Peter D. Sly

Description:Objective: To examine the overall incidence rate and trends in emergency department (ED) presentations related to asthma and allergic diseases in regional Australia with a particular focus on First Nations Australians. Methods: A retrospective analysis of data from the Emergency Department Information System. Methods: This study used data from 12 public hospitals in Central Queensland, Australia, a region encompassing regional, rural and remote outback areas. Methods: A total of 813 112 ED presentations between 2018 and 2023. Methods: Asthma and allergic diseases were identified using the International Classification of Diseases-Tenth Revision-Australian Modification codes. Results: There were 13 273 asthma and allergic disease-related ED presentations, with an overall prevalence of 1.6% (95% CI 1.6, 1.7). There was a significantly higher incidence rate of asthma and allergic disease-related ED presentations among First Nations Australians at 177.5 per 10 000 person-years (95% CI 169.3, 186.0) compared with 98.9 per 10 000 person-years (95% CI 97.2, 100.8) among Australians of other descents. The incidence rates, with corresponding 95% CIs, of the four most common cases among First Nations Australians and Australians of other descents, respectively, were as follows: asthma (87.8 (82.0, 93.8) and 40.2 (39.0, 41.3)), unspecified allergy (55.3 (50.8, 60.2) and 36.0 (34.9, 37.1)), atopic/allergic contact dermatitis (17.1 (14.6, 19.9) and 10.6 (10.0, 11.2)) and anaphylaxis (7.2 (5.6, 9.1) and 6.2 (5.7, 6.6)). Conclusions: Our findings highlight a significantly higher rate of asthma and allergic disease-related ED presentations among First Nations Australians compared with Australians of other descents. This underscores the urgent need for targeted healthcare interventions integrating culturally appropriate approaches, alongside additional research to understand causality.

Description:Background: Allergic sensitization and respiratory infections commonly occur in childhood. Interplay between them in asthma development is known as the 'two-hit' hypothesis. There has been no previous investigation of this hypothesis on adult lung function. Objective: In a birth cohort at high risk for allergic diseases, we investigated interactions between these two factors and lung function outcomes into adulthood. Methods: Allergic sensitization was assessed at age 24 months by skin prick testing to aero and food allergens. Respiratory infection was defined as cough, rattle or wheeze measured by frequent questionnaires up to age 24 months. Regression models were utilized to identify interactions between these exposures and associations with lung function at ages 12, 18 and 25 years. Results: At age 25 years, those sensitized at age 2 years(n = 118) demonstrated reductions in pre-bronchodilator FEV1 of 0.06(95% CI: -0.12, 0.00, z-score units, p = .055) for each additional month of respiratory infections. Those not sensitized (n = 120) had increases in pre-bronchodilator FEV1 of 0.07 (95% CI: 0.02, 0.13, z-score units, p = .012) for each additional month of respiratory infection(pinteraction = .012). Similar findings were noted for FEV1/FVC ratio(pinteraction = .011), FEF25-75(pinteraction = .007) and absolute change in pre and post bronchodilator lung function. At 18 years, findings were similar; however, there was less evidence for interactions at 12 years. Conclusions: Our study findings support the 'two-hit' hypothesis of interactions between early-life allergic sensitization and increasing respiratory infections, and impairment in lung function up to age 25 years. Early childhood respiratory infections however had different impacts on lung function depending upon the presence or absence of allergic sensitization.

Description:The association between air pollution and adverse health outcomes has been extensively documented, with oxidative stress widely considered a contributing factor. However, the precise underlying mechanism(s) remains unclear. Recent studies suggest that environmentally persistent free radicals (EPFRs) may provide the missing connection between air pollution and its detrimental health effects. Nevertheless, the indoor environment has received limited attention in EPFR research. Therefore, in this study, we measured EPFRs in house dust samples from two locations in Australia and examined household characteristics associated with their presence. Household characteristics and behaviours that influence indoor air quality were collected from an online questionnaire; 24-h indoor and outdoor air quality were measured with a TSI DustTrak™ DRX Aerosol monitor 8,533; annual indoor and outdoor air quality were matched to two validated, satellite-based land-use regression models; and dust samples were collected from house vacuums. Dust samples were analyzed using nano electron paramagnetic resonance (EPR) to determine spin concentrations, g-factor, and delta H peak-to-peak (Hp-p). Key variables were identified using Lasso-penalized regression models, followed by unpenalized linear regression and post-selection inference to estimate coefficients and assess the robustness of the findings. Our analysis revealed that factors such as extractor fan usage during cooking, exposure to traffic-related air pollution and ambient PM2.5 levels, indoor combustion activities, seasonal variation, housing construction type, ventilation, and cleaning practices were significantly associated with EPFR concentrations in Australian homes. Notably, consistent use of extractor fans during cooking was strongly and consistently associated with lower EPFR concentrations in house dust across both study locations. Our research provided insight into the potential impact of household characteristics on EPFR concentrations, which can potentially lead to adverse health effects. Future research should link our research findings on factors affecting indoor EPFRs to their potential health effects.

Description:Background: Exposure to plastic additives, such as phthalates and bisphenols, has been associated with a higher risk of allergic conditions, but the evidence is inconsistent for children younger than five. Objective: To examine the association between pre- and postnatal urinary phthalates and bisphenols, and allergic conditions, and potential effect modification by sex, in pre-school children, through a pooled analysis. Methods: We pooled data from the Barwon Infant Study (Australia), the Canadian Healthy Infant Longitudinal Development Study (Canada), the Health Outcomes and Measures of the Environment (United States) and the Environmental Influences on Child Health Outcomes-wide cohorts (United States). Urinary phthalates and bisphenols were measured during pregnancy and early childhood. We estimated daily intakes from urinary concentrations, except for mono-(3-carboxypropyl) phthalate (MCPP). Outcomes, including asthma, wheeze, eczema, and rhinitis, were assessed up to five years of age through questionnaires and clinical assessments. We used generalised estimating equations for single compounds and quantile G-computation for the chemical mixtures. Results: 5306 children were included. A two-fold increase in prenatal dibutyl phthalates (DBP; risk ratio [RR] = 1.08; 95% confidence interval [CI]: 1.00-1.16) and benzyl butyl phthalate (BBzP; RR = 1.06; 95%CI: 1.00-1.12) increased the risk of asthma in children under five. Prenatal MCPP levels were associated with rhinitis (RR = 1.05; 95%CI: 1.01-1.09). Postnatal BBzP levels increased the risk of wheezing (RR = 1.05; 95%CI 1.01-1.09), as well as di(2-ethylhexyl) phthalate (DEHP; RR = 1.06; 95%CI: 1.01-1.11) and MCPP (RR = 1.09; 95%CI: 1.04-1.14). These were also inversely associated with eczema. A one-quartile increase in the postnatal chemical mixture increased the risk of wheezing (RR = 1.14; 95%CI: 1.02-1.26). There was limited evidence of effect modification by sex. Conclusions: Phthalates and bisphenols are widespread and may contribute to allergic conditions in children. We pooled data from 5000 children across multiple birth cohorts, suggesting that early-life exposure to these chemicals is associated with increased risks of asthma, wheezing, and rhinitis by age five. We further investigated the timing of exposure, non-linear dose-response relationships, and effect measure modification by sex. This study provides a comprehensive assessment of early-life exposure to phthalates and bisphenols and strengthens the evidence for their role in the development of childhood allergic outcomes.

Description:Endocrine-disrupting chemicals are commonly found in food due to their migration from plastic packaging. Despite their functional benefits, these additives can disrupt the endocrine system, leading to several adverse health outcomes. This review aims to examine the migration of phthalates, bisphenols, and per-and-polyfluoroalkyl substances (PFAS) from plastic food packaging into food substances. Six electronic databases were systematically screened for observational, case reports, or experimental studies investigating any food for human consumption exposed to food packaging. Sixty-seven studies, including 5,378 samples, were included. Phthalates and bisphenols consistently migrated from food packaging. PFAS migration was also detected but too few studies were published to draw conclusions. Migration rates were influenced by factors such as temperature, exposure time, and food composition, with high-fat or acidic foods leading to higher migration rates. Based on a standard Western Diet, 713.8 µg of di-2-ethylhexyl phthalate, 347.7 µg of di-n-butyl phthalate, 17.3 µg of butyl-benzyl phthalate, 35,250 µg of di-iso-decyl phthalate, and 65.4 µg of other plasticizers, totaling 36,349.2 µg, could be consumed from food packaging daily. However, these estimates may not be generalizable to other dietary patterns, such as Mediterranean or plant-based diets. Further research into low migration or safer alternative to current plasticizers, alongside regulatory efforts considering potential exposure via food contact materials may help reduce risks associated with endocrine-disrupting chemicals in food packaging.