title: Effects of persistent organic pollutants on the developing respiratory and immune systems: a systematic review.
abstract: BACKGROUND
  Disruption of developing immune and respiratory systems by early-life exposure to persistent organic pollutants (POPs) could result into reduced capacity to fight infections and increased risk to develop allergic manifestations later in life.
  
  
  OBJECTIVE
  To systematically review the epidemiologic literature on the adverse effects of early-life exposure to POPs on respiratory health, allergy and the immune system in infancy, childhood and adolescence.
  
  
  METHODS
  Based on published guidelines for systematic reviews, two independent researchers searched for published articles in MEDLINE and SCOPUS using defined keywords on POPs and respiratory health, immune function and allergy. Study eligibility criteria were defined to select the articles.
  
  
  RESULTS
  This review of 41 studies finds limited evidence for prenatal exposure to DDE, PCBs and dioxins and risk of respiratory infections. Evidence was limited also for postnatal exposure to PCBs, specifically ndl-PCBs, and reduced immune response after vaccination in childhood. The review indicates lack of association between postnatal exposure to PCBs/ndl-PCBs and risk of asthma-related symptoms. For the other exposure-outcome associations reviewed evidence was inadequate.
  
  
  CONCLUSIONS
  Current epidemiological evidence suggests that early-life exposure to POPs can adversely influence immune and respiratory systems development. Heterogeneity between studies in exposure and outcome assessment and the small number of studies for any given exposure-outcome relationship currently make comparisons difficult and meta-analyses impossible. Also, mechanisms remain largely unexplored. Recommendations for significantly improving our understanding thus include harmonization of exposure and outcome assessment between studies, conduct of larger studies, long-term assessment of respiratory infections and asthma symptoms in order to identify critical periods of susceptibility, integration of the potential immunotoxic mechanisms of POPs, and use of new statistical tools to detangle the role of multiple exposures on multiple outcomes.
authors.affiliation: Centre for Research in Environmental Epidemiology (CREAL), Dr. Aiguader 88, Barcelona, Catalonia, Spain. mgascon@creal.cat
authors.forename: Mireia
authors.initials: M
authors.lastname: Gascon
authors.forename: Eva
authors.initials: E
authors.lastname: Morales
authors.forename: Jordi
authors.initials: J
authors.lastname: Sunyer
authors.forename: Martine
authors.initials: M
authors.lastname: Vrijheid
mesh_terms: D001249:Asthma / Q000139:chemically induced / Q000453:epidemiology; D003633:Dichlorodiphenyl Dichloroethylene / Q000633:toxicity; D004147:Dioxins / Q000633:toxicity; D015386:Hazardous Substances / Q000633:toxicity*; D006801:Humans; D006967:Hypersensitivity / Q000453:epidemiology; D007107:Immune System / Q000187:drug effects* / Q000254:growth & development; D011078:Polychlorinated Biphenyls / Q000633:toxicity; D012137:Respiratory System / Q000187:drug effects* / Q000254:growth & development; D012141:Respiratory Tract Infections / Q000139:chemically induced / Q000453:epidemiology / Q000276:immunology
chemical_list: D004147:Dioxins; D015386:Hazardous Substances; D003633:Dichlorodiphenyl Dichloroethylene; D011078:Polychlorinated Biphenyls