Introduction: Endotoxin is a collective term designating a characteristic group of chemical constituents of the outer membrane of Gram negative bacteria, the lipopolysaccharides (LPS).
Background: LPS provocation tests in healthy subjects (50 microg) induce asthma-like airflow obstruction with a neutrophilic inflammatory influx, similar to reactions observed in non-atopic asthma. Asthmatic subjects show the same reaction with smaller doses of LPS (20 microg), revealing higher sensitivity to LPS than normal subjects. Low levels (2 microg) of LPS do not induce either airflow obstruction or bronchial hyperreactivity. Among exposed workers, particularly in agriculture, endotoxin is the most significant component of the bioaerosol that is associated with airway disease. In clinical studies, exposure to LPS is associated with severe asthma. Conversely, epidemiological studies, in both urban and rural areas, assessing the relationship between exposure to LPS and asthma and asthma- related symptoms are inconsistent.
Perspectives: Longitudinal epidemiological studies, especially in farm children, may confirm the putative protective effects of LPS with respect to atopic asthma.
Conclusion: Exposure to indoor LPS is frequently associated with asthma and asthma-like symptoms in current studies. Their definitive role needs to be confirmed by birth cohort studies currently under way that should define the controversial protective effect of LPS with respect to atopic asthma in farming populations.