Clinical immunotoxicity of pesticides.

Because of the wide use of pesticides for domestic and industrial purposes, the evaluation of their immunotoxic effects is of major concern for public health. Despite the large amount of experimental data describing pesticide-induced immunosuppression, evidence that pesticides may severely impair immune functions in humans is lacking or scarce. Contact hypersensitivity is a well-identified immunotoxic effect of pesticides but remains a rare complaint in pesticide-exposed workers. By contrast, immunologically mediated systemic reactions have been described only as debatable case reports. The association between autoimmune diseases and pesticide exposure has more recently been suggested. Despite the lack of convincing human data, a potential risk for the immune system should not be excluded, especially during chronic exposure to pesticides or in otherwise (immuno) compromised patients (malnutrition, children, old patients). Epidemiological studies including markers of exposure and the assessment of immune competence in exposed individuals, or registries of sentinel diseases related to immunosuppression (e.g., non-Hodgkin's lymphoma, opportunistic infections) or autoimmunity (e.g. lupus erythematosus, rheumatoid arthritis), are warranted.