New York State (NYS) employees who responded to the World Trade Center (WTC) disaster on or after 11 September 2001 potentially experienced exposures that might have caused persistent respiratory effects. NYS responders represent a more moderately exposed population than typical first responders. 

To assess whether NYS employees who were WTC responders were more likely than controls to report lower respiratory symptoms (LRS) or a diagnosis of asthma 5 years post-9/11, persistence and severity of symptoms were also evaluated. 

Participants were initially mailed self-administered questionnaires (initial, Year 1, Year 2) and then completed a telephone interview in Year 3. Data were analysed using Poisson’s regression models. 

WTC exposure was associated with LRS, including cough symptoms suggestive of chronic bronchitis, 5 years post-9/11. When exposure was characterized using an exposure assessment method, the magnitude of effect was greater in those with exposure scores above the mean. WTC exposure was associated with persistence of LRS over the 3 year study period. Results also suggest that participants with the highest exposures were more likely to experience increased severity of their asthma condition and/or LRS. 

The findings suggest that even in a moderately exposed responder population, lower respiratory effects were a persistent problem 5 years post-9/11, indicating that some WTC responders require ongoing monitoring.  

Literature: Mauer MP, Cummings KR, Hoen R., Long-term respiratory symptoms in World Trade Center responders, Bureau of Occupational Health, Center for Environmental Health, New York State Department of Health, Occup Med (Lond). 2009 Dec 24.

The prevalence of allergic diseases such as asthma and pollinosis is steadily increasing and seems to be associated with modern lifestyle. Therefore, it has been hypothesized that high living standards and hygienic conditions reduce exposure to microbial components, and lead to an imbalance in the immune system, especially in the Thl and Th2 system, which increases the risk for the development of allergic diseases.

However, recent accumulated epidemiological evidences have demonstrated that air pollutants including diesel exhaust particulate (DEP) and NO2 are responsible for the increased prevalence of allergies. The effects of environmental chemicals have also been supported by the in vivo and in vitro studies. It is important to prevent allergy development in our life as early as possible (e.g., since our infancy). 

Reference: Nakamura H, Hitomi Y., Environmental factors in allergic diseases, Kanazawa University, Nippon Rinsho. 2009 Nov;67(11):2043-7.

The study described was initiated by the Israel Ministry of Health as an effort to respond to and deal with public concern about possible health disorders related to odorous emissions (composed of a great many of organic and inorganic chemicals) from the regional industrial park (IP) in the Negev, southern Israel. Previous ecological studies found that adverse health effects in the Negev Bedouin population were associated with residential proximity to the IP. The objective of the current study was to investigate a hypothesis concerning the link between the IP proximity and life prevalence (LP) of upper respiratory tract chronic diseases (URTCD) and asthma in children aged 0-14 years living in rural Negev, Israel, in small agricultural communities.  

The cross-sectional study was conducted in 7 localities simultaneously during 2002. The following indirect exposure indicators were used: (1) distance (less than 20 km/ more than 20 km) from the IP (‘distance’); (2) presence (yes/no) of the dominant wind direction being from the IP toward a child’s locality (‘wind direction’); and (3) the child’s mother having made odour complaints (yes/no) related to the IP (‘odour complaints’). A 20 km cut-off point was used for ‘distance’ dichotomization as derived from the maximum range of ‘odour complaints’. This gave 3 proximal and 4 distant localities, and division of these by the ‘wind direction’ gave one versus two localities. The study population consisted of 550 children born in the localities. Medical diagnoses were collected from local clinic records. The following were included in the interviewer-administered questionnaire for a child’s parents: (1) demography (the child’s birth date, gender, mother being married or not, parental origin and education, number of siblings); (2) the child’s birth history (pregnancy and delivery) and breast-feeding duration; (3) the child’s parental respiratory health; and (4) environmental factors (parental smoking and occupational hazardous exposure, domestic use of pesticides, domestic animals, outdoor odour related to the IP emissions). For statistical analysis, Pearson’s chi(2), t-tests and multivariate logistic regressions were used, as well as adjusted odds ratios (OR) within a 95% confidence interval.  

The multivariate analysis showed that increased LP of URTCD in children of proximal localities was statistically significant when associated with odour complaints (OR = 3.76 [1.16, 12.23]). In proximal localities, LP of URTCD was higher (at borderline level statistical insignificance p = 0.06) than in distant localities (OR = 2.31 [0.96, 5.55]). The following factors were found to be related to the excess of the LP of URTCD: (1) father’s lower education (by distance: OR = 2.62 [1.23, 5.57]; by wind direction: OR = 4.07 [1.65, 10.03]); (2) in-vitro fertilization (by distance: OR = 3.03 [1.17, 7.87]; by wind direction: OR = 4.34 [1.48, 12.72]). In proximal localities, the increase in asthma LP was associated with: (1) wind direction (OR = 1.95 [1.01, 3.76]); (2) a child’s male gender (OR = 2.95 [1.48, 5.87]); and (3) a child’s mother’s having had an acute infectious disease during pregnancy (OR = 4.84 [1.33, 17.63]).  

An increased LP of chronic respiratory morbidity among children living in small agricultural localities in the Negev was found to be associated with indirect measurements of exposure (distance, wind direction and odour complaints) to IP emissions. These results, in conjunction with previously reported findings in the Negev Bedouin population, indicate a need for environmental protection measures, and monitoring of air pollution and the health of the rural population. 

Reference: Karakis I, Kordysh E, Lahav T, Bolotin A, Glazer Y, Vardi H, Belmaker I, Sarov B., Life prevalence of upper respiratory tract diseases and asthma among children residing in rural area near a regional industrial park: cross-sectional study, School of Public Health, University of Haifa, Haifa, Israel. Rural Remote Health. 2009 Jul-Sep;9(3):1092 

A recent paper on sauna therapy by Dr. Martin L. Pall argues for a novel mechanism for its mode of action (1). Pall argues that sauna therapy acts primarily by increasing the availability of a compound called tetrahydrobiopterin (BH4) in the body. BH4 is reported or thought to be depleted in a number of medical conditions that are also reported to respond positively to sauna therapy, including multiple chemical sensitivity, fibromyalgia, chronic fatigue syndrome, hypertension, vascular endothelial dysfunction and heart failure. This pattern of action can be explained, therefore, if sauna therapy increases the availability in the body of BH4.

Pall argues for two distinct mechanisms by which sauna therapy is expected to increase availability of BH4. Both of these act by increasing the synthesis of an enzyme, known as GTP cyclohydolase I, the rate limiting enzyme in the biosynthesis of BH4.

Sauna therapy is known to produce large increases in blood flow in the outer heated parts of the body and the consequent increase in vascular shear stress has been shown to induce large increases in GTP cyclohydrolase I activity and consequent increases in BH4.

A second such mechanism is mediated through the action of the heat shock protein, Hsp90, a protein known to be induced by modest tissue heating and a protein that is recruited into a complex of proteins containing GTP cyclohydrolase I. The Hsp90 protein lowers the proteolytic degradation of GTP cyclohydrolase I protein, leading to increased BH4 synthesis and this has been shown to lower, in turn, the partial uncoupling of the eNOS nitric oxide synthase. Increases in BH4 synthesis in response to both of these two mechanisms may be expected to feed BH4 to various tissues in the body including those not directly impacted by sauna therapy.

The health benefits of vigorous exercise may also be mediated, in part, via these same mechanisms.

A number of additional diseases are reported to involved BH4 depletion including Alzheimer’s, Parkinson’s, asthma, schizophrenia, bipolar disorder, pulmonary hypertension and type 2 diabetes so that each of these may respond to sauna therapy, as well.

It has been commonly assumed that the response of MCS cases to sauna therapy is mediated by a detoxification process known as depuration. There is some published evidence that some increase in detoxification does occur in response to sauna therapy. However the main influence of sauna therapy on MCS cases and certainly in these other medical conditions may well be through increased BH4 availability.

Reference: 1. Pall ML. 2009 Do sauna therapy and exercise act by raising the availability of tetrahydrobiopterin? Med Hypotheses. 2009 Jul 4.