Association between domestic water hardness, chlorine, and atopic dermatitis risk in early life: A population-based cross-sectional study

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• 作者：Michael R. Perkin ; PhD^a ; Joanna Craven ; MPH^b ; Kirsty Logan ; PhD^b ; David Strachan ; MD^a ; Tom Marrs ; BM BS^b ; Suzana Radulovic ; MD^b ; Linda E. Campbell ; BSc^c ; Stephanie F. MacCallum ; MSc^c ; W.H. Irwin McLean ; DSc^c ; Gideon Lack ; MD^b ; Carsten Flohr ; PhD^b ; ^d ; ^{carsten.flohr@kcl.ac.uk" class="auth_mail" title="E-mail the corresponding author} ; on behalf of the Enquiring About Tolerance Study TeamLouise Young (Nursing staff) ; Victoria Offord (Nursing staff) ; Mary DeSousa (Nursing staff) ; Jason Cullen (Nursing staff) ; Katherine Taylor (Nursing staff) ; Anna Tseng (Dietitian) ; Bunmi Raji (Dietitian) ; Sarah Nesbeth (Dietitian) ; Gillian Regis (Dietitian) ; Charlie Bigwood (Dietitian) ; Charlotte Stedman (Dietitian) ; Sharon Tonner (Study management ; administration) ; Emily Banks (Study management ; administration) ; Yasmin Kahnum (Study management ; administration) ; Rachel Babic (Study management ; administration) ; Ben Stockwell (Study management ; administration) ; Erin Thompson (Study management ; administration) ; Lorna Wheatley (Study management ; administration) ; Devi Patkunam (Phlebotomist) ; Kerry Richards (Laboratory project) ; Ewa Pietraszewicz (Laboratory project) ; Alick Stephens (Laboratory project) ; Asha Sudra (Laboratory project) ; Victor Turcanu (Laboratory project)
• 关键词：Filaggrin ; eczema ; atopic dermatitis ; transepidermal water loss ; water hardness
• 刊名：Journal of Allergy and Clinical Immunology
• 出版年：2016
• 出版时间：August 2016
• 年：2016
• 卷：138
• 期：2
• 页码：509-516
• 全文大小：1716 K

文摘

Domestic water hardness and chlorine have been suggested as important risk factors for atopic dermatitis (AD).

Objective

We sought to examine the link between domestic water calcium carbonate (CaCO₃) and chlorine concentrations, skin barrier dysfunction (increased transepidermal water loss), and AD in infancy.

Methods

We recruited 1303 three-month-old infants from the general population and gathered data on domestic water CaCO₃ (in milligrams per liter) and chlorine (Cl₂; in milligrams per liter) concentrations from local water suppliers. At enrollment, infants were examined for AD and screened for filaggrin (FLG) skin barrier gene mutation status. Transepidermal water loss was measured on unaffected forearm skin.

Results

CaCO₃ and chlorine levels were strongly correlated. A hybrid variable of greater than and less than median levels of CaCO₃ and total chlorine was constructed: a baseline group of low CaCO₃/low total chlorine (CaL/ClL), high CaCO₃/low total chlorine (CaH/ClL), low CaCO₃/high total chlorine (CaL/ClH) and high CaCO₃/high total chlorine (CaH/ClH). Visible AD was more common in all 3 groups versus the baseline group: adjusted odds ratio (AOR) of 1.87 (95% CI, 1.25-2.80; P = .002) for the CaH/ClL group, AOR of 1.46 (95% CI, 0.97-2.21; P = .07) for the CaL/ClH, and AOR of 1.61 (95% CI, 1.09-2.38; P = .02) for the CaH/ClH group. The effect estimates were greater in children carrying FLG mutations, but formal interaction testing between water quality groups and filaggrin status was not statistically significant.

Conclusions

High domestic water CaCO₃ levels are associated with an increased risk of AD in infancy. The influence of increased total chlorine levels remains uncertain. An intervention trial is required to see whether installation of a domestic device to decrease CaCO₃ levels around the time of birth can reduce this risk.