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Chlorinated pool exposure, allergic sensitization, and risk of age 5-year asthma

Pediatric Research volume 94, pages 1254–1257 (2023)Cite this article

Bronchiolitis is an infection of small airways causing breathing difficulties in young children. This infection is also the leading cause of US infant hospitalization (severe bronchiolitis)1 and a major risk factor for childhood asthma. Many factors contribute to the development of childhood asthma, within this high-risk previously hospitalized group as well as the general population, including environmental factors.2,3 These environmental factors include, but are not limited to, passive smoke exposure, inhaled chemical byproducts, and air pollution. The “pool chlorine hypothesis” suggests that increased exposure of children to toxic gases and aerosols around indoor chlorinated pools, mainly trichloramine, may contribute to the rise in childhood asthma.2 Mean trichloramine levels are around 0.5 mg/m3, making this gas one of the most concentrated air pollutants that children in industrialized countries are regularly exposed to.2

This “pool chlorine hypothesis” has been examined by several researchers; however, there is no clear consensus about the association between early-life chlorinated pool exposure and the development of childhood asthma, even when stratifying by indoor vs outdoor pools2,3,4,5,6,7,8,9—and especially within a high-risk group of infants hospitalized with bronchiolitis. Some studies have proposed a stronger link between swimming pool exposure and asthma among children with allergic sensitization.3,7,10 One case–control study of 337 adolescents with asthma and 633 controls reported that swimming pool exposure in early life was associated with a significantly higher risk of pre-school asthma onset, and children who were both sensitized and exposed were at even higher risk.3

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Data availability

The data presented in this study are available upon reasonable request, from the corresponding author, if the proposed research investigates severe bronchiolitis, recurrent wheezing, asthma, and related concepts. The data are not publicly available to be compliant with the informed consent forms of the MARC-35 study and the data sharing plan.

References

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Funding

This study was supported by the grants U01 AI-087881, R01 AI-114552, and UG3/UH3 OD-023253 from the National Institutes of Health (Bethesda, MD). G.M. was supported by T32 AI-007306. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA

    Elie J. Mitri, Sabrina Ferhani, Jingya Gao, Vanessa Cardenas, Janice A. Espinola, Kohei Hasegawa & Carlos A. Camargo Jr.

  2. Division of Allergy and Clinical Immunology, Brigham & Women’s Hospital, Boston, MA, USA

    Geneva Mehta

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  1. Elie J. Mitri
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Contributions

E.J.M. and S.F. conceived the study. E.J.M. and V.C. assisted in data collection. J.A.E. and J.G. conducted statistical analysis. J.A.E., J.G., C.A.C., K.H., and G.M. assisted in the interpretation of data. E.J.M. drafted the manuscript and all authors contributed substantially to its revision. All authors approved the final version for publication.

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Correspondence to Carlos A. Camargo Jr..

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Parents/guardians of all children provided informed consent and all participating hospitals had local approval of their institutional review board.

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Mitri, E.J., Ferhani, S., Gao, J. et al. Chlorinated pool exposure, allergic sensitization, and risk of age 5-year asthma. Pediatr Res 94, 1254–1257 (2023). https://doi.org/10.1038/s41390-023-02615-0

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