{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T19:27:01Z","timestamp":1788377221145,"version":"build-2803163510"},"reference-count":44,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T00:00:00Z","timestamp":1774915200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The potential immunotoxicity of per- and polyfluoroalkyl substances (PFAS) is a growing public health concern, yet epidemiological evidence in adults remains inconsistent. This inconsistency may partly stem from relying on single-pollutant models that do not fully capture the dynamics of chemical mixtures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We investigated the association between concurrent exposure to a mixture of five PFAS congeners and serum total immunoglobulin E (IgE) levels in a representative sample of 2,987 Korean adults from the 4th Korean National Environmental Health Survey (2018-2020). We employed Weighted Quantile Sum (WQS) regression, Quantile g-computation (Qgcomp), and Restricted Cubic Spline (RCS) analysis to assess mixture effects and non-linear associations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A statistically significant positive association was identified between the overall PFAS mixture and total IgE levels (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f0.033,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.026), with perfluorodecanoic acid (PFDeA) being the major contributor. RCS analysis revealed a distinct J-shaped, non-linear dose-response relationship between PFDeA and IgE (P\n                      <jats:italic>\n                        <jats:sub>non-linear<\/jats:sub>\n                      <\/jats:italic>\n                      &amp;lt; 0.001). Furthermore, a significant interaction with smoking status was identified (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001); the positive association was significant only among non-smokers.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion\/Conclusion<\/jats:title>\n                    <jats:p>Exposure to long-chain PFAS mixtures is positively associated with atopic tendencies in adults. These findings highlight the importance of mixture modeling and lifestyle stratification in environmental epidemiology.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1761049","type":"journal-article","created":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T05:33:19Z","timestamp":1774935199000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Relationship between perfluoroalkyl substance exposure and immunoglobulin E among Korean adults from Korean National Environmental Health Survey cycle 4 (2018\u20132020): a cross-sectional study"],"prefix":"10.3389","volume":"14","author":[{"given":"Dongwoo","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Occupational and Environmental Medicine, Soonchunhyang University Seoul Hospital","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyung-Jae","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Occupational and Environmental Medicine, Soonchunhyang University Seoul Hospital","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"June-Hee","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Occupational and Environmental Medicine, Soonchunhyang University Seoul Hospital","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"InHo","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Occupational and Environmental Medicine, Soonchunhyang University Cheonan Hospital","place":["Cheonan, Republic of Korea"]},{"name":"Department of Physiology, College of Medicine, Soonchunhyang University","place":["Cheonan, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,31]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1186\/s12890-025-03518-y","article-title":"Global, regional, and national epidemiology of allergic diseases in children from 1990 to 2021: findings from the global burden of disease study 2021","volume":"25","author":"Zheng","year":"2025","journal-title":"BMC Pulm Med"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"100080","DOI":"10.1016\/j.waojou.2019.100080","article-title":"IgE allergy diagnostics and other relevant tests in allergy, a world allergy organization position paper","volume":"13","author":"Ansotegui","year":"2020","journal-title":"World Allergy Organ J"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1146\/annurev-immunol-061020-053712","article-title":"IgE, IgE receptors and anti-IgE biologics: protein structures and mechanisms of action","volume":"41","author":"McDonnell","year":"2023","journal-title":"Annu Rev Immunol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1002\/ieam.258","article-title":"Perfluoroalkyl and polyfluoroalkyl substances in the environment: terminology, classification, and origins","volume":"7","author":"Buck","year":"2011","journal-title":"Integr Environ Assess Manag"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"eabg9065","DOI":"10.1126\/science.abg9065","article-title":"Per- and polyfluoroalkyl substances in the environment","volume":"375","author":"Evich","year":"2022","journal-title":"Science"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"107149","DOI":"10.1016\/j.envint.2022.107149","article-title":"Human exposure pathways to poly-and perfluoroalkyl substances (PFAS) from indoor media: a systematic review","volume":"162","author":"DeLuca","year":"2022","journal-title":"Environ Int"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"532","DOI":"10.1021\/acs.estlett.0c00255","article-title":"Scientific basis for managing PFAS as a chemical class","volume":"7","author":"Kwiatkowski","year":"2020","journal-title":"Environ Sci Technol Lett"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"2508","DOI":"10.1021\/acs.est.6b04806","article-title":"A never-ending story of per-and polyfluoroalkyl substances (PFASs)?","volume":"51","author":"Wang","year":"2017","journal-title":"Environ Sci Technol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1038\/s41545-023-00274-6","article-title":"Revisiting the \u201cforever chemicals\u201d, PFOA and PFOS exposure in drinking water","volume":"6","author":"Wee","year":"2023","journal-title":"NPJ Clean Water"},{"key":"ref10","volume-title":"Guidance on PFAS Exposure, Testing, and Clinical Follow-Up","year":"2022"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1001\/jama.2011.2034","article-title":"Serum vaccine antibody concentrations in children exposed to perfluorinated compounds","volume":"307","author":"Grandjean","year":"2012","journal-title":"JAMA"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"e08160","DOI":"10.1016\/j.heliyon.2021.e08160","article-title":"Perfluoroalkyl substances exposure and immunity, allergic response, infection, and asthma in children: review of epidemiologic studies","volume":"7","author":"Von Holst","year":"2021","journal-title":"Heliyon"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"114","DOI":"10.1016\/j.envres.2018.11.005","article-title":"Serum perfluoroalkyl substances (PFAS) and risk of asthma and various allergies in adolescents. The Troms\u00f8 study fit futures in northern Norway","volume":"169","author":"Averina","year":"2019","journal-title":"Environ Res"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1129","DOI":"10.1289\/ehp.1306606","article-title":"Perfluoroalkyl chemicals and asthma among children 12\u201319 years of age: NHANES (1999\u20132008)","volume":"122","author":"Humblet","year":"2014","journal-title":"Environ Health Perspect"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"100078","DOI":"10.1016\/j.jacig.2023.100078","article-title":"Associations between serum per- and polyfluoroalkyl substances and asthma morbidity in the National Health and nutrition examination survey (2003-18)","volume":"2","author":"Burbank","year":"2023","journal-title":"J Allergy Clin Immunol Glob"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"53948","DOI":"10.1007\/s11356-023-26119-w","article-title":"Association of perfluoroalkyl substances with pulmonary function in adolescents (NHANES 2007\u20132012)","volume":"30","author":"Shi","year":"2023","journal-title":"Environ Sci Pollut Res"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1136\/oemed-2014-102364","article-title":"A cohort incidence study of workers exposed to perfluorooctanoic acid (PFOA)","volume":"72","author":"Steenland","year":"2015","journal-title":"Occup Environ Med"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1469","DOI":"10.1021\/acs.est.4c08701","article-title":"Per- and Polyfluoroalkyl substances and female health concern: gender-based accumulation differences, adverse outcomes, and mechanisms","volume":"59","author":"Li","year":"2025","journal-title":"Environ Sci Technol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"153031","DOI":"10.1016\/j.tox.2021.153031","article-title":"Per- and poly-fluoroalkyl substances (PFAS) and female reproductive outcomes: PFAS elimination, endocrine-mediated effects, and disease","volume":"465","author":"Rickard","year":"2022","journal-title":"Toxicology"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"e24633","DOI":"10.1016\/j.heliyon.2024.e35888","article-title":"Sex and obesity influence the relationship between perfluoroalkyl substances and lean body mass: NHANES 2011\u20132018","volume":"10","author":"Jia","year":"2024","journal-title":"Heliyon"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1033","DOI":"10.3390\/ijerph15051033","article-title":"Tobacco smoke induces and alters immune responses in the lung triggering inflammation, allergy, asthma and other lung diseases: a mechanistic review","volume":"15","author":"Strzelak","year":"2018","journal-title":"Int J Environ Res Public Health"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1389","DOI":"10.1111\/all.15229","article-title":"Climate change and global health: a call to more research and more action","volume":"77","author":"Agache","year":"2022","journal-title":"Allergy"},{"key":"ref23","volume-title":"The Korean National Environmental Health Survey (KoNEHS) Cycle 4 Analytical Manual for Environmental Toxicants in Biospecimens - Organic Compounds","year":"2022"},{"key":"ref24","volume-title":"The Korean National Environmental Health Survey (KoNEHS) Cycle 4 Raw Data Use Guideline (Adults)","year":"2022"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1007\/s13253-014-0180-3","article-title":"Characterization of weighted quantile sum regression for highly correlated data in a risk analysis setting","volume":"20","author":"Carrico","year":"2015","journal-title":"J Agric Biol Environ Stat"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"2855","DOI":"10.1016\/j.mex.2019.11.008","article-title":"Repeated holdout validation for weighted quantile sum regression","volume":"6","author":"Tanner","year":"2019","journal-title":"MethodsX"},{"key":"ref27","article-title":"gWQS: Generalized weighted quantile sum regression","author":"Renzetti","year":"2023","journal-title":"R package version 3.0.5"},{"key":"ref28","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-319-19425-7","volume-title":"Regression Modeling Strategies: With Applications to Linear Models, Logistic and Ordinal Regression, and Survival Analysis","author":"Harrell","year":"2015"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"047004","DOI":"10.1289\/EHP5838","article-title":"A quantile-based g-computation approach to addressing the effects of exposure mixtures","volume":"128","author":"Keil","year":"2020","journal-title":"Environ Health Perspect"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"469","DOI":"10.1007\/s40572-023-00417-4","article-title":"Asthma and environmental exposures to phenols, polycyclic aromatic hydrocarbons, and phthalates in children","volume":"10","author":"Jackson-Browne","year":"2023","journal-title":"Curr Environ Health Rep"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"10619","DOI":"10.1021\/es401905e","article-title":"Biomonitoring of perfluoroalkyl acids in human urine and estimates of biological half-life","volume":"47","author":"Zhang","year":"2013","journal-title":"Environ Sci Technol"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1038\/s41370-018-0094-1","article-title":"A review of the pathways of human exposure to poly-and perfluoroalkyl substances (PFASs) and present understanding of health effects","volume":"29","author":"Sunderland","year":"2019","journal-title":"J Expo Sci Environ Epidemiol"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"117044","DOI":"10.1016\/j.taap.2024.117044","article-title":"Associations between prenatal exposure to per- and polyfluoroalkyl substances and plasma immune molecules in three-year-old children in China","volume":"490","author":"Huang","year":"2024","journal-title":"Toxicol Appl Pharmacol"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1186\/s12940-022-00958-5","article-title":"Consideration of pathways for immunotoxicity of per- and polyfluoroalkyl substances (PFAS)","volume":"22","author":"Ehrlich","year":"2023","journal-title":"Environ Health"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1016\/j.envint.2015.12.020","article-title":"Perfluoroalkyl substances and food allergies in adolescents","volume":"88","author":"Buser","year":"2016","journal-title":"Environ Int"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1080\/1547691X.2016.1254306","article-title":"Association between perfluoroalkyl substance exposure and asthma and allergic disease in children as modified by MMR vaccination","volume":"14","author":"Timmermann","year":"2017","journal-title":"J Immunotoxicol"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"378","DOI":"10.1210\/er.2011-1050","article-title":"Hormones and endocrine-disrupting chemicals: low-dose effects and nonmonotonic dose responses","volume":"33","author":"Vandenberg","year":"2012","journal-title":"Endocr Rev"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"1235","DOI":"10.1007\/s00204-011-0661-x","article-title":"Sub-chronic effect of perfluorooctanesulfonate (PFOS) on the balance of type 1 and type 2 cytokine in adult C57BL6 mice","volume":"85","author":"Dong","year":"2011","journal-title":"Arch Toxicol"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"119462","DOI":"10.1016\/j.ecoenv.2025.119462","article-title":"Associations of per-and polyfluoroalkyl substances exposure with kidney function in the Korean general population","volume":"307","author":"Choi","year":"2025","journal-title":"Ecotoxicol Environ Saf"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.35371\/aoem.2020.32.e7","article-title":"Descriptive analysis of prevalence and medical expenses of cancer, cardio-cerebrovascular disease, psychiatric disease, and musculoskeletal disease in Korean firefighters","volume":"32","author":"Min","year":"2020","journal-title":"Ann Occup Environ Med"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"e10","DOI":"10.35371\/aoem.2024.36.e10","article-title":"Association between serum perfluoroalkyl substances concentrations and non-alcoholic fatty liver disease among Korean adults: a cross-sectional study using the National Environmental Health Survey cycle 4","volume":"36","author":"Park","year":"2024","journal-title":"Ann Occup Environ Med"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"114644","DOI":"10.1016\/j.ijheh.2025.114644","article-title":"Exposure characteristics of legacy PFAS, and their precursors and alternatives among children and adolescents of Korea","volume":"269","author":"Chae","year":"2025","journal-title":"Int J Hyg Environ Health"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"484","DOI":"10.1080\/10408444.2025.2501420","article-title":"Per- and polyfluoroalkyl substances (PFAS): immunotoxicity at the primary sites of exposure","volume":"55","author":"Arnesdotter","year":"2025","journal-title":"Crit Rev Toxicol"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"6452","DOI":"10.1021\/acs.est.4c13205","article-title":"Three-dimensional cultured human nasal epithelial cell model for testing respiratory toxicity and neurotoxicity of air pollutants","volume":"59","author":"Wang","year":"2025","journal-title":"Environ Sci Technol"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1761049\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T05:33:20Z","timestamp":1774935200000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1761049\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,31]]},"references-count":44,"alternative-id":["10.3389\/fpubh.2026.1761049"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1761049","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,31]]},"article-number":"1761049"}}