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2 "Seungho Lee"
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Introduction to the Forensic Research via Omics Markers in Environmental Health Vulnerable Areas (FROM) study
Jung-Yeon Kwon, Woo Jin Kim, Yong Min Cho, Byoung-gwon Kim, Seungho Lee, Jee Hyun Rho, Sang‑Yong Eom, Dahee Han, Kyung-Hwa Choi, Jang-Hee Lee, Jeeyoung Kim, Sungho Won, Hee-Gyoo Kang, Sora Mun, Hyun Ju Yoo, Jung-Woong Kim, Kwan Lee, Won-Ju Park, Seongchul Hong, Young-Soub Hong
Epidemiol Health. 2024;e2024062.   Published online July 12, 2024
DOI: https://doi.org/10.4178/epih.e2024062    [Accepted]
  • 220 View
  • 10 Download
AbstractAbstract PDF
Abstract
OBJECTIVES
Exposure to humidifier disinfectants has been linked to respiratory diseases, including interstitial lung disease, asthma, and pneumonia. Consequently, numerous toxicological studies have explored respiratory damage as both a necessary and sufficient condition for these diseases. We systematically reviewed and integrated evidence from toxicological studies by applying the evidence integration method established in previous research to confirm the biological plausibility of the association between exposure and disease.
METHODS
We conducted a literature search focusing on polyhexamethylene guanidine phosphate (PHMG) and chloromethylisothiazolinone/methylisothiazolinone (CMIT/MIT), the primary ingredients in humidifier disinfectants. We selected relevant studies based on their quality and the population, exposure, comparator, outcome (PECO) statements. These studies were categorized into 3 lines of evidence: hazard information, animal studies, and mechanistic studies. Based on a systematic review, we integrated the evidence to develop an aggregate exposure pathway–adverse outcome pathway (AEP-AOP) model for respiratory damage. The reliability and relevance of our findings were assessed by comparing them with the hypothesized pathogenic mechanisms of respiratory diseases.
RESULTS
The integration of each AEP-AOP component for PHMG and CMIT/MIT led to the development of an AEP-AOP model, wherein disinfectants released from humidifiers in aerosol or gaseous form reached target sites, causing respiratory damage through molecular initiating events and key events. The model demonstrated high reliability and relevance to the pathogenesis of respiratory diseases.
CONCLUSIONS
The AEP-AOP model developed in this study provides strong evidence that exposure to humidifier disinfectants causes respiratory diseases. This model demonstrates the pathways leading to respiratory damage, a hallmark of these conditions.
Summary
Original Article
A comprehensive study of deaths due to exposure to humidifier disinfectant in Korea: focusing on medical records, assessment of exposure to humidifier disinfectants, and causes of death
Yeong Jun Ju, Seungho Lee, Seungsoo Sheen, Dong-Woo Choi, Jong-Han Leem, Soon Young Lee
Epidemiol Health. 2021;43:e2021091.   Published online November 1, 2021
DOI: https://doi.org/10.4178/epih.e2021091
  • 10,340 View
  • 300 Download
  • 4 Web of Science
  • 5 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
We aimed to determine the characteristics of the deceased victims of deaths caused by exposure to humidifier disinfectants, and present the distribution of the victims’ data submitted for damage application, demographic characteristics, imaging findings, characteristics of humidifier disinfectant exposure, and distribution of the causes of death.
METHODS
An integrated database of victims was established using the medical records data of 1,413 victims submitted during the application for death damage caused by exposure to humidifier disinfectants, and the demographic characteristics, medical records, imaging findings, exposure characteristics, and cause of death were examined.
RESULTS
The average numbers of data submissions of each applicant for death damage were 3.0 medical use records. A total of 608 (43.0%) victims had more than one finding of acute, subacute, or chronic interstitial lung diseases. The average daily and cumulative use times of the victims were 14.40 and 24,645.81 hours, respectively, indicating greater exposure in this group than in the survivors. The humidifier disinfectants’ components comprised polyhexamethylene guanidine (72.8%), chloromethylisothiazolinone/methylisothiazolinone (10.5%), other components (15.0%), and oligo-[2-(2-ethoxy)-ethoxyethyl] guanidine chloride (1.5%). The components’ distribution was 67.8% for single-component use, which was higher than that in the survivors (59.8%). The distribution of the causes of death were: respiratory diseases (54.4%), neoplasms (16.8%), and circulatory diseases (6.3%). Other interstitial lung diseases (65.5%) were the most common cause of death among those who died due to respiratory diseases.
CONCLUSIONS
Careful discussions of appropriate remedies should be conducted based on a comprehensive understanding of the characteristics of the deceased victims, considering their specificities and limitations.
Summary
Korean summary
가습기 살균제 사망 피해 신청자 들 중 건강피해를 인정받지 못한 신청자들이 여전히 많이 남아있으며 (약 40%), 피해판정의 복잡성과 다양한 이슈들이 산적해 있어 사망 피해 신청자들의 적정 구제를 위해 종합적인 특성파악을 바탕으로 세심한 관점에서의 검토가 필요하다. 특히, 가습기 살균제 사망 피해 신청자의 특수성과 피해구제의 제한점을 고려하여야 하며, 기계적인 건강피해 판정을 지양하고 사망 피해 신청자 중심의 세밀한 특성 파악을 바탕으로 다양한 전문가집단이 참여하는 종합적인 논의를 통해 적정구제를 이루어 나가야 함을 제안한다.
Key Message
Careful discussions of appropriate remedies should be conducted based on a comprehensive understanding of the characteristics of the deceased victims, considering their specificities and limitations.

Citations

Citations to this article as recorded by  
  • Polyhexamethylene Guanidine Phosphate Enhanced Procoagulant Activity through Oxidative-Stress-Mediated Phosphatidylserine Exposure in Platelets
    Ju Hee Choi, Keunyoung Kim
    Toxics.2024; 12(1): 50.     CrossRef
  • Next generation risk assessment of biocides (PHMG-p and CMIT/MIT)-induced pulmonary fibrosis using adverse outcome pathway-based transcriptome analysis
    Jun Woo Kim, Hyung Sik Kim, Ha Ryong Kim, Kyu Hyuck Chung
    Journal of Hazardous Materials.2024; 476: 134986.     CrossRef
  • Metabolite analysis of 14C-labeled chloromethylisothiazolinone/methylisothiazolinone for toxicological consideration of inhaled isothiazolinone biocides in lungs
    Jung Eun Park, Seung-Hun Ryu, Satoshi Ito, Hyunil Shin, Young-Hee Kim, Jongho Jeon
    Chemosphere.2024; 362: 142666.     CrossRef
  • Gene expression related to lung cancer altered by PHMG-p treatment in PBTE cells
    Yoon Hee Park, Sang Hoon Jeong, Hyejin Lee, Cherry Kim, Yoon Jeong Nam, Ja Young Kang, Jin Young Choi, Yu-Seon Lee, Su A. Park, Jaeyoung Kim, Eun-Kee Park, Yong-Wook Baek, Hong Lee, Ju-Han Lee
    Molecular & Cellular Toxicology.2023; 19(1): 205.     CrossRef
  • Health Effects Associated With Humidifier Disinfectant Use: A Systematic Review for Exploration
    Ji-Hun Song, Joonho Ahn, Min Young Park, Jaeyoung Park, Yu Min Lee, Jun-Pyo Myong, Jung-Wan Koo, Jongin Lee
    Journal of Korean Medical Science.2022;[Epub]     CrossRef
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