title: Occupational endotoxin exposure reduces the risk of atopic sensitization but increases the risk of bronchial hyperresponsiveness.
abstract: BACKGROUND
  Microbial exposures in both childhood and adult life are protective against atopy, allergic rhinitis and atopic asthma. In adults, this protective effect is paralleled by an increased prevalence of non-atopic asthma. This study was undertaken to investigate associations between occupational endotoxin exposure and atopic sensitization and bronchial hyperresponsiveness to methacholine (BHR) in agricultural workers. In addition, the role of atopy in endotoxin-related respiratory effects was studied.
  
  
  METHODS
  Data were available for 427 farmers and agricultural industry workers, for whom airborne endotoxin exposure levels were estimated by 249 personal exposure measurements. Atopy was assessed as specific serum IgE to common inhalant allergens, and respiratory symptoms and personal characteristics by standardized questionnaires. BHR was determined in a subset of 113 subjects. Associations were adjusted for age, sex, smoking and living on a farm during childhood.
  
  
  RESULTS
  Endotoxin exposure was positively associated with BHR and wheeze (p < 0.05). In contrast, endotoxin exposure was inversely associated with atopy and IgE to grass pollen (p < 0.001). The proportions of wheeze and BHR that were attributable to atopy were only 16.6 and 32.8%, respectively.
  
  
  CONCLUSIONS
  High endotoxin exposure is a risk factor for BHR and wheeze, which were characterized by a predominantly non-atopic phenotype. At the same time, endotoxin exposure is related to a reduced risk of atopy and IgE to grass pollen in adults. It is unlikely that this is entirely a result of healthy worker selection, as significant inverse associations between endotoxin and IgE to grass pollen were found regardless of reported allergic symptoms.
authors.affiliation: Institute for Risk Assessment Sciences, Division of Environmental Epidemiology, Utrecht University, Utrecht, The Netherlands. L.A.Smit@uu.nl
authors.forename: Lidwien A M
authors.initials: LA
authors.lastname: Smit
authors.forename: Dick
authors.initials: D
authors.lastname: Heederik
authors.forename: Gert
authors.initials: G
authors.lastname: Doekes
authors.forename: Jan-Willem J
authors.initials: JW
authors.lastname: Lammers
authors.forename: Inge M
authors.initials: IM
authors.lastname: Wouters
mesh_terms: D000328:Adult; D000383:Agriculture; D000395:Air Pollutants, Occupational / Q000009:adverse effects / Q000032:analysis / Q000276:immunology; D000485:Allergens / Q000276:immunology; D016535:Bronchial Hyperreactivity / Q000453:epidemiology* / Q000503:physiopathology; D001985:Bronchial Provocation Tests; D004731:Endotoxins / Q000009:adverse effects* / Q000032:analysis* / Q000276:immunology; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000453:epidemiology* / Q000276:immunology; D007073:Immunoglobulin E / Q000097:blood / Q000276:immunology; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D016273:Occupational Exposure / Q000009:adverse effects* / Q000032:analysis*; D016017:Odds Ratio; D011058:Pollen / Q000276:immunology; D015995:Prevalence; D012135:Respiratory Sounds / Q000209:etiology; D006255:Rhinitis, Allergic, Seasonal / Q000453:epidemiology / Q000276:immunology; D012307:Risk Factors; D011795:Surveys and Questionnaires
chemical_list: D000395:Air Pollutants, Occupational; D000485:Allergens; D004731:Endotoxins; D007073:Immunoglobulin E