title: Relationship between urine dichlorophenol levels and asthma morbidity.
abstract: BACKGROUND
  Chlorinated phenols are associated with atopic conditions, but it is not known whether they are associated with wheeze or asthma and whether atopy is involved in these associations.
  
  
  OBJECTIVE
  To test the association between urine levels of 2 dichlorophenols (2,4- and 2,5-dichlorophenols) and asthma morbidity in atopic and nonatopic wheezers and between total serum immunoglobulin E (IgE) levels.
  
  
  METHODS
  Data from a sample of 2,125 participants at least 6 years old from the US National Health and Nutrition Examination Survey 2005 to 2006 were analyzed. Asthma morbidity data were available for those participants who reported wheezing in the past year ("wheezers"; n = 250). This subsample was categorized as atopic or nonatopic.
  
  
  RESULTS
  Atopic wheezers with higher 2,5-dichlorophenol levels were more frequently diagnosed with asthma by a physician (odds ratio [OR] 4.7 for highest vs lowest tertile, P < .001), required more prescriptions for asthma medications (OR 2.2, P = .046), and reported more exercise-induced wheezing (OR 5.8, P = .045) than atopic wheezers with low dichlorophenol levels. Atopic wheezers with higher 2,5- or 2,4-dichloropheonol levels also were more likely to miss work or school because of wheezing (OR 10.0, P < .001; OR 11.4, P < .01, respectively). In contrast, in nonatopic wheezers, there were no significant associations between dichlorophenol levels and asthma morbidity measurements. The 2 dichlorophenol metabolites were positively associated with increased serum IgE levels in the larger study sample.
  
  
  CONCLUSIONS
  These findings indicate that in patients with atopy and a history of wheezing, asthma morbidity is associated with high urinary dichlorophenol levels. Increased urine dichlorophenol levels are associated with higher total serum IgE.
authors.affiliation: Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York. Electronic address: elina.jerschow@einstein.yu.edu.
authors.forename: Elina
authors.initials: E
authors.lastname: Jerschow
authors.affiliation: Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York.
authors.forename: Purvi
authors.initials: P
authors.lastname: Parikh
authors.affiliation: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Aileen P
authors.initials: AP
authors.lastname: McGinn
authors.affiliation: Department of Medicine, Albert Einstein College of Medicine/Jacobi Medical Center, Bronx, New York.
authors.forename: Gabriele
authors.initials: G
authors.lastname: de Vos
authors.affiliation: Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York.
authors.forename: Sunit
authors.initials: S
authors.lastname: Jariwala
authors.affiliation: Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York.
authors.forename: Golda
authors.initials: G
authors.lastname: Hudes
authors.affiliation: Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York.
authors.forename: David
authors.initials: D
authors.lastname: Rosenstreich
mesh_terms: D000328:Adult; D001249:Asthma / Q000188:drug therapy / Q000652:urine*; D002733:Chlorophenols / Q000652:urine*; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood*; D008297:Male; D012135:Respiratory Sounds / Q000187:drug effects; D011795:Surveys and Questionnaires
chemical_list: D002733:Chlorophenols; D007073:Immunoglobulin E; C056892:2,5-dichlorophenol; C004762:2,4-dichlorophenol
references.citation: Clin Exp Allergy. 2006 Apr;36(4):402-25
references.pmid: 16630145
references.citation: Environ Res. 2013 Oct;126:164-70
references.pmid: 23932849
references.citation: Environ Health Perspect. 2006 Aug;114(8):1210-4
references.pmid: 16882527
references.citation: Int J Hyg Environ Health. 2014 Mar;217(2-3):294-9
references.pmid: 23899931
references.citation: N Engl J Med. 1989 Feb 2;320(5):271-7
references.pmid: 2911321
references.citation: Ann Allergy Asthma Immunol. 2012 Dec;109(6):420-5
references.pmid: 23176881
references.citation: Eur Respir J. 2009 Dec;34(6):1296-303
references.pmid: 19541724
references.citation: Anal Bioanal Chem. 2005 Dec;383(7-8):1119-26
references.pmid: 16261326
references.citation: Arch Environ Health. 2001 Jan-Feb;56(1):77-83
references.pmid: 11256860
references.citation: J Anim Sci. 2002 Jun;80(6):1683-9
references.pmid: 12078750
references.citation: Environ Health Perspect. 2001 Feb;109(2):173-8
references.pmid: 11266329
references.citation: Environ Health. 2005 Apr 14;4(1):5
references.pmid: 15831097
references.citation: Thorax. 2002 Nov;57(11):951-7
references.pmid: 12403877
references.citation: J Allergy Clin Immunol. 2009 Sep;124(3):447-53
references.pmid: 19647861
references.citation: Environ Health Perspect. 2014 Apr;122(4):351-5
references.pmid: 24451842
references.citation: Am J Ind Med. 2003 May;43(5):532-8
references.pmid: 12704626
references.citation: N Engl J Med. 2006 Nov 23;355(21):2226-35
references.pmid: 17124020
references.citation: J Allergy Clin Immunol. 2012 Aug;130(2):453-60.e7
references.pmid: 22704536
references.citation: Arch Environ Health. 2001 Nov-Dec;56(6):485-92
references.pmid: 11958547
references.citation: FASEB J. 2005 Apr;19(6):656-8
references.pmid: 15671152
references.citation: Am J Respir Crit Care Med. 2008 Jan 1;177(1):11-8
references.pmid: 17932376
references.citation: Occup Environ Med. 2009 Nov;66(11):718-24
references.pmid: 19289390
references.citation: Environ Health Perspect. 2011 Mar;119(3):390-6
references.pmid: 21062687
references.citation: Environ Sci Technol. 2013 Apr 2;47(7):3439-47
references.pmid: 23469879
references.citation: FEMS Microbiol Ecol. 2011 Oct;78(1):150-64
references.pmid: 21426365
references.citation: Thorax. 2004 Sep;59(9):746-51
references.pmid: 15333849
references.citation: Occup Environ Med. 2007 Jun;64(6):417-21
references.pmid: 17182637
references.citation: Arch Environ Health. 2002 Nov-Dec;57(6):541-7
references.pmid: 12696651