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Epidemiology meets Toxicology: The Bitterfeld Project – A success story

Date: 1 December, 2011

Background: Environmental epidemiological studies commonly face its limits, when
causality issues are discussed. Additional toxicological experiments, animal or human
exposure studies might help to justify the interpretation of epidemiological findings
as causal.

Objectives: The Bitterfeld project is a cohort study on long-term effects of ambient
air pollution exposure on several health parameters in children. Three areas differing
in air pollution levels were included. In addition to the cross-sectional study design
temporal changes of the health status in children were investigated while air quality
was strongly improving. In addition to this observational study, ambient particulate
matter, collected from these different areas, was used for an animal experiment and
a human exposure study in order to study consistency between findings from
observational studies and experimental work.

Methods: The study consists of three repeated regional cross-sectional studies of
children aged five to fourteen years examined at the beginning, middle and end of
the 1990 years in East Germany. In parallel, ambient air samples were collected and
particles were used for experimental studies.
Results: We found a strong improvement of non-allergic respiratory health including
lung function in parallel with the improved air quality in terms of a decline of
ambient levels of SO2 and PM. However, allergic diseases like asthma, hay fever, and
in addition prevalence of allergic sensitization was not declining (Heinrich et al.
Epidemiology 2002a). In addition, the regional differences for these allergic disease
entities remained stable although there was a strong converge of ambient air
pollutant levels between the three areas (Heinrich et al. 2002b). We speculated that
the increased levels of allergic diseases in one area might be caused by the high
emissions of heavy metals from copper plants. Collected PM10 and PM2.5 particles
were therefore applied to a mouse model. We found that particles from the mining
area showed stronger signals in ovalbumine sensitized mices for allergic reactions
compared to particles collected from the control area with a much lower content
heavy metals (Gavett et al. 2003). Human exposure studies instilled tiny amounts of

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