title: Association between perfluoroalkyl substance exposure and asthma and allergic disease in children as modified by MMR vaccination.
abstract: Perfluoroalkyl substances (PFASs) are highly persistent chemicals that might be associated with asthma and allergy, but the associations remain unclear. Therefore, this study examined whether pre- and postnatal PFAS exposure was associated with childhood asthma and allergy. Measles, mumps, and rubella (MMR) vaccination in early life may have a protective effect against asthma and allergy, and MMR vaccination is therefore taken into account when evaluating these associations. In a cohort of Faroese children whose mothers were recruited during pregnancy, serum concentrations of five PFASs - Perfluorohexane sulfonic acid (PFHxS), perfluorooctane sulfonic acid (PFOS), perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA), and perfluorodecanoic acid (PFDA) - were measured at three timepoints (maternal serum in pregnancy week 34-36 and child serum at ages 5 and 13 years) and their association with immunoglobulin E (IgE) (cord blood and at age 7 years) and asthma/allergic diseases (questionnaires at ages 5 and 13 years and skin prick test at age 13 years) was determined. A total of 559 children were included in the analyses. Interactions with MMR vaccination were evaluated. Among 22 MMR-unvaccinated children, higher levels of the five PFASs at age 5 years were associated with increased odds of asthma at ages 5 and 13. The associations were reversed among MMR-vaccinated children. Prenatal PFAS exposure was not associated with childhood asthma or allergic diseases regardless of MMR vaccination status. In conclusion, PFAS exposure at age 5 was associated with increased risk of asthma among a small subgroup of MMR-unvaccinated children but not among MMR-vaccinated children. While PFAS exposure may impact immune system functions, this study suggests that MMR vaccination might be a potential effect-modifier.
authors.affiliation: a Department of Environmental Medicine , University of Southern Denmark , Odense , Denmark.
authors.forename: Clara Amalie Gade
authors.initials: CA
authors.lastname: Timmermann
authors.affiliation: b Section of Biostatistics , University of Copenhagen , Copenhagen , Denmark.
authors.forename: Esben
authors.initials: E
authors.lastname: Budtz-Jørgensen
authors.affiliation: a Department of Environmental Medicine , University of Southern Denmark , Odense , Denmark.
authors.forename: Tina Kold
authors.initials: TK
authors.lastname: Jensen
authors.affiliation: c Center for Virology and Vaccine Research , Beth Israel Deaconess Medical Center, Harvard Medical School , Boston , MA , USA.
authors.forename: Christa Elyse
authors.initials: CE
authors.lastname: Osuna
authors.affiliation: d Department of Occupational Medicine and Public Health , Faroe Islands, Denmark.
authors.forename: Maria Skaalum
authors.initials: MS
authors.lastname: Petersen
authors.affiliation: d Department of Occupational Medicine and Public Health , Faroe Islands, Denmark.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Steuerwald
authors.affiliation: a Department of Environmental Medicine , University of Southern Denmark , Odense , Denmark.
authors.forename: Flemming
authors.initials: F
authors.lastname: Nielsen
authors.affiliation: e Allergy Clinic , Copenhagen University Hospital Gentofte , Hellerup , Denmark.
authors.forename: Lars K
authors.initials: LK
authors.lastname: Poulsen
authors.affiliation: d Department of Occupational Medicine and Public Health , Faroe Islands, Denmark.|f Faculty of Natural and Health Sciences , University of the Faroe Islands , Faroe Islands, Denmark.
authors.forename: Pál
authors.initials: P
authors.lastname: Weihe
authors.affiliation: a Department of Environmental Medicine , University of Southern Denmark , Odense , Denmark.|g Department of Environmental Health , Harvard T.H. Chan School of Public Health , Boston , MA , USA.
authors.forename: Philippe
authors.initials: P
authors.lastname: Grandjean
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003718:Denmark; D004781:Environmental Exposure / Q000009:adverse effects; D005260:Female; D005466:Fluorocarbons / Q000009:adverse effects*; D005500:Follow-Up Studies; D006801:Humans; D006967:Hypersensitivity / Q000276:immunology*; D007073:Immunoglobulin E / Q000097:blood; D007223:Infant; D008297:Male; D022542:Measles-Mumps-Rubella Vaccine / Q000276:immunology*; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000276:immunology*; D012882:Skin Tests; D014611:Vaccination
chemical_list: D005466:Fluorocarbons; D022542:Measles-Mumps-Rubella Vaccine; D007073:Immunoglobulin E
keywords: Allergy; MMR vaccination; asthma; children; perfluoroalkyl substances