Abstract
BackgroundThe occurrence of numerous cases of interstitial lung disease in children (chILD) every spring in Korea starting in 2006 raised suspicion about a causal relationship with the use of humidifier disinfectants (HDs). The aim of this study was to evaluate the association between HD use and the risk of chILD.MethodsThis retrospective, 1∶3 matched case-control study consisted of 16 cases of chILD that had developed between 2010 and 2011. The three groups of parallel controls (patients with acute lobar pneumonia, asthma, and healthy children) were matched by age, gender, and index date. Indoor/outdoor environmental risk factors, including HD use, were investigated by asking the guardians to complete a questionnaire.ResultsThe median age of the affected children (43.8% male) was 26 months (18.25–36.25). The chILD group did not differ significantly from the control groups with respect to socio-demographic and clinical variables. Indoor and outdoor environmental factors were not associated with a risk of chILD. However, the previous use of HDs (OR; 2.73. 95% CI; 1.41–5.90, P = 0.00) were independently associated with an increased risk.ConclusionsThis study showed that HDs, which are widely used in South Korea in the winter season, independently increased the risk of chILD in spring. Therefore, continuous monitoring and, if needed, changes in policy are essential to prevent and control pediatric diseases caused by toxic chemicals.
Highlights
Children’s interstitial lung disease refers to a diverse spectrum of rare and diffuse lung pathologies that are associated with high morbidity and mortality. [1] Various causes of chILD including infection, environmental agents, radiation, medications, genetic predisposition, metabolic storage diseases, and autoimmune diseases have been identified
While the rapid progression and radiological findings were similar to what is seen in hypersensitivity pneumonitis, the pathological findings and clinical course were quite different
The cause was suspected to be either an inflammatory process interacting with an altered immune response against an appropriate genetic background, or as-yet unidentified environmental factors which the household members were evenly exposed at the same time, in winter
Summary
Children’s interstitial lung disease (chILD) refers to a diverse spectrum of rare and diffuse lung pathologies that are associated with high morbidity and mortality. [1] Various causes of chILD including infection, environmental agents, radiation, medications, genetic predisposition, metabolic storage diseases, and autoimmune diseases have been identified. [3] Briefly, these cases were the young children and parents of two families who coincidentally developed the disease in spring. In each of these cases, the same clinico-radiologic-pathological findings were noted, including a clinically rapid progression to respiratory failure. While the rapid progression and radiological findings were similar to what is seen in hypersensitivity pneumonitis, the pathological findings and clinical course (poor response to the treatment and a poor prognosis) were quite different. The occurrence of numerous cases of interstitial lung disease in children (chILD) every spring in Korea starting in 2006 raised suspicion about a causal relationship with the use of humidifier disinfectants (HDs). The aim of this study was to evaluate the association between HD use and the risk of chILD
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