Environmental agents as cause of health disorders in children presented at an outpatient unit of environmental medicine.

There are no publications on the frequency of environmental agents causing diseases in children presented at centers of environmental medicine. The aim of this study was to perform a statistical analysis of the data of children who visited the outpatient Unit of Environmental Medicine (UEM) at the University Hospital of Aachen, Germany. Data of all UEM patient files from January 1988 to September 1996 were evaluated. From a total of 682 patients, 75 were children (40 girls, 35 boys, age range 1-12 years). Forty-six children were presented with unspecific health disorders, 12 to examine a possible relationship between environmental agents and a current condition, mostly atopy (n = 10). Complaints were mucosal irritations (n = 38), unspecific (n = 19), dermatological (n = 16), gastrointestinal (n = 4), heart/circulation-related (n = 2), musculoskeletal (n = 1) and neurological (n = 1) symptoms. Wood preservatives were mentioned as suspected environmental causative agents in 22 cases, followed by unspecific indoor factors (n = 15), factories/disposal sites near homes (n = 9), formaldehyde (n = 5) and unspecific exposures (n = 5). Biomonitoring was done in 44 cases, local inspections and ambient monitoring in 10 cases. No evidence for a cause-and-effect relationship was found in 55 children, but was deemed possible in nine cases. In nine other children, a relatively high degree of exposure was determined by chemical analysis, but clinical relevance remained unclear. One child suffered from subclinical mercury poisoning caused by inadequate homeopathic medication. In most children referred to an environmental medicine center, it is difficult or impossible to verify an environmental cause using the diagnostic instruments currently available.

Predictive value of human biomonitoring in environmental medicine: experiences at the outpatient unit of environmental medicine (UEM) of the University Hospital Aachen, Germany.

There is little data on the distribution of biomonitoring parameters in patients at outpatient Units of Environmental Medicine (UEM). We evaluated the biomonitoring parameters of 646 UEM outpatients from our University Hospital 1988-1998. Few patients were exposed to specific substances. Data of patients who were not obviously exposed was analysed statistically (geometric mean, standard deviation, median, 95th percentile). Results were compared with reference values in literature. Normal distribution of biomonitoring parameters was rare. 95th percentiles for arsenic, chromium, selenium, zinc, phenol and toluene were below standard, 95th percentiles for copper and mercury above, and 95th percentiles for lead, cadmium, pentachlorophenol, lindane, and beta-hexachlorocyclohexane were within the published range of reference values. Thallium as well as most volatile organic compounds analyzed were below detection levels. Aluminum and fluorine exposure was rarely analysed. In view of these results, it is concluded that the indication for biomonitoring needs to be stringent as levels of biomonitoring parameters are generally not risen in patients of the UEM.