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House dust endotoxin and wheeze in the first year of life
J H Park1, D R Gold, D L Spiegelman
1Department of Environmental Health, Harvard School of Public Health, and Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
Insights
Infant endotoxin exposure in the family room dust was linked to increased wheezing risk. This finding suggests home endotoxin may independently raise the risk of wheeze in children with a family history of asthma or allergies.
Area of Science:
- Environmental Health
- Pediatric Allergy
- Epidemiology
Background:
- Infants with a parental history of asthma or allergy are at higher risk for respiratory issues.
- Early life environmental exposures are critical in the development of allergic diseases.
- Wheezing in infancy is a common concern with potential long-term implications.
Purpose of the Study:
- To investigate the association between home endotoxin exposure and wheezing episodes in infants.
- To determine if endotoxin exposure independently increases wheezing risk in a high-risk infant cohort.
- To identify specific home environments where endotoxin exposure is most relevant to infant wheeze.
Main Methods:
- A birth cohort of 499 infants with a family history of asthma/allergy was studied.
- Endotoxin levels were measured in settled dust from various home locations within 3 months of birth.
- Wheezing episodes (any wheeze, repeated wheeze) were primary outcomes assessed during the first year of life.
Main Results:
- Elevated endotoxin (> or = 100 EU/mg) in family room dust showed a significant univariate association with increased risk of any wheeze (RR = 1.29).
- In multivariate models, controlling for confounders, elevated family room endotoxin remained associated with marginally significant risk of any wheeze (RR = 1.33).
- Elevated family room endotoxin was significantly associated with increased risk of repeated wheeze (RR = 1.56) in multivariate analyses.
Conclusions:
- Home endotoxin exposure, particularly in the family room, may independently increase the risk of wheezing in infants.
- Findings suggest a potential role for endotoxin in the development of wheezing in genetically predisposed children.
- Reducing endotoxin levels in the home environment could be a strategy to mitigate wheezing risk in high-risk infants.
Abstract:
We examined endotoxin exposure and wheezing episodes during the first year of life in a birth cohort of 499 infants with one or both parents having a history of asthma or allergy. We measured endotoxin in settled dust from the baby's bed, bedroom floor, family room, and kitchen floor within the first 3 mo after birth. The primary outcomes were any wheeze (versus no wheeze), and repeated wheeze (versus one or no report of wheeze). We found a significant univariate association of elevated endotoxin (> or = 100 EU/ mg) in family room dust with increased risk of any wheeze (Relative Risk = 1.29, 95% CI = 1.03-1.62). The association was not confounded by cockroach allergen, lower respiratory illness (croup, bronchitis, bronchiolitis, and pneumonia), smoking during pregnancy, lower birth weight, maternal asthma, presence of dog, and race/ethnicity in a multivariate model; the multivariate relative risk (RR = 1.33) was marginally significant (95% CI: 1.00-1.76, p < 0.05). In a multivariate model, controlling for the above covariates, elevated endotoxin in family room dust was significantly associated with increased risk (RR = 1.56, 95% CI = 1.03-2.38) of repeated wheeze. These results suggest that home endotoxin exposure may independently increase risk of any wheeze and repeated wheeze during the first year of life for children with a familial predisposition to asthma or allergy.