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Published online before print February 6, 2008
Eur Respir J 2008, doi:10.1183/09031936.00090607
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ORIGINAL ARTICLE

Exposure-response analysis of allergy and respiratory symptoms in endotoxin exposed adults

L.A.M. Smit 1*, D. Heederik 1, G. Doekes 1, C. Blom 1, I. van Zweden 1, I.M. Wouters 1

1 Institute for Risk Assessment Sciences, Division Environmental Epidemiology, Utrecht University, The Netherlands

* To whom correspondence should be addressed. E-mail: L.Smit{at}uu.nl.


  Abstract

The objective of this study was to investigate exposure-response relations between current endotoxin exposure and allergic and respiratory symptoms in adults, taking farming exposures during childhood into account.

A cross-sectional study was conducted among 877 Dutch farmers and agricultural industry workers in 2006. Based on 249 full-shift personal airborne endotoxin samples, a job-exposure matrix was constructed to assign endotoxin exposure levels to all participants. Associations between endotoxin exposure and questionnaire data on symptoms were studied by multiple logistic regression.

Adjusted odds ratios (OR) for an interquartile range increase of endotoxin level were elevated for respiratory symptoms such as wheezing (OR 1.41, 95% confidence interval (CI) 1.16–1.72), wheezing with shortness of breath (OR 1.50, 95% CI 1.18–1.90) and daily cough (OR 1.29, 95% CI 1.03–1.62). In contrast, endotoxin was strongly associated with a decreased prevalence of hay fever (OR 0.62, 95% CI 0.49–0.78). Workers who had grown up on a farm had a lower prevalence of hay fever, but no evidence of effect modification by farm childhood was found.

In conclusion, occupational endotoxin exposure in adulthood is associated with an increased risk of asthma-like symptoms, but a reduced prevalence of hay fever.

Keywords:  Allergy, endotoxin exposure, epidemiology, farming, occupational exposure, respiratory symptoms




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