Background: Emerging research suggests health effects in offspring after parental chemical exposures before conception. Many future mothers are exposed to potent chemicals at work, but potential offspring health effects are hardly investigated. Objective: We sought to investigate childhood asthma in relation to mother's occupational exposure to cleaning products and disinfectants before conception. Methods: The multicenter Respiratory Health In Northern Europe/Respiratory Health In Northern Europe, Spain and Australia generation study investigated asthma and wheeze starting at age less than 10 years in 3318 mother-offspring pairs. From an asthma-specific Job-Exposure Matrix and mothers' occupational history, we defined maternal occupational exposure to indoor cleaning agents (cleaning products/ detergents and disinfectants) starting before conception, in the 2-year period around conception and pregnancy, or after birth. Never-employed mothers were excluded. Exposed groups include cleaners, health care workers, cooks, and so forth. Associations were analyzed using mixed-effects logistic regression and ordinary logistic regression with clustered robust SEs and adjustment for maternal education. Results: Maternal occupational exposure to indoor cleaning starting preconception and continuing (n 5 610) was associated with offspring's childhood asthma: odds ratio 1.56 (95% CI, 1.05-2.31), childhood asthma with nasal allergies: 1.77 (1.13-2.77), and childhood wheeze and/or asthma: 1.71 (95% CI, 1.19-2.44). Exposure starting around conception and pregnancy (n 5 77) was associated with increased childhood wheeze and/or asthma: 2.25 (95% CI, 1.03-4.91). Exposure starting after birth was not associated with asthma outcomes (1.13 [95% CI, 0.71-1.80], 1.15 [95% CI, 0.67-1.97], 1.08 [95% CI, 0.69-1.67]). Conclusions: Mother's occupational exposure to indoor cleaning agents starting before conception, or around conception and pregnancy, was associated with more childhood asthma and wheeze in offspring. Considering potential implications for vast numbers of women in childbearing age using cleaning agents, and their children, further research is imperative. (J Allergy Clin Immunol 2021;nnn:nnn-nnn.)

Background While direct effects of occupational exposures on an individual’s respiratory health are evident, a new paradigm is emerging on the possible effects of pre-conception occupational exposure on respiratory health in offspring. We aimed to study the association between parental occupational exposure starting before conception and asthma in their offspring (at 0–15 years of age). Methods We studied 3985 offspring participating in the Respiratory Health in Northern Europe, Spain and Australia (RHINESSA) generation study. Their mothers or fathers (n = 2931) previously participated in the European Community Respiratory Health Survey (ECRHS). Information was obtained from questionnaires on parental job history pre- and post-conception which was linked to an asthma-specific job-exposure matrix (JEM). We assessed the association between parental occupational exposure and offspring asthma, applying logistic regression models, clustered by family and adjusted for study centre, offspring sex, parental characteristics (age, asthma onset, place of upbringing, smoking) and grandparents’ level of education. Results Parental occupational exposure to microorganisms, pesticides, allergens or reactive chemicals pre-conception or both pre- and post-conception was not related to offspring asthma; in general, subgroup analyses confirmed this result. However, maternal exposure both pre- and post-conception to allergens and reactive chemicals was associated with increased odds for early-onset asthma in offspring (0–3 years of age); odds ratio 1.70 (95% CI: 1.02–2.84) and 1.65 (95% CI: 0.98–2.77), respectively. Conclusions This study did not find evidence that parental occupational exposure, defined by an asthma JEM before conception only or during pre- and post-conception vs non-exposed, was associated with offspring asthma.

Although there was a downward trend in SHCs among exposed workers in the follow-up period, they reported more subjective neurological complaints than controls. Symptoms may be mediated by perceived pollution and health risk perception, and adaptation or anxiety may cause a chronic effect, manifested by a dysfunctional and persistent neuropsychological response.

Foul-smelling environmental pollution was a major concern following a chemical workplace explosion. Malodorous pollution has previously been associated with aggravated physical and psychological health, and in persons affected by a trauma, an incidence-related odour can act as a traumatic reminder. Olfaction may even be of significance in the development and persistence of post-traumatic stress symptoms (PTSS). The present longitudinal study assessed whether perceived smell related to malodorous environmental pollution in the aftermath of the explosion was a determinant of subjective health complaints (SHC) and PTSS among gainfully employed adults, when the malodorous pollution was present, and after pollution clean-up. Questionnaire data from validated instruments were analysed using mixed effects models. Individual odour scores were computed, and the participants (n=486) were divided into high and low odour score groups, respectively. Participants in the high odour score group (n=233) reported more SHC and PTSS than those in the low odour score group (n=253), before and even after the pollution was eliminated. These associations lasted for at least three years after the pollution was removed, and might indicate that prompt clean-up is important to avoid persistent health effects after malodorous chemical spills.

Health in the aftermath of a malodorous chemical explosionSubjective health complaints and post-traumatic stress symptoms among workers My midway evaluators, Ole Jakob Møllerløkken and Randi Jacobsen Bertelsen, also deserve credits; pointing out possible new aims and methods for the third paper included in the thesis. Meanwhile the unpleasant smell was continuously present in the area. AimsThe main aim of this thesis was to study long-term health effects among workers in the aftermath of a chemical explosion that emitted malodorous sulphurous compounds.The first objective was to assess whether employees in the industrial area and cleanup workers had more subjective health complaints than controls one and a half years after the oil tank explosion. The second objective was to assess whether the subjective health complaints in this group declined over a four-year period following the explosion. The third objective was to investigate whether perceived smell related to the malodorous environmental pollution was a determinant of subjective health complaints and post-traumatic stress symptoms among employed adults, when the malodorous pollution was present at the explosion site, and after pollution clean-up. Material and methodsOne and a half years after the accident, all residents living within six km to the explosion site and the whole population working in the industrial harbor area or participating in the firefighting or clean-up operation were invited to participate in a health survey including a questionnaire and a clinical examination. Inhabitants, matched by gender and age to the working population and the residents, and living 9 20-30 km away from the explosion site, were invited as controls. Of the total 1016 persons who were invited, 734 persons decided to participate (response rate 72 %).This thesis is based on sub-populations from this study.From the main cohort, the employees in the industrial area, the clean-up workers and controls were included in a cross sectional study using the Subjective HealthComplaints Inventory (SHC) in 2008. Similar data were obtained in 2012, and were analysed by a linear mixed effects model in a longitudinal study.Next, all employed adults from the main cohort were divided into high and low odour score groups based on an individual odour score that was computed as the percentage of months each participant had noticed the specific incident-related odour.Questionnaire data from the Subjective Health Complaints Inventory (SHC) and the Impact of Event Scale-Revised (IES-R), both validated instruments, were analysed using a mixed effects model in a longitudinal study involving data from when the malodorous pollution was present until three years after pollution clean-up (2008, 2010 and 2012, respectively). ResultsEmployees in the industrial area and clean-up workers reported significantly more subjective health complaints, particularly neurological symptoms, compared to controls in 2008. In the longitudinal study, subjective health complaints among employees in the industrial ar...

Emerging research suggests environmental exposures before conception may adversely affect allergies and lung diseases in future generations. Most studies are limited as they have focused on single exposures, not considering that these diseases have a multifactorial origin in which environmental and lifestyle factors are likely to interact. Traditional exposure assessment methods fail to capture the interactions among environmental exposures and their impact on fundamental biological processes, as well as individual and temporal factors. A valid estimation of exposure preconception is difficult since the human reproductive cycle spans decades and the access to germ cells is limited. The exposome is defined as the cumulative measure of external exposures on an organism (external exposome), and the associated biological responses (endogenous exposome) throughout the lifespan, from conception and onwards. An exposome approach implies a targeted or agnostic analysis of the concurrent and temporal multiple exposures, and may, together with recent technological advances, improve the assessment of the environmental contributors to health and disease. This review describes the current knowledge on preconception environmental exposures as related to respiratory health outcomes in offspring. We discuss the usefulness and feasibility of using an exposome approach in this research, advocating for the preconception exposure window to become included in the exposome concept.

Workers in the fish processing industry have increased risk of developing respiratory diseases due to occupational exposure to bioaerosols and related allergens [1–4]. The literature reports more occupational asthma in workers handling salmon [2, 5], and an exposure–response relationship between total protein exposure and cross-shift changes in forced expiratory volume in 1 s (FEV1) and lower respiratory tract symptoms [6]. To our knowledge, there are no published reports on hypersensitivity pneumonitis from this industry. Hypersensitivity pneumonitis is a complex disease for which there are no generally accepted diagnostic criteria, particularly at earlier stages of the disease. We present the case of a fish processing worker diagnosed with hypersensitivity pneumonitis caused by proteins from salmon, in which the aetiology was established using specific inhalation challenge (SIC) as a diagnostic tool.

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