Rhinitis was the most frequently diagnosed disorder among users of humidifier disinfectants (HDs). The aim of our study was to investigate on the relationship between allergic rhinitis (AR) and HD uses.
Our study used the data from the eighth Panel Study on Korean Children; a total of 1,540 participants were enrolled. The χ2 test and multiple logistic regression analyses were conducted to debunk the association between AR and HD uses.
In our analysis, odds ratios (ORs) of doctor-diagnosed AR increased significantly when simply the response of whether HDs were used in the past was considered. When the brands of HD were considered, ORs of doctor-diagnosed AR were found to be increased significantly for those who have used polyhexamethylene guanidine phosphate/oligo(2-[2-ethoxy]-ethoxyethyl)guanidinium-containing HDs (model 3: 1.41, 95% confidence interval [CI]: 1.02–1.95). However, once duration of usage was additionally considered, ORs of doctor-diagnosed AR increased significantly only for those who have used chloromethylisothiazolinone/methylisothiazolinone-containing HDs for more than or equal to 3 months (model 3: 2.08, 95% CI: 1.17–3.69). Further, past use of HD was associated with significantly increased ORs of AR diagnosed before 2013 (model 3: 1.35, 95% CI: 1.02–1.79).
Results of our study suggest that past uses of HDs may be associated with an increased risk of AR.
Flow chart of the selection of study subjects. PSKC: Panel Study on Korean Children; AR: allergic rhinitis; HD: humidifier disinfectant.
Socioeconomic characteristics of the subjects
Characteristics | Category | All subjects (n = 1,540) | Have ever used HD (n = 409) | Have never used HD (n = 1,131) | |
---|---|---|---|---|---|
Sex | Male | 791 (51.4) | 210 (51.3) | 581 (51.4) | 0.993 |
Female | 749 (48.6) | 199 (48.7) | 550 (48.6) | ||
Maternal occupation | White-collar | 466 (31.0) | 130 (32.4) | 336 (30.5) | 0.484 |
Blue-collar | 190 (12.6) | 55 (13.7) | 135 (12.2) | ||
Student/housewife | 847 (56.4) | 216 (53.9) | 631 (57.3) | ||
Paternal occupation | White-collar | 694 (49.3) | 197 (53.1) | 497 (47.9) | 0.216 |
Blue-collar | 626 (44.5) | 154 (41.5) | 472 (45.5) | ||
Student/unemployed | 88 (6.2) | 20 (5.4) | 68 (6.6) | ||
Maternal education | Bachelor's degree or more | 444 (29.0) | 110 (26.9) | 334 (29.7) | 0.498 |
Junior college graduate | 421 (27.5) | 119 (29.1) | 302 (26.9) | ||
High school graduate or less | 667 (43.5) | 180 (44.0) | 487 (43.4) | ||
Paternal education | Bachelor's degree or more | 399 (26.4) | 96 (23.8) | 303 (27.3) | 0.393 |
Junior college graduate | 304 (20.3) | 85 (21.1) | 222 (20.2) | ||
High school graduate or less | 806 (53.3) | 222 (55.1) | 584 (52.7) | ||
Household income distribution | I (highest) | 121 (7.9) | 33 (8.2) | 88 (7.8) | 0.717 |
II | 531 (34.9) | 140 (34.8) | 391 (34.9) | ||
III | 513 (33.7) | 143 (35.6) | 370 (33.0) | ||
IV | 327 (21.5) | 77 (19.2) | 250 (22.3) | ||
V (lowest) | 31 (2.0) | 9 (2.2) | 22 (2.0) |
Values are presented as number (%). Analyzed by χ2test. HD: humidifier disinfectant.
Characteristics regarding allergic disorders and relevant environmental exposures of the subjects
Characteristics | Category | All subjects (n = 1,540) | Have ever used HD (n = 409) | Have never used HD (n = 1,131) | |
---|---|---|---|---|---|
Visible mold spots at the residence | No | 1,019 (66.8) | 271 (66.9) | 748 (66.8) | 0.963 |
Yes | 506 (33.2) | 134 (33.1) | 372 (33.2) | ||
Passive smoking | No | 942 (61.2) | 279 (68.2) | 663 (58.6) | 0.001 |
Yes | 598 (38.8) | 130 (31.8) | 468 (41.4) | ||
Parents' AR | No | 749 (48.6) | 179 (43.8) | 570 (50.4) | 0.022 |
Yes | 791 (51.4) | 230 (56.2) | 561 (49.6) | ||
Presence of pet cats or dogs | No | 1,401 (91.6) | 374 (91.7) | 1,027 (91.6) | 0.974 |
Yes | 128 (8.4) | 34 (8.3) | 94 (8.4) | ||
Doctor-diagnosed asthma | No | 1,447 (94.1) | 378 (92.7) | 1,069 (94.7) | 0.133 |
Yes | 90 (5.9) | 30 (7.3) | 60 (5.3) | ||
Doctor-diagnosed AD | No | 1227 (79.7) | 317 (77.5) | 910 (80.5) | 0.203 |
Yes | 313 (20.3) | 92 (22.5) | 221 (19.5) | ||
Doctor-diagnosed AR | No | 816 (53.0) | 190 (46.5) | 626 (55.4) | 0.002 |
Yes | 724 (47.0) | 219 (53.6) | 505 (44.6) | ||
Diagnosed with AR before 2011 (the year when HDs were banned) | No | 1,339 (88.6) | 347 (86.5) | 992 (89.3) | 0.137 |
Yes | 173 (11.4) | 54 (13.5) | 119 (10.7) | ||
Received treatment for AR during last 12 months | No | 1,032 (67.1) | 251 (61.5) | 781 (69.2) | 0.005 |
Yes | 505 (32.9) | 157 (38.5) | 348 (30.8) |
Values are presented as number (%). Analyzed by χ2 test. HD: humidifier disinfectant; AR: allergic rhinitis; AD: atopic dermatitis.
Association between doctor-diagnosed AR and types and duration of HDs used
Characteristics | Category | Doctor-diagnosed AR | |||
---|---|---|---|---|---|
Total | No | Yes | |||
Have used PGH/PHMG-containing HDs | Have never used HD | 768 | 626 (55.4) | 505 (44.6) | < 0.001 |
No, but have used other types | 154 | 81 (52.6) | 73 (47.4) | ||
Yes | 255 | 109 (42.7) | 146 (57.3) | ||
Have used CMIT/MIT-containing HDs | Have never used HD | 768 | 626 (55.4) | 505 (44.6) | 0.015 |
No, but have used other types | 253 | 112 (44.3) | 141 (55.7) | ||
Yes | 156 | 78 (50.0) | 78 (50.0) | ||
Duration of HD use | Have never used HD | 768 | 626 (55.4) | 505 (44.6) | 0.003 |
Less than 3 months | 239 | 115 (48.1) | 124 (51.9) | ||
3–6 months | 70 | 30 (42.9) | 40 (57.1) | ||
3–6 months Greater than or equal to 6 month | 70 hs 100 | 30 (42.9) 45 (45.0) | 40 (57.1) 55 (55.0) |
Values are presented as number (%). Analyzed by Mantel-Haenszel χ2 test. AR: allergic rhinitis; HD: humidifier disinfectant; PGH: oligo(2-[2-ethoxy]-ethoxyethyl)guanidinium; PHMG: polyhexamethylene guanidine; CMIT: chloromethylisothiazolinone; MIT: methylisothiazolinone.
Crude and adjusted OR for doctor-diagnosed AR based on HD use in the past
Characteristics | Category | Model 1 |
Model 2 |
Model 3 |
|||
---|---|---|---|---|---|---|---|
OR | 95% CI | OR | 95% CI | OR | 95% CI | ||
Have ever used HD | No | 1.00 | – | 1.00 | – | 1.00 | – |
Yes | 1.43 | 1.14–1.79 | 1.42 | 1.12–1.82 | 1.33 | 1.02–1.75 | |
Have used PHMG/PGH-containing HD | Have never used HD | 1.00 | – | 1.00 | – | 1.00 | – |
No, but have used other types of HDs | 1.12 | 0.80–1.57 | 1.20 | 0.83–1.73 | 1.22 | 0.81–1.82 | |
Yes | 1.66 | 1.26–2.19 | 1.57 | 1.17–2.11 | 1.41 | 1.02–1.95 | |
Have used CMIT/MIT-containing HD | Have never used HD | 1.00 | – | 1.00 | – | 1.00 | – |
No, but have used other types of HDs | 1.56 | 1.18–2.05 | 1.47 | 1.09–1.97 | 1.28 | 0.93–1.77 | |
Yes | 1.24 | 0.89–1.73 | 1.36 | 0.95–1.95 | 1.43 | 0.96–2.13 |
Analyzed by multiple logistic regression model. OR: odds ratio; AR: allergic rhinitis; HD: humidifier disinfectant; CI: confidence interval; PHMG: polyhexamethylene guanidine; PGH: oligo(2-[2-ethoxy]-ethoxyethyl)guanidinium; CMIT: chloromethylisothiazolinone; MIT: methylisothiazolinone.
Unadjusted;
Adjusted for sex, paternal/maternal occupation and household income;
Model 2 + additionally adjusted for past medical history of asthma, parental history of AR and presence of mold at the residence.
Crude and adjusted OR for doctor-diagnosed AR based on HD use in the past further stratified by duration
Characteristics | Category | Model 1 |
Model 2 |
Model 3 |
|||
---|---|---|---|---|---|---|---|
OR 1.00 | 95% CI | OR 1.00 | 95% CI | OR 1.00 | 95% CI | ||
Have ever used HD | No | 1.00 | – | 1.00 | – | 1.00 | – |
Yes (less than 3 months) | 1.00 1.34 | −1.01–1.77 | 1.00 1.34 | −1.00–1.81 | 1.00 1.26 | −0.91–1.75 | |
Yes (greater than or equal to 3 months) | 1.57 | 1.14–2.17 | 1.55 | 1.09–2.21 | 1.46 | 0.99–2.16 | |
Have used PHMG/PGH-containing HD | Have never used HD | 1.00 | – | 1.00 | – | 1.00 | – |
No, but have used other types | 1.12 | 1.01–1.77 | 1.20 | 0.83–1.73 | 1.22 | 0.81–1.82 | |
Yes (less than 3 months) | 1.60 | 1.14–2.17 | 1.52 | 1.05–2.20 | 1.39 | 0.92–2.32 | |
Yes (greater than or equal to 3 months) | 1.74 | 1.18–2.58 | 1.66 | 1.08–2.54 | 1.45 | 0.90–2.33 | |
Have used CMIT/MIT-containing HD | Have never used HD | 1.00 | – | 1.00 | – | 1.00 | – |
No, but have used other types | 1.00 1.56 | – 1.19–2.05 | 1.00 1.47 | – 1.09–1.97 | 1.00 1.28 | – 0.93–1.77 | |
Yes (less than 3 months) | 1.56 1.00 | 1.19–2.05 0.64–1.56 | 1.47 1.04 | 1.09–1.97 0.64–1.69 | 1.28 1.04 | 0.93–1.77 0.61–1.76 | |
Yes (greater than or equal to 3 months) | 1.59 | 0.99–2.56 | 1.83 | 1.09–3.06 | 2.08 | 1.17–3.69 |
Analyzed by multiple logistic regression model. OR: odds ratio; AR: allergic rhinitis; HD: humidifier disinfectant; CI: confidence interval; PHMG: polyhexamethylene guanidine; PGH: oligo(2-[2-ethoxy]-ethoxyethyl)guanidinium; CMIT: chloromethylisothiazolinone; MIT: methylisothiazolinone.
Unadjusted;
Adjusted for sex, paternal/maternal occupation and household income;
Model 2 + additionally adjusted for past medical history of asthma, parental history of AR and presence of mold at the residence.
Crude and adjusted OR for doctor-diagnosed AR before 2011 and 2013 based on HD use in the past
Characteristics | Category | Model 1 |
Model 2 |
Model 3 |
|||
---|---|---|---|---|---|---|---|
OR | 95% CI | OR | 95% CI | OR | 95% CI | ||
Diagnosed with AR before 2011 (the year when HDs were banned) | No | 1.00 | – | 1.00 | – | 1.00 | – |
Yes | 1.27 | 0.92–1.83 | 1.36 | 0.94–1.95 | 1.21 | 0.83–1.76 | |
Diagnosed with AR before 2013 (risk period) | Yes | 1.00 | – | 1.00 | – | 1.00 | – |
No | 1.48 | 1.15–1.89 | 1.46 | 1.12–1.91 | 1.35 | 1.02–1.79 |
Analyzed by multiple logistic regression model. OR: odds ratio; AR: allergic rhinitis; HD: humidifier disinfectant; CI: confidence interval.
Unadjusted;
Adjusted for sex, paternal/maternal occupation and household income;
Model 2 + additionally adjusted for past medical history of asthma, parental history of AR and presence of mold at the residence.