Franke K, Vincent M, Rogers S, Rivera B, Wikoff D. Assessment of non-occupational exposures to cleaning products and the incidence of asthma and respiratory disease. Abstract 3393, Society of Toxicology Annual Meeting, Salt Lake City, UT, March 2024.
Abstract
Background and Purpose: Assessments of exposures to cleaning products and respiratory health outcomes, particularly asthma, have largely focused on occupational cleaners and hospital workers with cleaning duties. Results from these studies are not generalizable to non-worker populations, as both the frequency and tasks, and often the cleaning products used, are not representative of household cleaning or use of cleaning products in schools and other public locations that may involve children and other potentially vulnerable populations. The objective herein was to systematically assess the existing body of literature evaluating non-occupational exposures to cleaning products and the incidence of asthma and respiratory disease. Methods: The assessment was carried out using systematic mapping methods. Following the a priori development of a protocol, a systematic literature search was conducted using PubMed and Embase; DistillerSR was used to facilitate the review. References were screened against inclusion criteria based on the PECO statement, defined as P: any population (later refined to non-occupational cleaners); E: exposure to or use of cleaning products or agents (not individual chemicals); C: lower or no exposure to or use of cleaning products or agents; and O: respiratory disease or measures of sensitivity or irritation. At the title and abstract level, references were screened using a combination of human review and DistillerSR Automated Reviewer. Studies characterized as “general population” studies were reviewed at full-text (FT) review and data extracted. Results from screening and data extraction were mapped and examined for trends, limitations, and research opportunities. Results: The systematic literature search resulted in identification of 86 publications that involved non-occupational population exposures: 5 studies provided supporting evidence via animal or in vitro data, including one guideline (ASTM-E-981) study on respiratory toxicity of fabric softener emissions in mice that reported irritation following inhalation exposure. The remaining studies were epidemiological, and all but one were observational in design. Across the epidemiology studies, exposure assessment methods varied widely, including ever/never, frequency of use, and various cleaning patterns; and exposure information was exclusively self-reported except for a single controlled consumer trial of a laundry product. No epidemiology studies were identified that quantitatively measured specific exposures during cleaning. Only 22 of the FT studies contained odds ratios or adjusted odds ratios; another five presented other risk estimates. Risk estimates were mixed, and most associations were not statistically significant or of low magnitude (between 1 and 2-fold with confidence intervals closely approaching the null); of those that were, the majority were attributed to general “cleaning products,” scented products, and sprays. Conclusions: This systematic literature review and mapping characterizes the evidence on non-occupational exposures to cleaning products and respiratory outcomes. Mapping of individual study attributes allowed for identification of aspects important to further assess. Most notably, confidence in the reliability of study findings is limited by the lack of confidence in exposure characterization and inability to differentiate whether the reported outcomes are specific to product use scenarios, or additional environmental factors that may result in uncontrolled confounding or residual biases. Supporting animal and in vitro data is limited by the small number of studies utilizing cleaning products, as opposed to specific chemicals, as the exposure substance. A subsequent critical study appraisal and body of evidence evaluation using techniques to address residual bias would enable more precise evaluation of existing evidence for non-occupational exposures.