Domestic use of hypochlorite bleach, atopic sensitization, and respiratory symptoms in adults

doi:10.1016/j.jaci.2009.06.007

Journal of Allergy and Clinical Immunology

Volume 124, Issue 4, October 2009, Pages 731-738.e1

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https://doi.org/10.1016/j.jaci.2009.06.007 Get rights and content

Background

Professional use of hypochlorite (bleach) has been associated with respiratory symptoms. Bleach is capable of inactivating allergens, and there are indications that its domestic use may reduce the risk of allergies in children.

Objective

To study the associations between household use of bleach and atopic sensitization, allergic diseases, and respiratory health status in adults.

Methods

We identified 3626 participants of the European Community Respiratory Health Survey II in 10 countries who did the cleaning in their homes and for whom data on specific serum IgE to 4 environmental allergens were available. Frequency of bleach use and information on respiratory symptoms were obtained in face-to-face interviews. House dust mite and cat allergens in mattress dust were measured in a subsample. Associations between the frequency of bleach use and health outcomes were evaluated by using multivariable mixed logistic regression analyses.

Results

The use of bleach was associated with less atopic sensitization (odds ratio [OR], 0.75; 95% CI, 0.63-0.89). This association was apparent for specific IgE to both indoor (cat) and outdoor (grass) allergens, and was consistent in various subgroups, including those without any history of respiratory problems (OR, 0.85). Dose-response relationships (P < .05) were apparent for the frequency of bleach use and sensitization rates. Lower respiratory tract symptoms, but not allergic symptoms, were more prevalent among those using bleach 4 or more days per week (OR, 1.24-1.49). The use of bleach was not associated with indoor allergen concentrations.

Conclusion

People who clean their homes with hypochlorite bleach are less likely to be atopic but more likely to have respiratory symptoms.

Section snippets

Study design and participants

The ECRHS is a multicenter study designed to identify risk factors for asthma and allergy. Participants age between 20 and 44 years were recruited from 1992 to 1994 by random sampling from a community-based sampling frame in each center. A random sample of responders to a short postal questionnaire was invited for clinical testing. In 2001 and 2002, participants who had taken part in these clinical investigations were invited for further study (ECRHS II).¹⁸ Twenty-two centers from 10 European

Results

About two thirds of the study population were women (Table I). Twenty-eight percent had any atopic sensitization, predominantly against grass and house dust mite. Allergic conditions (rhinitis, eczema, and to a lesser extent, asthma) and associated symptoms were common.

Sixty-three percent of the study population reported ever using bleach in their homes; approximately 1 in 4 (28%) used bleach on a weekly basis, and 1 in 10 did so at least every second day, if not daily (Table II). The use of

Discussion

In this large observational study among adults from 10 European countries, we found that the use of hypochlorite bleach in the home was associated with lower rates of sensitization to common environmental allergens. This inverse association was present for specific IgE to both indoor and outdoor allergens, and was consistent in various subgroups including those without clinically apparent respiratory disease, and the effect was stronger when bleach was used more frequently. Allergic symptoms

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Citation Excerpt :
Other blocks also appeared to be relevant (e.g., “chemical products”, “humid cleaning”). Furthermore, it is interesting to note that bleach, the use of which may vary across social groups [39] regardless of other general cleaning habits, resulted in a single-variable block, indicating that this variable was not correlated with the other ones, conditionally on class. The seven resulting classes also appeared relevant as they could be distinguished by the intensity of general cleaning tasks and the intensity of use of specific products, and for some classes distinction according to the type of products used (e.g., specific chemicals vs. sprays).
Clustering methods may be useful in epidemiology to better characterize exposures and account for their multidimensional aspects. In this context, application of clustering models allowing for highly dependent variables is of particular interest. We aimed to characterize patterns of domestic exposure to cleaning products using a novel clustering model allowing for highly dependent variables.
To identify domestic cleaning patterns in a large population of French women, we used a mixture model of dependency blocks. This novel approach specifically models within-class dependencies, and is an alternative to the latent class model, which assumes conditional independence. Analyses were conducted in 19,398 participants of the E3N study (women aged 61–88 years) who completed a questionnaire regarding household cleaning habits.
Seven classes were identified, which differed with the frequency of cleaning tasks (e.g., dusting/sweeping/hoovering) and use of specific products (e.g., bleach, sprays). The model also grouped the variables into conditionally independent blocks, providing a summary of the main dependencies among the variables.
The mixture model of dependency blocks, a useful alternative to the latent class model, may have broader application in epidemiology, in particular, in the context of exposome research and growing need for data-reduction methods.

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: The coordination of the European Community Respiratory Health Survey II was supported by the European Commission as part of their Quality of Life program. This work was also funded by the US National Institutes of Health (grant 1R01HL062633) and the Carlos III Health Institute of the Spanish Ministry of Health and Consumption (Fondo de Investigaciones Santarias [FIS] grant 01/3058). The following bodies funded the local studies in the European Community Respiratory Health Survey II included in this article: Albacete, FIS (grants 97/0035-01, 99/0034-01, and 99/0034-02), Hospital Universitario de Albacete, Consejeria de Sanidad; Antwerp, Fund for Scientific Research, Flanders, Belgium (grant G.0402.00), University of Antwerp, Flemish Health Ministry; Barcelona, SEPAR, Public Health Service (grant R01 HL62633-01), FIS (grants 97/0035-01, 99/0034-01, and 99/0034-02), CIRIT (grant 1999SGR 00241), Red Respira ISCII; Basel, Swiss National Science Foundation, Swiss Federal Office for Education and Science, Swiss National Accident Insurance Fund, USC NIEHS Center (grant 5P30 ES07048); Bergen, Norwegian Research Council, Norwegian Asthma and Allergy Association, Glaxo Wellcome AS, Norway Research Fund; Erfurt, GSF-National Research Centre for Environment and Health, Deutsche Forschungsgemeinschaft (grant FR 1526/1-1); Galdakao, Basque Health Department; Göteborg, Swedish Heart Lung Foundation, Swedish Foundation for Health Care Sciences and Allergy Research, Swedish Asthma and Allergy Foundation, Swedish Cancer and Allergy Foundation; Grenoble, Programme Hospitalier de Recherche Clinique-DRC de Grenoble 2000 no. 2610, Ministry of Health, Direction de la Recherche Clinique, Ministere de l'Emploi et de la Solidarite, Direction Generale de la Sante, CHU de Grenoble, Comite des Maladies Respiratoires de l'Isere; Hamburg, GSF-National Research Centre for Environment and Health, Deutsche Forschungsgemeinschaft (grant MA 711/4-1); Ipswich and Norwich, Asthma UK (formerly known as the National Asthma Campaign); Huelva, FIS (grants 97/0035-01, 99/0034-01, and 99/0034-02); Oviedo, FIS (grants 97/0035-01, 99/0034-01, and 99/0034-02);Paris, Ministere de l'Emploi et de la Solidarite, Direction Generale de la Sante, UCB-Pharma (France), Aventis (France), Glaxo France, Programme Hospitalier de Recherche Clinique-DRC de Grenoble 2000 no. 2610, Ministry of Health, Direction de la Recherche Clinique, CHU de Grenoble; Pavia, GlaxoSmithKline Italy, Italian Ministry of University and Scientific and Technological Research, Local University Funding for research 1998 and 1999; Tartu, Estonian Science Foundation; Turin, ASL 4 Regione Piemonte, AO CTO/ICORMA Regione Piemonte, Italian Ministry of University and Scientific and Technological Research; GlaxoSmithKline Italy; Umeå, Swedish Heart Lung Foundation, Swedish Foundation for Health Care Sciences and Allergy Research, Swedish Asthma and Allergy Foundation, Swedish Cancer and Allergy Foundation; Uppsala, Swedish Heart Lung Foundation, Swedish Foundation for Health Care Sciences and Allergy Research, Swedish Asthma and Allergy Foundation, Swedish Cancer and Allergy Foundation; Verona, University of Verona; Italian Ministry of University and Scientific and Technological Research; GlaxoSmithKline Italy.

: Disclosure of potential conflict of interest: G. Benke has received research support from the National Health and Medical Research Council of Australia. P. D. Blanc has received research support from the National Institutes of Health, UC Tobacco Related Diseases, and FAMRI and has served as an expert witness on hepatotoxicity and inhalation injury. J. Sunyer has received research support from the European Union, Ministry of Health, Spain, and the Ministry of Health, Catalonia. The rest of the authors have declared that they have no conflict of interest.

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Rhinitis, sinusitis, and upper airway diseaseDomestic use of hypochlorite bleach, atopic sensitization, and respiratory symptoms in adults

Background

Objective

Methods

Results

Conclusion

Section snippets

Study design and participants

Results

Discussion

Food Chem Toxicol

Chest

Chest

Clin Chest Med

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

Immunobiology

Mass casualties from acute inhalation of chloramine gas

Mil Med

Home exposures to chlorine/chloramine gas: review of 216 cases

South Med J

Severe lung injury after exposure to chloramine gas from household cleaners

N Engl J Med

Reactive airways dysfunction syndrome in housewives due to a bleach-hydrochloric acid mixture

Inhal Toxicol

Severe asthma and ARDS triggered by acute short-term exposure to commonly used cleaning detergents

Eur Respir J

Rhinitis, sinusitis, and upper airway disease
Domestic use of hypochlorite bleach, atopic sensitization, and respiratory symptoms in adults