Prevalence of nickel sensitization and urinary nickel content of children are increased by nickel in ambient air.

In a cross-sectional study performed in 2000, an unexpected positive association between nickel (Ni) in ambient air, urinary Ni content and the prevalence of Ni sensitization in a subgroup of 6-yr-old children living near a steel mill was observed. Between 2005 and 2006, in a different and larger study population, we examined if Ni from ambient air or urinary Ni concentration was related to Ni sensitization in children living next to Ni-emitting steel mills. We studied 749 school beginners living in four Ni-polluted industrial areas of North Rhine-Westphalia, Germany. We assessed Ni in ambient air, Ni in urine from children and mothers, and Ni in tap water, conducted patch tests in children (including the NiSO(4)-dilution test) and collected questionnaire data. Statistics were done by linear and logistic regression analyses, adjusted for covariates. At increased Ni concentration in ambient air (unit of increase: 10 ng/m(3)), urinary Ni concentrations rose in both mothers (9.1%; 95% CI: 6.8-11.4%) and children (2.4%; 95% CI: 0.4-4.4%). The prevalence of Ni sensitization in children was associated with increased Ni from ambient air (unit of increase: 18 ng/m(3); odds ratio 1.28; 95% CI: 1.25-1.32) and urinary Ni concentration (unit of increase: 7.1 µg/L; odds ratio 2.4; 95% CI: 1.20-4.48). Ni in ambient air of areas with Ni-emitting factories contributes to internal Ni exposure in residents via inhalation and, furthermore, is a risk factor for the development of Ni sensitization in children.

Does airborne nickel exposure induce nickel sensitization?

BACKGROUND AND OBJECTIVE: Nickel is one of the most prevalent causes of contact allergy in the general population. This study focuses on human exposure to airborne nickel and its potential to induce allergic sensitization. MATERIALS AND METHODS: The study group consisted of 309 children at school-starter age living in the West of Germany in the vicinity of two industrial sources and in a rural town without nearby point sources of nickel. An exposure assessment of nickel in ambient air was available for children in the Ruhr district using routinely monitored ambient air quality data and dispersion modelling. Internal nickel exposure was assessed by nickel concentrations in morning urine samples of the children. RESULTS: The observed nickel sensitization prevalence rates varied between 12.6% and 30.7%. Statistically significant associations were showed between exposure to nickel in ambient air and urinary nickel concentration as well as between urinary nickel concentration and nickel sensitization. Furthermore, an elevated prevalence of nickel sensitization was associated with exposure to increased nickel concentrations in ambient air. CONCLUSION: The observed associations support the assumption that inhaled nickel in ambient air might be a risk factor for nickel sensitization; further studies in larger collectives are necessary.

The Duisburg birth cohort study: influence of the prenatal exposure to PCDD/Fs and dioxin-like PCBs on thyroid hormone status in newborns and neurodevelopment of infants until the age of 24 months.

Prenatal exposure to polychlorinated biphenyls (PCBs) and polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) can affect neurobehavioral development of infants and children. This effect may be mediated through disruption of thyroid hormone homeostasis. However, epidemiological studies reveal no consistent influence of PCDD/Fs and PCBs on thyroid status and neurodevelopment at environmental background levels. The effects may resolve with time of further decreasing exposure to these compounds. The aim of this study was to find out if there are still effects related to prenatal PCDD/F and PCB observable at the meanwhile decreased levels of exposure by using the same methods which have been applied in similar studies during the last 10 years in Europe. The birth cohort study was initiated in the year 2000 in the industrialized city of Duisburg, Germany. 232 healthy mother-infant pairs were recruited between 2000 and 2002. Dioxins, dioxin-like PCBs and six indicator PCBs were analyzed in maternal blood during pregnancy and in maternal milk following extraction and sample clean-up by HRGC/HRMS. Thyroid stimulating hormone (TSH), total thyroxine (T4), total triiodothyronine (T3), free thyroxine (FT4) and free triiodothyronine (FT3) were measured in serum samples of the pregnant women and in cord serum samples by chemiluminescent immunometric assay. Neurological examinations were performed at ages 2 weeks and 18 months using the neurological optimality score (NOS), mental and motor development were assessed using the Bayley Scales of Infant Development (BSID) at ages 12 and 24 months. Multiple linear regression analysis was used to describe the association of PCDD/F and PCB in maternal blood or milk with the outcome measurements after adjustment for confounding. Blood levels (n=182) of WHO 2005 toxic equivalents (TEQ) (PCDD/F+PCB) were in the range of 3.8-58.4 pg/glipid base (median: 19.3 pg/glipid base). The corresponding data for human milk (n=149) were 2.6-52.4 pg/glipid base (median: 19.7 pg/glipid base). Multiple regression analysis showed no decrease of thyroid hormones related to WHO 2005 TEQ in blood and milk of mothers and their newborns. Furthermore, no associations between exposure and neurological and developmental measures were observed. This study supports the view that the current decreased exposure to PCDD/Fs and PCBs does not impair thyroid function of newborns and neurodevelopment of infants until the age of 24 months.

Polychlorinated dibenzo-p-dioxins/polychlorinated dibenzofurans (PCDD/Fs), polychlorinated biphenyls (PCBs), and organochlorine pesticides in human blood of pregnant women from Germany.

Blood samples from 226 pregnant women aged between 19 and 41 yr, living in an industrialized area of Germany (Duisburg birth cohort study), were collected between September 2000 and November 2002 and analyzed for their content of persistent organic pollutants (POPs). Levels of polychlorinated dibenzo-p-dioxins (PCDDs), polychlorinated dibenzofurans (PCDFs), and polychlorinated biphenyls (PCBs) were in the range of 4.34-97.3 pg WHO 1998 TEq/g(lipid base) (median: 25.96) or 3.77-63.56 pg WHO 2005 TEq/g(lipid base) (median: 19.38), respectively. Whole blood volume-based concentrations of organochlorine pesticides and their metabolites were 0.036-0.53 microg/L (median: 0.15) hexachlorobenzene (HCB), 4.5-1300 ng/L (median: 67) beta-hexachlorocyclohexane (HCH), 0.6-520 ng/L (median: 18) 4,4'-dichlorodiphenyltrichloroethane (DDT), and 0.1-9.1 microg/L (median: 0.54) 4,4'-dichlorodiphenyldichloroethene (DDE). Parameters influencing the POP levels in human blood were examined using multiple regression models. Levels and the levels scatter widths of most PCDD/F and PCB congeners and HCB increased significantly with age. Within the multiple regression model a weak age dependence was also found for beta-HCH and DDT, whereas blood levels of alpha- and gamma- HCH and DDE were not age dependent. The total lactation period for earlier born children decreased most POP blood levels, except for alpha- and gamma-HCH. Over the study period of 27 mo only a low decreasing effect on human POP blood levels was observed. The body mass index had in general no or a low positive influence on contaminant levels. Because exposure to PCDD/F and PCB is higher in most industrialized countries in comparison to less industrialized ones, lower levels of these substances were detected in blood samples of women who had lived outside Western Europe for a longer period. In contrast, these women showed higher blood levels of organochlorine pesticides, indicating that these chemicals are still in use outside Western Europe.

Lack of neurodevelopmental adversity by prenatal exposure of infants to current lowered PCB levels: comparison of two German birth cohort studies.

Polychlorinated biphenyls (PCBs), persistent environmental contaminants, may affect neurodevelopment of infants following prenatal exposure. A negative impact of prenatal PCB exposure on neurodevelopment was found in the Dusseldorf (Germany) cohort study (1993-2000). PCB levels of the sum of the three indicator congeners in breast milk were negatively associated with mental/motor development as assessed by the Bayley Scales of Infant Development (BSID) in infants. Since general exposure to PCB has decreased, a new birth cohort study was initiated in 2000 in the industrial city of Duisburg, which is located 30 km downstream from Dusseldorf on the River Rhine. A subgroup of the Duisburg birth cohort study was used to compare PCB exposure and developmental effects with results from the Dusseldorf cohort. The recruitment phase of the Duisburg cohort study occurred from 2000 to 2002. Mental and motor development was assessed by means of the BSID at the ages of 12 and 24 mo. Prenatal PCB exposure of newborns from Duisburg cohort was about two- to threefold lower than the Dusseldorf cohort. Although in the Dusseldorf birth cohort mental and motor development at ages 18 and 30 mo were negatively associated with PCB exposure, there was no association observed in the Duisburg study. Evidence indicates that exposure to PCB at current exposure levels no longer apparently impair neurodevelopment of infants.

Human biomonitoring studies in North Rhine-Westphalia, Germany.

The areas along the rivers Rhine, Ruhr and Wupper in North Rhine-Westphalia (NRW), Germany, represent the largest urban and industrial agglomeration in Europe with about 10 million inhabitants. Human biomonitoring (HBM) studies have been conducted in these areas since more than 30 years, mainly designed to evaluate internal exposure to air pollutants. Recent studies were focussed on residents living near industrial sources. The contaminants studied comprise heavy metals, metabolites of polycyclic aromatic hydrocarbons (PAH), persistent organic pollutants (POPs), volatile organic compounds (VOC), and markers of DNA exposure. Study groups were mainly children and elderly subjects. Human milk, blood, urine, teeth, hair and nails were investigated. Time trend analyses demonstrate a significant decline of exposure to many contaminants such as POPs and heavy metals. More recent studies suggest that there still is an increased internal exposure to metals, PAH and DNA damaging agents in children and women living very close to industrial sources.

Influence of industrial sources on children's health--hot spot studies in North Rhine Westphalia, Germany.

The aim of this study was to evaluate exposure and health outcome of children living close to industrial sources. Exposure and health outcome was assessed in nearly 1000 children at school beginner age living in the vicinity of industrial sources of three different hot spots (Duisburg North, Duisburg South and Dortmund Hörde) and in a rural area of North Rhine Westphalia (NRW), Germany. The cross-sectional study was undertaken between March and May 2000. Exposure assessment comprised modelling of ambient air quality data and human biomonitoring (HBM). Depending on the site-specific contaminants, HBM included the measurement of PAH (polycyclic aromatic hydrocarbons) and benzene metabolites in urine as well as heavy metals in blood and urine. Markers of early effects were DNA strand breaks as measured by the comet assay in lymphocytes and excretion of alpha-1-microglobuline and N-acetyl-beta-D-glucosamidase in urine. Health outcome was assessed by questionnaire, lung function test, dermatological examination as well as by RAST (radioallergosorbent test), patch tests and prick tests. The influence of exposure variables on biomarkers and health outcome was measured by means of multiple linear and logistic regression analysis. The most striking results were as follows. Children living close to a coke oven plant (Duisburg North) had increased levels of PAH metabolites in urine, and DNA exposure was increased. Children living at the Dortmund Hörde hot spot (increased chromium and nickel ambient air levels from a steel mill) revealed a high prevalence of allergic sensitizations. Sensitization, especially against nickel, was associated with the current internal nickel exposure, and nickel in ambient air was positively associated with the frequency of allergic symptoms. Children from the hot spot areas had increased specific airway resistance and total lung capacity as compared to those of the reference area. In Duisburg North particularly, specific airway resistance and total lung capacity significantly increased with increasing TSP (total suspended particulate). The only positive associations between external and internal exposure were found between benzo[a]pyrene in ambient air and 1-hydroxypyrene in urine, and between lead in ambient air and in the blood of the children. It is concluded that despite improvements of the general air quality during the last decades, living in the vicinity of industrial sources results to some extent in increased internal contaminant exposure and in effects on health outcome. Still ongoing studies are aimed to find out whether the increased PAH and DNA exposure of children from Duisburg North had decreased after the coke oven plant had been shut down in 2003, and if the striking results on the high prevalence of allergic sensitization can be confirmed by introducing an expanded cross-sectional study at four hot spots with increased chromium and nickel ambient air levels.

PCDD/F and dioxin-like PCB in human blood and milk from German mothers.

Blood samples of pregnant women aged between 19 and 42 years at the time they gave birth and milk samples from the same women following delivery were collected between September 2000 and January 2003 from 169 participants living in an industrialized area of Germany (Duisburg birth cohort study). All samples were analyzed for their content of polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/F) as well as dioxin-like and indicator polychlorinated biphenyls (PCB). Levels of WHO-TEq were in the range of 4.34-97.3 pg/g(lipid base) (median: 26.37, arithmetic mean: 28.36) for blood, or 3.01-78.7 pg/g(lipid base) (median: 26.40, arithmetic mean: 27.27) for milk, respectively. The four congeners 12378-PeCDD, 23478-PeCDF, 33'44'5-PeCB (# 126) and 233'44'5-HxCB (# 156) contribute the main share to total WHO-TEq. The contribution of PCDD/F in relation to PCB to total WHO-TEq was 60:40% in blood and 52:48% in milk. Good correlations of the contaminant levels in lipid base between both matrices were found. The distribution between blood and milk depends on the molecular weight of the substances. Higher chlorinated PCDD/F- and PCB-congeners were found in 2-4-fold higher concentrations in blood in relation to milk and the concentrations of lower chlorinated PCB-congeners were up to 2-fold higher in milk in relation to blood. The body burden of PCDD/F and PCB increases with age and decreases over the total nursing period. Women who had lived outside highly industrialized countries showed lower concentrations of PCDD/F and PCB. In some cases, elevated levels of PCB were observed when the women had previously lived in Eastern Europe for a long time. In comparison with recent data, the decline in human PCDD/F and PCB levels observed during the nineties seems to have stopped. The individual exposures of the infants due to breastfeeding within the first 18 months were calculated to be from 4.4 to 318 ng WHO-TEq (median: 106, arithmetic mean: 118). The actual mean daily exposure of a breastfed infant can be estimated to 131 pg WHO-TEq/kg(body weight).

Human biomonitoring of cadmium and lead exposure of child-mother pairs from Germany living in the vicinity of industrial sources (hot spot study NRW).

Cadmium (Cd) and lead (Pb) exposure of children and their mothers living in the vicinity of industrial sources (metal refining) was assessed by a cross-sectional study performed in 2000. Study areas were the highly industrialized city of Duisburg and a rural area of North Rhine Westphalia, Germany. Exposure to ambient air concentrations of Cd and Pb was calculated from a Lagrange dispersion model using data sets from ambient air quality measurements. Cd in blood and urine and Pb in blood were measured by AAS. Mean age (years) was 6.4 (range 5.5-7.7) for children (n = 238) and 36 (range 23-48) for mothers (n = 213). A total of 49% of the children were males. Factors suspected to influence metal levels in blood or urine were obtained by questionnaire. Individual ambient Cd and Pb levels according to the home address ranged from 0.5 ng/m3 (Cd) and 0.03 microg/m3 (Pb) (rural area) up to 31.2 ng/m3 (Cd) and 0.73 microg/m3 (Pb) (industrialized area). Cd levels (geometric mean) in blood (0.13 and 0.10 microg/L) and urine (both areas 0.09 microg/L) of children did not differ between the two areas. Cd levels in blood and urine of mothers from the industrialized area were higher (blood 0.39 microg/L, urine 0.28 microg/L) than in those from the rural area (blood 0.25 microg/L, urine 0.25 microg/L). Pb levels in the blood of children from the industrialized area were higher (31 microg/L) than in those from the rural area (21 microg/L). Pb levels in the blood of mothers did not differ between the two areas (both 24 microg/L). Pb levels in blood showed a significant association between child and mother (n = 192; r = 0.26, p < 0.001). This did not apply for Cd in blood or urine. Regression analysis clearly revealed that Pb levels in ambient air were associated with Pb in the blood of children. Minor associations were also found between Cd in air and Cd in the blood of mothers and between Cd in air and urine of mothers.

Ambient exposure and nasal inflammation in adults and children--a preliminary analysis.

The epidemiological evidence that ambient exposure, including particulate matter (PM) is related to adverse health outcomes continues to mount. Inflammation and disease of the upper respiratory tract are commonly suggested as effects of ambient exposure. Therefore we studied both ambient exposure and nasal effects in a 4-months cross-sectional survey in Nordrhein-Westfalen (Germany). At 4 locations in 3 different cities ambient exposure to TSP (total suspended particles), O3, NOx and SO2 was derived from compliance measurements by governmental offices, and 884 subjects (501 mothers and 383 children, 6-7 years old) were screened using nasal lavage, with success rates of 90 and 75%, respectively. No differences in total cell counts or percentage of neutrophils were found between mothers or children from the 4 different locations, despite small but significant differences in ambient exposure to TSP, SO2, O3, and NOx during this period. A higher epithelial cell count in mothers and children from one city might be related to general higher ambient pollution in that location. Interestingly, total cells and interleukin-8 levels in children were higher than in mothers and possibly reflect their increased susceptibility to effects of air pollution. Future analysis will concentrate on temporal relations between inflammation and exposure, including individual risk factors such as allergy, smoking and the presence of disease.

Childhood social position and associations between environmental exposures and health outcomes.

BACKGROUND: Growing evidence indicates that environmental exposures are more prevalent among socially disadvantaged groups. We investigated the distribution of environmental exposures and health outcomes in preschool children, and examined the role of social position on their associations. METHODS: We analysed data from a cross-sectional study on 968 preschool children from three districts in the Ruhr Area and one rural community in North Rhine-Westphalia in 2000. Parents filled in a questionnaire on socio-demographic characteristics, environmental exposures, respiratory infections and allergic diseases. Residential annual total suspended particulate matter (TSP) mass concentrations were derived from a small-scale interpolation model. Lung function, allergic sensitisation and immunologic function were assessed. We analysed the associations between environmental exposures and health outcomes in social subgroups with logistic regression. RESULTS: High TSP concentrations at the home address and unfavourable living conditions were more prevalent in the socially disadvantaged groups, while allergic and respiratory infectious diseases were reported more frequently in the privileged groups. The odds ratio for the association between TSP and history of allergic diseases was 1.17 (95% CI 0.95-1.45) in children without immigration background and 0.71 (95% CI 0.53-0.95) with immigration background. Heterogeneity for exposure-outcome associations was also seen between TSP and lung function as well as unfavourable living conditions and allergic diseases. CONCLUSIONS: We found evidence for an influence of social position on environment-health associations. Possible explanations for heterogeneity include social group-specific over- and underreporting and effect measure modification, which need to be taken into account when designing and analysing environmental health studies.