The Impact of Early-Life Exposure to Antimicrobials on Asthma and Eczema Risk in Children

  • Medina S. Jackson-BrowneEmail author
  • Noelle Henderson
  • Marisa Patti
  • Adam Spanier
  • Joseph M. Braun
Synthetic Chemicals and Health (A Zota and T James-Todd, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Synthetic Chemicals and Health


Purpose of Review

We examined recent research on associations of prenatal and early-childhood exposure to the antimicrobial compounds, triclosan, and parabens, with the risk of asthma and eczema in children. We will discuss potential biological mechanisms of this association and highlight strengths and limitations of the study design and exposure assessment of current findings.

Recent Findings

Results of available toxicological and epidemiologic studies indicate a potential link of triclosan and paraben exposures with asthma and eczema in children, as well as changes in microbiome diversity and immune dysfunction, which could possibly mediate an association with the health outcomes.


A small number of studies suggest that triclosan and paraben exposures could be related to the risk of asthma and eczema in children. Although current findings are far from conclusive, there is emerging evidence that changes in microbiome diversity and immune function from antimicrobial exposure may mediate these relations.


Triclosan Parabens Children’s health Eczema Asthma Immune system 


Compliance with Ethical Standards

Conflict of Interest

Dr. Braun reports personal fees from Beveridge-Diamond outside of the submitted work. The other authors declare no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Wesemann DR, Nagler CR. The microbiome, timing, and barrier function in the context of allergic disease. Immunity. 2016;44:728–38. Scholar
  2. 2.
    Gassner M, Grize L, Neu U. Prevalence of hay fever and allergic sensitization in farmer’s children and their peers living in the same rural community. Clin Exp Allergy. 1999;29:28–34. Scholar
  3. 3.
    Martinez FD, Vercelli D. Asthma. Lancet. 2013;382:1360–72 Available from: Scholar
  4. 4.
    • Spergel JM. From atopic dermatitis to asthma: the atopic march. Ann Allergy Asthma Immunol. 2010;105:99–106 quiz 107–9, 117. [cited 2014 Oct 29]. Available from: This paper reviews possible mechanisms for sequential allergic disease development. CrossRefGoogle Scholar
  5. 5.
    Casillas AM. An update on the immunopathogenesis of asthma as an inflammatory disease enhanced by environmental pollutants. Allergy Asthma Proc. 1997;18:227–33.PubMedCrossRefGoogle Scholar
  6. 6.
    • Eder W, Ege M, von Muitus E. The asthma epidemic. N Engl J Med. 2006;355:2226–35. This paper reviews potential determinants of asthma development. PubMedCrossRefGoogle Scholar
  7. 7.
    • Ker J, Hartert TV. The atopic march: what’s the evidence? Ann Allergy Asthma Immunol. 2009;103:282–9 [cited 2014 Oct 29]. Available from: This paper reviews evidence supporting the atopic march paradigm. CrossRefGoogle Scholar
  8. 8.
    O’Connell EJ. The burden of atopy and asthma in children. Allergy. 2004;59(Suppl 7):7–11.PubMedCrossRefGoogle Scholar
  9. 9.
    Weinmann S, Kamtsiuris P, Henke K-D, Wickman M, Jenner A, Wahn U. The costs of atopy and asthma in children: assessment of direct costs and their determinants in a birth cohort. Pediatr Allergy Immunol. 2003;14:18–26. Scholar
  10. 10.
    Weiss KB, Sullivan SD. The health economics of asthma and rhinitis. I. Assessing the economic impact. J Allergy Clin Immunol. 2001:3–8 [cited 2017 Oct 30]. Available from: Scholar
  11. 11.
    Stafford RS, Ma J, Finkelstein SN, Haver K, Cockburn I. National trends in asthma visits and asthma pharmacotherapy, 1978–2002. J Allergy Clin Immunol. 2003;111:729–35 [cited 2017 Oct 30]. Available from: Scholar
  12. 12.
    Stevens CA, Turner D, Kuehni CE, Couriel JM, Silverman M. The economic impact of preschool asthma and wheeze. Eur Respir J. 2003;21:1000–6 [cited 2017 Oct 30]. Available from: Scholar
  13. 13.
    Centers for Disease Control and Prevention. CDC - Asthma - Most Recent Asthma Data. 2017 [cited 2017 Nov 29]. Available from:
  14. 14.
    Nurmagambetov T, Kuwahara R, Garbe P. The economic burden of asthma in the United States, 2008–2013. Ann Am Thorac Soc. 2018;15:348–56 [cited 2019 Jun 5]. Available from: Scholar
  15. 15.
    Novak N, Bieber T, Leung DYM. Immune mechanisms leading to atopic dermatitis. J Allergy Clin Immunol. 2003;112:128–39 [cited 2017 Nov 29]. Available from: Scholar
  16. 16.
    Wold AE. The hygiene hypothesis revised: is the rising frequency of allergy due to changes in rising the intestinal flora? Allergy Eur J Allergy Clin Immunol. 1998.Google Scholar
  17. 17.
    • Ege MJ. The hygiene hypothesis in the age of the microbiome. Ann Am Thorac Soc. 2017;14:S348–53 Available from: This paper reviews possible biological mechanisms for asthma and allergies. PubMedCrossRefGoogle Scholar
  18. 18.
    • Stiemsma LT, Turvey SE. Asthma and the microbiome: defining the critical window in early life. Allergy Asthma Clin Immunol. 2017;13:3. This paper reviews mouse-model and epidemiological studies for associations between airway microbiota and asthma and atopic disease. Google Scholar
  19. 19.
    • Knaysi G, Smith AR, Wilson JM, Wisniewski JA. The skin as a route of allergen exposure: part II. Allergens and role of the microbiome and environmental exposures. Curr Allergy Asthma Rep. 2017;17:7. This paper reviews evidence of the relationship between skin and gut microbiome and atopic dermatitis. Google Scholar
  20. 20.
    McMurry LM, Oethinger M, Levy SB. Triclosan targets lipid synthesis [4]. Nature, [cited 2017 Nov 28]. Available from: 1998:531–2.
  21. 21.
    Villalaín J, Mateo CR, Aranda FJ, Shapiro S, Micol V. Membranotropic effects of the antibacterial agent triclosan. Arch Biochem Biophys. 1991;290:128–36 [cited 2017 Nov 28]. Available from: Scholar
  22. 22.
    • Calafat AM, Ye X, Wong LY, Reidy JA, Needham LL. Urinary concentrations of triclosan in the U.S. population: 2003-2004. Environ Health Perspect. 2008;116:303–7. This paper summarizes U.S. triclosan concentrations. PubMedCrossRefGoogle Scholar
  23. 23.
    Stacy SL, Eliot M, Etzel T, Papandonatos G, Calafat AM, Chen A, et al. Patterns, variability, and predictors of urinary triclosan concentrations during pregnancy and childhood. Environ Sci Technol. 2017;51:6404–13. Scholar
  24. 24.
    Woodruff TJ, Zota AR, Schwartz JM. Environmental chemicals in pregnant women in the United States: NHANES 2003–2004. Environ Health Perspect. 2011;119:878.PubMedPubMedCentralCrossRefGoogle Scholar
  25. 25.
    Han C, Lim YH, Hong YC. Ten-year trends in urinary concentrations of triclosan and benzophenone-3 in the general U.S. population from 2003 to 2012. Environ Pollut:2016.Google Scholar
  26. 26.
    Arbuckle TE, Weiss L, Fisher M, Hauser R, Dumas P, Bérubé R, et al. Maternal and infant exposure to environmental phenols as measured in multiple biological matrices. Sci Total Environ. 2015;508:575–84. Scholar
  27. 27.
    Bertelsen RJ, Engel SM, Jusko TA, Calafat AM, Hoppin JA, London SJ, et al. Reliability of triclosan measures in repeated urine samples from Norwegian pregnant women. J Expo Sci Environ Epidemiol, Available from: 2014:1–5.
  28. 28.
    Mortensen ME, Calafat AM, Ye X, Wong LY, Wright DJ, Pirkle JL, et al. Urinary concentrations of environmental phenols in pregnant women in a pilot study of the National Children’s Study. Environ Res. 2014;129:32–8. Scholar
  29. 29.
    Philippat C, Botton J, Calafat AM, Ye X, Charles M-A, Slama R, et al. Prenatal exposure to phenols and growth in boys. Epidemiology. 2014;25.PubMedPubMedCentralCrossRefGoogle Scholar
  30. 30.
    Pycke BFG, Geer LA, Dalloul M, Abulafia O, Jenck AM, Halden RU. Human fetal exposure to triclosan and triclocarban in an urban population from Brooklyn, New York. Environ Sci Technol. 2014;48:8831–8.PubMedPubMedCentralCrossRefGoogle Scholar
  31. 31.
    Weiss L, Arbuckle TE, Fisher M, Ramsay T, Mallick R, Hauser R, et al. Temporal variability and sources of triclosan exposure in pregnancy. Int J Hyg Environ Health. 2015;218:507–13. Scholar
  32. 32.
    Dann AB, Hontela A. Triclosan: environmental exposure, toxicity and mechanisms of action. J Appl Toxicol. 2011;31:285–311.PubMedCrossRefGoogle Scholar
  33. 33.
    Sandborgh-Englund G, Adolfsson-Erici M, Odham G, Ekstrand J. Pharmacokinetics of triclosan following oral ingestion in humans. J Toxicol Environ Health. 2006;69:1861–73.CrossRefGoogle Scholar
  34. 34.
    Hines EP, Mendola P, von Ehrenstein OS, Ye X, Calafat AM, Fenton SE. Concentrations of environmental phenols and parabens in milk, urine and serum of lactating North Carolina women. Reprod Toxicol. 2015;54:120–8. Scholar
  35. 35.
    • Lowe AJ, Wang X, Mueller JF, Abramson MJ, Yeh RY, Erbas B, et al. Exposure to breast-milk triclosan and parabens and eczema phenotypes at 12-months: a nested case-control study. J Allergy Clin Immunol. 2019. This study shows evidence that paraben concentrations measured in breast milk are associated with risk of atopic eczema. Google Scholar
  36. 36.
    Food and Drug Administration H. Safety and effectiveness of consumer antiseptics; topical antimicrobial drug products for over-the-counter human use. Final rule. Fed Regist. 2016;81:61106–30 Available from: Scholar
  37. 37.
    Parabens in cosmetics | FDA [Internet]. [cited 2019 Jun 5]. Available from:
  38. 38.
    Nowak K, Jabłońska E, Ratajczak-Wrona W. Immunomodulatory effects of synthetic endocrine disrupting chemicals on the development and functions of human immune cells. Environ Int. 2019;125:350–64 [cited 2019 Jun 8]. Available from: Scholar
  39. 39.
    Guidry VT, Longnecker MP, Aase H, Eggesbø M, Zeiner P, Reichborn-Kjennerud T, et al. Measurement of total and free urinary phenol and paraben concentrations over the course of pregnancy: assessing reliability and contamination of specimens in the Norwegian mother and child cohort study. Environ Health Perspect. 2015;123:705–11 [cited 2017 Nov 28]. Available from: Scholar
  40. 40.
    Larsson K, Ljung Björklund K, Palm B, Wennberg M, Kaj L, Lindh CH, et al. Exposure determinants of phthalates, parabens, bisphenol A and triclosan in Swedish mothers and their children. Environ Int. 2014;73:323–33. Scholar
  41. 41.
    Shin M-Y, Shin C, Choi JW, Lee J, Lee S, Kim S. Pharmacokinetic profile of propyl paraben in humans after oral administration. Environ Int. 2019;130:104917 [cited 2019 Jul 18]. Available from: Scholar
  42. 42.
    • Calafat AM, Ye X, Wong LY, Bishop AM, Needham LL. Urinary concentrations of four parabens in the U.S. population: NHANES 2005-2006. Environ Health Perspect. 2010;118:679–85. This paper summarizes U.S. paraben concentrations. PubMedPubMedCentralCrossRefGoogle Scholar
  43. 43.
    CDC. Fourth national report on human exposure to environmental chemicals: executive summary. 2019.Google Scholar
  44. 44.
    •• Spanier AJ, Fausnight T, Camacho TF, Braun JM. The associations of triclosan and paraben exposure with allergen sensitization and wheeze in children. Allergy Asthma Proc. 2014;35:475–81. This paper shows evidence that triclosan and paraben concentrations are associated with asthma and sensitization. PubMedPubMedCentralCrossRefGoogle Scholar
  45. 45.
    •• Savage JH, Johns CB, Hauser R, Litonjua AA. Urinary triclosan levels and recent asthma exacerbations. Ann Allergy Asthma Immunol. 2014;112:179–83. This paper shows evidence that triclosan and paraben concentrations are associated with sensitization. CrossRefGoogle Scholar
  46. 46.
    •• Overgaard LEK, Main KM, Frederiksen H, Stender S, Szecsi PB, Williams HC, et al. Children with atopic dermatitis and frequent emollient use have increased urinary levels of low-molecular-weight phthalate metabolites and parabens. Allergy. 2017;72:1768–77. This paper shows evidence that children with atopic dermatitis had higher paraben concentrations compared to non-atopic dermatitis children. PubMedCrossRefGoogle Scholar
  47. 47.
    •• Mitsui-Iwama M, Yamamoto-Hanada K, Fukutomi Y, Hirota R, Muto G, Nakamura T, et al. Exposure to paraben and triclosan and allergic diseases in Tokyo: a pilot cross-sectional study. Asia Pac Allergy. 2019. This paper shows evidence that paraben concentrations are associated with atopic dermatitis and wheeze. Google Scholar
  48. 48.
    •• Quirós-Alcalá L, Hansel NN, McCormack MC, Matsui EC. Paraben exposures and asthma-related outcomes among children from the US general population. J Allergy Clin Immunol. 2019;143:948–956.e4 [cited 2019 Jun 8]. Available from: This paper shows evidence that paraben concentrations were associated with increased emergency department visits among asthmatic boys. PubMedCrossRefGoogle Scholar
  49. 49.
    •• Aung MT, Ferguson KK, Cantonwine DE, Bakulski KM, Mukherjee B, Loch-Caruso R, et al. Associations between maternal plasma measurements of inflammatory markers and urinary levels of phenols and parabens during pregnancy: a repeated measures study. Sci Total Environ. 2019. This paper shows evidence that triclosan and paraben concentrations are associated with inflammatory markers. Google Scholar
  50. 50.
    Ashley-Martin J, Dodds L, Arbuckle TE, Marshall J. Prenatal triclosan exposure and cord blood immune system biomarkers. Int J Hyg Environ Health. 2016.Google Scholar
  51. 51.
    •• Vernet C, Pin I, Giorgis-Allemand L, Philippat C, Benmerad M, Quentin J, et al. In utero exposure to select phenols and phthalates and respiratory health in five-year-old boys: a prospective study. Environ Health Perspect. 2017;125:097006 Available from: This paper shows evidence that paraben concentrations were not associated with asthma.
  52. 52.
    •• Lee-Sarwar K, Hauser R, Calafat AM, Ye X, O’Connor GT, Sandel M, et al. Prenatal and early-life triclosan and paraben exposure and allergic outcomes. J Allergy Clin Immunol. 2018. This paper shows evidence that triclosan and paraben concentrations were not associated with asthma nor sensitization. Google Scholar
  53. 53.
    •• Berger K, Eskenazi B, Balmes J, Holland N, Calafat AM, Harley KG. Associations between prenatal maternal urinary concentrations of personal care product chemical biomarkers and childhood respiratory and allergic outcomes in the CHAMACOS study. Environ Int. 2018;121:538–49 [cited 2019 Jun 8]. Available from: This paper shows evidence that paraben concentrations were associated with elevated immune biomarkers. PubMedCrossRefGoogle Scholar
  54. 54.
    •• Buckley JP, Quirós-Alcalá L, Teitelbaum SL, Calafat AM, Wolff MS, Engel SM. Associations of prenatal environmental phenol and phthalate biomarkers with respiratory and allergic diseases among children aged 6 and 7 years. Environ Int. 2018;115:79–88 [cited 2019 Jan 9]. Available from: This paper shows evidence that child sex modifies associations between prenatal triclosan concentrations and asthma and eczema. PubMedPubMedCentralCrossRefGoogle Scholar
  55. 55.
    Chalubinski M, Kowalski ML. Endocrine disrupters – potential modulators of the immune system and allergic response. Allergy. 2006;61:1326–35. Scholar
  56. 56.
    Anderson SE, Franko J, Kashon ML, Anderson KL, Hubbs AF, Lukomska E, et al. Exposure to triclosan augments the allergic response to ovalbumin in a mouse model of asthma. Toxicol Sci. 2013;132:96–106.PubMedCrossRefGoogle Scholar
  57. 57.
    • Hitota R, Ohya Y, Yamamoto-Hanada K, Fukutomi Y. Triclosan-induced alteration of gut microbiome and aggravation of asthmatic airway response in aeroallergen-sensitized mice. Artic Allergy. 2018; Available from: This paper shows evidence of associations between triclosan concentrations and allergic responses in a mouse model.
  58. 58.
    Tobar S, Tordesillas L, Berin MC. Triclosan promotes epicutaneous sensitization to peanut in mice. Clin Transl Allergy. 2016.Google Scholar
  59. 59.
    Taylor SL, Leong LEX, Choo JM, Wesselingh S, Yang IA, Upham JW, et al. Inflammatory phenotypes in patients with severe asthma are associated with distinct airway microbiology. J Allergy Clin Immunol. 2018.Google Scholar
  60. 60.
    • Singanayagam A, Ritchie AI, Johnston SL. Role of microbiome in the pathophysiology and disease course of asthma. Curr Opin Pulm Med. 2017. This paper reviews the role of lung and gut microbiota in asthma development.Google Scholar
  61. 61.
    • Dickson RP, Martinez FJ, Huffnagle GB. The role of the microbiome in exacerbations of chronic lung diseases. Lancet. 2014;384:691–702 Available from: This paper reviews evidence that respiratory tract microbiome diversity plays a role in severity of lung disease. CrossRefGoogle Scholar
  62. 62.
    •• Bertelsen R, Ringel-Kulka T, Peddada S, Kaul A, Real FG, Svanes C. Oral microbiome and associations with chemical exposure, asthma and lung function. Epidemiology. 2017:OA321 [cited 2019 Jul 15]. Available from: This paper reviews evidence that increasing oral microbiome diversity is associated withincreased lung function in women and that exposure to parabens modifies this association.
  63. 63.
    Lloyd-Price J, Abu-Ali G, Huttenhower C. The healthy human microbiome. Genome Med. 2016;8:51 Available from: Scholar
  64. 64.
    Consortium HMP. Structure, function and diversity of the healthy human microbiome. Nature. 2012;486:207–14 Available from: Scholar
  65. 65.
    Mazmanian SK, Round JL, Kasper DL. A microbial symbiosis factor prevents intestinal inflammatory disease. Nature. 2008.Google Scholar
  66. 66.
    Costello EK, Lauber CL, Hamady M, Fierer N, Gordon JI, Knight R. Bacterial community variation in human body habitats across space and time. Science. 2009.Google Scholar
  67. 67.
    Turnbaugh PJ, Hamady M, Yatsunenko T, Cantarel BL, Duncan A, Ley RE, et al. A core gut microbiome in obese and lean twins. Nature. 2009.Google Scholar
  68. 68.
    Lynch SV, Boushey HA. The microbiome and development of allergic disease. Curr Opin Allergy Clin Immunol, Available from: 2016;16:165–71. This paper reviews evidence that lung and gut microbiome diversity is associated with sensitization and atopic disease.
  69. 69.
    •• Holt PG. The mechanism or mechanisms driving atopic asthma initiation: the infant respiratory microbiome moves to center stage. J Allergy Clin Immunol. 2015;136:15–22. This paper reviews possible mechanisms for the development for early onset asthma. PubMedCrossRefGoogle Scholar
  70. 70.
    Marsland BJ, Trompette A, Gollwitzer ES. The gut-lung axis in respiratory disease. Ann Am Thorac Soc. 2015.Google Scholar
  71. 71.
    Yueh M-F, Tukey RH. Triclosan: a widespread environmental toxicant with many biological effects. Annu Rev Pharmacol Toxicol. 2016;56:251–72 Available from: Scholar
  72. 72.
    Allmyr M, Adolfsson-Erici M, McLachlan MS, Sandborgh-Englund G. Triclosan in plasma and milk from Swedish nursing mothers and their exposure via personal care products. Sci Total Environ. 2006;372:87–93.PubMedCrossRefGoogle Scholar
  73. 73.
    Witorsch RJ. Critical analysis of endocrine disruptive activity of triclosan and its relevance to human exposure through the use of personal care products. Crit Rev Toxicol. 2014.Google Scholar
  74. 74.
    Hu J, Raikhel V, Gopalakrishnan K, Fernandez-Hernandez H, Lambertini L, Manservisi F, et al. Effect of postnatal low-dose exposure to environmental chemicals on the gut microbiome in a rodent model. Microbiome. 2016.Google Scholar
  75. 75.
    Narrowe AB, Albuthi-Lantz M, Smith EP, Bower KJ, Roane TM, Vajda AM, et al. Perturbation and restoration of the fathead minnow gut microbiome after low-level triclosan exposure. Microbiome. 2015.Google Scholar
  76. 76.
    Poole AC, Pischel L, Ley C, Suh G, Goodrich JK, Haggerty TD, et al. Crossover control study of the effect of personal care products containing triclosan on the microbiome. mSphere. 2016. This paper shows evidence that triclosan concentrations in breast milk is associated with infant fecal microbiome diversity. Google Scholar
  77. 77.
    • Bever CS, Rand AA, Nording M, Taft D, Kalanetra KM, Mills DA, et al. Effects of triclosan in breast milk on the infant fecal microbiome. Chemosphere. 2018;203:467–73 [cited 2019 Jul 16]. Available from: Scholar
  78. 78.
    Wang C-F, Tian Y. Reproductive endocrine-disrupting effects of triclosan: population exposure, present evidence and potential mechanisms. Environ Pollut. 2015;206:195–201 Available from: Scholar
  79. 79.
    Aker AM, Watkins DJ, Johns LE, Ferguson KK, Soldin OP, Anzalota Del Toro LV, et al. Phenols and parabens in relation to reproductive and thyroid hormones in pregnant women. Environ Res. 2016;151:30–7.PubMedPubMedCentralCrossRefGoogle Scholar
  80. 80.
    Aker AM, Johns L, TF ME, Cantonwine DE, Mukherjee B, Meeker JD. Associations between maternal phenol and paraben urinary biomarkers and maternal hormones during pregnancy: a repeated measures study. Environ Int. 2018;113:341–9 [cited 2018 Jul 3]. Available from: Scholar
  81. 81.
    Braun JM, Chen A, Hoofnagle A, Papandonatos GD, Jackson-Browne M, Hauser R, et al. Associations of early life urinary triclosan concentrations with maternal, neonatal, and child thyroid hormone levels. Horm Behav. 2018;101:77–84 [cited 2018 Jan 10]. Available from: Scholar
  82. 82.
    Wang C, Chen L, Zhao S, Hu Y, Zhou Y, Gao Y, et al. Impacts of prenatal triclosan exposure on fetal reproductive hormones and its potential mechanism. Environ Int. 2018;111:279–86 [cited 2018 Oct 30]. Available from: Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Medina S. Jackson-Browne
    • 1
    Email author
  • Noelle Henderson
    • 2
  • Marisa Patti
    • 2
  • Adam Spanier
    • 3
  • Joseph M. Braun
    • 2
  1. 1.Epidemiology Program, College of Health SciencesUniversity of DelawareNewarkUSA
  2. 2.Department of EpidemiologyBrown UniversityProvidenceUSA
  3. 3.Department of Pediatrics, Division of General PediatricsUniversity of Maryland School of MedicineBaltimoreUSA

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