Exposure to phthalate increases the risk of eczema in children: Findings from a systematic review and meta-analysis

One year respiratory and neurodevelopmental outcome of premature neonates after exposure to plasticizers in the neonatal intensive care unit - A prospective cohort study

BACKGROUND

Premature neonates have an increased risk of long-term effects, including impaired respiratory and neurodevelopment. During NICU admission, they are exposed to endocrine-disrupting phthalates and alternative plasticizers. The objective was to study the association between cumulative NICU-based plasticizer exposure and respiratory and neurodevelopmental outcome during the first year of life.

METHODS

Premature neonates (gestational age <31 weeks and/or birth weight <1500 g) were prospectively enrolled at the Antwerp University Hospital, Belgium. Outcome was assessed at 12 months corrected age, using the Bayley Scales of Infant and Toddler Development-III and validated questionnaires for respiratory outcome. Urinary concentrations of plasticizers' biomarkers were measured weekly during NICU stay. Weighted quantile sum regression was utilized to assess associations between plasticizer biomarkers' mixtures and outcome.

RESULTS

Exposure of premature neonates (n = 110) to specific plasticizer mixtures correlated with worse fine motor (ß -0.96; 95%-CI -1.76, -0.15; p = 0.02) and receptive language development (ß -0.77; 95%-CI -1.23, -0.32; p = 0.001), and better gross motor (ß 2.24; 95%-CI 0.62, 3.86; p = 0.01) and expressive language development (ß 1.50; 95%-CI 0.33, 2.67; p = 0.02). NICU exposure to different plasticizer mixtures was associated with eczema (aOR 3.12; 95%-CI 1.23, 9.11; p = 0.02), repeated ear infections (aOR 5.53; 95%-CI 1.87, 23.14; p = 0.01), and respiratory-related healthcare visits during the first year of life (aOR 8.50; 95%-CI 2.05-55.91; p = 0.01).

CONCLUSIONS

Cumulative NICU exposure to phthalates and alternative plasticizers was associated with increased respiratory morbidity and eczema during the first year of life. Exposure to specific plasticizer mixtures correlated with worse or better neurodevelopment at one year of age.

Association of Phthalate Exposure with Respiratory and Allergic Symptoms and Type 2 and Non-Type 2 Inflammation: The Hokkaido Study

Phthalate exposure is linked to asthma and allergic symptoms, yet their individual and combined effects on symptoms and inflammatory biomarkers, type 2 (T2) and non-T2, remain unexplored. This study examined the association of phthalate metabolites with allergic symptoms (wheeze, allergic rhinoconjunctivitis, and eczema), T2 biomarker (fraction of exhaled nitric oxide (FeNO), blood eosinophil count, and total immunoglobulin E (IgE)), and non-T2 biomarker (absolute neutrophil count (ANC)) and also their association with oxidative stress biomarkers, such as 4-hydroxynonenal, hexanoyl-lysine, and 8-hydroxy-2-deoxyguanosine. Ten urinary phthalate metabolites were measured using UPLC-MS/MS in 421 children (aged 9-12 years) from The Hokkaido Cohort, Japan. Symptoms were defined using the International Study of Asthma and Allergies in Childhood questionnaire, and biomarkers were measured in blood. Logistic regression assessed individual metabolites, while quantile-g computation and Bayesian kernel machine regression analyzed mixture effects on binary outcomes. Individual analysis showed that MnBP (mono-n-butyl phthalate) was positively associated with allergic rhinoconjunctivitis and eosinophil ≥ 300 cells/μL, while ∑DBP (dibutyl phthalate) and OH-MiNP (mono-hydroxy-isononyl phthalate) were linked with FeNO ≥ 35 ppb. DEHP (di(2-ethylhexyl) phthalate) metabolites were associated with a high prevalence of blood eosinophils ≥ 300 cells/μL. We found a positive association between phthalates and oxidative stress markers, but no link was observed between oxidative stress and inflammatory markers. Mixture analysis identified MnBP as a major contributor to the high FeNO level, with di-n-butyl phthalate (DnBP) and DEHP metabolites contributing to eosinophil count ≥ 300 cells/μL and ANC ≥ 4400 cells/μL. These findings suggest that phthalate exposure from DnBP and DEHP is associated with immune dysregulation by triggering both T2 and non-T2 inflammatory responses.

The clinical, mechanistic, and social impacts of air pollution on atopic dermatitis

Atopic dermatitis (AD) is a complex disease characterized by dry, pruritic skin and significant atopic and psychological sequelae. Although AD has always been viewed as multifactorial, early research was dominated by overlapping genetic determinist views of either innate barrier defects leading to inflammation or innate inflammation eroding skin barrier function. Since 1970, however, the incidence of AD in the United States has increased at a pace that far exceeds genetic drift, thus suggesting a modern, environmental etiology. Another implicated factor is Staphylococcus aureus; however, a highly contagious microorganism is unlikely to be the primary etiology of a noncommunicable disease. Recently, the roles of the skin and gut microbiomes have received greater attention as potentially targetable drivers of AD. Here too, however, dysbiosis on a population scale would require induction by an environmental factor. In this review, we describe the evidence supporting the environmental hypothesis of AD etiology and detail the molecular mechanisms of each of the AD-relevant toxins. We also outline how a pollution-focused paradigm demands earnest engagement with environmental injustice if the field is to meaningfully address racial and geographic disparities. Identifying specific toxins and their mechanisms can also inform in-home and national mitigation strategies.

Association between phthalate exposure and risk of allergic rhinitis in children: A systematic review and meta-analysis

Phthalates are ubiquitous in diverse environments and have been linked to a myriad of detrimental health outcomes. However, the association between phthalate exposure and allergic rhinitis (AR) remains unclear. To address this knowledge gap, we conducted a systematic review and meta-analysis to comprehensively evaluate the relationship between phthalate exposure and childhood AR risk. We searched the Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica Database, and PubMed to collect relevant studies and estimated pooled odds ratios (OR) and 95% confidence intervals (CI) for risk estimation. Ultimately, 18 articles, including seven cross-sectional, seven case-control, and four prospective cohort studies, were selected for our systematic review and meta-analysis. Our pooled data revealed a significant association between di-2-ethylhexyl phthalate (DEHP) exposure in children's urine and AR risk (OR = 1.188; 95% CI = 1.016-1.389). Additionally, prenatal exposure to combined phthalates and their metabolites in maternal urine was significantly associated with the risk of childhood AR (OR = 1.041; 95% CI = 1.003-1.081), although specific types of phthalates and their metabolites were not significant. Furthermore, we examined environmental phthalate exposure in household dust and found no significant association with AR risk (OR = 1.021; 95% CI = 0.980-1.065). Our findings underscore the potential hazardous effects of phthalates on childhood AR and offer valuable insights into its pathogenesis and prevention.

Influencing factors and risk assessment of phthalate ester pollution in the agricultural soil on a tropical island

Phthalate esters (PAEs) are widely prevalent in agricultural soil and pose potential risks to crop growth and food safety. However, the current understanding of factors influencing the behavior and fate of PAEs is limited. This study conducted a large-scale investigation (106 sites in 18 counties with 44 crop types) of 16 types of PAEs on a tropical island. Special attention was given to the impacts of land use type, soil environmental conditions, agricultural activity intensity, and urbanization level. The health risks to adults and children from soil PAEs via multiple routes of exposure were also evaluated. The results showed that the mean concentration of PAEs was 451.87 ± 284.08 μg kg-1 in the agricultural soil. Elevated agricultural and urbanization activities contributed to more pronounced contamination by PAEs in the northern and southern regions. Land use type strongly affected the concentration and composition of PAEs in agricultural soils, and the soil PAE concentration decreased in the order of vegetable fields, orchards, paddy fields, and woodlands. In paddy fields, di-isobutyl phthalate and di-n-butyl phthalate made more substantial contributions to the process through which the overlying water inhibited volatilization. Soil microplastic abundance, pesticide usage, crop yield, gross domestic product, and distance to the nearest city were calculated to be the major factors influencing the concentration and distribution of PAEs. Soil pH, organic matter content, microplastic abundance and the fertilizer application rate can affect the adsorption of PAEs by changing the soil environment. A greater risk was detected in the northern region and paddy fields due to the higher soil PAE concentrations and the dietary structure of the population. This study reveals important pathways influencing the sources and fate of PAE pollution in agricultural soils, providing fundamental data for controlling PAE contamination.