Perfluoroalkyl substances exposure and immunity, allergic response, infection, and asthma in children: review of epidemiologic studies

Background: Increased exposure to perfluoroalkyl substances (PFAS) potentially affects infant and childhood health through immunosuppression. Given rapidly evolving research on PFAS, it is important to comprehensively examine the impact of PFAS exposure among the pediatric population as new research becomes available due to potential fragility of the developing immune system. Objectives: This review assessed the effects of PFAS fetal, infant and childhood exposures upon the development of immune function during early life stages. Methods: Researchers completed a literature review, searching PubMed for human studies published since 2010 for PFAS and health outcomes among infants and children. Included articles incorporated key search terms in the title or abstract; nonresearch reports and non-English papers were excluded. The search identified 518 studies for possible inclusion. Following hands-on review, 34 were determined relevant. Subsequent analyses found 8 additional relevant articles, totaling 42 studies. Results: Major immune-related sequelae from PFAS exposures on infant and child health outcomes documented in recent literature include: center dot Strong indication of immunosuppression, with diminished childhood antibody response to vaccination, particularly with PFOA, PFOS and PFHxS exposures. center dot Some indication of increased risks of childhood infectious diseases/infections, particularly from PFOS exposures. center dot Limited indication of an effect of PFAS exposure on allergic reactions/allergen specific IgE antibodies. center dot Limited indication of an effect of PFAS exposure on atopic dermatitis (AD). center dot Limited indication of an effect of PFAS exposure on asthma and lung function. Conclusion: This review summarizes recent findings of PFAS effects on infant and childhood immune health. Evidence of immunosuppression, diminished vaccine efficacy, and increased risk of infections, allergies, asthma and AD were described following in utero, infant, and early childhood PFAS exposures. Further investigation is warranted to characterize PFAS exposure pathways and potential modes of action in relation to PFAS effects on the developing immune system. Incontrovertible proof of PFAS immunotoxic effects could optimally be obtained by a large prospective study cohort of mothers and children from infancy through school-age. Regular assessments of circulating antibodies and response to infant and childhood vaccines during growth years could prove invaluable.

Automated summary

Recent literature has documented major immune-related sequelae from PFAS exposures on infant and child health outcomes, including strong evidence of immunosuppression, reduced vaccine efficacy, increased risk of infections, and limited impact on allergies, atopic dermatitis, asthma, and lung function. Further research is needed to understand PFAS exposure pathways and the mechanisms of action on the developing immune system, with a recommendation for large prospective studies tracking mothers and children from infancy to school-age for optimal evidence of PFAS immunotoxic effects. Regular assessments of antibodies and vaccine response during growth years could provide valuable insights.