The 1995 Wingspread Consensus Statement99 formulated some important summary comments and predictions about the potential for immune system disruption from exposure to environmental substances.

Clinical Considerations

Cancer

The principles applied to determine the etiology of childhood cancer are similar to those for adult-onset cases in that the clinician will typically first investigate family history of cancer and then will consider relevant exposures of the affected individual. Since there is some evidence of prenatal and pre-conceptional routes for childhood cancer, it is important that the clinician also inquire about occupational exposures of both parents prior to and during pregnancy and other exposures of the mother during pregnancy.

There are numerous web-based resources that will aid the clinician in determining the relative carcinogenicity of specific substances encountered in the workplace or in consumer products. Material Safety Data Sheets identify relevant chemical exposures and some information about health effects. They are available from employers and manufacturers or can be accessed online.

Health Canada will occasionally issue advisories if they learn of exposures of concern for children's health. For example, di-isononyl phthalate ester (DINP), a plasticizer found in PVC plastic toys, was the subject of advisories to the public and to physicians for its suspected carcinogenic potential in experimental tests on rodents:

Health Canada advises parents and caregivers of very young children to dispose of soft vinyl (PVC) teethers and soft vinyl (PVC) rattles

Information for Physicians: Soft Vinyl (PVC) Products For Very Young Children

Immunological Effects

There is growing evidence that many different contaminants present in the environment have the capacity to alter immune system development in animals and people. The clinical significance of the data summarized above on immunotoxicity is, however, difficult to address.

In terms of the implications for human health, we know that health depends largely on proper functioning of the immune system, the foundations for which are established early in development. It appears that immune system impairment is a potentially long-term result of altered developmental processes, the effects of which may not manifest or be recognized until later in life, long after exposure.

The authors of Our Stolen Future propose that such hypotheses, however preliminary, suggest "a new paradigm for studying and preventing many infectious diseases may emerge, in which you need first to understand the contamination history and status of the person exposed to an infectious disease."

From the perspective of the clinician, these ideas may have limited relevance to the diagnosis and management of individual patients. However, the suggestion is that, since there is potential for effects to be population-wide, new ways of thinking are required to improve our approach to disease prevention.

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