title: Effects of phthalates on the development and expression of allergic disease and asthma.
abstract: OBJECTIVE
  To review recent evidence relating phthalate exposures to allergies and asthma and to provide an overview for clinicians interested in the relevance of environmental health research to allergy and who may encounter patients with concerns about phthalates from media reports.
  
  
  METHODS
  PubMed, TOXLINE, and Web of Science were searched using the term phthalate(s) combined with the keywords allergy, asthma, atopy, and inflammation.
  
  
  METHODS
  Articles were selected based on relevance to the goals of this review. Studies that involved humans were prioritized, including routes and levels of exposure, developmental and early-life exposures, immunotoxicity, and the development of allergic disease.
  
  
  RESULTS
  The general public and those with allergy are exposed to significant levels of phthalates via diet, pharmaceuticals, phthalate-containing products, and ambient indoor environment via air and dust. Intravenous exposures occur through medical equipment. Phthalates are metabolized and excreted quickly in the body with metabolites measured in urine. Phthalates, which are known endocrine disrupting compounds, have been associated with oxidative stress and alterations in cytokine expression. Metabolites in human urine, particularly of the higher-molecular-weight phthalates, have been associated with allergies and asthma in multiple studies.
  
  
  CONCLUSIONS
  Despite mounting evidence implicating phthalates, causation of allergic disease by these compounds cannot currently be established. In utero and early-life exposures and possible transgenerational effects are not well understood. However, considering the current evidence, reducing exposures to phthalates by avoiding processed and foods packaged and stored in plastics, personal care products with phthalates, polyvinyl chloride materials indoors, and reducing home dust is advised. Further longitudinal, molecular, and intervention studies are needed to understand the association between phthalates and allergic disease.
authors.affiliation: Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada; Allergy Research Unit, Kingston General Hospital, Kingston, Ontario, Canada; Division of Allergy and Immunology, Department of Medicine, Queen's University, Kingston, Ontario, Canada.
authors.forename: Michelle L
authors.initials: ML
authors.lastname: North
authors.affiliation: Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.
authors.forename: Tim K
authors.initials: TK
authors.lastname: Takaro
authors.affiliation: Department of Earth Sciences, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Miriam L
authors.initials: ML
authors.lastname: Diamond
authors.affiliation: Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada; Allergy Research Unit, Kingston General Hospital, Kingston, Ontario, Canada; Division of Allergy and Immunology, Department of Medicine, Queen's University, Kingston, Ontario, Canada. Electronic address: ellisa@queensu.ca.
authors.forename: Anne K
authors.initials: AK
authors.lastname: Ellis
mesh_terms: D001249:Asthma / Q000209:etiology* / Q000276:immunology; D004781:Environmental Exposure / Q000009:adverse effects; D006801:Humans; D000922:Immunotoxins / Q000009:adverse effects* / Q000494:pharmacology; D007249:Inflammation / Q000276:immunology; D010795:Phthalic Acids / Q000009:adverse effects* / Q000494:pharmacology
chemical_list: D000922:Immunotoxins; D010795:Phthalic Acids