August 2022 additions to NERDB

August 2022 additions to NERDB

NERDB is the New and emerging risks database. This bibliographic database is an initiative of Nicole Palmen and Annet Lenderink with the support of Modernet and is currently powered by Airtable.

More information on this database is on the NERDB page

On the website, we will publish regular updates on new disease-exposure combinations we added to the database. Currently, we have 350 entries. Ordered by year in which the abstract is published

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New entries:

The health of sperm is threatened by pesticides
Afbeelding van Ri Butov via Pixabay

Lam J, Koustas E, Sutton P, Padula AM, Cabana MD, Vesterinen H, Griffiths C, Dickie M, Daniels N, Whitaker E, Woodruff TJ. Exposure to formaldehyde and asthma outcomes: A systematic review, meta-analysis, and economic assessment. PLoS One. 2021 Mar 31;16(3):e0248258. doi: 10.1371/journal.pone.0248258. PMID: 33788856; PMCID: PMC8011796.

Background: Every major federal regulation in the United States requires an economic analysis estimating its benefits and costs. Benefit-cost analyses related to regulations on formaldehyde exposure have not included asthma in part due to lack of clarity in the strength of the evidence.

Objectives: 1) To conduct a systematic review of evidence regarding human exposure to formaldehyde and diagnosis, signs, symptoms, exacerbations, or other measures of asthma in humans; and 2) quantify the annual economic benefit for decreases in formaldehyde exposure.

Methods: We developed and registered a protocol in PROSPERO (Record ID #38766, CRD 42016038766). We conducted a comprehensive search of articles published up to April 1, 2020. We evaluated potential risk of bias for included studies, identified a subset of studies to combine in a meta-analysis, and rated the overall quality and strength of the evidence. We quantified economics benefit to children from a decrease in formaldehyde exposure using assumptions consistent with EPA’s proposed formaldehyde rule.

Results: We screened 4,821 total references and identified 150 human studies that met inclusion criteria; of these, we focused on 90 studies reporting asthma status of all participants with quantified measures of formaldehyde directly relevant to our study question. Ten studies were combinable in a meta-analysis for childhood asthma diagnosis, and five combinable for exacerbation of childhood asthma (wheezing and shortness of breath). Studies had a low to probably-low risk of bias across most domains. A 10-μg/m3 increase in formaldehyde exposure was associated with increased childhood asthma diagnosis (OR = 1.20, 95% CI: [1.02, 1.41]). We also found a positive association with exacerbation of childhood asthma (OR = 1.08, 95% CI: [0.92, 1.28]). The overall quality and strength of the evidence was rated as “moderate” quality and “sufficient” for asthma diagnosis and asthma symptom exacerbation in both children and adults. We estimated that EPA’s proposed rule on pressed wood products would result in 2,805 fewer asthma cases and a total economic benefit of $210 million annually.

Conclusion: We concluded there was “sufficient evidence of toxicity” for associations between exposure to formaldehyde and asthma diagnosis and asthma symptoms in both children and adults. Our research documented that when exposures are ubiquitous, excluding health outcomes from benefit-cost analysis can underestimate the true benefits to health from environmental regulations.

Kolodziej M, Kiewert A, Skudlik C, Brans R. Allergic contact dermatitis to phenoxyethanol: A rare, but possible cause of hand dermatitis. Contact Dermatitis. 2022 Apr;86(4):319-320. doi: 10.1111/cod.14029. Epub 2021 Dec 30. PMID: 34921565.

Phenoxyethanol (PE; Syn. 2-Phenyoxethanol; CAS no. 122-99-6) is one of the most commonly used preservatives in cosmetics and is also found in industrial products, including metalworking fluids. It is considered to have a low sensitization potent

A 59-year-old male toolmaker presented with therapy-resistant, 1-yearlasting hand dermatitis suspected to be of occupational origin. Despite being on work leave and treatment with alitretinoin for the past5 months, severe dermatitis of hands and lower arms was observed.

Patch testing showed a positive reaction to phenoxyethanol. This was not an ingredient of the metal working fluid, but was found in the patient’s skin care products. Despite its widespread use as a preservative in cosmetic and pharmaceutical products as well as for other applications, only very few cases of allergic contact dermatitis and contact urticaria to PE have been reported.

Although rare, allergic contact dermatitis to PE should be considered and if undiscovered may lead to longstanding disease and inefficient treatments. The present case illustrates the importance of performing early patch tests to avoid delays in diagnosis and prevention measures. Diagnostic workup of patients with suspected occupational hand dermatitis should include patch testing and in doubtful cases also ROAT (Repeated Open Application Test) with patient’s own skin care products.

Fu, M., Feng, C. M., Cao, L. J., Hu, X. W., Xu, Q. X., Xia, H. L., … & Zhang, J. Q. (2022). Acute Respiratory Distress Syndrome Caused by Occupational Exposure to Waterproofing Spray: A Case Report and Literature ReviewFrontiers in public health10.

Background: Acute respiratory distress syndrome (ARDS) is a serious respiratory disease, caused by severe infection, trauma, shock, inhalation of harmful gases and poisons and presented with acute-onset and high mortality. Timely and accurate identification will be helpful to the treatment and prognosis of ARDS cases. Herein, we report a case of ARDS caused by occupational exposure to waterproofing spray. To our knowledge, inhalation of waterproofing spray is an uncommon cause of ARDS, and what makes our case special is that we ruled out concurrent infections with some pathogens by using metagenomic next-generation sequencing (mNGS) as an auxiliary diagnosis, which presents the most comprehensive etiological examination of similar reports.

Case Presentation: A previously healthy 25 years old delivery man developed hyperpyrexia, chest tightness, cough and expectoration. The symptoms occurred and gradually exacerbated after exposure to a waterproofing spray. The chest computed tomography (CT) finding showed diffuse ground glass and infiltrative shadows in both lungs. The diagnosis of ARDS related to waterproofing spray was established on the basis of comprehensive differential diagnosis and etiological examination. The patient achieved a good curative effect after proper systemic glucocorticoid therapy.

Conclusions: The diagnosis and differential diagnosis of acute respiratory failure for outdoor workers, such as delivery drivers or hikers, should be considered whether toxic aerosol exposure exists from daily contact. The case can educate the public that more attention should be paid to avoid exposure to these chemicals by aerosols/ingestion mode and some preventive strategies should be taken in the occupational environment. The treatment effect of glucocorticoids is significant in ARDS patients with general chemical damage caused by inhaling toxic gases and substances.

Knapke ET, Magalhaes DP, Dalvie MA, Mandrioli D, Perry MJ. Environmental and occupational pesticide exposure and human sperm parameters: A Navigation Guide review. Toxicology. 2022 Jan 15;465:153017. doi: 10.1016/j.tox.2021.153017. Epub 2021 Oct 29. PMID: 34756984.

Global sperm counts have declined in recent decades, coinciding with the proliferation of endocrine-disrupting chemicals, of which pesticides are some of the most common. Previous systematic reviews of epidemiologic studies published between 1991 through 2013 have reported associations between environmental and occupational pesticide exposure and reduced sperm quality, particularly associations with reduced sperm concentration.

This systematic review used the Navigation Guide to critically evaluate the current body of evidence examining sperm quality and pesticide exposure in epidemiological studies. PubMed, Scopus, and Web of Science databases were searched for all English-language articles published after September 2012 until August 2021. Original observational studies that assessed human sperm quality parameters, defined as concentration, motility, morphology, and DNA integrity, and individual-level pesticide exposure were included. The risk of bias for each included study and the strength of evidence were evaluated using the Navigation Guide protocol.

Nineteen studies assessing environmental or occupational pesticide exposure and sperm parameters were included. Eighteen studies were cross-sectional studies and one prospective cohort; sample sizes ranged from 42 to 2122 men from 14 different countries. Fifteen (79 %) studies found at least one significant association between pesticide exposure and reduced sperm quality. The overall risk of bias across studies was classified as low to moderate. The quality of evidence was determined to be moderate based on systematic evaluation criteria.

There were consistent adverse associations between pesticide exposure and sperm motility (63 % of studies) and DNA integrity (80 % of studies). For sperm concentration and morphology, 42 % and 36 % of studies found significant negative associations, respectively. The strength of the body of evidence overall was rated as having sufficient evidence of toxicity. Regarding specific sperm endpoints, there was sufficient evidence that pesticides are toxic for sperm motility and DNA integrity; limited evidence of toxicity for sperm concentration; and inadequate evidence of toxicity for sperm morphology.

The studies reviewed here showed consistent associations between pesticide exposure and diminished sperm parameters, particularly sperm motility and sperm DNA integrity. These findings are largely consistent with results of previous reviews, which have found significant negative associations between pesticide exposure and sperm quality in 13 of 20 (65 %) studies published between 1991 and 2008, and in 14 of 17 (82 %) studies published between 2008 and 2012. After thirty years of mounting evidence, actions are needed to reduce pesticide risks to testicular function and male fertility.

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