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The Impact of Ambient Environmental Exposures to Microbial Products on Asthma Outcomes from Birth to Childhood.

ABSTRACT: PURPOSE OF REVIEW:Asthma is a chronic respiratory condition with increasing domestic and worldwide prevalence that burdens individuals and the healthcare system with high costs associated with long-term treatments and acute emergency room (ER) visits. It can be triggered by ambient microbes, including bacteria, viruses, and fungi. In this review, we examine the outcomes of asthma patients in relation to environmental exposures to ambient microbe products, focusing on whether exposure leads to asthma development from birth to childhood and if particular microbes are associated with worsened asthma exacerbations. RECENT FINDINGS:Bacterial endotoxin is more prominent in homes with pets and may cause cytokine cascades that lead to asthma exacerbation. However, some studies have demonstrated a protective effect with early exposure. Patients with positive Aspergillus skin testing are more prone to moderate-severe or severe-uncontrolled asthma. Fungal sensitization is also associated with earlier onset of asthma and demonstrates a dose-dependent relationship of symptom severity and duration. Among viruses, rhinovirus has the greatest association with decreased lung function, severe asthma, and asthma-related hospital admissions. Distribution of microbial products and associated asthma symptoms depends on the geographical climate. Genetic variations among individuals also mitigate the effects of microbial products on asthma development and symptom severity. Microbial products of bacteria, fungi, and viruses are associated with the development of asthma, more severe asthma symptoms, and worse outcomes. However, some early exposure studies have also demonstrated a protective effect. Bacterial and fungal products are related to decreased lung function and earlier onset of asthma. Viral products are related to asthma-associated hospital admissions; and the climate and patient genetics can also temper or intensify the relationships between microbial products, asthma development, and asthma symptom severity. Further research should focus on the effects of early microbe exposure and its interaction with human immune systems and asthma-related outcomes.

SUBMITTER: Howard E

PROVIDER: S-EPMC7088961 | biostudies-literature | 2019 Nov

REPOSITORIES: biostudies-literature

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The Impact of Ambient Environmental Exposures to Microbial Products on Asthma Outcomes from Birth to Childhood.

Howard Evin E Orhurhu Vwaire V Huang Lisa L Guthrie Barbara B Phipatanakul Wanda W

Current allergy and asthma reports 20191128 12

<h4>Purpose of review</h4>Asthma is a chronic respiratory condition with increasing domestic and worldwide prevalence that burdens individuals and the healthcare system with high costs associated with long-term treatments and acute emergency room (ER) visits. It can be triggered by ambient microbes, including bacteria, viruses, and fungi. In this review, we examine the outcomes of asthma patients in relation to environmental exposures to ambient microbe products, focusing on whether exposure lea ...[more]

PMID: 31781873

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Project description:BackgroundChildren with congenital heart defects have an increased risk of neurodevelopmental disability. The impact of environmental chemical exposures during daily life on neurodevelopmental outcomes in toddlers with congenital heart defects is unknown.MethodsThis prospective study investigated the impacts of early childhood exposure to mixtures of environmental chemicals on neurodevelopmental outcomes after cardiac surgery. Outcomes were assessed at 18 months of age using The Bayley Scales of Infant and Toddler Development-III. Urinary concentrations of exposure biomarkers of pesticides, phenols, parabens, and phthalates, and blood levels of lead, mercury, and nicotine were measured at the same time point. Bayesian profile regression and weighted quantile sum regression were utilized to assess associations between mixtures of biomarkers and neurodevelopmental scores.ResultsOne-hundred and forty infants were enrolled, and 110 (79%) returned at 18 months of age. Six biomarker exposure clusters were identified from the Bayesian profile regression analysis; and the pattern was driven by 15 of the 30 biomarkers, most notably 13 phthalate biomarkers. Children in the highest exposure cluster had significantly lower adjusted language scores by -9.41 points (95%CI: -17.2, -1.7) and adjusted motor scores by -4.9 points (-9.5, -0.4) compared to the lowest exposure. Weighted quantile sum regression modeling for the overall exposure-response relationship showed a significantly lower adjusted motor score (β = -2.8 points [2.5th and 97.5th percentile: -6.0, -0.6]). The weighted quantile sum regression index weights for several phthalates, one paraben, and one phenol suggest their relevance for poorer neurodevelopmental outcomes.ConclusionsLike other children, infants with congenital heart defects are exposed to complex mixtures of environmental chemicals in daily life. Higher exposure biomarker concentrations were associated with significantly worse performance for language and motor skills in this population.

Project description:IntroductionEarly onset and high prevalence of allergic diseases result in high individual and socio-economic burdens. Several studies provide evidence for possible effects of environmental factors on allergic diseases, but these are mainly single-exposure studies. The exposome provides a novel holistic approach by simultaneously studying a large set of exposures. The aim of the study was to evaluate the association between a broad range of prenatal and childhood environmental exposures and allergy-related outcomes in children.Material and methodsAnalyses of associations between 90 prenatal and 107 childhood exposures and allergy-related outcomes (last 12 months: rhinitis and itchy rash; ever: doctor-diagnosed eczema and food allergy) in 6-11 years old children (n = 1270) from the European Human Early-Life Exposome cohort were performed. Initially, we used an exposome-wide association study (ExWAS) considering the exposures independently, followed by a deletion-substitution-addition selection (DSA) algorithm considering all exposures simultaneously. All the exposure variables selected in the DSA were included in a final multi-exposure model using binomial general linear model (GLM).ResultsIn ExWAS, no exposures were associated with the outcomes after correction for multiple comparison. In multi-exposure models for prenatal exposures, lower distance of residence to nearest road and higher di-iso-nonyl phthalate level were associated with increased risk of rhinitis, and particulate matter absorbance (PMabs) was associated with a decreased risk. Furthermore, traffic density on nearest road was associated with increased risk of itchy rash and diethyl phthalate with a reduced risk. DSA selected no associations of childhood exposures, or between prenatal exposures and eczema or food allergy.DiscussionThis first comprehensive and systematic analysis of many environmental exposures suggests that prenatal exposure to traffic-related variables, PMabs and phthalates are associated with rhinitis and itchy rash.

Project description:BackgroundPersistent disparities in academic performance may result from a confluence of adverse exposures accruing disproportionately to specific subpopulations.ObjectiveOur overarching objective was to investigate how multiple exposures experienced over time affect early childhood educational outcomes. We were specifically interested in whether there were: racial/ethnic disparities in prevalence of adverse exposures; racial/ethnic disparities in associations observed between adverse exposures and early childhood educational outcomes; and interactions between exposures, suggesting that one exposure augments susceptibility to adverse effects of another exposure.MethodsWe link geocoded North Carolina birth data for non-Hispanic white (NHW) and non-Hispanic black (NHB) children to blood lead surveillance data and 4th grade end-of-grade (EOG) standardized test scores (n = 65,151). We construct a local, spatial index of racial isolation (RI) of NHB at the block group level. We fit race-stratified multi-level models of reading and mathematics EOG scores regressed on birthweight percentile for gestational age, blood lead level, maternal smoking, economic disadvantage, and RI, adjusting for maternal- and child-level covariates and median household income.ResultsThere were marked racial/ethnic disparities in prevalence of adverse exposures. Specifically, NHB children were more likely than NHW children to be economically disadvantaged (80% vs. 40%), live in block groups with the highest quintile of RI (46% vs. 5%), have higher blood lead levels (4.6 vs. 3.7 μg/dL), and lower birthweight percentile for gestational age (mean: 39th percentile vs. 51st percentile). NHB children were less likely to have mothers who reported smoking during pregnancy (11% and 22%). We observed associations between key adverse exposures and reading and math EOG scores in 4th grade. Higher birthweight percentile for gestational age was associated with higher EOG scores, while economic disadvantage, maternal smoking, and elevated blood lead levels were associated with lower EOG scores. Associations observed for NHB and NHW children were generally not statistically different from one another, with the exception of neighborhood RI. NHB children residing in block groups in the highest RI quintile had reading and math scores 1.54 (0.74, 2.34) and 1.12 (0.38, 1.87) points lower, respectively, compared to those in the lowest RI quintile; statistically significant decrements in EOG scores associated with RI were not observed for NHW children. We did not find evidence of multiplicative interactions between exposures for NHB or NHW children.DiscussionKey adverse host, environmental, and social exposures accrue disproportionately to NHB children. Decrements in test scores associated with key adverse exposures were often but not always larger for NHB children, but were not significantly different from those estimated for NHW children. While we did not observe interactive effects, NHB children on average experience more deleterious combined exposures, resulting in larger decrements to test scores compared to NHW children.

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The Impact of Ambient Environmental Exposures to Microbial Products on Asthma Outcomes from Birth to Childhood.

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The Impact of Ambient Environmental Exposures to Microbial Products on Asthma Outcomes from Birth to Childhood.

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