title: Environmental exposure to endotoxin and its relation to asthma in school-age children.
abstract: BACKGROUND
  In early life, the innate immune system can recognize both viable and nonviable parts of microorganisms. Immune activation may direct the immune response, thus conferring tolerance to allergens such as animal dander or tree and grass pollen.
  
  
  METHODS
  Parents of children who were 6 to 13 years of age and were living in rural areas of Germany, Austria, or Switzerland where there were both farming and nonfarming households completed a standardized questionnaire on asthma and hay fever. Blood samples were obtained from the children and tested for atopic sensitization; peripheral-blood leukocytes were also harvested from the samples for testing. The levels of endotoxin in the bedding used by these children were examined in relation to clinical findings and to the cytokine-production profiles of peripheral-blood leukocytes that had been stimulated with lipopolysaccharide and staphylococcal enterotoxin B. Complete data were available for 812 children.
  
  
  RESULTS
  Endotoxin levels in samples of dust from the child's mattress were inversely related to the occurrence of hay fever, atopic asthma, and atopic sensitization. Nonatopic wheeze was not significantly associated with the endotoxin level. Cytokine production by leukocytes (production of tumor necrosis factor alpha, interferon-gamma, interleukin-10, and interleukin-12) was inversely related to the endotoxin level in the bedding, indicating a marked down-regulation of immune responses in exposed children.
  
  
  CONCLUSIONS
  A subject's environmental exposure to endotoxin may have a crucial role in the development of tolerance to ubiquitous allergens found in natural environments.
authors.affiliation: Institute of Social and Preventive Medicine, Basel, Switzerland. c.braun@unibas.ch
authors.forename: Charlotte
authors.initials: C
authors.lastname: Braun-Fahrländer
authors.forename: Josef
authors.initials: J
authors.lastname: Riedler
authors.forename: Udo
authors.initials: U
authors.lastname: Herz
authors.forename: Waltraud
authors.initials: W
authors.lastname: Eder
authors.forename: Marco
authors.initials: M
authors.lastname: Waser
authors.forename: Leticia
authors.initials: L
authors.lastname: Grize
authors.forename: Soyoun
authors.initials: S
authors.lastname: Maisch
authors.forename: David
authors.initials: D
authors.lastname: Carr
authors.forename: Florian
authors.initials: F
authors.lastname: Gerlach
authors.forename: Albrecht
authors.initials: A
authors.lastname: Bufe
authors.forename: Roger P
authors.initials: RP
authors.lastname: Lauener
authors.forename: Rudolf
authors.initials: R
authors.lastname: Schierl
authors.forename: Harald
authors.initials: H
authors.lastname: Renz
authors.forename: Dennis
authors.initials: D
authors.lastname: Nowak
authors.forename: Erika
authors.initials: E
authors.lastname: von Mutius
mesh_terms: D000293:Adolescent; D000383:Agriculture; D000485:Allergens / Q000032:analysis; D001249:Asthma / Q000453:epidemiology* / Q000276:immunology; D002648:Child; D003430:Cross-Sectional Studies; D016207:Cytokines / Q000097:blood; D004391:Dust / Q000032:analysis*; D004731:Endotoxins / Q000032:analysis* / Q000276:immunology; D004781:Environmental Exposure / Q000032:analysis; D005260:Female; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000453:epidemiology* / Q000276:immunology; D007073:Immunoglobulin E / Q000097:blood; D007962:Leukocytes / Q000276:immunology; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D011795:Surveys and Questionnaires
chemical_list: D000485:Allergens; D016207:Cytokines; D004391:Dust; D004731:Endotoxins; D007073:Immunoglobulin E