There are more than 82,000 chemicals used commercially in the United States, of which over 2,500 are considered high volume production chemicals- meaning that they are produced or imported into the U.S. in quantities of at least 1 million pounds or 500 tons per year. Less than 200 of these chemicals have been tested to ensure safety. Studies have documented that industrial chemicals and toxic metals accumulate in human tissue through air, water, and dietary exposure routes. Levels of these toxicants can be found in newborns, children, and non-occupationally exposed adults and are either causal for or related to morbidity and mortality from cardiovascular disease, diabetes, obesity, and autoimmune disease. Recently epidemiologic evidence points to environmental toxicant exposure as a cause of both compromised immune defense and induction of autoimmunity.

The following toxicants (found in 75-100% of representative samples of the US population) have significant effects on the gut microbiome and/or immune response:

• Triclosan (found in clothing, personal care products, cutting boards, blankets, food storage containers)

• Pesticides (dietary origin or exposure related to outdoor and indoor use)

• Perfluorinates (non-stick/non-stain compounds)

• PCBs (polychlorinated biphenyls)- found in fish, butter, meat and indoor and outdoor air 

Epidemiologic evidence shows that in high income countries infectious diseases, in particular lower respiratory tract infections, remain among the top five causes of death. Evidence for the effects of cigarette smoke and dioxin-like compounds, show that developmental exposures to these toxicants critically impact the immune system. Several studies have suggested that environmental pollutants, such as pesticides, air pollution and cigarette smoke contribute to poorer clinical outcomes after infection. And as an example of a commonly unknown and ignored cause of illness by physicians, exposure to technical chlordane still occurring through vaporization in home environments, has been show to significantly effect T and B cell activation and increase risk for autoimmunity. There are potentially 52 million people in the US at risk for disease related to this exposure, according to the Agency for Toxic Substances and Disease Registry. There is a significant relationship between toxins and immune function- toxins dysregulate the immune system making it less capable of vigilant responses against invaders and more likely to respond inappropriately to a toxic exposure or a viral challenge. Therefore, toxic load must be addressed in order to achieve optimal immune function. This activity is designed to increase healthcare provider’s awareness of the adverse health effects of immunotoxic chemicals and the provider’s ability to use laboratory methods for assessing immune toxicant exposure. As well, learners will become familiar with the evidence that exists regarding published avoidance strategies designed to minimize specific toxicant exposures and interventions designed to address the immunotoxicity of these compounds- the goal being improved outcomes through toxicant evaluation and medical intervention. At the conclusion of this course, attendees will be able to identify, diagnose, and treat conditions that are associated with immune toxicant chemical exposure.

Learning Objectives:

1. Identify exposure sources of immunotoxic chemicals in patient’s environment
2. Identify the pathologic effects on human immunity and risk for infection related to pesticide, polychlorinated biphenyls, toxicant metals, mold and mycotoxin exposure
3. Review strategies and resources for avoidance of exposure to pesticides, polychlorinated biphenyls, toxicant metals, mold and mycotoxins