Is Swimming Pool Chlorine Fueling the Allergy Epidemic?

Only this morning, I saw a patient who had wheezing after swimming both indoors and outdoors.  This is a timely article.

Is swimming pool chlorine fueling the allergy epidemic?

By Megan Brooks Mon Sep 14, 10:15 am ET

NEW YORK (Reuters Health) – Swimming in a chlorinated pool may boost the odds that a child susceptible to asthma and allergies will develop these problems, a study released today indicates.

"These new data clearly show that by irritating the airways of swimmers chlorination products in water and air of swimming pools exert a strong additive effect on the development of asthma and respiratory allergies such as hay fever and allergic rhinitis," Dr. Alfred Bernard, a toxicologist at the Catholic University of Louvain in Brussels, Belgium, noted in an email to Reuters Health.

"The impact of these chemicals on the respiratory health of children and adolescents appears to be much more important -- at least by a factor of five -- than that associated with secondhand smoke," Bernard noted.

Taken together with his team's prior studies, he added, "There is little doubt that pool chlorine is an important factor implicated in the epidemic of allergic diseases affecting the westernized world."

In the current study, Bernard and colleagues compared the health of 733 adolescents, 13 to 18 years old, who swam in chlorinated outdoor and indoor pools for various amounts of time with that of 114 "control" adolescents who swam mostly in pools sanitized with a concentration of copper and silver.

In children with allergic sensitivities, swimming in chlorinated pools significantly increased the likelihood of asthma and respiratory allergies, the researchers report in the journal Pediatrics.

Among "sensitive" adolescents, the odds for hay fever were between 3.3- and 6.6-fold higher in those who swam in chlorinated pools for greater than 100 hours and the odds of allergic rhinitis were increased 2.2- to 3.5-fold among those who logged more than 1000 hours of chlorinated pool time.

For example, among children and teens who swam in chlorinated pools for 100-500 lifetime hours, 22 children out of 369 (6.0%) had current asthma, compared with those who had spent less than 100 hours (2 of 144, 1.8%). The proportions with asthma rose with longer exposure, to 14 out of 221 (6.4%) who had been swimming for 500-1000 hours, and 17 out of 143 (11.9%) who swam for more than 1000 hours.

The risk of asthma and allergy was not influenced by swimming in copper-silver sanitized pools and children without allergic tendencies were not at increased risk of developing allergies.

"The only plausible explanation" for these observations, the researchers argue, is that the chlorine-based toxic chemicals in the water or hovering in the air at the pool surface cause changes in the airway and promote the development of allergic diseases.

"It is probably not by chance," Bernard told Reuters Health, "that countries with the highest prevalence of asthma and respiratory allergies are also those where swimming pools are the most popular."

The current findings, he and colleagues conclude, "reinforce" the need for further study on the issue and to enforce regulations concerning the levels of these chemicals in water and air of swimming pools.

SOURCE: Pediatrics, October 2009.

It must be Allergy...

At some point I should post an Allergy 101, or point to some good descriptions of what is and what isn't allergy. Many of my patients interpret vague or continuous symptoms that they can't pinpoint as allergy. So the "cold that never goes away" could be an allergy to something that is around in the environment for a long period of time, such as mold or dust mite, but could equally well be a chronic sinus infection, nasal polyps, or the result of a deviated nasal septum (the bone dividing the nostril being crooked) or even the reflux of acid from the stomach up to the upper airway. I'll write more about all of these later. Another common complaint is "I"m tired all the time. I must be allergic to something in the air." That's when I need to be a detective and think about all the causes of fatigue...from thyroid disease to anemia and even depression. Yes, and also allergy, becuse having even just hay fever, or seasonal allergies can wipe you out. Reactions to foods are also commonly blamed on allergy. That's a complicated issue I will tackle separately.

About me

If you are going to be reading my blog, you should know something of my background. I am currently in the private practice of allergy and immunology in Somerville, NJ. I am associated with David Bortniker MD who is an experienced otolaryngologist, head and neck surgeon. David's well-established practice - Ear Nose & Throat Care PC is now "Ear Nose & Throat Care PC & Allergy". We are both affiliated with Somerset Medical Center. Our website is www.entcarepc.com.

For the last 16 years I have been conducting patient care and teaching at UMDNJ - New Jersey Medical School, in Newark NJ. I am a member of the voluntary teaching faculty and currently hold the title of Clinical Professor of Medicine in the Department of Medicine, Division of Allergy and Immunology. During the same period of time, I worked for several pharmaceutical companies, conducting either clinical research or supporting medical affairs for allergy and other products. My most recent position, up until 2008, was with the McNeil Division of Johnson & Johnson, where I was Senior Director of Medical Affairs. One of my responsibilities was helping get the antihistamine Zyrtec converted from prescription to over-the-counter marketing. Earlier, I was working in academic medicine full-time at Saint Louis University School of Medicine, in St. Louis, Missouri. I left there as Associate Professor of Medicine and Assistant Professor of Otolaryngology. I trained in allergy and immunology at the National Institute of Allergy and Infectious Diseases (NIAID) at the National Institutes of Health, in Bethesda, Maryland.

Professionally, I am a member of the rhinosinusitis committee of the American Academy of Allergy, Asthma and Immunology (AAAAI), and the respiratory diseases committee of the American College of Allergy, Asthma and Immunology (ACAAI). I will be writing more about these professional organizations later.

Welcome to my Blog!

Hi! I'm Dr. Howard Druce and I have started this blog for my patients, friends, and all those interested in allergy. In this blog you will read about allergy, my medical practice, and a little bit about me and my interests. It's an opportunity to express my opinions in an informal way, get some feedback and perhaps start some new thoughts on allergy and its treatment. So first, two disclaimers! This is not a substitute for medical advice, so I can't be specific on this blog. If you are interested in becoming a patient, I will post links to the practice website later. Second, I am no longer affiliated with any pharmaceutical company, so the views expressed are purely my own.