxic effects on a variety of body tissues and organs. Heavy metals disrupt cellular events including growth, proliferation, differentiation, damage-repairing processes, and apoptosis. Comparison of the mechanisms of action reveals similar pathways for these metals to induce toxicity including ROS generation, weakening of the antioxidant defense, enzyme inactivation, and oxidative stress. On the other hand, some of them have selective binding to specific macromolecules. The interaction of lead with aminolevulinic acid dehydratase and ferrochelatase is within this context. Reactions of other heavy metals with certain proteins were discussed as well. Some toxic metals including chromium, cadmium, and arsenic cause genomic instability. Defects in DNA repair following the induction of oxidative stress and DNA damage by the three metals have been considered as the cause of their carcinogenicity. Even with the current knowledge of hazards of heavy metals, the incidence of poisoning remains considerable and requires preventive and effective treatment. The application of chelation therapy for the management of metal poisoning could be another aspect of heavy metals to be reviewed in the future.

Foetal exposure to heavy metals and risk of atopic diseases in early childhood

BACKGROUND

Accumulating evidence suggests that in utero exposures can influence the development of the immune system and thus contribute to disease development. Studies investigating the association between prenatal exposures to heavy metals and atopic diseases, however, are scarce.

METHODS

Children from the EDEN birth cohort were prospectively followed up using parental questionnaires with validated questions on asthma, allergic rhinitis, eczema, and food allergy symptoms. The questionnaires were administered every 4 months during the children's first year, and then every year until the age of 5, with a final survey at the age of 8. Serum concentrations of lead (Pb), cadmium (Cd), and manganese (Mn) were assessed in maternal blood samples collected during mid-pregnancy and in cord blood of 651 mother-children pairs. Hazard ratios (HR) for the incidence of each atopic disease in relation to the exposure to metals were calculated using Cox proportional hazard models.

RESULTS

Levels of Cd in cord blood were associated with greater risk of asthma (hazard ratio [95% confidence interval] for upper vs lower quartile: 1.81 [1.00-3.29]), eczema (1.60 [1.09-2.35]), and food allergy (3.17 [1.36-7.38]), while Mn levels in maternal serum were associated with eczema (1.55 [1.05-2.28]). These associations were similar in males and females and were confirmed using log concentrations of metals as exposures.

CONCLUSIONS

Our results support the hypothesis that fetal exposure to heavy metals may affect the development of asthma, eczema, and food allergy in childhood and suggest that timing of exposure in utero may have a role in these associations.

Exploring persistent racial/ethnic disparities in lead exposure among American children aged 1-5 years: results from NHANES 1999-2016

OBJECTIVE

The aim of this study was to determine whether long-standing racial disparities in lead exposure still exists for children age 1-5 years old. We examined if blood lead levels were higher among non-Hispanic Black children and others compared to non-Hispanic White children.

METHODS

Data from the National Health and Nutrition Examination Survey (NHANES) from 1999-2016 were used. Geometric mean blood lead levels (BLLs) were compared by race/ethnicity using log-transformed simple linear regression. Associations between race and elevated BLL were assessed using weighted Chi-square tests. Log-transformed multiple weighted linear regression was used to assess what factors affected BLLs.

RESULTS

A total of 6772 children were included in this study. In 1999-2000, the geometric mean BLL for non-Hispanic Black children was 3.08 μg/dL, compared to 2.03 μg/dL for non-Hispanic White children (p = 0.01). The difference in geometric mean BLL between non-Hispanic Black children and non-Hispanic White children continued to be statistically significant in later years (all p < 0.05) until 2015-2016 (0.89 μg/dL vs 0.74 μg/dL, p = 0.17). Log-transformed linear regression showed that being non-Hispanic Black and having low family income were independently associated with higher BLL.

CONCLUSION

Although lead exposure in the general population continued to decline for all racial/ethnic groups, non-Hispanic Black children still had higher BLL than non-Hispanic White children. In more recent years, the racial/ethnic gap was lesser but persisted. Racial/ethnic disparity in childhood BLL could be partially explained by socio-economic factors.

Early life blood lead levels and asthma diagnosis at age 4-6 years

The USA has a high burden of childhood asthma. Previous studies have observed associations between higher blood lead levels and greater hypersensitivity in children. The objective of the present study was to estimate the association between blood lead concentrations during early childhood and an asthma diagnosis between 48 and 72 months of age amongst a cohort with well-characterized blood lead concentrations. Blood lead concentrations were measured at 6, 12, 18, 24, 36, and 48 months of age in 222 children. The presence of an asthma diagnosis between 48 and 72 months was assessed using a questionnaire which asked parents or guardians whether they had been told by a physician, in the past 12 months, that their child had asthma. Crude and adjusted risk ratios (RR) of an asthma diagnosis were estimated for several parameterizations of blood lead exposure including lifetime average (6 to 48 months) and infancy average (6 to 24 months) concentrations. After adjustment for child sex, birthweight, daycare attendance, maternal race, education, parity, breastfeeding, income, and household smoking, age-specific or composite measures of blood lead were not associated with asthma diagnosis by 72 months of age in this cohort.

Combined exposure to heavy metals in PM2.5 and pediatric asthma

BACKGROUND

Asthma is the most common chronic allergic disease in children; it affects more than 300 million people worldwide. Information on the association between exposure to ambient heavy metals and incidence of pediatric asthma is limited.

OBJECTIVE

We sought to evaluate the effects of heavy metals during pregnancy and infancy periods with asthma and identify a sensitive time window, clarifying the effect of ambient heavy metals on lung development.

METHODS

A total of 171,281 children, who were born from 2004 to 2011 in Taichung City, were followed until 2014. Concentrations of ambient heavy metals such as arsenic (As), cadmium (Cd), mercury (Hg), and lead (Pb) were obtained from the Weather Research and Forecasting/Chem model, considering the top 75 emission sources in Taiwan. The distributed lag nonlinear model was used to investigate the relationship between combined exposure to heavy metals in 2.5 μm particulate matter and asthma in pregnant women and 1-year-old infants.

RESULTS

We identified 31,277 new asthma cases from the birth cohort. After adjustment for socioeconomic status, maternal age, maternal atopy, maternal anemia, and maternal kidney disease, distributed lag nonlinear model results revealed positive associations of asthma with exposure to Pb during gestational weeks 1 to 14 and 21 to 40, and 1 to 3 weeks after birth. Regarding the sensitivity analyses, coexposure to Pb and As, coexposure to Pb and Cd, and coexposure to Pb and Hg were positively associated with asthma onset as well.

CONCLUSIONS

Our study suggested that combined exposure to Pb with As, Cd, and Hg during early and late gestational weeks was associated with the incidence of pediatric asthma.

The association between residential proximity to brownfield sites and high-traffic areas and measures of immunity

The mechanisms by which neighborhood environmental exposures influence health are poorly understood, although immune system dysregulation represents a potential biological pathway. While many neighborhood exposures have been investigated, there is little research on residential proximity to brownfield waste. Using biomarker data from 262 participants in the Detroit Neighborhood Health Study, we estimated the association between proximity to brownfields and heavy traffic and signal joint T-cell receptor excision circles (sjTRECs, a measure of naive T-cell production), C-reactive protein (CRP, a measure of systemic inflammation), and interleukin-6 (IL-6, a pro-inflammatory cytokine). We assessed residential proximity ≤200 m from brownfields and highways on all three biomarkers using multivariate regression. We demonstrated that living ≤200 m from a brownfield site was associated with a 0.30 (95% CI = 0.59, 0.02, p = 0.04) log_e-unit decrease in sjTRECs per million whole blood cells, as well as non-significantly elevated levels of CRP and IL-6. Heavy traffic was not associated with any biomarker. Persons living in close proximity to brownfield sites had significantly lower naive T-cell production, suggesting accelerated immune aging. Decreased T-cell production associated with brownfield proximity may be caused by toxicant exposure in brownfield sites, or may serve as a marker of other neighborhood stressors.

The effect of environmental lead exposure on human health and the contribution of inflammatory mechanisms, a review

Lead (Pb) pollution has been considered as a major threat for human health due to induction of inflammatory cascades in various tissues. The aim of present review is to summarize the literature on the effects of lead exposure on respiratory, neurologic, digestive, cardiovascular and urinary disorders and the role of inflammation as an underlying mechanism for these effects. Various databases such as ISI Web of Knowledge, Medline, PubMed, Scopus, Google Scholar and Iran Medex, were searched from 1970 to November 2017 to gather the required articles using appropriate keywords such as lead, respiratory disorders, neurologic disorders, digestive disorders, cardiovascular disorders, urinary disorders and inflammation. Disorders of various body systems and the role of inflammation due to lead exposure has been proven by various studies. These studies indicate that lead exposure may cause respiratory, neurologic, digestive, cardiovascular and urinary diseases. The results were also indicated the increased inflammatory cells and mediators due to lead exposure including cytokines and chemokines due to lead exposure which suggested to be the cause various organ disorders.

Associations between environmental heavy metal exposure and childhood asthma: A population-based study

BACKGROUND/PURPOSE

The health risks of environmental heavy metals have been of concern are well known. The greater likelihood of heavy metal contamination in the physical environment increases the risk of asthma, especially in children. This cross-sectional, population-based study sought to investigate associations between heavy metal exposure and childhood asthma or wheezing.

METHODS

Data from 5866 subjects, stratified into age groups of 2-5, 6-11, and 12-15 years, from the National Health and Nutrition Examination Survey 2007-2012 conducted by the Centers for Disease Control and Prevention were analyzed retrospectively. The primary outcome was active asthma. Variables included demographics, anthropometric, and clinical data. Univariate and multivariate logistic regression analyses were used to identify associations between blood heavy metal concentrations and adjusted odds (aORs) of active asthma.

RESULTS

Higher concentration of blood lead was associated with higher adjusted odds of having asthma (aOR = 1.08, 95% CI = 1.00-1.16), but no significant effect was shown for current wheezing or whistling. Age-stratified analysis showed that higher blood lead concentration was associated with higher risk for active asthma (aOR = 1.24, 95% CI = 1.08-1.42) and current wheezing or whistling (aOR = 1.19, 95% CI = 1.04-1.38) in the 6-11 years age group, while higher blood mercury concentration was associated with lower risk of current wheezing or whistling (aOR = 0.95, 95% CI = 0.90-0.99). The medium concentration of blood lead was associated with decreased risks of current wheezing or whistling (aOR = 0.54, 95% CI = 0.30-0.96) in the 2-5 years age group.

CONCLUSION

Higher concentrations of blood lead are associated with higher odds of asthma in children aged 2-15 years.

Blood lead levels, pulmonary function and agility in Polish schoolchildren

BACKGROUND

Reduced vital capacity (VC) and forced vital capacity (FVC) are associated with lead (Pb) exposure.

AIM

The objective of this study is to analyse the effects of Pb on FVC and the shuttle run performance.

SUBJECTS AND METHODS

Data were available for 184 male and 189 female Polish schoolchildren aged 10-15 years. Regression analysis was performed of shuttle run performance (dependent) on Pb and FVC.

RESULTS

Shuttle run time increased by 1.75 (± 0.77) and 1.97 (± 0.77) seconds for each 10 µg/dL increase in Pb blood among males and females, respectively. Higher shuttle run times indicate poorer performance. Average unadjusted blood Pb level in the sample was 5.27 μg/dL (± 0.19 SE) and 3.82 μg/dL (± 0.10 SE), respectively. Path analysis was used to assess the association of Pb level with shuttle run time. Blood Pb had a significant negative effect on VC (B= -13.60 ± 3.28 [SE], p < 0.0001) and FVC (B = -13.08 ± 3.27, p < 0.0001). FVC had a small but significant effect on shuttle run time (B = -0.04 ± 0.007, p < 0.0001). Pb had a significant effect on the residual of shuttle run time among males (B = 1.59 ± 0.75, p < 0.03) and females after the effect of FVC was removed (B = 1.49 ± 0.73, p < 0.04).

CONCLUSIONS

Thus, Pb had direct and indirect effects that increased shuttle run time, i.e. negatively affected performance.

Lead exposure, IgE, and the risk of asthma in children

Lead (Pb) has adverse effects on our nervous system and renal systems. Young children are more vulnerable to Pb exposure. However, the role of low-level Pb exposure in the immune system and allergic diseases in children is not well established. The aims of this study are to investigate the associations between Pb exposure and allergic diseases; between Pb and immunoglobulin E (IgE) as an intervening variable; and gender-based differences. We used multistage stratified random sampling to recruit kindergarten children nationwide in Taiwan. Information about allergic diseases and environmental exposures was collected by questionnaire. We compared children with and without allergic diseases for blood Pb levels measured by inductively coupled plasma mass spectrometry. The association between blood Pb and allergic diseases was assessed by logistic regression and those between Pb and IgE by generalized linear models. We also conducted mediation analysis to evaluate how much risk of allergic diseases related to Pb exposure is explained by IgE. A total of 930 children completed specimen collections. There was a positive association between Pb and asthma. Blood Pb were also positively linked with serum IgE (β=0.26 kU/l per ln-unit increase Pb concentration; 95% CI 0.009-0.50 kU/l), after adjusting for potential confounders. Analyses stratified by gender revealed that blood Pb correlated with IgE only in boys (β=0.40 kU/l; 95% CI 0.03-0.76 kU/l). We estimated that 38% of the total effect of Pb exposure on asthma is mediated by IgE levels. In conclusion, Pb exposure is associated with both blood IgE and asthma in boys. Moreover, the effect of Pb exposure on asthma may be mediated by IgE levels.

Association between Concentrations of Metals in Urine and Adult Asthma: A Case-Control Study in Wuhan, China

BACKGROUND

Several metals have been reported to be associated with childhood asthma. However, the results on relationships between metals and risk of childhood asthma are inconclusive, and the research on adult asthma in the Chinese general population is rare.

OBJECTIVES

To investigate potential associations between levels of urinary metals and adult asthma.

METHODS

A case-control study of 551 adult asthma cases and 551 gender- and age-matched controls was conducted in Wuhan, China. Demographic information was obtained, and lung function was assessed. The urinary concentrations of 22 metals were measured by inductively coupled plasma mass spectrometry.

RESULTS

After adjusting for other metalsand other covariates, urinary cadmium, molybdenum, chromium, copper, uranium and selenium were positively associated with asthma, with odds ratios (95% CI) of 1.69 (1.00, 2.85), 3.76 (2.30, 6.16), 4.89 (3.04, 7.89), 6.06 (3.27, 11.21), 6.99 (4.37, 11.19) and 9.17 (4.16, 20.21), respectively. By contrast, urinary lead, barium, iron, zinc, nickel, manganese and rubidium were negatively associated with asthma, with odds ratios (95% CI) of 0.48 (0.29, 0.80), 0.44 (0.27, 0.71), 0.41 (0.26, 0.64), 0.40 (0.24, 0.66), 0.30 (0.22, 0.41), 0.23 (0.14, 0.39) and 0.07 (0.03, 0.15), respectively. When comparing urinary metals in different subgroups of cases with those in matched controls, the associations of above 13 metals with asthma prevalence were nearly the same.

CONCLUSIONS

Our results suggested that asthma prevalence in the Chinese adults was positively associated with urinary chromium, chromium, selenium, molybdenum, cadmium, and uranium, and negatively associated with urinary manganese, iron, nickel, zinc, rubidium, barium and lead. Additional research with larger populations in different regions is required to support our findings.

Detectable Blood Lead Level and Body Size in Early Childhood

Rates of childhood obesity have risen at the same time rates of high blood lead levels (BLLs) have fallen. Recent studies suggest that higher BLL is inversely associated with body size in older children (ages 3-19 years). No contemporaneous studies have examined if having a detectable BLL is associated with body size in very early childhood. We examined if detectable BLL is associated with body size in early childhood. A total of 299 birth cohort participants completed a study visit at ages 2-3 years with weight and height measurements; prior to this clinic visit, a BLL was drawn as part of routine clinical care. Body mass index (BMI) percentile and Z-score were calculated; children with BMI ≥85th percentile were considered overweight/obese at age of 2 years. Detectable BLL was defined as BLL ≥1 μg/dL. A total of 131 (43.8 %) children had a detectable BLL measured at mean aged 15.4 ± 5.5 months. Mean age at body size assessment was 2.2 ± 0.3 years (53.2 % male, 68.6 % African-American). After adjusting for race, sex, and birth weight, children with a detectable BLL had a 43 % lower risk of BMI ≥85th percentile (P = 0.041) and a 0.35-unit lower BMI Z-score (P = 0.008) compared to children without a detectable BLL. Neither race nor sex modified this association (all interactions P > 0.21). Consistent with recent studies in older children, having a detectable BLL was associated with smaller body size at ages 2-3 years. Additional research on the mechanism of this association is needed but may include mechanisms of appetite suppression via lead.

Blood lead levels and childhood asthma

OBJECTIVE

To measure blood lead levels in children (5-14 y) with bronchial asthma, and correlate with asthma severity.

DESIGN

Cross-sectional analytical.

SETTING

Pediatric Allergy and Immunology Clinic of a Childrens hospital in Cairo, Egypt.

PARTICIPANTS

200 children (127 males) with bronchial asthma and 125 age- and sex-matched healthy controls (80 males).

PROCEDURE

Blood lead levels were measured by atomic absorption spectrophotometer technique, and were subsequently correlated with asthma severity.

RESULTS

No significant difference in mean (SD) blood lead levels was observed between children with asthma [13.3 (4.8) ug/dL] and control group [11.4 (3.9) ug/dL]. 190 children (58.5%) had elevated blood lead levels (>10 ug/dL), with no significant difference between patients (60%) and controls (56%). Patients with elevated blood lead levels had significantly higher frequency of eosinophilia (66.7%) and increased total immunoglobulin E (83.3%) compared to other patients with blood lead levels <10ug/dL (10% and 43.8%, respectively). Patients of asthma with elevated blood lead levels had higher grades of severity of asthma compared to those with blood lead levels <10 ug/dL.

CONCLUSIONS

Blood lead levels are not significantly associated with diagnosis of asthma but elevated blood lead levels seem to be associated with increased asthma severity and higher frequency of eosinophilia and elevated immunoglobulin E levels.

Lead exposure and increased food allergic sensitization in U.S. children and adults

BACKGROUND

Whether blood lead levels are associated with sensitization to food allergens in adults and children is unclear. Prior studies have shown that exposure to lead is associated with atopic sensitization and modulation of several cytokines (eg, interleukin [IL]-12, IL-10, interferon [IFN]-γ, and IL-4 production) and with T-cell dysregulation and bias toward T helper 2 (Th2) activity. The objective of this work was to assess whether exposure to lead is independently associated with allergic symptoms and sensitizations in a large nationally representative sample of children and adults.

METHODS

We studied 2712 children and 4333 adults enrolled in the 2005-2006 cycle of the National Health and Nutritional Examination Surveys (NHANES). Participants were tested for serum-specific immunoglobulin E (IgE) levels to food allergens as well as blood lead levels. Food allergens tested included shrimp, egg, peanut, and milk. Logistic regression models adjusted for demographic factors, body mass index, history of asthma, smoking, housing characteristics, and current exposure to animals in the home, to assess the association of blood lead levels with sensitization to food allergens.

RESULTS

Median (interquartile range [IQR]) for serum blood was 0.87 μg/L (0.61 to 1.31) in children and 1.48 μg/L (0.92 to 2.34) in adults. At baseline, 672 (24.7%) of children participants and 719 (16.6%) of adult participants tested positive for increased sensitization to food allergens. A 2-fold increase in blood lead levels in adult participants was associated with increased sensitization to food allergens (odds ratio [OR], 1.11; 95% confidence interval [CI], 1.02 to 1.22). Blood lead was not associated with sensitization to food allergens among pediatric participants (OR, 0.95; 95% CI, 0.82 to 1.10).

CONCLUSION

Exposure to lead was associated with increased odds of sensitization to food allergens in adult but not children participants.

Exploring childhood lead exposure through GIS: a review of the recent literature

Childhood exposure to lead remains a critical health control problem in the US. Integration of Geographic Information Systems (GIS) into childhood lead exposure studies significantly enhanced identifying lead hazards in the environment and determining at risk children. Research indicates that the toxic threshold for lead exposure was updated three times in the last four decades: 60 to 30 micrograms per deciliter (µg/dL) in 1975, 25 µg/dL in 1985, and 10 µb/dL in 1991. These changes revealed the extent of lead poisoning. By 2012 it was evident that no safe blood lead threshold for the adverse effects of lead on children had been identified and the Center for Disease Control (CDC) currently uses a reference value of 5 µg/dL. Review of the recent literature on GIS-based studies suggests that numerous environmental risk factors might be critical for lead exposure. New GIS-based studies are used in surveillance data management, risk analysis, lead exposure visualization, and community intervention strategies where geographically-targeted, specific intervention measures are taken.

The relationship of blood lead with immunoglobulin E, eosinophils, and asthma among children: NHANES 2005-2006

Early life lead exposure may alter immune function and predispose a child to develop asthma. In an initial exploration of this hypothesis, we examined the association between blood lead, and serum immunoglobulin E (IgE), eosinophils, and asthma prevalence in a cross-sectional study of 1788 children from the National Health and Nutrition Examination Survey 2005-2006. Geometric mean blood lead, serum IgE, and percent eosinophils were 1.13 μg/dL (95% confidence interval (CI): 1.04, 1.22), 46.3 kU/L (95% CI: 40.3, 53.1), and 2.82 percent (95% CI 2.67, 2.98), respectively. Prevalence of asthma, atopic asthma, and atopy were 11.8% (95% CI: 9.5, 14.2), 8.1% (6.2, 9.9), and 44.4% (40.1, 48.7), respectively. Regression models controlled for season, age, sex, race/ethnicity, education, passive smoke exposure, and body mass index. Based on these models, there was an 11.1% (95% CI: 5.6, 16.9) increase in IgE and a 4.9% (95% CI: 2.3, 7.6) increase in eosinophils per 1 μg/dL increase in blood lead. In independent stratified analyses, lead was found to increase IgE and eosinophils among non-Hispanic whites, but not other children; and stronger associations were observed among children who lived with a smoker vs. not. Lead was not associated with asthma, atopic asthma, or general atopy. This study provides additional evidence of a cross-sectional association between lead with IgE and new evidence for eosinophils. This may be a mechanism for development of downstream allergic disease. The mechanisms that determine ultimate development of allergic disease are currently unknown, but are the focus of ongoing studies.

Respiratory symptoms and pulmonary function testes in lead exposed workers

Background

The exposure to noxious agwents such as lead my cause lung disorders.

Objectives

In the present study, pulmonary function tests and self-reported respiratory symptoms in lead exposure workers were compared with matched control subjects.

Materials and Methods

The frequency of respiratory symptoms were evaluated in a sample of 108 lead exposure workers and 100 control subjects with similar age using a questionnaire including questions on respiratory symptoms in the past year. Pulmonary function tests (PFT) were also measured in lead exposure workers and in controls.

Results

Most lead exposure workers (63%) reported work-related respiratory symptoms. Chest tightness (26%), cough (17%) and sputum (16%) were the most common symptoms and only 6% of lead exposure workers reported wheezing (P < 0.001 for all case except wheezing). Most PFT values were also significantly reduced among lead exposure workers (P < 0.05 to P < 0.001 except MEF75, MEF50, MEF25, and MMEF. The lead concentration in urine and serum of lead exposure workers were significantly higher than control (P < 0.001 for both cases).

Conclusions

These results showed that c lead exposure workers have higher frequencies of respiratory symptoms higher serum and urine lead concentration but lower PFT values.

Environmental cigarette smoke exposure modulates IgE levels of Pb-exposed children

In urban areas with a predominance of early to mid-20th century housing stock, islands of children possessing blood lead levels (PbB) in excess of CDC guidelines (>10μg/dL) exist. Many of these children are also exposed to environmental tobacco smoke (ETS). The current study examined the impact of Pb-exposure (PbB levels of 1-55μg/dL) with/without concurrent ETS exposure on immune system function in 318 children aged 6-84 months from the urban area of Springfield-Greene County, MO. In this population, 36.5% of children possessed PbB levels >10μg/dL, 62.9% of children came from smoking homes, 51.9% of children were under 2 years of age, and the population was WIC eligible and predominantly of white, non-Hispanic ethnicity. Multiple immune function markers including cell counts, IgE levels, sCD25 (sIL2R) and IL4 concentrations, and titers to common childhood immunizations were analyzed for correlation with Pb and/or ETS exposure. Increased IgE levels (p<0.01) were found in children with PbB levels within CDC Classes II-IV - this finding was primarily attributable to elevated IgE levels in the subpopulation of children with concurrent Pb and ETS exposure. A trend (0.05<p<0.01) of increases in % total T-cells (p=0.06) was also found in children with concurrent elevated PbB levels and ETS exposure. This trend was not found in the subset of children without ETS exposure nor was it present in the analysis of the entire population set. Conversely, alterations in median values for % lymphocytes, % granulocytes, and % activated T-cells across Pb classes were present in the subpopulation of children expose to Pb alone (without concurrent ETS exposure) though a clear trend was not evident. In the entire population set, a statistically significant correlation between ETS and PbB levels was found. This study indicates that prior reports of a correlation between elevated PbB levels and serum IgE levels may be strongly influenced by exposure to ETS. Findings from this study also indicate that Pb is an immune modulator and PbB levels may be influenced by ETS exposure.

Asthma: a health disparity among African American children: the impact and implications for pediatric nurses

Asthma is the most common chronic illness among children and is a significant health disparity for African American children and their families. This article provides current statistics that clearly define the problem of asthma and explains the relevance of this health problem for pediatric nurses. The Healthy People 2010 objectives for pediatric asthma care are discussed as outcome measures. The individual, sociocultural, and environmental characteristics of asthma are described. The impact and implications for pediatric nurses in the roles of (a) coordinator of care, (b) child/family advocate, and (c) evaluator of care are explained.

Intrauterine exposure to lead may enhance sensitization to common inhalant allergens in early childhood: a prospective prebirth cohort study

BACKGROUND

Several in vivo and in vitro studies have shown that metal-rich particles may enhance allergic responses to house dust mites and induce an increased release of allergy-related cytokines.

OBJECTIVES

The main goal of this analysis is to define the possible association of intrauterine exposure to lead and mercury with the occurrence of skin sensitization to common aeroallergens in early childhood.

MATERIAL AND METHODS

The present study refers to a sample of 224 women in the second trimester of pregnancy recruited from Krakow inner city area who had full term pregnancies and whose children underwent skin prick testing (SPT) at the age of 5. Lead and mercury levels were assessed in cord blood and retested in children at age of 5 years. Aeroallergen concentrations in house dust were measured at the age of 3 years. The main health outcome (atopic status) was defined as the positive SPT to at least one common aeroallergen (Der f1, Der p1, Can f1 and Fel d1) at the age of 5 years. In the statistical analysis of the association between atopic status of children and exposure to metals, the study considered a set of covariates such as maternal characteristics (age, education, atopy), child's gender, number of older siblings, prenatal (measured via cord blood cotinine) and postnatal environmental tobacco smoke together with exposure to polycyclic aromatic hydrocarbons (PAH) as measured by PAH-DNA adducts.

RESULTS AND CONCLUSION

In the binary regression analysis, which controlled for the confounders, the risk ratio (RR) estimate for atopic sensitization was significantly associated with the lead exposure (RR=2.25, 95%CI: 1.21-4.19). In conclusion, the data suggest that even very low-level of prenatal lead exposure may be implicated in enhancing sensitization to common aeroallergens in early childhood.

Lead poisoning and asthma among low-income and African American children in Saginaw, Michigan

OBJECTIVE

We sought to ascertain whether asthmatic children are more likely to have elevated blood lead levels (EBLLs), BLLs ≥ 10 μg/dL, than non-asthmatic children. Household risk factors associated with both lead and asthma were examined.

METHOD

We undertook a cross-sectional study involving children residing in mainly low-income and minority households in Michigan which were identified by the Statewide Systemic Tracking of Elevated Lead Levels and Remediation database (STELLAR) (n=356 children).

RESULTS

Of the 356 index children, 19% had EBLLs and 15% were doctor-diagnosed asthmatic. After adjusting for confounders known to be related to lead poisoning and/or asthma, association remained between asthmatic children and EBLL children (AOR: 5.17; 95% CI (1.25-21.37)).

CONCLUSIONS

The results of our study show that asthmatic children are over 5 times more likely to have EBLLs than non-asthmatics (AOR: 5.17; 95% CI (1.25-21.37)). Intervention strategies designed to address lead poisoning prevention may be effective in reducing incidence of asthma. Further study is required.

Blood lead levels and increased bronchial responsiveness

The immune system is one of the targets most sensitive to lead toxicity, and the association between lead exposure and serum immunoglobulin E (IgE) has been published. Recent studies also reported that lead caused the development of IgE-mediated allergy. To investigate whether blood lead levels contribute to other allergic conditions, we examined the effect of blood lead on bronchial responsiveness (BR) in the general population. We performed a cross-sectional study with adults aged 19 to 58 years in a Korean community. Blood lead level and the methacholine provocation test were performed. The overall mean blood lead level was 2.9 microg/dl, and the mean BR index was 1.14. The percent of subjects with clinically diagnosed asthma was 21 (4%) and there was no difference in blood lead level with and without asthma. In the multiple regression model, the elevation of blood lead level was related to the increase of BR after adjusting for age, sex, height, smoking status, and the presence of asthma. Blood lead level was significantly associated with increased BR that came from the elevation of the IgE level with lead exposure. Lead may contribute to the increase of asthma and other allergic conditions.

Environmental factors and allergic disorders

Despite numerous studies on possible associations between environmental exposure and allergic disorders, any conclusions made remain a matter of controversy. We conducted a review of evidence in relation to environmental and nutritional determinants and wheeze, asthma, atopic dermatitis, and allergic rhinitis. Identified were 263 articles for analysis after consideration of 1093 papers that were published since 2000 and selected by electronic search of the PubMed database using keywords relevant to epidemiological studies. Most were cross-sectional and case-control studies. Several prospective cohort studies revealed inconsistent associations between various environmental factors and the risk of any allergic disorder. Therefore, the evidence was inadequate to infer the presence or absence of a causal relationship between various environmental exposures and allergic diseases. However, evidence is suggestive of positive associations of allergies with heredity. Because almost all the studies were performed in Western countries, the application of these findings to people in other countries, including Japan, may not be appropriate. Further epidemiological information gained from population-based prospective cohort studies, in particular among Japanese together with other Asians, is needed to assess causal relationships between various environmental factors and allergic diseases.

Lead and immune function

The heavy metal lead is a widely deposited environmental toxicant known to impact numerous physiological systems, including the reproductive, neurological, hepatic, renal, and immune systems. Studies illustrating the capacity of lead to impair immune function and/or host resistance to disease date back to at least the 1960s. However, it has only been in recent years that lead has been recognized among a new category of immunotoxicants-those that dramatically shift immune functional capacity while producing only modest changes to immune cell populations and lymphoid organs. These relatively noncytotoxic immunomodulating chemicals and drugs represent the immunotoxic hazards most difficult to identify and problematic for risk assessment using historic approaches. As a result, such environmental factors are also among the most likely to contribute to chronic immune-related disease at relevant exposure levels. This review considers the animal and human evidence that lead exposure can produce a stark shift in immune functional capacity with a skewing predicted to elevate the risk of atopic and certain autoimmune diseases. At the same time, host defenses against infectious agents and cancer may be reduced. Age-based exposure studies also suggest that levels of blood lead previously thought to be safe, that is, below 10 microg/dl, may be associated with later life immune alterations.

Applying epidemiologic concepts of primary, secondary, and tertiary prevention to the elimination of racial disparities in asthma

Despite medical and scientific advances, racial and ethnic disparities persist in US asthma morbidity and mortality rates. Progress in the elimination of these disparities will involve disentangling the contribution of social constructs, such as race, socioeconomic status, and culture, from that of the physical environment and genetic susceptibility. One approach to reducing asthma disparities is through the traditional disease prevention stages of intervention. As such, primary prevention targets reductions in asthma incidence; secondary prevention is the mitigation of established disease and involves disease detection, management, and control; and tertiary prevention is the reduction of complications caused by severe disease. Once causative factors at each level of disease prevention are understood, this knowledge can be translated into clinical practice and public health policy.