EDUCATION

THE TWO SIDES OF THE "ENDOTOXIN COIN"

K Radon

Correspondence to:
Correspondence to:
Dr K Radon
Unit for Occupational and Environmental Epidemiology & Net Teaching, Institute and Outpatient Clinic for Occupational and Environmental Medicine, Ziemssenstr. 1, 80336 Munich, Germany; katja.radon@med.uni-muenchen.de

Keywords: asthma; atopy; chronic bronchitis; farmer; hygiene hypothesis

The first 150 words of the full text of this article appear below.

Endotoxins, part of the outer membrane of Gram negative bacteria, are a potent inducer of neutrophilic airway inflammation. A large number of studies in occupational epidemiology has shown that exposure to endotoxins increases the likelihood of organic dust toxic syndrome, chronic bronchitis, and asthma-like syndrome. In contrast, it has been shown that exposure to endotoxins in the occupational and environmental setting protects from respiratory allergies and sensitisation to allergens.

With respect to asthma, the evidence is conflicting at first glance. While some studies indicated an increased risk of asthma after endotoxin exposure, others have shown that endotoxin exposure protects from asthma. However, these differences can be explained when different asthma phenotypes are taken into account. The risk of atopic asthma, mainly dominated by eosinophilic response, is decreased in those exposed to endotoxins. In contrast, the risk of non-atopic asthma, characterised by neutrophilic response, is enhanced in subjects with higher endotoxin . . . [Full text of this article]

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