Cent Eur J Public Health 2025, 33(1):3-11 | DOI: 10.21101/cejph.a8437

Association between complex exposure to cadmium and mercury and atopic dermatitis in elementary school students: analysis using data from the Korean National Environmental Health Survey (KoNEHS) Cycle 4

Kiook Baek1, 2, 3
1 Department of Preventive Medicine, College of Medicine, Dongguk University Gyeongju, Gyeongju, Republic of Korea
2 Department of Occupational and Environmental Medicine, Dongguk University Gyeongju Hospital, Gyeongju, Republic of Korea
3 Department of Medicine, Graduate School of Kyungpook National University, Daegu, Republic of Korea

Objectives: Atopic dermatitis (AD) is a common allergic disease with potential links to environmental pollutants, including heavy metals. This study investigates the association between co-exposure to cadmium and mercury and AD among Korean children.

Methods: Data from the fourth cycle of the Korean National Environmental Health Survey (KoNEHS) included 736 elementary school students. Urinary cadmium and mercury levels were measured, and their association with lifetime prevalence of AD was analysed using logistic regression, weighted quantile sum (WQS) regression, quantile g-computation (QGC), and Bayesian kernel machine regression (BKMR). Confounders adjusted included age, sex, urinary cotinine, income, and body mass index. Sensitivity analyses used symptomatic AD and AD treatment as outcome variables.

Results: Among two metals, only cadmium in the highest tertile showed an odds ratio (OR) of 2.39 (95% CI: 1.12-5.10) compared with lowest tertile, with a significant trend per tertile increase (OR 1.58, 95% CI: 1.08-2.31) in multiple logistic regression. Co-exposure analysis using WQS and QGC revealed significant associations with AD prevalence, with WQS showing an OR of 1.47 (95% CI: 1.18-1.83) and QGC showing an OR of 1.60 (95% CI: 1.20-2.13) per tertile increase of exposure. BKMR indicated a dose-dependent relationship between overall exposure and AD risk. For symptomatic AD, similar trend was found. The treatment status of AD did not show a significant association with either heavy metal.

Conclusion: This study suggests a significant association between co-exposure to cadmium and mercury and atopic dermatitis, emphasizing the need to consider combined environmental exposures in epidemiological studies.

Keywords: atopic dermatitis, cadmium, co-exposure, heavy metals, mercury

Received: October 11, 2024; Revised: October 11, 2024; Accepted: March 14, 2025; Published: March 31, 2025  Show citation

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Baek K. Association between complex exposure to cadmium and mercury and atopic dermatitis in elementary school students: analysis using data from the Korean National Environmental Health Survey (KoNEHS) Cycle 4. Cent Eur J Public Health. 2025;33(1):3-11. doi: 10.21101/cejph.a8437.
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    References

    1. Schneider L, Tilles S, Lio P, Boguniewicz M, Beck L, LeBovidge J, et al. Atopic dermatitis: a practice parameter update 2012. J Allergy Clin Immunol. 2013 Feb;131(2):295-9.e1-27. doi: 10.1016/j.jaci.2012.12.672. Go to original source... Go to PubMed...
    2. Nutten S. Atopic dermatitis: global epidemiology and risk factors. Ann Nutr Metab. 2015;66 Suppl 1:8-16. Go to original source... Go to PubMed...
    3. Ahn K. The role of air pollutants in atopic dermatitis. J Allergy Clin Immunol. 2014 Nov;134(5):993-9; discussion 1000. doi: 10.1016/j.jaci.2014.09.023. Go to original source... Go to PubMed...
    4. Kim JH, Jeong KS, Ha EH, Park H, Ha M, Hong YC, et al. Association between prenatal exposure to cadmium and atopic dermatitis in infancy. J Korean Med Sci. 2013;28(4):516-21. Go to original source... Go to PubMed...
    5. Wang J, Yin J, Hong X, Liu R. Exposure to heavy metals and allergic outcomes in children: a systematic review and meta-analysis. Biol Trace Elem Res. 2022 Nov;200(11):4615-31. Go to original source... Go to PubMed...
    6. Jain RB. Co-exposures to toxic metals cadmium, lead, and mercury and their impact on unhealthy kidney function. Environ Sci Pollut Res Int. 2019 Oct;26(29):30112-8. Go to original source... Go to PubMed...
    7. Sanders AP, Mazzella MJ, Malin AJ, Hair GM, Busgang SA, Saland JM, et al. Combined exposure to lead, cadmium, mercury, and arsenic and kidney health in adolescents age 12-19 in NHANES 2009-2014. Environ Int. 2019 Oct;131:104993. doi: 10.1016/j.envint.2019.104993. Go to original source... Go to PubMed...
    8. Pan S, Lin L, Zeng F, Zhang J, Dong G, Yang B, et al. Effects of lead, cadmium, arsenic, and mercury co-exposure on children's intelligence quotient in an industrialized area of southern China. Environ Pollut. 2018 Apr;235:47-54. Go to original source... Go to PubMed...
    9. Park C, Yu SD. Status and prospects of the Korean National Environmental Health Survey (KoNEHS). J Environ Health Sci. 2014;40(1):1-9. Go to original source...
    10. Hong S, Kim OJ, Jung SK, Jeon HL, Kim S, Kil J. The Exposure status of environmental chemicals in South Korea: the Korean National Environmental Health Survey 2018-2020. Toxics. 2024;12(11):829. doi: 10.3390/toxics12110829. Go to original source... Go to PubMed...
    11. Hong SY, Kim OJ, Kil JH, Lee CW, Kim SJ, Chung HM. [Manual for analysis of clinical specimen from the fourth ('18-'20) Korean National Environmental Health Survey]. Incheon, Republic of Korea: National Institute of Environmental Research; 2022. Korean.
    12. Carrico C, Gennings C, Wheeler DC, Factor-Litvak P. Characterization of weighted quantile sum regression for highly correlated data in a risk analysis setting. J Agric Biol Environ Stat. 2015;20(1):100-20. Go to original source... Go to PubMed...
    13. Tanner EM, Bornehag CG, Gennings C. Repeated holdout validation for weighted quantile sum regression. MethodsX. 2019;6:2855-60. Go to original source... Go to PubMed...
    14. Keil AP, Buckley JP, O'Brien KM, Ferguson KK, Zhao S, White AJ. A Quantile-based g-computation approach to addressing the effects of exposure mixtures. Environ Health Perspect. 2020 Apr;128(4):47004. doi: 10.1289/EHP5838. Go to original source... Go to PubMed...
    15. Bobb JF, Valeri L, Claus Henn B, Christiani DC, Wright RO, Mazumdar M, et al. Bayesian kernel machine regression for estimating the health effects of multi-pollutant mixtures. Biostatistics. 2015;16(3):493-508. Go to original source... Go to PubMed...
    16. Min G, Shin J, Kim D, Woo J, Sung K, Cho M, et al. Assessment of heavy metal exposure levels (Pb, Hg, Cd) among South Koreans and contribution rates by exposure route - Korean National Environmental Health Survey (KoNEHS) Cycle 4 (2018-2020). J Environ Health Sci. 2023;49(5):262-74. Go to original source...
    17. Kim NS, Ahn J, Lee BK, Park J, Kim Y. Environmental exposures to lead, mercury, and cadmium among South Korean teenagers (KNHANES 2010-2013): body burden and risk factors. Environ Res. 2017 Jul;156:468-76. Go to original source... Go to PubMed...
    18. Kim JH, Jung M, Mun J, Seo DJ, Leem JH, Park SG, et al. Association of weight and dietary habits with high blood mercury levels in Korean adolescents: data from the KoNEHS cycle 4, 2018-2020. Ann Occup Environ Med. 2025;37:e5. doi: 10.35371/aoem.2025.37.e5. Go to original source... Go to PubMed...
    19. Watanabe T, Kim ES, Ko YS, Yang HR, Moon CS, Nakatsuka H, et al. Food intake survey of kindergarten children in Korea: Part 3 cadmium and lead burden. Environ Health Prev Med. 2015 Jul;20(4):307-13. Go to original source... Go to PubMed...
    20. Moon CS, Paik JM, Choi CS, Kim DH, Ikeda M. Lead and cadmium levels in daily foods, blood and urine in children and their mothers in Korea. Int Arch Occup Environ Health. 2003;76(4):282-8. Go to original source... Go to PubMed...
    21. Kim JH, Jung M, Mun J, Seo DJ, Leem JH, Park SG, et al. Association of weight and dietary habits with high blood mercury levels in Korean adolescents: data from the KoNEHS cycle 4, 2018-2020. Ann Occup Environ Med. 2025;37:e5. doi: 10.35371/aoem.2025.37.e5. Go to original source... Go to PubMed...
    22. Yoo BW, Kim B, Joshi P, Kwon SO, Kim Y, Oh JS, et al. Effect of dietary patterns on the blood/urine concentration of the selected toxic metals (Cd, Hg, Pb) in Korean children. Food Sci Biotechnol. 2018 Feb 24;27(4):1227-37. Go to original source... Go to PubMed...
    23. Lee JW, Lee CK, Moon CS, Choi IJ, Lee KJ, Yi SM, et al. Korea National Survey for Environmental Pollutants in the Human Body 2008: heavy metals in the blood or urine of the Korean population. Int J Hyg Environ Health. 2012 Jul;215(4):449-57. Go to original source... Go to PubMed...
    24. Batáriová A, Spěvácková V, Beneš B, Čejchanová M, Šmíd J, Černá M. Blood and urine levels of Pb, Cd and Hg in the general population of the Czech Republic and proposed reference values. Int J Hyg Environ Health. 2006 Jul;209(4):359-66. Go to original source... Go to PubMed...
    25. Hossein-Khannazer N, Azizi G, Eslami S, Alhassan Mohammed H, Fayyaz F, Hosseinzadeh R, et al. The effects of cadmium exposure in the induction of inflammation. Immunopharmacol Immunotoxicol. 2020 Feb;42(1):1-8. Go to original source... Go to PubMed...
    26. Tucovic D, Popov Aleksandrov A, Mirkov I, Ninkov M, Kulas J, Zolotarevski L, et al. Oral cadmium exposure affects skin immune reactivity in rats. Ecotoxicol Environ Saf. 2018 Nov 30;164:12-20. Go to original source... Go to PubMed...
    27. Kempuraj D, Asadi S, Zhang B, Manola A, Hogan J, Peterson E, et al. Mercury induces inflammatory mediator release from human mast cells. J Neuroinflammation. 2010 Mar 11;7:20. doi: 10.1186/1742-2094-7-20. Go to original source... Go to PubMed...
    28. Strenzke N, Grabbe J, Plath KE, Rohwer J, Wolff HH, Gibbs BF. Mercuric chloride enhances immunoglobulin E-dependent mediator release from human basophils. Toxicol Appl Pharmacol. 2001 Aug 1;174(3):257-63. Go to original source... Go to PubMed...
    29. Kim JH, Jeong KS, Ha EH, Park H, Ha M, Hong YC, et al. Association between prenatal exposure to cadmium and atopic dermatitis in infancy. J Korean Med Sci. 2013 Apr;28(4):516-21. Go to original source... Go to PubMed...
    30. Tsai TL, Wang SL, Hsieh CJ, Wen HJ, Kuo CC, Liu HJ, et al. Association between prenatal exposure to metals and atopic dermatitis among children aged 4 years in Taiwan. JAMA Netw Open. 2021 Oct 27;4(10):e2131327. doi: 10.1001/jamanetworkopen.2021.31327. Go to original source... Go to PubMed...
    31. Park H, Kim K. Association of blood mercury concentrations with atopic dermatitis in adults: a population-based study in Korea. Environ Res. 2011 May;111(4):573-8. Go to original source... Go to PubMed...
    32. Shin J, Kim BM, Ha M, Park HS, Hong YC, Kim Y, et al. The Association between mercury exposure and atopic dermatitis in early childhood: a mothers and children's environmental health study. Epidemiology. 2019 Jul;30 Suppl 1:S3-8. Go to original source... Go to PubMed...
    33. Miyake Y, Tanaka K, Yasutake A, Sasaki S, Hirota Y. Lack of association of mercury with risk of wheeze and eczema in Japanese children: the Osaka Maternal and Child Health Study. Environ Res. 2011 Nov;111(8):1180-4. Go to original source... Go to PubMed...
    34. Wei J, Zhang JJ, Ji JS. Association of environmental exposure to heavy metals and eczema in US population: Analysis of blood cadmium, lead, and mercury. Arch Environ Occup Health. 2019;74(5):239-51. Go to original source... Go to PubMed...
    35. Holmes P, James KA, Levy LS. Is low-level environmental mercury exposure of concern to human health? Sci Total Environ. 2009;408(2):171-82. Go to original source... Go to PubMed...
    36. Colombo M, Hamelin C, Kouassi E, Fournier M, Bernier J. Differential effects of mercury, lead, and cadmium on IL-2 production by Jurkat T cells. Clin Immunol. 2004 Jun;111(3):311-22. Go to original source... Go to PubMed...
    37. Daum JR, Shepherd DM, Noelle RJ. Immunotoxicology of cadmium and mercury on B-lymphocytes-I. Effects on lymphocyte function. Int J Immunopharmacol. 1993 Apr;15(3):383-94. Go to original source... Go to PubMed...
    38. Pan Z, Guo Y, Xiang H, Hui Y, Ju H, Xu S, et al. Effects of lead, mercury, and cadmium co-exposure on children's pulmonary function. Biol Trace Elem Res. 2020 Mar;194(1):115-20. Go to original source... Go to PubMed...
    39. Kim JH, Na JE, Lee J, Park YE, Lee J, Choi JH, et al. Blood concentrations of lead, cadmium, and mercury are associated with alcohol-related liver disease. J Korean Med Sci. 2023 Dec 18;38(49):e412. doi: 10.3346/jkms.2023.38.e412. Go to original source... Go to PubMed...
    40. Lee JY, Choi YH, Choi HI, Moon KW. Association between environmental mercury exposure and allergic disorders in Korean children: Korean National Environmental Health Survey (KoNEHS) cycles 3-4 (2015-2020). Sci Rep. 2024 Jan 17;14(1):1472. doi: 10.1038/s41598-024-51811-3. Go to original source... Go to PubMed...
    41. Han CY, Park JG, Kang DW, Park SY, Kim BH, Kim YB, et al. Analysis of case studies of treating atopic dermatitis-focusing on Korean herbal medicine used in cases. J Korean Med Ophthalmol Otolaryngol Dermatol. 2019;32(3):151-63.
    42. Choi MJ, Byun JY, Choi HY, Choi YW. Quantitative analysis of metal contents in Korean herbs and herbal products to give advice for metal allergic patient. Ann Dermatol. 2019 Aug;31(4):414-9. Go to original source... Go to PubMed...
    43. Howards PP, Schisterman EF, Poole C, Kaufman JS, Weinberg CR. "Toward a clearer definition of confounding" revisited with directed acyclic graphs. Am J Epidemiol. 2012 Sep 15;176(6):506-11. Go to original source... Go to PubMed...

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