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Crit Rev Toxicol. 2016;46(4):279-331. doi: 10.3109/10408444.2015.1122573. Epub 2016 Jan 13.

A critical review of perfluorooctanoate and perfluorooctanesulfonate exposure and immunological health conditions in humans.

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a Health Sciences Practice, Exponent, Inc , Menlo Park , CA , USA ;
b Division of Epidemiology, Department of Health Research and Policy , Stanford University School of Medicine , Stanford , CA , USA ;
c Department of Epidemiology , Harvard T. H. Chan School of Public Health , Boston , MA , USA ;
d Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute , New York , NY , USA ;
e Division of Allergy and Immunology , Washington University School of Medicine , St. Louis , MO , USA.


Whether perfluorooctanoate (PFOA) and perfluorooctanesulfonate (PFOS), two widely used and biopersistent synthetic chemicals, are immunotoxic in humans is unclear. Accordingly, this article systematically and critically reviews the epidemiologic evidence on the association between exposure to PFOA and PFOS and various immune-related health conditions in humans. Twenty-four epidemiologic studies have reported associations of PFOA and/or PFOS with immune-related health conditions, including ten studies of immune biomarker levels or gene expression patterns, ten studies of atopic or allergic disorders, five studies of infectious diseases, four studies of vaccine responses, and five studies of chronic inflammatory or autoimmune conditions (with several studies evaluating multiple endpoints). Asthma, the most commonly studied condition, was evaluated in seven studies. With few, often methodologically limited studies of any particular health condition, generally inconsistent results, and an inability to exclude confounding, bias, or chance as an explanation for observed associations, the available epidemiologic evidence is insufficient to reach a conclusion about a causal relationship between exposure to PFOA and PFOS and any immune-related health condition in humans. When interpreting such studies, an immunodeficiency should not be presumed to exist when there is no evidence of a clinical abnormality. Large, prospective studies with repeated exposure assessment in independent populations are needed to confirm some suggestive associations with certain endpoints.


Asthma; CAS No. 1763-23-1; CAS No. 335-67-1; autoimmune diseases; epidemiology; hypersensitivity; immune system; immunization; immunological factors; infection; perfluoroalkyl substances; polyfluoroalkyl substances

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