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Health effects of exposure to chlorination by-products in swimming pools: Position Paper
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  • Mariana Couto,
  • Alfred Bernard,
  • Luís Delgado,
  • Franchek Drobnic,
  • Marcin Kurowski,
  • André Moreira,
  • Rodrigo Rodrigues-Alves,
  • Maia Rukhadze,
  • Sven Seys,
  • Marta Wiszniewska,
  • Santiago Quirce
Mariana Couto
Hospital CUF Descobertas
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Alfred Bernard
Louvain Center for Toxicology and Applied Pharmacology (LTAP)
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Luís Delgado
University of Porto Faculty of Medicine
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Franchek Drobnic
Olympic Training Center
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Marcin Kurowski
Medical University of Lodz
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André Moreira
University of Porto Faculty of Medicine
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Rodrigo Rodrigues-Alves
Hospital do Divino Espírito Santo de Ponta Delgada EPE
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Maia Rukhadze
Center of Allergy and Immunology
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Sven Seys
KU Leuven
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Marta Wiszniewska
Nofer Institute of Occupational Medicine
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Santiago Quirce
Hospital LA Paz Health Research Institute (IdiPaz)
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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 they have been epidemiologically associated with the development of various clinical manifestations. The higher the concentration of these 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. 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, the EAACI Joint Task Force of the Working Group of Allergy, Asthma & Sports and the Interest Groupf of Environmental & Occupational Allergy discusses 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.

Peer review status:UNDER REVIEW

21 Feb 2021Submitted to Allergy
22 Feb 2021Assigned to Editor
22 Feb 2021Submission Checks Completed
23 Feb 2021Reviewer(s) Assigned