Dichlorophenol-containing pesticides and allergies: results from the US National Health and Nutrition Examination Survey 2005-2006

Published:October 02, 2012DOI:https://doi.org/10.1016/j.anai.2012.09.005



      Epidemiologic studies support the hypothesis that reduced microbial exposure in westernized societies promotes atopy. Dichlorophenols are widely used as pesticides and for chlorination of water. They have a strong bactericidal effect that could affect microflora in the environment. However, it is unknown whether their use is associated with a higher prevalence of allergies.


      To test the association between exposure to environmental pesticides represented by dichlorophenols and allergic sensitization measured by allergen-specific serum IgE levels in a US nationally representative sample of 2,211 persons 6 years and older in the National Health and Nutrition Examination Survey 2005-2006.


      Exposure to dichlorophenols was defined as high if their levels in urine were present at the 75th percentile and above. Association of the high exposure to dichlorophenols with sensitization to food and environmental allergens was assessed in logistic regression models after adjustment for sample weights and potential confounders.


      Sensitizations to 1 or more food allergens were more common in those with exposure to 2 dichlorophenol metabolites. After multivariable adjustment, urine dichlorophenol levels at the 75th percentile and above were associated with the presence of sensitization to foods (odds ratio, 1.8; 95% confidence interval, 1.2-2.5; P = .003). No significant association was found between dichlorophenol exposure and sensitization to aeroallergens alone.


      High urine levels of dichlorophenols are associated with the presence of sensitization to foods in a US population. Excessive use of dichlorophenols may contribute to the increasing incidence of food allergies in westernized societies.
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        • Eder W.
        • Ege M.J.
        • von Mutius E.
        The asthma epidemic.
        N Engl J Med. 2006; 355: 2226-2235
        • Umetsu D.T.
        • Dekruyff R.H.
        99th Dahlem conference on infection, inflammation and chronic inflammatory disorders: microbes, apoptosis and TIM-1 in the development of asthma.
        Clin Exp Immunol. 2010; 160: 125-129
        • von Mutius E.
        99th Dahlem conference on infection, inflammation and chronic inflammatory disorders: farm lifestyles and the hygiene hypothesis.
        Clin Exp Immunol. 2010; 160: 130-135
        • von Hertzen L.
        • Haahtela T.
        Disconnection of man and the soil: reason for the asthma and atopy epidemic?.
        J Allergy Clin Immunol. 2006; 117: 334-344
        • Toivola M.
        Personal Exposure to Micronbial Aerosols.
        University of Kuopio, Kuopio, Finland2004 (National Health Institute publication A13/2004)
      1. Demographics. 2009. http://www.epa.gov/agriculture/ag101/demographics.html. Accessed December 20, 2011.

      2. Industrial Farming vs. Sustainable Farming. 2011. http://www.epa.gov/agriculture/ag101/demographics.html. Accessed December 20, 2011.

        • Environmental Protection Agency
        The Incorporation of Water Treatment Effects on Pesticide Removal and Transfromations in Food Quality Protection Act (FQPA) Drinking Water Assessments: Science Policy.
        Environmental Protection Agency, Washington, DC2001
        • von Hertzen L.
        • Laatikainen T.
        • Pitkanen T.
        • et al.
        Microbial content of drinking water in Finnish and Russian Karelia: implications for atopy prevalence.
        Allergy. 2007; 62: 288-292
      3. Chemical Information. 2,4-Dichlorophenol. http://www.cdc.gov/exposurereport/data_tables/24D_ChemicalInformation.html. Accessed December 25, 2011.

      4. Chemical Information. Trichlorophenols. http://www.cdc.gov/exposurereport/data_tables/Trichlorophenols_ChemicalInformation.html. Accessed January 30, 2012.

      5. Chemical Information. 2,5-Dichlorophenol. http://www.cdc.gov/exposurereport/data_tables/25D_ChemicalInformation.html. Accessed February 19, 2012.

        • World Health Organization
        Chlorophenols in Drinking Water.
        World Health Organization, Geneva, Switzerland1996
        • Dodson R.E.
        • Houseman E.A.
        • Levy J.I.
        • Spengler J.D.
        • Shine J.P.
        • Bennett D.H.
        Measured and modeled personal exposures to and risks from volatile organic compounds.
        Environ Sci Technol. 2007; 41: 8498-8505
      6. Glossary of Classes of Non-persistent Pesticides. 2012. http://www.cdc.gov/nceh/clusters/fallon/#glossaries. Accessed February 19, 2012.

      7. US Census 2000 Urban and Rural Classification 2000. http://www.census.gov/geo/www/ua/ua_2k.html. Accessed March 27, 2012.

        • Sharief S.
        • Jariwala S.
        • Kumar J.
        • Muntner P.
        • Melamed M.L.
        Vitamin D levels and food and environmental allergies in the United States: results from the National Health and Nutrition Examination Survey 2005-2006.
        J Allergy Clin Immunol. 2011; 127: 1195-1202
        • Berns S.H.
        • Halm E.A.
        • Sampson H.A.
        • Sicherer S.H.
        • Busse P.J.
        • Wisnivesky J.P.
        Food allergy as a risk factor for asthma morbidity in adults.
        J Asthma. 2007; 44: 377-381
        • Liu A.H.
        • Jaramillo R.
        • Sicherer S.H.
        • et al.
        National prevalence and risk factors for food allergy and relationship to asthma: results from the National Health and Nutrition Examination Survey 2005-2006.
        J Allergy Clin Immunol. 2010; 126: 798-806
        • Barr D.B.
        • Wilder L.C.
        • Caudill S.P.
        • Gonzalez A.J.
        • Needham L.L.
        • Pirkle J.L.
        Urinary creatinine concentrations in the U.S. population: implications for urinary biologic monitoring measurements.
        Environ Health Perspect. 2005; 113: 192-200
        • Kalogeromitros D.
        • Makris M.P.
        • Chliva C.
        • et al.
        An internet survey on self-reported food allergy in Greece: clinical aspects and lack of appropriate medical consultation.
        J Eur Acad Dermatol Venerol. February 21, 2012; ([published online ahead of print])https://doi.org/10.1111/j.1468-3083.2012.04482.x
        • Asero R.
        • Antonicelli L.
        • Arena A.
        • et al.
        Causes of food-induced anaphylaxis in Italian adults: a multi-centre study.
        Int Arch Allergy Immunol. 2009; 150: 271-277
        • Sicherer S.H.
        • Munoz-Furlong A.
        • Sampson H.A.
        Prevalence of seafood allergy in the United States determined by a random telephone survey.
        J Allergy Clin Immunol. 2004; 114: 159-165
        • Hoppin J.A.
        • Umbach D.M.
        • London S.J.
        • et al.
        Pesticide use and adult-onset asthma among male farmers in the Agricultural Health Study.
        Eur Respir J. 2009; 34: 1296-1303
        • Chatzi L.
        • Alegakis A.
        • Tzanakis N.
        • Siafakas N.
        • Kogevinas M.
        • Lionis C.
        Association of allergic rhinitis with pesticide use among grape farmers in Crete, Greece.
        Occup Environ Med. 2007; 64: 417-421
        • Slager R.E.
        • Poole J.A.
        • LeVan T.D.
        • Sandler D.P.
        • Alavanja M.C.
        • Hoppin J.A.
        Rhinitis associated with pesticide exposure among commercial pesticide applicators in the Agricultural Health Study.
        Occup Environ Med. 2009; 66: 718-724
        • Salam M.
        • Li Y.
        • Langholz B.
        • Gilliland F.
        Early-life environmental risk factors for asthma: findings from the Children's Health Study.
        Environ Health Perspect. 2004; 112: 760-765
        • Dong W.
        • Gilmour M.I.
        • Lambert A.L.
        • Selgrade M.K.
        Enhanced allergic responses to house dust mite by oral exposure to carbaryl in rats.
        Toxicol Sci. 1998; 44: 63-69
        • Holt P.G.
        • van den Biggelaar A.H.
        99th Dahlem conference on infection, inflammation and chronic inflammatory disorders: the role of infections in allergy: atopic asthma as a paradigm.
        Clin Exp Immunol. 2010; 160: 22-26
        • Wold A.E.
        The hygiene hypothesis revised: is the rising frequency of allergy due to changes in the intestinal flora?.
        Allergy. 1998; 53: 20-25
        • Noverr M.C.
        • Noggle R.M.
        • Toews G.B.
        • Huffnagle G.B.
        Role of antibiotics and fungal microbiota in driving pulmonary allergic responses.
        Infect Immun. 2004; 72: 4996-5003
        • Bechold H.
        • Ehrlich P.
        Beziehungen zwischen chemischer Konstitution und Desinfektionswirkung.
        Z Physiol Chem. 1906; 47: 173-199
        • Jensen N.
        • Whitfield F.B.
        Role of Alicyclobacillus acidoterrestris in the development of a disinfectant taint in shelf-stable fruit juice.
        Lett Appl Microbiol. 2003; 36: 9-14
      8. 2,4-Dichlorophenol. 2012. http://toxmap.nlm.nih.gov/toxmap/main/chemPage.jsp?chem=2,4-Dichlorophenol. Accessed February 19, 2012.

      9. Regulatory Update - Products to be withdrawn from the market containing sodium chlorate. Health and Safety Executive, 2009. http://www.pesticides.gov.uk/guidance/industries/pesticides/topics/pesticide-approvals/eu/eu-reviews/regulatory-update-products-to-be-withdrawn-from-the-market-containing-sodium-chlorate. Accessed June 26, 2012.

        • Callaway T.R.
        • Anderson R.C.
        • Genovese K.J.
        • et al.
        Sodium chlorate supplementation reduces E. coli O157:H7 populations in cattle.
        J Anim Sci. 2002; 80: 1683-1689
        • Bjorksten B.
        • Naaber P.
        • Sepp E.
        • Mikelsaar M.
        The intestinal microflora in allergic Estonian and Swedish 2-year-old children.
        Clin Exp Allergy. 1999; 29: 342-346
        • Akinbami L.J.
        • Schoendorf K.C.
        Trends in childhood asthma: prevalence, health care utilization, and mortality.
        Pediatrics. 2002; 110: 315-322
        • Almqvist C.
        • Li Q.
        • Britton W.J.
        • et al.
        Early predictors for developing allergic disease and asthma: examining separate steps in the 'allergic march'.
        Clin Exp Allergy. 2007; 37: 1296-1302
        • Linneberg A.
        • Gislum M.
        • Johansen N.
        • Husemoen L.L.
        • Jorgensen T.
        Temporal trends of aeroallergen sensitization over twenty-five years.
        Clin Exp Allergy. 2007; 37: 1137-1142
        • Raukas-Kivioja A.
        • Raukas E.S.
        • Meren M.
        • Loit H.M.
        • Ronmark E.
        • Lundback B.
        Allergic sensitization to common airborne allergens among adults in Estonia.
        Int Arch Allergy Immunol. 2007; 142: 247-254
        • Sampson H.A.
        Utility of food-specific IgE concentrations in predicting symptomatic food allergy.
        J Allergy Clin Immunol. 2001; 107: 891-896
        • European Environment Agency
        Increasing environmental pollution load.
        in: The European Environment State and Outlook. European Environment Agency, Copenhagen, Denmark2010
        • Branum A.M.
        • Lukacs S.L.
        Food allergy among children in the United States.
        Pediatrics. 2009; 124: 1549-1555