Different Characteristics of Childhood Asthma Related to Polyhexamethylene Guanidine Exposure

Lee, So‐Yeon; Ahn, Hee-Sung; Kim, Eun Mi; Kim, Kyung Kon; Kang, Mi‐Jin; Park, Min Jee; Cho, Hyun Ju; Lee, Eun; Jung, Sungsu; Yoon, Jisun; Yang, Song-I; Park, Dong-Uk; Hong, Soo‐Jong

doi:10.1513/annalsats.202007-807oc

Cited by 10 publications

(11 citation statements)

References 40 publications

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“… 10 11 12 13 16 17 There are also several studies on asthma showing causality. 18 19 20 However, little is known about other non-specific respiratory injuries. 21 Judgment on injury due to HDs should be based not only on whether the patient meets certain criteria for acknowledgment but also on the diverse clinical circumstances experienced by each individual victim.…”

Section: Introductionmentioning

confidence: 99%

Need for individual-based evaluation to determine the association between humidifier disinfectants and health injuries

Kim

Mun

Lee

et al. 2021

Ann Occup Environ Med

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Background Injuries caused by humidifier disinfectants (HDs) can no longer be grouped under the concept of HD lung injury. Focusing on individual cases, we were able to evaluate the relevance not only of diseases for which epidemiological correlation is recognized but also all diseases and symptoms that the victims complain of. Methods In-depth interviews and reassessment of 113 HD-exposed patients who had not been acknowledged as victims by the government were conducted, and their medical records were reviewed. Based on these processes, an assessment questionnaire for the injuries related to HDs was completed and the involvement of HDs was assessed either as “strong association,” “association,” or “no association.” Results In this study, of the 113 patients included who claimed damages, 78 (69.0%) had HD-related injuries. Among the cases of 22 patients who applied for injury acknowledgment due to upper respiratory inflammation that was not included among the acknowledged diseases, 17 (77.3%) were judged to be HD-related injuries (strong association vs. association: 10 [45.5%] vs. 7 [31.8%]). When the cases of 12 rhinitis patients were reassessed, 9 were HD-related injuries (strong association vs. association: 4 [33.3%] vs. 5 [41.7%]). When the cases of 18 asthma patients unacknowledged as a victim were reassessed, 17 (94.4%) were humidifier-related injuries (strong association vs. association: 12 [66.6%] vs. 5 [27.8%]). Among 4 interstitial lung disease patients unacknowledged as a victim, 2 (50.0%) were HD-related injuries. Conclusions HD-related health injuries should be assessed through both individual interviews and detailed chart reviews for more accurate injury acknowledgment. In the future, efforts should go beyond existing methods based on the adherence to acknowledgment criteria to directly listen to the victims.

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Section: Introductionmentioning

confidence: 99%

Need for individual-based evaluation to determine the association between humidifier disinfectants and health injuries

Kim

Mun

Lee

et al. 2021

Ann Occup Environ Med

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“…For group 1, studies published on humans, a total of 49 articles were selected ( Table 2 ). 1 2 3 4 5 6 7 9 10 11 12 13 14 17 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 The suspicion that humidifier disinfectant might be a cause of lung damage was suggested in 2011. Studies in international journals began to appear in 2013.…”

Section: Resultsmentioning

confidence: 99%

“…28 Overall, annual humidifier disinfectant sales showed high correlations with the concentration and number of HDLI cases. 29 30 31 Respiratory diseases such as idiopathic interstitial pneumonia, 17 bronchitis and allergic rhinitis, 32 33 and asthma 34 have been described in human studies on non-HDLI diseases. Leem et al 35 proposed that these disease types should be grouped and named humidifier disinfectant-related respiratory syndrome.…”

Section: Resultsmentioning

confidence: 99%

Health Effects Associated With Humidifier Disinfectant Use: A Systematic Review for Exploration

et al. 2022

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Background It has been 10 years since the outbreak of lung disease caused by humidifier disinfectants in Korea, but the health effects have not yet been summarized. Therefore, this study aims to systematically examine the health effects of humidifier disinfectants that have been discovered so far. Methods All literature with humidifier disinfectants and their representative components as the main words were collected based on the web, including PubMed, Research Information Sharing Service, and government publication reports. A total of 902 studies were searched, of which 196 were selected. They were divided into four groups: published human studies (group 1), published animal and cytotoxicology studies (group 2), technical reports (group 3), and gray literature (group 4). Results Out of the 196 studies, 97 (49.5%) were published in peer-reviewed journals as original research. Group 1 consisted of 49 articles (50.5%), while group 2 consisted of 48 articles (49.5%). Overall, respiratory diseases such as humidifier disinfectant associated lung injury, interstitial lung disease, and asthma have a clear correlation, but other effects such as liver, heart, thymus, thyroid, fetal growth, metabolic abnormalities, and eyes are observed in toxicological experimental studies, but have not yet been identified in epidemiologic studies. Conclusion The current level of evidence does not completely rule out the effects of humidifier disinfectants on extrapulmonary disease. Based on the toxicological evidence so far, it is required to monitor the population of humidifier disinfectant exposure continuously to see if similar damage occurs.

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“…Many people who use household humidifiers containing chemical-based disinfectants (HDs) in the Republic of Korea (Korea) have developed lung injury, including chemical-associated asthma, interstitial pneumonitis, and widespread lung fibrosis [ 1 , 2 , 3 , 4 ]. These casualties are confirmed to be associated with the use of HDs.…”

Section: Introductionmentioning

confidence: 99%

Characteristics of the Molecular Weight of Polyhexamethylene Guanidine (PHMG) Used as a Household Humidifier Disinfectant

et al. 2021

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(1) Background: Household humidifier disinfectant (HD) brands containing polyhexamethylene guanidine (PHMG) have been found to cause the most HD-associated lung injuries (HDLIs) in the Republic of Korea. Nevertheless, no study has attempted to characterize the potential association of the health effects, including HDLI, with the physicochemical properties of PHMG dissolved in different HD brands. This study aimed to characterize the molecular weight (MW) distribution, the number-average molecular weight (Mn), the weight-average molecular weight (Mw), and the structural types of PHMG used in HD products. (2) Methods: Quantitative measurements were made using matrix-assisted laser desorption/ionization–time-of-flight mass spectrometry (MALDI-TOF MS). The Mn, Mw, and MW distributions were compared among various HD products. (3) Results: The mean Mn and Mw were 542.4 g/mol (range: 403.0–692.2 g/mol) and 560.7 g/mol (range: 424.0–714.70 g/mol), respectively. The degree of PHMG oligomerization ranged from 3 to 7. The MW distribution of PHMG indicated oligomeric compounds regardless of the HD brands. (4) Conclusions: Based on the molecular weight distribution, the average molecular weight of PHMG, and the degree of polymerization, the PHMG collected from HDLI victims could be regarded as an oligomer. PHMG, as used in household humidifiers, should not be exempted from toxic chemical registration as a polymer. Further study is necessary to examine the association of PHMG oligomeric compounds and respiratory health effects, including HDLI.

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Different Characteristics of Childhood Asthma Related to Polyhexamethylene Guanidine Exposure

Cited by 10 publications

References 40 publications

Need for individual-based evaluation to determine the association between humidifier disinfectants and health injuries

Need for individual-based evaluation to determine the association between humidifier disinfectants and health injuries

Health Effects Associated With Humidifier Disinfectant Use: A Systematic Review for Exploration

Characteristics of the Molecular Weight of Polyhexamethylene Guanidine (PHMG) Used as a Household Humidifier Disinfectant

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