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Health effects of exposure to chlorination by-products in swimming pools
Authors:Mariana Couto  Alfred Bernard  Luís Delgado  Franchek Drobnic  Marcin Kurowski  André Moreira  Rodrigo Rodrigues-Alves  Maia Rukhadze  Sven Seys  Marta Wiszniewska  Santiago Quirce
Affiliation:1. Centro de Alergia, Hospital CUF Descobertas, Lisboa, Portugal;2. Louvain Centre for Toxicology and Applied Pharmacology, Institute of Experimental and Clinical Research (IREC), Catholic University of Louvain, Brussels, Belgium;3. Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal;4. Head of Medical Services - Shenhua Greenland FC, Shanghai, China;5. Department of Immunology and Allergy, Medical University of Łódź, Łódź, Poland;6. Unidade de Imunoalergologia, Hospital do Divino Espírito Santo, Ponta Delgada, Portugal;7. Center of Allergy & Immunology, Teaching University Geomedi LLC, Tbilisi, Georgia;8. Laboratory of Clinical Immunology, Department of Clinical Immunology, KU Leuven, Leuven, Belgium;9. Department of Occupational Diseases and Environmental Health, Nofer Institute of Occupational Medicine, Lodz, Poland;10. Department of Allergy, La Paz University Hospital, IdiPAZ, and Universidad Autónoma de Madrid, Madrid, Spain
Abstract:
Concerns have been raised regarding the potential negative effects on human health of water disinfectants used in swimming pools. Among the disinfection options, the approaches using chlorine-based products have been typically preferred. Chlorine readily reacts with natural organic matter that are introduced in the water mainly through the bathers, leading to the formation of potentially harmful chlorination by-products (CBPs). The formation of CBPs is of particular concern since some have been epidemiologically associated with the development of various clinical manifestations. The higher the concentration of volatile CBPs in the water, the higher their concentration in the air above the pool, and different routes of exposure to chemicals in swimming pools (water ingestion, skin absorption, and inhalation) contribute to the individual exposome. Some CBPs may affect the respiratory and skin health of those who stay indoor for long periods, such as swimming instructors, pool staff, and competitive swimmers. Whether those who use chlorinated pools as customers, particularly children, may also be affected has been a matter of debate. In this article, we discuss the current evidence regarding the health effects of both acute and chronic exposures in different populations (work-related exposures, intensive sports, and recreational attendance) and identify the main recommendations and unmet needs for research in this area.
Keywords:chlorination by-products  disinfection by-products  occupational exposure  recreational exposure  sports
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