Chlorinated pool attendance, airway epithelium defects and the risks of allergic diseases in adolescents: Interrelationships revealed by circulating biomarkers
Abstract
It has been suggested that allergic diseases might be epithelial disorders driven by various environmental stressors but the epidemiological evidence supporting this concept is limited. In a cross-sectional study of 835 school adolescents (365 boys; mean age, 15.5 yr), we measured the serum concentrations of Club cell protein (CC16), surfactant-associated protein D (SP-D) and of total and aeroallergen-specific IgE. We used the serum CC16/SP-D concentration ratio as an index integrating changes in the permeability (SP-D) and secretory function (CC16) of the airway epithelium. In both sexes, early swimming in chlorinated pools emerged as the most consistent and strongest predictor of low CC16 and CC16/SP-D ratio in serum. Among girls, a low CC16/SP-D ratio was associated with increased odds (lowest vs. highest tertile) for pet sensitization (OR 2.97, 95% CI 1.19-8.22) and for hay fever in subjects sensitized to pollen (OR 4.12, 95% CI 1.28-14.4). Among boys, a low CC16/SP-D ratio was associated with increased odds for house-dust mite (HDM) sensitization (OR 2.01, 95% CI 1.11-3.73), for allergic rhinitis in subjects sensitized to HDM (OR 3.52, 95% CI 1.22-11.1) and for asthma in subjects sensitized to any aeroallergen (OR 3.38, 95% CI 1.17-11.0), HDM (OR 5.20, 95% CI 1.40-24.2) or pollen (OR 5.82, 95% CI 1.51-27.4). Odds for allergic sensitization or rhinitis also increased with increasing SP-D or decreasing CC16 in serum. Our findings support the hypothesis linking the developm…
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In that study, CC16 was not associated with any sensitization or prevalence of asthma, hay fever or rhinitis.
“CC16 was not associated with any | sensitization or prevalence of asthma, hay fever or | rhinitis.”
From Inorganic chloramines: a critical review of the toxicological and epidemiological evidence as a basis for occupational exposure limit setting (2020) · cites this paper as Bernard et al. (2015)
In that study, among boys, a low CC16/SP-D ratio was associated with a higher prevalence (OR, 95% CI) of house dust mite sensitization, of allergic rhinitis in subjects sensitized to house dust mite and asthma in those sensitized to any aeroallergen (3.4, 0.1-0.8), house dust mite (5.2, 1.4-24) or pollen (5.8, 1.5-27).
“Among boys, a low CC16/SP-D ratio was | associated with a higher prevalence (OR, 95% CI) of | house dust mite sensitization, of allergic rhinitis in | subjects sensitized to house dust mite and asthma | in those sensitized to any aeroallergen (3.4, 0.1-0.8), | house dust mite (5.2, 1.4-24) or pollen (5.8, 1.5-27).”
From Inorganic chloramines: a critical review of the toxicological and epidemiological evidence as a basis for occupational exposure limit setting (2020) · cites this paper as Bernard et al. (2015)
In that study, among girls, a low CC16/SP-D ratio was associated with pet sensitization and with hay fever in those sensitized to pollen, but not with asthma.
“Among girls, a low CC16/SP-D ratio was associated | with pet sensitization and with hay fever in those | sensitized to pollen, but not with asthma”
From Inorganic chloramines: a critical review of the toxicological and epidemiological evidence as a basis for occupational exposure limit setting (2020) · cites this paper as Bernard et al. (2015)
In a cross-sectional study of Belgian school children, children with the highest pool attendance (total or before the age of 7 years) had significantly lower levels of CC16 and CC16/SP-D ratio than other children.
“Children with the highest pool attendance (total or | before the age of 7 years) had significantly lower | levels of CC16 and CC16/SP-D ratio than other | children.”
From Inorganic chloramines: a critical review of the toxicological and epidemiological evidence as a basis for occupational exposure limit setting (2020) · cites this paper as Bernard et al. (2015)
Cites
The biodiversity hypothesis and allergic disease: world allergy organization position statement
Haahtela, T., Holgate, S., Pawankar, R., Akdis, C. A., Benjaponpitak, S., Caraballo, L., Demain, J., Portnoy, J., & von Hertzen, L. (2013) · World Allergy Organization Journal · doi:10.1186/1939-4551-6-3 · Cited by 426 · see citing works
Bernard, A., Carbonnelle, S., Dumont, X., & Nickmilder, M. (2007) · Pediatrics · doi:10.1542/peds.2006-3333 · Cited by 141 · see citing works
Self-citationShort-Term Changes in Respiratory Biomarkers after Swimming in a Chlorinated Pool
Font-Ribera, L., Kogevinas, M., Zock, J.-P., Gómez, F. P., Barreiro, E., Nieuwenhuijsen, M. J., Fernandez, P., Lourencetti, C., Pérez-Olabarría, M., Bustamante, M., et al. (2010) · Environmental Health Perspectives · doi:10.1289/ehp.1001961 · Cited by 119 · see citing works
Lagerkvist, B. J., Bernard, A., Blomberg, A., Bergstrom, E., Forsberg, B., Holmstrom, K., Karp, K., Lundstrom, N.-G., Segerstedt, B., Svensson, M., et al. (2004) · Environmental Health Perspectives · doi:10.1289/ehp.7027 · Cited by 96 · see citing works
Self-citationSwimming pool attendance and respiratory symptoms and allergies among Dutch children
Jacobs, J. H., Fuertes, E., Krop, E. J. M., Spithoven, J., Tromp, P., & Heederik, D. J. J. (2012) · Occupational and Environmental Medicine · doi:10.1136/oemed-2011-100621 · Cited by 34 · see citing works
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Wastensson, G., & Eriksson, K. (2020) · Critical Reviews in Toxicology · doi:10.1080/10408444.2020.1744514 · Cited by 30 · see citing works
- Authors
- Bernard, A., Nickmilder, M., & Dumont, X.
- Affiliations
- UCLouvain (BE)
- Corresponding author
- Bernard, Alfred
- ORCID
- Bernard, Alfred
- Venue
- Environmental Research
- Publisher
- Elsevier BV
- Published
- 2015-07
- Volume
- 140
- Pages
- 119-126
- ISSN
- 0013-9351 (ISSN-L)
- OpenAlex
- W2007609035
- Cited by
- 30
- References
- 5
- Citations by year
- 2026: 2 · 2024: 3 · 2023: 1 · 2022: 1 · 2021: 4 · 2020: 2 · 2019: 1 · 2018: 5 · 2017: 5 · 2016: 5 · 2015: 1
- FWCI
- 3.56
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Environmental Research (publishedVersion)
- PubMed (publishedVersion)
- Digital Access to Libraries (submittedVersion)
- Funders
- French Agency for the Safety of the Work and Environment
- Topics
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Health Sciences › Medicine › Immunology and Allergy › Allergic Rhinitis and Sensitization
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Occupational exposure and asthma
- Keywords
- airway epithelium, epithelial barrier dysfunction, allergic diseases, CC16, allergen sensitization, allergic rhinitis, asthma, house dust mite sensitization, pollen sensitization, adolescents, environmental exposure
- MeSH terms
- Adolescent, Belgium, Bronchi, Chlorine, Cross-Sectional Studies, Environmental Exposure, Epithelium, Female, Humans, Hypersensitivity, Immunoglobulin E, Male, Risk Factors, Swimming Pools, Trachea, Biomarkers, Chemokines, CC, Pulmonary Surfactant-Associated Protein D
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