151
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Hoy RF, Brims F. Occupational lung diseases in Australia. Med J Aust 2017; 207:443-448. [PMID: 29129163 DOI: 10.5694/mja17.00601] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 09/15/2017] [Indexed: 01/19/2023]
Abstract
Occupational exposures are an important determinant of respiratory health. International estimates note that about 15% of adult-onset asthma, 15% of chronic obstructive pulmonary disease and 10-30% of lung cancer may be attributable to hazardous occupational exposures. One-quarter of working asthmatics either have had their asthma caused by work or adversely affected by workplace conditions. Recently, cases of historical occupational lung diseases have been noted to occur with new exposures, such as cases of silicosis in workers fabricating kitchen benchtops from artificial stone products. Identification of an occupational cause of a lung disease can be difficult and requires maintaining a high index of suspicion. When an occupational lung disease is identified, this may facilitate a cure and help to protect coworkers. Currently, very little information is collected regarding actual cases of occupational lung diseases in Australia. Most assumptions about many occupational lung diseases are based on extrapolation from overseas data. This lack of information is a major impediment to development of targeted interventions and timely identification of new hazardous exposures. All employers, governments and health care providers in Australia have a responsibility to ensure that the highest possible standards are in place to protect workers' respiratory health.
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Ollé‐Monge M, Cruz M, Gomez‐Ollés S, Ojanguren I, Vanoirbeek J, Muñoz X. Effect of anti-IgE in occupational asthma caused by exposure to low molecular weight agents. Allergy 2017; 72:1720-1727. [PMID: 28439933 DOI: 10.1111/all.13190] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND The role of immunoglobulin (Ig)-E in occupational asthma (OA) due to low molecular weight (LMW) agents is not well established compared to classical atopic asthma. In this study, we evaluate whether anti-IgE monoclonal antibody (mAb) has an effect in a mouse model of OA, using persulfate salts. METHODS On days 1 and 8, BALB/C mice were dermally sensitized with 5% ammonium persulfate (AP) or dimethyl sulfoxide (DMSO). On days 15, 18, and 21, animals were injected intraperitoneally with anti-IgE mAb or PBS 6 hours before challenge with AP or saline. Airway hyper-responsiveness (AHR) using a methacholine test, airway inflammation in bronchoalveolar lavage (BAL) and lung tissue, and total free IgE in serum samples were analyzed 24, 48, and 96 hours after the last challenge. RESULTS Anti-IgE mAb treatment almost completely neutralized free serum IgE. In AP-sensitized and challenged mice, anti-IgE mAb treatment abolished AHR 24 hour and 48 hour after the last challenge and significantly reduced the total number of eosinophils and neutrophils 48 hour and 96 hour after the last AP challenge compared with nontreated mice. Levels of interleukin (IL)-13 in BAL were also significantly decreased after anti-IgE administration 24 hour and 48 hour after the last AP challenge. Histological analysis of the lung sections from anti-IgE-treated mice revealed normal inflammatory patterns similar to control groups 48 hour after the last challenge. CONCLUSIONS Anti-IgE-treated mice showed a significant improvement in asthma features related to the AHR and airway inflammation. Anti-IgE mAb has positive effects in OA induced by persulfate salts.
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Affiliation(s)
- M. Ollé‐Monge
- Servicio de Neumologia Hospital Universitario Vall d'Hebron Barcelona Spain
- CIBER Enfermedades Respiratorias (CibeRes) Barcelona Spain
- Departament de Medicina Universitat Autònoma de Barcelona Barcelona Spain
| | - M.J. Cruz
- Servicio de Neumologia Hospital Universitario Vall d'Hebron Barcelona Spain
- CIBER Enfermedades Respiratorias (CibeRes) Barcelona Spain
- Departament de Medicina Universitat Autònoma de Barcelona Barcelona Spain
| | - S. Gomez‐Ollés
- Servicio de Neumologia Hospital Universitario Vall d'Hebron Barcelona Spain
- CIBER Enfermedades Respiratorias (CibeRes) Barcelona Spain
- Departament de Medicina Universitat Autònoma de Barcelona Barcelona Spain
| | - I. Ojanguren
- Servicio de Neumologia Hospital Universitario Vall d'Hebron Barcelona Spain
- CIBER Enfermedades Respiratorias (CibeRes) Barcelona Spain
- Departament de Medicina Universitat Autònoma de Barcelona Barcelona Spain
| | - J. Vanoirbeek
- Department of Public Health and Primary Care Centre for Environment and Health KU Leuven Leuven Belgium
| | - X. Muñoz
- Servicio de Neumologia Hospital Universitario Vall d'Hebron Barcelona Spain
- CIBER Enfermedades Respiratorias (CibeRes) Barcelona Spain
- Departament de Medicina Universitat Autònoma de Barcelona Barcelona Spain
- Department of Cell Biology Physiology and Immunology Universitat Autònoma de Barcelona Barcelona Spain
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153
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Harber P, Redlich CA, Hines S, Filios M, Storey E. Recommendations for a Clinical Decision Support System for Work-Related Asthma in Primary Care Settings. J Occup Environ Med 2017; 59:e231-e235. [PMID: 29023337 PMCID: PMC6282164 DOI: 10.1097/jom.0000000000001182] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to describe a recommended clinical decision support (CDS) approach for work-related asthma for incorporation in electronic health records (EHRs) for primary care health care providers. METHODS Subject matter experts convened by the American Thoracic Society reviewed available guidelines and published literature to develop specific recommendations. RESULTS It is important to recognize possible work-related asthma among persons with new-onset or worsening asthma. The work group recommends incorporating three simple questions about temporal relations between asthma symptoms and work in EHR systems and identified specific clinical conditions to trigger this intervention. Patients with positive responses to the three questions should have the asthma diagnosis documented and have further evaluation, education, and possible referral. CONCLUSION An effective CDS system for improving recognition of work-related asthma may help reduce morbidity and mortality of asthma in adults.
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Affiliation(s)
- Philip Harber
- Department of Community, Environment, and Policy. Mel and Enid Zuckerman College of Public Health, University Of Arizona, Tucson, Arizona, USA
| | - Carrie A. Redlich
- Department of Medicine, Yale University School of Medicine, New Haven Connecticut USA
| | - Stella Hines
- Department of Medicine, University Of Maryland, Baltimore Maryland
| | - Margaret Filios
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention (CDC), Morgantown, WV, USA
| | - Eileen Storey
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention (CDC), Morgantown, WV, USA
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154
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Beyan AC, Alici NS, Cimrin A. Assessment of work-related Asthma cases: Our three-year experience. Pak J Med Sci 2017; 33:1230-1235. [PMID: 29142570 PMCID: PMC5673739 DOI: 10.12669/pjms.335.12923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective Work-related asthma (WRA) is one of the most common occupational diseases. In this study, we aimed to review diagnosing procedures and the characteristics of patients who were diagnosed with WRA. Methods Between November 2013 and June 2016; 214 patients were referred to our clinic with WRA suspicion by an occupational health specialist, personal visit, chest disease specialists [61 (28%), 51 (23%), and 102 (47%) respectively]. Occupational history, functional and radiological assessment, skin prick test, PEF monitoring were done. Results Fifty-four patients (25%) were diagnosed with OA, and 24 (11%) with WEA, total 78 workers were diagnosed with WRA. Twenty-five (32.1%) had allergic rhinitis, 13 (16.7%) had allergic dermatitis, and 8 (10%) had both diseases. Conclusion WRA can be seen in many areas. Complaints are the basic route for admission to physician, and the diagnosis can be delayed for a long time as one year. Lower rates of referral by occupational health physicians are the signs of limitations on management of cases. Non-specific BPT and skin prick test for selected cases would be sufficient besides occupational history and clinical examination for the diagnosis of WRA. PEF assessment, one of the most important tests for the diagnosis of WRA, must be performed.
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Affiliation(s)
- Ayse Coskun Beyan
- Ayse Coskun Beyan, Dokuz Eylul University Faculty of Medicine, Occupational Medicine Department, Izmir, Turkey
| | - Nur Safak Alici
- Nur Safak Alici, Dokuz Eylul University Faculty of Medicine, Occupational Medicine Department, Izmir, Turkey
| | - Arif Cimrin
- Arif Cimrin, Dokuz Eylul University Faculty of Medicine, Occupational Medicine Department, Izmir, Turkey
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155
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Dumas O, Wiley AS, Quinot C, Varraso R, Zock JP, Henneberger PK, Speizer FE, Le Moual N, Camargo CA. Occupational exposure to disinfectants and asthma control in US nurses. Eur Respir J 2017; 50:50/4/1700237. [PMID: 28982772 DOI: 10.1183/13993003.00237-2017] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 07/15/2017] [Indexed: 11/05/2022]
Abstract
Disinfectant use has been associated with adverse respiratory effects among healthcare workers. However, the specific harmful agents have not been elucidated. We examined the association between occupational exposure to disinfectants and asthma control in the Nurses' Health Study II, a large cohort of female nurses.Nurses with asthma were invited in 2014 to complete two questionnaires on their current occupation and asthma (response rate 80%). Asthma control was defined by the Asthma Control Test (ACT). Exposure to major disinfectants was evaluated by a job-task-exposure matrix (JTEM).Analyses included 4102 nurses with asthma (mean age 58 years). Asthma control was poor (ACT score 16-19) in 12% of nurses and very poor (ACT score ≤15) in 6% of nurses. Use of disinfectants to clean medical instruments (19% exposed) was associated with poorly (OR 1.37; 95% CI 1.05-1.79) and very poorly (OR 1.88, 95% CI 1.38-2.56) controlled asthma (ptrend=0.004, after adjustment for potential confounders). Using JTEM estimates, exposure to formaldehyde, glutaraldehyde, hypochlorite bleach, hydrogen peroxide and enzymatic cleaners was associated with poor asthma control (all ptrend<0.05); exposure to quaternary ammonium compounds and alcohol was not.Use of several disinfectants was associated with poor asthma control. Our findings suggest targets for future efforts to prevent worsening of asthma control in healthcare workers.
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Affiliation(s)
- Orianne Dumas
- INSERM U1168, VIMA: Aging and Chronic Diseases, Epidemiological and Public Health Approaches, Villejuif, France .,Université Versailles St-Quentin-en-Yvelines, UMRS 1168, Montigny le Bretonneux, France
| | - Aleta S Wiley
- Channing Division of Network Medicine, Dept of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Catherine Quinot
- INSERM U1168, VIMA: Aging and Chronic Diseases, Epidemiological and Public Health Approaches, Villejuif, France.,Université Versailles St-Quentin-en-Yvelines, UMRS 1168, Montigny le Bretonneux, France
| | - Raphaëlle Varraso
- INSERM U1168, VIMA: Aging and Chronic Diseases, Epidemiological and Public Health Approaches, Villejuif, France.,Université Versailles St-Quentin-en-Yvelines, UMRS 1168, Montigny le Bretonneux, France
| | - Jan-Paul Zock
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Paul K Henneberger
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, WV, USA
| | - Frank E Speizer
- Channing Division of Network Medicine, Dept of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Nicole Le Moual
- INSERM U1168, VIMA: Aging and Chronic Diseases, Epidemiological and Public Health Approaches, Villejuif, France.,Université Versailles St-Quentin-en-Yvelines, UMRS 1168, Montigny le Bretonneux, France
| | - Carlos A Camargo
- Channing Division of Network Medicine, Dept of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Dept of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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156
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Hamamoto Y, Ano S, Allard B, O'Sullivan M, McGovern TK, Martin JG. Montelukast reduces inhaled chlorine triggered airway hyperresponsiveness and airway inflammation in the mouse. Br J Pharmacol 2017; 174:3346-3358. [PMID: 28718891 PMCID: PMC5595758 DOI: 10.1111/bph.13953] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 03/20/2017] [Accepted: 04/13/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND PURPOSE Cysteinyl leukotrienes (CysLTs) are pro-inflammatory lipid mediators that exacerbate disease state in several asthma phenotypes including asthma induced by allergen, virus and exercise. However, the role of CysLTs in irritant-induced airway disease is not well characterized. The purpose of the current study was to investigate the effect of montelukast, a CysLT1 receptor antagonist, on parameters of irritant-induced asthma induced by inhalation of chlorine in the mouse. EXPERIMENTAL APPROACH BALB/c mice were exposed to chlorine in air (100 ppm, for 5 min). Montelukast (3 mg·kg-1 ) or the vehicle (1% methylcellulose) was administered 24 and 1 h prior to chlorine exposure and 1 h prior to outcome measurements. Twenty-four hours after exposure, responses to inhaled aerosolized methacholine, cell composition and an array of cytokines/chemokines in bronchoalveolar lavage (BAL) fluid were measured. Neutralizing antibodies against IL-6 and VEGF were administered prior to exposures. KEY RESULTS Montelukast reduced chlorine -induced airway hyperresponsiveness (AHR) to methacholine in the peripheral lung compartment as estimated from dynamic elastance, but not in large conducting airways. Montelukast treatment attenuated chlorine-induced macrophage influx, neutrophilia and eosinophilia in BAL fluid. Chlorine exposure increased VEGF, IL-6, the chemokines KC and CCL3 in BAL fluid. Montelukast treatment prevented chlorine-induced increases in VEGF and IL-6. Anti-IL-6 antibody inhibited chlorine-induced neutrophilia and reduced AHR. CONCLUSIONS AND IMPLICATIONS Pre-treatment with montelukast attenuated chlorine-induced neutrophilia and AHR in mice. These effects are mediated, in part, via IL-6.
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Affiliation(s)
- Yoichiro Hamamoto
- Meakins‐Christie Laboratories, The Research Institute of McGill University Health Centre and the Department of MedicineMcGill UniversityMontrealQCCanada
| | - Satoshi Ano
- Meakins‐Christie Laboratories, The Research Institute of McGill University Health Centre and the Department of MedicineMcGill UniversityMontrealQCCanada
| | - Benoit Allard
- Meakins‐Christie Laboratories, The Research Institute of McGill University Health Centre and the Department of MedicineMcGill UniversityMontrealQCCanada
| | - Michael O'Sullivan
- Meakins‐Christie Laboratories, The Research Institute of McGill University Health Centre and the Department of MedicineMcGill UniversityMontrealQCCanada
| | - Toby K McGovern
- Meakins‐Christie Laboratories, The Research Institute of McGill University Health Centre and the Department of MedicineMcGill UniversityMontrealQCCanada
| | - James G Martin
- Meakins‐Christie Laboratories, The Research Institute of McGill University Health Centre and the Department of MedicineMcGill UniversityMontrealQCCanada
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157
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Pérez-Calderón R, Gonzalo-Garijo MÁ, Rodríguez-Velasco FJ, Sánchez-Vega S, Bartolomé-Zavala B. Occupational respiratory allergy in peach crop workers. Allergy 2017; 72:1556-1564. [PMID: 28317175 DOI: 10.1111/all.13163] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Occupational respiratory diseases in workers of peach tree crops have been reported punctually and have been associated with sensitization to proteins present in both pollen and leaf tree. We report the study of 37 workers with respiratory symptoms related to occupational exposure to peach trees. METHODS Prick tests and specific IgE determinations were performed with extracts from leaves and branches of peach tree. Immunodetection in leaf extract was realized by sodium dodecyl sulfate-polyacrylamide gel electrophoresis SDS-PAGE-immunoblotting with patient sera and rabbit serum anti-Pru p 3. Immunodetection inhibition was performed with rPru p 3 and pollen profilins. The clinical relevance of sensitization was demonstrated by specific bronchial challenge test (SBCT) with peach leaf extract. RESULTS Most patients suffered symptoms when peach trees had leaves, specifically during thinning and harvesting fruit (rhinoconjunctivitis: 100% and asthma: 67.5%). Sensitization to leaf extract was demonstrated in 86% of patients. IgE-immunoblotting with peach leaf extract revealed in six patient sera a pair of bands of 10 and 16 kDa, and in nine a 16-kDa band. Those bands could be two isoforms of peach leaf lipid transfer proteins( LTP), so the recognition frequency of some LTP isoform by our patient sera was 42%. 33% of the sera recognized a doubled band of about 14.5 kDa and this recognition was inhibited by nPho d 2. The SBCT with peach leaf extract was positive in the asthmatic sensitized patients tested. CONCLUSIONS Sensitization to peach leaves was the cause of occupational respiratory symptoms in our patients. Some patient sera revealed IgE-binding proteins matching LTP and/or profilin.
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Affiliation(s)
- R. Pérez-Calderón
- Allergology Department; Infanta Cristina University Hospital; Badajoz Spain
| | | | | | - S. Sánchez-Vega
- Allergology Department; Infanta Cristina University Hospital; Badajoz Spain
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158
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Abstract
PURPOSE OF REVIEW Work-related asthma encompasses both sensitizer-induced and irritant-induced occupational asthma as well as work-exacerbated asthma. This review summarizes current diagnostic and management strategies for occupational asthma. RECENT FINDINGS Occupational asthma is the most common occupational lung disease in the industrialized world. Over 400 agents have been described to cause occupational asthma. Specific inhalation challenge is often considered the reference method for diagnosis of occupational asthma but specific inhalation challenge as well as other diagnostic tests all generate false positive or false negative results. Definitive avoidance of the inciting agent is the preferred strategy for sensitizer-induced occupational asthma and reduction of exposure is the next best step. Immunotherapy is not currently well established and can cause systemic reactions. SUMMARY An accurate diagnosis made in a timely fashion can positively impact the health and socioeconomic burden associated with occupational asthma. Newer diagnostic tools are promising, but much work needs to be done to standardize and validate these testing methods. Primary, secondary, and tertiary prevention strategies are crucial for effective management of sensitizer-induced occupational asthma.
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Abstract
PURPOSE OF REVIEW Asthma due to cleaning products has been known for 20 years, and the interest in this topic is still large because of the number of cleaning workers with respiratory problems. In this review, we sought to highlight the most recent findings on the relationship between exposure to cleaning products and asthma and to summarize the specific literature published between 2013 and 2016. RECENT FINDINGS Women are confirmed as most of workers exposed to cleaning products and have a higher frequency than men of work-related respiratory symptoms and diseases. Many cases of asthma due to cleaning products occur in healthcare occupations. The increased risk of asthma has been shown to be related to the number of years in the job and to early life disadvantage. Recent evidence suggests that predisposition to adult-onset asthma may be related to interaction between genes and occupational exposure to low-molecular weight agents/irritants. There is some evidence that an irritant mechanism is more common, although several case reports showed animmunologic mechanism (e.g. disinfectants, amine compounds, aldehydes and fragrances). SUMMARY The review updated recent findings on epidemiology, cleaning agents and their mechanism, and prevention of asthma due to cleaning agents. This article provides new information on the level of exposure, which is still high in professional cleaners and even more in domestic cleaners, and on the frequency of asthma in professional and domestic cleaners. An irritant mechanism is more common, although an immunological mechanism is possible, especially in healthcare workers exposed to disinfectants.
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160
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Simoneti CS, Ferraz E, de Menezes MB, Bagatin E, Arruda LK, Vianna EO. Allergic sensitization to laboratory animals is more associated with asthma, rhinitis, and skin symptoms than sensitization to common allergens. Clin Exp Allergy 2017; 47:1436-1444. [PMID: 28787776 DOI: 10.1111/cea.12994] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 06/21/2017] [Accepted: 07/06/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND Workers exposed to laboratory animals have a high risk of developing laboratory animal allergy (LAA). Atopy seems to be the main risk factor for LAA. We hypothesized that occupational sensitization is a better predictor for the development of asthma, rhinitis, and bronchial hyperresponsiveness (BHR) than common sensitization. OBJECTIVE To investigate the association between occupational sensitization to laboratory animals and clinical outcomes. METHODS This was a cross-sectional study performed at two universities on students and employees dealing with small rodents. The subjects were allocated in groups: non-sensitized, common sensitization, or occupational sensitization, according to the results of the skin prick test (SPT). All subjects answered a questionnaire about animal exposures, symptoms, allergic diseases, and underwent spirometry and bronchial challenge test with mannitol. Multivariate analysis was performed using Poisson regression to estimate the prevalence ratio (PR). RESULTS Data from 453 volunteers were analysed. Non-sensitized group comprised 237 subjects; common sensitization group, 142 subjects; and occupational sensitization group, 74 subjects. Occupational sensitization was associated with greater risk for all outcomes studied. When the common sensitization group was reference, skin symptoms had PR of 1.36, 95% confidence interval (CI): 1.01-1.85; wheezing had PR of 1.75, CI 95%: 1.21-2.53; rhinitis had PR of 1.25, 95%: 1.11-1.40; nocturnal dyspnoea had PR of 2.40, 95% CI: 1.31-4.40; bronchial hyperresponsiveness (BHR) had PR of 2.47, 95% CI: 1.50-4.09; and confirmed asthma had PR of 2.65, 95% CI: 1.45-4.85. In addition, the overlap of asthma, rhinitis, and skin symptoms in a same subject was significantly more prevalent in the occupational sensitization group, 16.2% versus 4.9% in the common sensitization group. CONCLUSION AND CLINICAL RELEVANCE Occupational sensitization is associated with allergic symptoms and respiratory diseases. SPT with occupational allergens along with other parameters may contribute to detection of risk for allergic and respiratory diseases associated with exposure to laboratory animals.
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Affiliation(s)
- C S Simoneti
- Department of Medicine, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - E Ferraz
- Regional University Center of Espírito Santo do Pinhal, Espírito Santo do Pinhal, Brazil
| | - M B de Menezes
- Department of Medicine, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - E Bagatin
- Faculty of Medical Sciences, Department of Preventive and Social Medicine, State University of Campinas, Campinas, Brazil
| | - L K Arruda
- Department of Medicine, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - E O Vianna
- Department of Medicine, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
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Mizoguchi I, Ohashi M, Chiba Y, Hasegawa H, Xu M, Owaki T, Yoshimoto T. Prediction of Chemical Respiratory and Contact Sensitizers by OX40L Expression in Dendritic Cells Using a Novel 3D Coculture System. Front Immunol 2017; 8:929. [PMID: 28824649 PMCID: PMC5543289 DOI: 10.3389/fimmu.2017.00929] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 07/20/2017] [Indexed: 12/19/2022] Open
Abstract
The use of animal models in chemical safety testing will be significantly limited due to the recent introduction of the 3Rs principle of animal experimentation in research. Although several in vitro assays to predict the sensitizing potential of chemicals have been developed, these methods cannot distinguish chemical respiratory sensitizers and skin sensitizers. In the present study, we describe a novel in vitro assay that can discriminate respiratory sensitizers from chemical skin sensitizers by taking advantage of the fundamental difference between their modes of action, namely the development of the T helper 2 immune response, which is critically important for respiratory sensitization. First, we established a novel three-dimensional (3D) coculture system of human upper airway epithelium using a commercially available scaffold. It consists of human airway epithelial cell line BEAS-2B, immature dendritic cells (DCs) derived from human peripheral blood CD14+ monocytes, and human lung fibroblast cell line MRC-5. Respective cells were first cultured in individual scaffolds and subsequently assembled into a 3D multi-cell tissue model to more closely mimic the in vivo situation. Then, three typical chemicals that are known respiratory sensitizers (ortho-phthaldialdehyde, hexamethylene diisocyanate, and trimellitic anhydride) and skin sensitizers (oxazolone, formaldehyde, and dinitrochlorobenzene) were added individually to the 3D coculture system. Immunohistochemical analysis revealed that DCs do not migrate into other scaffolds under the experimental conditions. Therefore, the 3D structure was disassembled and real-time reverse transcriptase-PCR analysis was performed in individual scaffolds to analyze the expression levels of molecules critical for Th2 differentiation such as OX40 ligand (OX40L), interleukin (IL)-4, IL-10, IL-33, and thymic stromal lymphopoietin. Both sensitizers showed similarly augmented expression of DC maturation markers (e.g., CD86), but among these molecules, OX40L expression in DCs was most consistently and significantly enhanced by respiratory sensitizers as compared to that by skin sensitizers. Thus, we have established a 3D coculture system mimicking the airway upper epithelium that may be successfully applied to discriminate chemical respiratory sensitizers from skin sensitizers by measuring the critical molecule for Th2 differentiation, OX40L, in DCs.
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Affiliation(s)
- Izuru Mizoguchi
- Department of Immunoregulation, Institute of Medical Science, Tokyo Medical University, Tokyo, Japan
| | - Mio Ohashi
- Department of Immunoregulation, Institute of Medical Science, Tokyo Medical University, Tokyo, Japan
| | - Yukino Chiba
- Department of Immunoregulation, Institute of Medical Science, Tokyo Medical University, Tokyo, Japan
| | - Hideaki Hasegawa
- Department of Immunoregulation, Institute of Medical Science, Tokyo Medical University, Tokyo, Japan
| | - Mingli Xu
- Department of Immunoregulation, Institute of Medical Science, Tokyo Medical University, Tokyo, Japan
| | - Toshiyuki Owaki
- Department of Immunoregulation, Institute of Medical Science, Tokyo Medical University, Tokyo, Japan
| | - Takayuki Yoshimoto
- Department of Immunoregulation, Institute of Medical Science, Tokyo Medical University, Tokyo, Japan
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162
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Fischer J, Ohmer M, Petersen M. The Weekday Wheezer. Clin Pediatr (Phila) 2017. [PMID: 28633529 DOI: 10.1177/0009922817715940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jakob Fischer
- 1 Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Megan Ohmer
- 1 Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Maureen Petersen
- 2 Walter Reed National Military Medical Center, Bethesda, MD, USA
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163
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Liu Y, Feng GZ, Du Q, Jin XX, Du XR. Fine particulate matter aggravates allergic airway inflammation through thymic stromal lymphopoietin activation in mice. Mol Med Rep 2017; 16:4201-4207. [PMID: 28765890 DOI: 10.3892/mmr.2017.7089] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 04/25/2017] [Indexed: 11/05/2022] Open
Abstract
Fine particulate matter (PM2.5) has been linked to exacerbation of allergic airway inflammation in mice. However, the mechanism underlying exposure to PM2.5 and subsequent and adverse effects remains to be fully elucidated. Therefore, the present study aimed to investigate the effects of PM2.5 by different levels on airway inflammation in mouse models of in allergic and steroid‑resistant asthma. BALB/c mice were nasally instilled with PBS (control) or 10, 31.6 or 100 µg PM2.5, and randomly assigned into nine groups. The acute asthma model was previously induced to investigate the change of inflammatory cells in bronchoalveolar lavage fluid (BALF). Histopathological changes of the lung were assessed, in addition to levels of interleukin (IL)‑4 and IL‑13 in BALF and immunoglobulin Ein serum. Thymic stromal lymphopoietin (TSLP) proteinexpression levels were assessed by western blotting. The present study demonstrated that medium‑ and high‑dose PM2.5 is linked to acute exacerbation of allergic airway inflammation in mice. In conclusion, the pathological mechanisms of PM2.5 may be associated with allergic/steroid‑resistant airway inflammation, T‑cell helper (Th)1/Th2 cytokine production and upregulation of TSLP expression in a murine model of allergic and steroid-resistant asthma.
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Affiliation(s)
- Yan Liu
- Department of Respiratory, The Central Hospital of Maanshan, Maanshan, Anhui 243000, P.R. China
| | - Gan-Zhu Feng
- Department of Respiratory Medicine, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210011, P.R. China
| | - Qiang Du
- Department of Respiratory Medicine, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210011, P.R. China
| | - Xiao-Xiang Jin
- Department of Respiratory, The Central Hospital of Maanshan, Maanshan, Anhui 243000, P.R. China
| | - Xing-Ran Du
- Department of Respiratory Medicine, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210011, P.R. China
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164
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Abstract
PURPOSE OF REVIEW Work-related asthma is a common disorder among adult asthma patients, and in the case of occupational asthma, it is induced by workplace exposures. RECENT FINDINGS Occupational asthma provides an excellent model and benchmark for identifying and testing different allergy or inflammatory biomarkers associated with its inception or progression. Moreover, specific inhalation challenge with the incriminated agent represents an experimental setting to identify and validate potential systemic or local biomarkers. Some biomarkers are mainly blood-borne, while local airway biomarkers are derived from inflammatory or resident cells. Genetic and gene-environment interaction studies also provide an excellent framework to identify relevant profiles associated with the risk of developing these work-related conditions. Despite significant efforts to identify clinically relevant inflammatory and genomic markers for occupational asthma, apart from the documented utility of airway inflammatory biomarkers, it remains elusive to define specific markers or signatures clearly associated with different endpoints or outcomes in occupational asthma.
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165
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Arts J, Kimber I. Azodicarbonamide (ADCA): A reconsideration of classification as a respiratory sensitiser. Regul Toxicol Pharmacol 2017; 89:268-278. [PMID: 28734852 DOI: 10.1016/j.yrtph.2017.07.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 06/30/2017] [Accepted: 07/19/2017] [Indexed: 12/18/2022]
Abstract
Azodicarbonamide (ADCA) is widely used by industry in the manufacture of a variety of products. ADCA has been classified as a respiratory allergen, and the purpose of this article was to consider whether this classification is appropriate based upon the available data. Here both clinical experience and relevant experimental data have been reviewed. Although there have been reports of an association between workplace exposure to ADCA and symptoms of respiratory allergy and occupational asthma, the evidence is less than persuasive, with in many instances a lack of properly controlled and executed diagnostic procedures. In addition, ADCA fails to elicit positive responses in mouse and guinea pig predictive tests for skin sensitisation; a lack of activity that is regarded as being inconsistent with respect to respiratory sensitising potential. Collectively, the data reviewed here do not provide an adequate basis for the classification of ADCA as a respiratory allergen.
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Affiliation(s)
- Josje Arts
- AkzoNobel NV, Velperweg 76, 6824 BM, Arnhem, The Netherlands.
| | - Ian Kimber
- Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester, M13 9PT, UK
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166
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Abstract
PURPOSE OF REVIEW Occupational asthma (OA) is one of the most frequent occupational diseases and its diagnosis is often difficult. This review summarizes its current diagnostic challenges. RECENT FINDINGS OA is associated with significant health and socio-economic burden. It is underdiagnosed and physicians need to adopt a stepwise approach to confirm the diagnosis. Although early removal from exposure to the offending agent is associated with a better prognosis, physicians should try to confirm the diagnosis of work-related asthma before taking a worker off work. A proper occupational and medical history is very important but is not enough to make the diagnosis of OA. Objective evidence of work-related asthma is required and this represents a serious challenge to most physicians. Measurement of non-specific bronchial responsiveness (NSBR) and spirometry may confirm the diagnosis of asthma but do not confirm the diagnosis of OA. Serial monitoring of peak expiratory flows (PEF), NSBR, and airway inflammation at and off work may confirm the diagnosis of OA but are often difficult to perform. Confirming sensitization by skin prick tests or specific IgE may help to support the diagnosis of OA. Specific inhalation challenges (SIC) in the lab or at work are considered the reference standard but are of limited access. Medical surveillance programs along with primary prevention (reducing exposure) may help to reduce the burden of OA, but the ideal program has yet to be defined. The diagnostic workup of OA remains a challenge and needs a rigorous stepwise evaluation.
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167
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Abstract
Healthcare workers (HCWs) are exposed to a range of high and low molecular weight agents that are allergic sensitizers or irritants including cleaners and disinfectants, natural rubber latex, and various medications. Studies have shown that exposed HCWs are at risk for work-related rhinitis and asthma (WRA). Work-related rhinitis may precede development of WRA and should be considered as an early marker of WRA. Avoidance of causative exposures through control strategies such as elimination, substitution, engineering controls, and process modification is the preferred primary prevention strategy for preventing development of work-related allergic diseases. There is limited evidence for the effectiveness of respirators in preventing occupational asthma. If sensitizer-induced WRA is diagnosed, it is important to avoid further exposure to the causative agent, preferably by more rigorous application of exposure control strategies to the workplace. This review focuses on allergic occupational respiratory diseases in HCWs.
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168
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Hawley B, Cummings KJ, Mohammed M, Dimmock AE, Bascom R. Allergic sinusitis and severe asthma caused by occupational exposure to locust bean gum: Case report. Am J Ind Med 2017; 60:658-663. [PMID: 28497854 DOI: 10.1002/ajim.22725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2017] [Indexed: 01/16/2023]
Abstract
We present a case that highlights the difficulties with diagnosis and the dangers of occupational allergic sinusitis and asthma left unrecognized. We describe the case history of a man who experienced work-related symptoms 1 year after beginning work as a cheesemaker at a creamery, and whose respiratory symptoms progressively worsened over 16 years before an occupational cause of his asthma was identified. His initial discrete episodes of sinusitis and acute bronchitis evolved into persistent asthma of increasing severity with exacerbations requiring repeated emergency room treatment. The case described in our report emphasizes the importance of clinician diagnosis of OA, and subsequent removal from exposure, such that asthma severity does not progress to near-fatal or fatal asthma in the sensitized worker. As demonstrated by this case report, identification of an occupational cause of asthma relies on a high degree of suspicion and excellent detective work by the clinician.
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Affiliation(s)
- Brie Hawley
- Respiratory Health Division; National Institute for Occupational Safety and Health; Morgantown West Virginia
| | - Kristin J. Cummings
- Respiratory Health Division; National Institute for Occupational Safety and Health; Morgantown West Virginia
| | | | - Anne E. Dimmock
- Pulmonary and Critical Care Medicine; Penn State Hershey College of Medicine; Hershey Pennsylvania
| | - Rebecca Bascom
- Pulmonary and Critical Care Medicine; Penn State Hershey College of Medicine; Hershey Pennsylvania
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169
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Lei T, Chen F, Liu H, Sun H, Kang Y, Li D, Li Y, Hou T. ADMET Evaluation in Drug Discovery. Part 17: Development of Quantitative and Qualitative Prediction Models for Chemical-Induced Respiratory Toxicity. Mol Pharm 2017; 14:2407-2421. [PMID: 28595388 DOI: 10.1021/acs.molpharmaceut.7b00317] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
As a dangerous end point, respiratory toxicity can cause serious adverse health effects and even death. Meanwhile, it is a common and traditional issue in occupational and environmental protection. Pharmaceutical and chemical industries have a strong urge to develop precise and convenient computational tools to evaluate the respiratory toxicity of compounds as early as possible. Most of the reported theoretical models were developed based on the respiratory toxicity data sets with one single symptom, such as respiratory sensitization, and therefore these models may not afford reliable predictions for toxic compounds with other respiratory symptoms, such as pneumonia or rhinitis. Here, based on a diverse data set of mouse intraperitoneal respiratory toxicity characterized by multiple symptoms, a number of quantitative and qualitative predictions models with high reliability were developed by machine learning approaches. First, a four-tier dimension reduction strategy was employed to find an optimal set of 20 molecular descriptors for model building. Then, six machine learning approaches were used to develop the prediction models, including relevance vector machine (RVM), support vector machine (SVM), regularized random forest (RRF), extreme gradient boosting (XGBoost), naïve Bayes (NB), and linear discriminant analysis (LDA). Among all of the models, the SVM regression model shows the most accurate quantitative predictions for the test set (q2ext = 0.707), and the XGBoost classification model achieves the most accurate qualitative predictions for the test set (MCC of 0.644, AUC of 0.893, and global accuracy of 82.62%). The application domains were analyzed, and all of the tested compounds fall within the application domain coverage. We also examined the structural features of the compounds and important fragments with large prediction errors. In conclusion, the SVM regression model and the XGBoost classification model can be employed as accurate prediction tools for respiratory toxicity.
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Affiliation(s)
- Tailong Lei
- College of Pharmaceutical Sciences, Zhejiang University , Hangzhou, Zhejiang 310058, P. R. China
| | - Fu Chen
- College of Pharmaceutical Sciences, Zhejiang University , Hangzhou, Zhejiang 310058, P. R. China
| | - Hui Liu
- College of Pharmaceutical Sciences, Zhejiang University , Hangzhou, Zhejiang 310058, P. R. China
| | - Huiyong Sun
- College of Pharmaceutical Sciences, Zhejiang University , Hangzhou, Zhejiang 310058, P. R. China
| | - Yu Kang
- College of Pharmaceutical Sciences, Zhejiang University , Hangzhou, Zhejiang 310058, P. R. China
| | - Dan Li
- College of Pharmaceutical Sciences, Zhejiang University , Hangzhou, Zhejiang 310058, P. R. China
| | - Youyong Li
- Institute of Functional Nano and Soft Materials (FUNSOM), Soochow University , Suzhou, Jiangsu 215123, P. R. China
| | - Tingjun Hou
- College of Pharmaceutical Sciences, Zhejiang University , Hangzhou, Zhejiang 310058, P. R. China.,State Key Lab of CAD&CG, Zhejiang University , Hangzhou, Zhejiang 310058, P. R. China
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170
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171
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172
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Lemaire M, Oppliger A, Hotz P, Renauld JC, Braun J, Maggi M, Barresi F, Schmid-Grendelmeier P, Huaux F, Dressel H. Can serum cytokine profile discriminate irritant-induced and allergen-induced symptoms? A cross-sectional study in workers mostly exposed to laboratory animals. Occup Environ Med 2017; 74:592-600. [PMID: 28416643 DOI: 10.1136/oemed-2016-104137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 03/02/2017] [Accepted: 03/19/2017] [Indexed: 11/03/2022]
Abstract
BACKGROUND In workers exposed mostly to laboratory animals (LA), symptoms may be due to irritants or allergens. Correct aetiological diagnosis is important for health surveillance. OBJECTIVES This study aims to test whether work-related (WR) allergen-induced symptoms are associated with a cytokine profile distinct from that due to irritants. METHODS In a cross-sectional study (n=114), WR respiratory and/or skin symptoms were assessed through a standardised clinical examination and sensitisation to rat and/or mouse allergen determined by serum immunoglobulin E. Serum cytokine concentrations were measured by multiplex assays. The predefined cytokine profiles 'sensitiser' (interleukin (IL)-4, IL-5, IL-13, eotaxin-1) and 'irritation' (IL-8, IL-17A, IL-17F, IL-22) were considered positive, when ≥3 concentrations exceeded the 95th percentile of the asymptomatic non-sensitised group. Results were examined by hierarchical clustering analyses (HCA) and multiple linear regression. Explorative analyses were carried out for nine additional cytokines. Exposure to allergens and endotoxin was assessed in a subpopulation. RESULTS The prevalence of the profile 'irritation' was comparable in 28 symptomatic non-sensitised workers and 71 asymptomatic non-sensitised workers. HCA showed that nearly all symptomatic non-sensitised workers were gathered in two subclusters, characterised by high IL-17A levels, but different IL-8 levels. Multiple linear regression identified drug consumption and current complaints as confounders. Sensitised subjects were too few (n=14) for testing the profile 'sensitiser'. CONCLUSIONS In this unselected population of LA workers, the profile 'irritation' did not prove to be a valuable health surveillance tool. Low power precluded assessment of the profile 'sensitiser'. The increased IL-17A concentration may originate from irritative constituents of organic dust.
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Affiliation(s)
- Muriel Lemaire
- de Duve Institute, Université catholique de Louvain, Brussels, Belgium.,Ludwig Institute for Cancer Research, Brussels Branch, Brussels, Belgium
| | - Anne Oppliger
- Institute for Work and Health, University of Lausanne, Lausanne, Switzerland
| | - Philipp Hotz
- Division of Occupational and Environmental Medicine, EBPI, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jean-Christophe Renauld
- de Duve Institute, Université catholique de Louvain, Brussels, Belgium.,Ludwig Institute for Cancer Research, Brussels Branch, Brussels, Belgium
| | - Julia Braun
- Department of Biostatistics, EBPI, University of Zurich, Zurich, Switzerland.,Department of Epidemiology, EBPI, University of Zurich, Zurich, Switzerland
| | - Marion Maggi
- Division of Occupational and Environmental Medicine, EBPI, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Fabio Barresi
- Division of Occupational and Environmental Medicine, EBPI, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - François Huaux
- Louvain Centre for Toxicology and Applied Pharmacology, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels, Belgium
| | - Holger Dressel
- Division of Occupational and Environmental Medicine, EBPI, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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173
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Racine G, Castano R, Cartier A, Lemiere C. Diagnostic Accuracy of Inflammatory Markers for Diagnosing Occupational Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 5:1371-1377.e1. [PMID: 28286155 DOI: 10.1016/j.jaip.2017.02.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 01/01/2017] [Accepted: 02/03/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND The assessment of airway responsiveness and inflammation is key to the investigation of occupational asthma (OA). OBJECTIVE We sought to assess and compare the diagnostic accuracies of the blood and sputum eosinophil counts and the methacholine challenge for the diagnosis of OA. METHODS We conducted a retrospective study assessing 618 patients who underwent specific inhalation challenges (SICs) for symptoms suggestive of OA between 2000 and 2015. A sputum induction and a methacholine challenge were performed before and after SICs. Blood samples were collected in all subjects before the SICs and in 100 subjects before and after SICs. The diagnostic accuracies of blood and sputum eosinophil counts and methacholine challenge were calculated for diagnosing OA. RESULTS The change in blood eosinophil count failed to differentiate workers with positive and negative SICs. The change in sputum eosinophil counts induced by the exposure to the offending agent had the highest diagnostic accuracy (receiver operating characteristic area under the curve: 86% [95% confidence interval: 0.8-0.9, P < .001]) for diagnosing OA compared with changes in concentration of methacholine inducing a 20% fall in forced expiratory volume in 1 second (PC20) and blood eosinophils. Combining a 2-fold or greater decrease in PC20 or a 3% or greater increase in sputum eosinophil count achieved a sensitivity of 84% and a specificity of 74% with a negative predictive value of 91% for the diagnosis of OA. CONCLUSIONS Blood eosinophil counts do not appear to be an effective aid for diagnosing OA. The performance of both sputum cell count analysis and a methacholine challenge before and after exposure to the offending agent may represent an effective alternative in diagnosing OA when SICs are unavailable.
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Affiliation(s)
- Geneviève Racine
- Centre intégré universitaire de santé et des services sociaux du Nord-de-l'Île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Université de Montréal, Montréal, Quebec, Canada
| | - Roberto Castano
- Centre intégré universitaire de santé et des services sociaux du Nord-de-l'Île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Université de Montréal, Montréal, Quebec, Canada
| | - André Cartier
- Centre intégré universitaire de santé et des services sociaux du Nord-de-l'Île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Université de Montréal, Montréal, Quebec, Canada
| | - Catherine Lemiere
- Centre intégré universitaire de santé et des services sociaux du Nord-de-l'Île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Université de Montréal, Montréal, Quebec, Canada.
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174
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Hu C, Cruz MJ, Ojanguren I, de Homdedeu M, Gonzalez-Barcala FJ, Munoz X. Specific inhalation challenge: the relationship between response, clinical variables and lung function. Occup Environ Med 2017; 74:586-591. [PMID: 28270447 DOI: 10.1136/oemed-2016-103806] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 01/30/2017] [Accepted: 02/10/2017] [Indexed: 11/03/2022]
Abstract
INTRODUCTION The specific inhalation challenge (SIC) is considered the gold standard for the diagnosis of occupational asthma (OA). However, its use is not standardised, and the intensity of exposure is regulated empirically. The aim of this study was to identify clinical variables and/or pulmonary function variables able to predict the scale of patients' response to SIC. MATERIAL AND METHODS All patients who underwent SIC at our centre between 2005 and 2013 were studied. Anthropometric characteristics, atopic status, type of causal agent, latency times, pulmonary function tests and SIC results were analysed. RESULTS Two hundred and one patients (51% men) were assessed, of whom 86 (43%) had positive SIC. In the patients with positive results, 29 (34%) were exposed to high molecular weight (HMW) agents and 57 (64%) to low molecular weight (LMW) agents. Patients with a positive SIC exposed to HMW agents had a higher fall in FEV1 after SIC compared with those exposed to LMW agents (p=0.036). The type of asthmatic reaction after SIC also differed between the groups (p=0.020). The logistic regression analysis showed that patients with a higher PC20 before SIC were less likely to have severe decreases in FEV1 after SIC after adjusting for potential confounders (OR=0.771, 95% CI 0.618 to 0.961, p=0.021). CONCLUSIONS The scale of the response to SIC is influenced mainly by the degree of bronchial hyper-responsiveness, regardless of whether the causative agent is HMW or LMW, or whether the response is early or late.
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Affiliation(s)
- Chunshao Hu
- Pulmonology, Hospital General Universitario Morales Meseguer, Murcia, Spain
| | - Maria-Jesus Cruz
- Servei de Pneumologia, Hospital Universitari Vall dHebron, Institut de Recerca (VHIR), Universitat Autnoma de Barcelona, Barcelona, Spain.,Respiratory, CIBER Enfermedades Respiratorias (Ciberes), Barcelona, Spain
| | - Iñigo Ojanguren
- Servei de Pneumologia, Hospital Universitari Vall dHebron, Institut de Recerca (VHIR), Universitat Autnoma de Barcelona, Barcelona, Spain.,Respiratory, CIBER Enfermedades Respiratorias (Ciberes), Barcelona, Spain
| | - Miquel de Homdedeu
- Servei de Pneumologia, Hospital Universitari Vall dHebron, Institut de Recerca (VHIR), Universitat Autnoma de Barcelona, Barcelona, Spain
| | | | - Xavier Munoz
- Servei de Pneumologia, Hospital Universitari Vall dHebron, Institut de Recerca (VHIR), Universitat Autnoma de Barcelona, Barcelona, Spain.,Respiratory, CIBER Enfermedades Respiratorias (Ciberes), Barcelona, Spain
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175
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Rava M, Ahmed I, Kogevinas M, Le Moual N, Bouzigon E, Curjuric I, Dizier MH, Dumas O, Gonzalez JR, Imboden M, Mehta AJ, Tubert-Bitter P, Zock JP, Jarvis D, Probst-Hensch NM, Demenais F, Nadif R. Genes Interacting with Occupational Exposures to Low Molecular Weight Agents and Irritants on Adult-Onset Asthma in Three European Studies. ENVIRONMENTAL HEALTH PERSPECTIVES 2017; 125:207-214. [PMID: 27504716 PMCID: PMC5289825 DOI: 10.1289/ehp376] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 04/18/2016] [Accepted: 06/13/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND The biological mechanisms by which cleaning products and disinfectants-an emerging risk factor-affect respiratory health remain incompletely evaluated. Studying genes by environment interactions (G × E) may help identify new genes related to adult-onset asthma. OBJECTIVES We identified interactions between genetic polymorphisms of a large set of genes involved in the response to oxidative stress and occupational exposures to low molecular weight (LMW) agents or irritants on adult-onset asthma. METHODS Our data came from three large European cohorts: Epidemiological Family-based Study of the Genetics and Environment of Asthma (EGEA), Swiss Cohort Study on Air Pollution and Lung and Heart Disease in Adults (SAPALDIA), and European Community Respiratory Health Survey in Adults (ECRHS). A candidate pathway-based strategy identified 163 genes involved in the response to oxidative stress and potentially related to exposures to LMW agents/irritants. Occupational exposures were evaluated using an asthma job-exposure matrix and job-specific questionnaires for cleaners and healthcare workers. Logistic regression models were used to detect G × E interactions, adjusted for age, sex, and population ancestry, in 2,599 adults (mean age, 47 years; 60% women, 36% exposed, 18% asthmatics). p-Values were corrected for multiple comparisons. RESULTS Ever exposure to LMW agents/irritants was associated with current adult-onset asthma [OR = 1.28 (95% CI: 1.04, 1.58)]. Eight single nucleotide polymorphism (SNP) by exposure interactions at five loci were found at p < 0.005: PLA2G4A (rs932476, chromosome 1), near PLA2R1 (rs2667026, chromosome 2), near RELA (rs931127, rs7949980, chromosome 11), PRKD1 (rs1958980, rs11847351, rs1958987, chromosome 14), and PRKCA (rs6504453, chromosome 17). Results were consistent across the three studies and after accounting for smoking. CONCLUSIONS Using a pathway-based selection process, we identified novel genes potentially involved in adult asthma by interaction with occupational exposure. These genes play a role in the NF-κB pathway, which is involved in inflammation. Citation: Rava M, Ahmed I, Kogevinas M, Le Moual N, Bouzigon E, Curjuric I, Dizier MH, Dumas O, Gonzalez JR, Imboden M, Mehta AJ, Tubert-Bitter P, Zock JP, Jarvis D, Probst-Hensch NM, Demenais F, Nadif R. 2017. Genes interacting with occupational exposures to low molecular weight agents and irritants on adult-onset asthma in three European studies. Environ Health Perspect 125:207-214; http://dx.doi.org/10.1289/EHP376.
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Affiliation(s)
- Marta Rava
- Inserm, U1168, VIMA: Aging and Chronic Diseases, Epidemiological and Public Health Approaches, Villejuif, France
- Spanish National Cancer Research Centre (CNIO), Genetic and Molecular Epidemiology Group, Human Cancer Genetics Program, Madrid, Spain
| | - Ismail Ahmed
- Inserm UMR 1181 [Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI)], Villejuif, France
- Institut Pasteur, UMR 1181, B2PHI, Paris, France
- Univ Versailles St.-Quentin-en-Yvelines, UMR 1181, B2PHI, Montigny le Bretonneux, France
| | - Manolis Kogevinas
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Nicole Le Moual
- Inserm, U1168, VIMA: Aging and Chronic Diseases, Epidemiological and Public Health Approaches, Villejuif, France
- Univ Versailles St.-Quentin-en-Yvelines, UMR-S 1168, Montigny le Bretonneux, France
| | - Emmanuelle Bouzigon
- Inserm, UMR-946, Genetic Variation and Human Diseases Unit, Paris, France
- Univ Paris Diderot, Sorbonne Paris Cité, Institut Universitaire d’Hématologie, Paris, France
| | - Ivan Curjuric
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Switzerland
| | - Marie-Hélène Dizier
- Inserm, UMR-946, Genetic Variation and Human Diseases Unit, Paris, France
- Univ Paris Diderot, Sorbonne Paris Cité, Institut Universitaire d’Hématologie, Paris, France
| | - Orianne Dumas
- Inserm, U1168, VIMA: Aging and Chronic Diseases, Epidemiological and Public Health Approaches, Villejuif, France
- Univ Versailles St.-Quentin-en-Yvelines, UMR-S 1168, Montigny le Bretonneux, France
| | - Juan R. Gonzalez
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Medea Imboden
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Switzerland
| | - Amar J. Mehta
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Switzerland
- Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Pascale Tubert-Bitter
- Inserm UMR 1181 [Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI)], Villejuif, France
- Institut Pasteur, UMR 1181, B2PHI, Paris, France
- Univ Versailles St.-Quentin-en-Yvelines, UMR 1181, B2PHI, Montigny le Bretonneux, France
| | - Jan-Paul Zock
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Madrid, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Deborah Jarvis
- Respiratory Epidemiology and Public Health, Imperial College, London, United Kingdom
- MRC-HPA (Medical Research Council and Health Protection Agency) Centre for Environment and Health, London, United Kingdom
| | - Nicole M. Probst-Hensch
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Switzerland
| | - Florence Demenais
- Inserm, UMR-946, Genetic Variation and Human Diseases Unit, Paris, France
- Univ Paris Diderot, Sorbonne Paris Cité, Institut Universitaire d’Hématologie, Paris, France
| | - Rachel Nadif
- Inserm, U1168, VIMA: Aging and Chronic Diseases, Epidemiological and Public Health Approaches, Villejuif, France
- Univ Versailles St.-Quentin-en-Yvelines, UMR-S 1168, Montigny le Bretonneux, France
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176
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Cullinan P, Muñoz X, Suojalehto H, Agius R, Jindal S, Sigsgaard T, Blomberg A, Charpin D, Annesi-Maesano I, Gulati M, Kim Y, Frank AL, Akgün M, Fishwick D, de la Hoz RE, Moitra S. Occupational lung diseases: from old and novel exposures to effective preventive strategies. THE LANCET RESPIRATORY MEDICINE 2017; 5:445-455. [PMID: 28089118 DOI: 10.1016/s2213-2600(16)30424-6] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 10/22/2016] [Accepted: 11/02/2016] [Indexed: 02/06/2023]
Abstract
Occupational exposure is an important, global cause of respiratory disease. Unlike many other non-communicable lung diseases, the proximal causes of many occupational lung diseases are well understood and they should be amenable to control with use of established and effective approaches. Therefore, the risks arising from exposure to silica and asbestos are well known, as are the means of their prevention. Although the incidence of occupational lung disease has decreased in many countries, in parts of the world undergoing rapid economic transition and population growth-often with large informal and unregulated workforces-occupational exposures continue to impose a heavy burden of disease. The incidence of interstitial and malignant lung diseases remains unacceptably high because control measures are not implemented or exposures arise in novel ways. With the advent of innovative technologies, new threats are continually introduced to the workplace (eg, indium compounds and vicinal diketones). In developed countries, work-related asthma is the commonest occupational lung disease of short latency. Although generic control measures to reduce the risk of developing or exacerbating asthma are well recognised, there is still uncertainty, for example, with regards to the management of workers who develop asthma but remain in the same job. In this Review, we provide recommendations for research, surveillance, and other action for reducing the burden of occupational lung diseases.
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Affiliation(s)
- Paul Cullinan
- Department of Occupational and Environmental Medicine, Imperial College, London, UK; MRC-PHE Centre for Environment and Health, London, UK
| | - Xavier Muñoz
- Servei de Pneumologia, Hospital Universitari Vall d'Hebron (CIBER de Enfermedades Respiratorias), Barcelona, Spain; CIBER de Enfermedades Respiratorias, Barcelona, Spain
| | - Hille Suojalehto
- Occupational Medicine, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Raymond Agius
- Centre for Occupational and Environmental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Surinder Jindal
- Department of Respiratory Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Anders Blomberg
- Department of Public Health and Clinical Medicine, Division of Medicine, and Division of Respiratory Medicine, Umeå University, Umeå, Sweden
| | - Denis Charpin
- Clinique des Bronches, Allergie et Sommeil, Hôpital Nord, Marseille, France; INSERM, Aix-Marseille Université, Marseille, France
| | - Isabella Annesi-Maesano
- Epidémiologie des Maladies Respiratoires et Allergiques, iPLESP INSERM et UPMC, Paris, France
| | - Mridu Gulati
- Section of Pulmonary, Critical Care, and Sleep Medicine, and Yale Occupational and Environmental Medicine Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Yangho Kim
- Department of Occupational and Environmental Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Arthur L Frank
- Division of Environmental and Occupational Health, Drexel University School of Public Health, Philadelphia, PA, USA
| | - Metin Akgün
- Department of Chest Diseases, Ataturk University School of Medicine, Erzurum, Turkey
| | - David Fishwick
- Centre for Workplace Health, University of Sheffield, Sheffield, UK
| | - Rafael E de la Hoz
- Department of Preventive Medicine, Division of Occupational and Environmental Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Subhabrata Moitra
- Department of Respiratory Medicine and Allergology, Faculty of Clinical Sciences, Lund University Lund, Sweden; Department of Pneumology, Allergy and Asthma Research Centre, Kolkata, India.
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177
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Anderson S, Long C, Dotson GS. Occupational Allergy. EUROPEAN MEDICAL JOURNAL 2017. [DOI: 10.33590/emj/10311285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
An estimated 11 million workers in the USA are potentially exposed to agents that can become a cause of allergic diseases such as occupational asthma and allergic contact dermatitis, which can adversely affect health and well-being. Hundreds of chemicals (e.g. metals, epoxy and acrylic resins, rubber additives, and chemical intermediates) and proteins (e.g. natural rubber latex, plant proteins, mould, animal dander) present in virtually every industry have been identified as causes of allergic disease. In general, allergens can be classified as low molecular weight (chemical) allergens and high molecular weight (protein) allergens. These agents are capable of inducing immunological responses that are both immunoglobulin E and non-immunoglobulin E-mediated. Interestingly, the same chemical can induce diverse immune responses in different individuals. As new hazards continue to emerge, it is critical to understand the immunological mechanisms of occupational allergic disease. Specific understanding of these mechanisms has direct implications in hazard identification, hazard communication, and risk assessment. Such efforts will ultimately assist in the development of risk management strategies capable of controlling workplace exposures to allergens to prevent the induction of sensitisation in naïve individuals and inhibit elicitation of allergic responses. The purpose of this short review is to give a brief synopsis of the incidence, agents, mechanisms, and research needs related to occupational allergy.
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Affiliation(s)
- Stacey Anderson
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Carrie Long
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - G. Scott Dotson
- Education and Information Division, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
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Çelebi Sözener Z, Aydın Ö, Demirel YS, Soyyiğit Ş, Çerçi P, Kendirlinan R, Bavbek S, Çelik GE, Misirligil Z, Sin BA, Keleşoğlu A, Mungan D. Does the medical diagnosis of occupational asthma coincide with the legal diagnosis? J Asthma 2017; 54:930-937. [PMID: 28055274 DOI: 10.1080/02770903.2016.1277541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The incidence of occupational asthma (OA) is increasing worldwide. In this study, we first aimed to document the rate of diagnosis of OA among patients who were referred to our clinic from the Social Security Institution and the factors that affected diagnosis; secondly, we aimed to assess the consistency of the medical and legal diagnoses. METHODS The study involved 132 consecutive patients who were referred to our clinic for the evaluation of OA between 2010 and 2015. Detailed workplace history, the tools used in the diagnosis such as peak expiratory flow (PEF) monitoring and bronchial provocation tests, and the final medical diagnosis were recorded from case files. RESULTS Asthma was diagnosed in 75% (n = 99) of the patients. Among them, 22.2% were diagnosed as having OA. The diagnosis was confirmed by serial PEF measurements, non-specific bronchial hyperreactivity assessment or both of the tests both at work and off-work periods. OA diagnosis was mostly established in active workers (72.7%). The legal diagnosis period was completed in 54.5% of these 22 patients, and 50% (n = 11) were officially diagnosed as having OA with a 91.6% concordance with medical diagnosis. CONCLUSION This study verifies the importance of diagnosing asthma correctly as a first step in the evaluation of OA. Diagnostic tests other than specific provocation tests could be preferential in patients who still work in the same field. We believe that cooperation with the patient's occupational physician and adequate recognition of the work environment will improve the consistency of legal and medical diagnoses.
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Affiliation(s)
- Zeynep Çelebi Sözener
- a Department of Chest Diseases, Division of Allergy and Clinical Immunology , Ankara University School of Medicine , Ankara , Turkey
| | - Ömür Aydın
- a Department of Chest Diseases, Division of Allergy and Clinical Immunology , Ankara University School of Medicine , Ankara , Turkey
| | - Yavuz Selim Demirel
- a Department of Chest Diseases, Division of Allergy and Clinical Immunology , Ankara University School of Medicine , Ankara , Turkey
| | - Şadan Soyyiğit
- a Department of Chest Diseases, Division of Allergy and Clinical Immunology , Ankara University School of Medicine , Ankara , Turkey
| | - Pamir Çerçi
- a Department of Chest Diseases, Division of Allergy and Clinical Immunology , Ankara University School of Medicine , Ankara , Turkey
| | - Reşat Kendirlinan
- a Department of Chest Diseases, Division of Allergy and Clinical Immunology , Ankara University School of Medicine , Ankara , Turkey
| | - Sevim Bavbek
- a Department of Chest Diseases, Division of Allergy and Clinical Immunology , Ankara University School of Medicine , Ankara , Turkey
| | - Gülfem Elif Çelik
- a Department of Chest Diseases, Division of Allergy and Clinical Immunology , Ankara University School of Medicine , Ankara , Turkey
| | - Zeynep Misirligil
- a Department of Chest Diseases, Division of Allergy and Clinical Immunology , Ankara University School of Medicine , Ankara , Turkey
| | - Betül Ayşe Sin
- a Department of Chest Diseases, Division of Allergy and Clinical Immunology , Ankara University School of Medicine , Ankara , Turkey
| | - Arif Keleşoğlu
- b Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital , Ankara , Turkey
| | - Dilşad Mungan
- a Department of Chest Diseases, Division of Allergy and Clinical Immunology , Ankara University School of Medicine , Ankara , Turkey
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179
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Conti P, Ronconi G, Caraffa A, Lessiani G, Duraisamy K. IL-37 a New IL-1 Family Member Emerges as a Key Suppressor of Asthma Mediated by Mast Cells. Immunol Invest 2016; 46:239-250. [PMID: 27982737 DOI: 10.1080/08820139.2016.1250220] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
In 1986, we reported a multiple biological effect of IL-1 including immunological, inflammatory, and tumor killing activity. Since then other IL-1 family cytokines have been discovered, some with inflammatory and other with anti-inflammatory activity. In this review article, we speculate on the possible inhibitory effect of IL-37 in the light of new findings. IL-37, formerly termed IL-1 family member 7 (IL-1F7), binding IL-18 receptor α chain, acts as a cytokine with intracellular as well as extracellular functionality and as a natural inhibitor of immune responses and inflammation. IL-37 inhibits many pro-inflammatory cytokine and increases anti-inflammatory cytokines such as IL-10. Asthma pathogenesis involves multiple cell types including mast cells, which are important cellular constituents of the human innate and adaptive immunity. IL-37 has an impact on inflammatory cytokines generated by mast cells and is beneficial for and protective in asthma. However, the precise mechanism(s), safety, and tolerability of IL-37 are unclear and still remain a mystery. ABBREVIATIONS GBP (Guanylate Binding Proteins); HMGB1 (High Mobility Group Box protein 1); NLRP (Nucleotide-like Receptor Pyrin domain 1); ASC (Apoptosis-associated Speck-like protein containing CARD, Caspase Recruitment Domain); FGF2 (Fibroblast Growth Factor 2).
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Affiliation(s)
- P Conti
- a Immunology Division, Postgraduate Medical School, University of Chieti-Pescara , Chieti , Italy
| | - G Ronconi
- b UOS Clinica dei Pazienti del Territorio, Policlinico Gemelli , Roma , Italy
| | - A Caraffa
- c Department of Pharmacology , University of Perugia , Perugia , Italy
| | - G Lessiani
- d Center of Intensive Rehabilitation, "S. Agnese" , Pineto ( TE ), Italy
| | - Kempuraj Duraisamy
- e Department of Neurology , Carver College of Medicine, University of Iowa , Iowa City , IA , USA
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180
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Abstract
PURPOSE OF REVIEW The present review summarizes the recent literature on the relation between chronic workplace irritant exposures and asthma, focusing on exposures of low to moderate levels. We discuss results from epidemiological surveys, potential biological mechanisms, and needs for further research. These aspects are largely illustrated by studies on exposure to cleaning products. RECENT FINDINGS Recent results from nine population-based and workplace-based epidemiological studies, mostly cross-sectional, found an increased risk of both new-onset and work-exacerbated asthma among participants exposed to moderate level of irritants and/or cleaning products. SUMMARY Evidence of a causal effect of chronic workplace irritant exposure in new-onset asthma remains limited, mainly because of a lack of longitudinal studies and the difficulty to evaluate irritant exposures. However, recent epidemiological studies strengthen the evidence of an effect of chronic exposure to irritants in work-related asthma. The underlying mechanism remains unknown but may be related to oxidative stress, neurogenic inflammation and dual irritant and adjuvant effects. However, disentangling chronic irritant effects from either acute irritant-induced asthma or immunological low molecular weight agent-induced asthma is difficult for some agents. Further research is needed to improve assessment of irritant exposures and identify biomarkers.
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181
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Aldrich TK, Weakley J, Dhar S, Hall CB, Crosse T, Banauch GI, Weiden MD, Izbicki G, Cohen HW, Gupta A, King C, Christodoulou V, Webber MP, Zeig-Owens R, Moir W, Nolan A, Kelly KJ, Prezant DJ. Bronchial Reactivity and Lung Function After World Trade Center Exposure. Chest 2016; 150:1333-1340. [PMID: 27445092 PMCID: PMC6026231 DOI: 10.1016/j.chest.2016.07.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 06/28/2016] [Accepted: 07/05/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND World Trade Center (WTC)-exposed rescue/recovery workers endured massive respiratory insult from inhalation of particulate matter and gases, resulting in respiratory symptoms, loss of lung function, and, for many, bronchial hyperreactivity (BHR). The persistence of respiratory symptoms and lung function abnormalities has been well-documented, whereas persistence of BHR has not been investigated. METHODS A total of 173 WTC-exposed firefighters with bronchial reactivity measured within 2 years after September 11, 2001 (9/11) (baseline methacholine challenge test), were reevaluated in 2013 and 2014 (follow-up methacholine challenge test). FEV1 measurements were obtained from the late pre-9/11, early post-9/11, and late post-9/11 periods. Respiratory symptoms and corticosteroid treatment were recorded. RESULTS Bronchial reactivity remained stable (within 1 doubling dilution) for most (n = 101, 58%). Sixteen of 28 (57%) with BHR (provocative concentration of methacholine producing a 20% decline in FEV1 <8 mg/mL) at baseline had BHR at follow-up, and an additional 27 of the 145 (19%) without BHR at baseline had BHR at follow-up. In multivariable models, we found that BHR baseline was strongly associated with BHR follow-up (OR, 6.46) and that BHR at follow-up was associated with an estimated 15.4 mL/y greater FEV1 decline than experienced by those without BHR at follow-up. Annual FEV1 decline was moderated by corticosteroid use. CONCLUSIONS Persistent BHR and its deleterious influence on lung function suggest a role for airway inflammation in perpetuation of WTC-associated airway disease. In future massive occupational exposure to inorganic dust/gases, we recommend early and serial pulmonary function testing, including measurements of bronchial reactivity, when possible, and inhaled corticosteroid therapy for those with symptoms or pulmonary function tests consistent with airway disease.
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Affiliation(s)
- Thomas K Aldrich
- Department of Medicine, Pulmonary Division, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY
| | - Jessica Weakley
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, NY
| | - Sean Dhar
- Department of Medicine, Pulmonary Division, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY
| | - Charles B Hall
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Tesha Crosse
- Department of Medicine, Pulmonary Division, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY
| | - Gisela I Banauch
- Pulmonary and Critical Care Medicine Division, University of Massachusetts Medical Center, Worcester, MA
| | - Michael D Weiden
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, NY; Department of Medicine, New York University School of Medicine, New York, NY
| | - Gabriel Izbicki
- Shaare Zedek Medical Center and the Hebrew University Hadassah Medical School, Jerusalem, Pulmonary Institute, Jerusalem, Israel
| | - Hillel W Cohen
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Aanchal Gupta
- Department of Medicine, Pulmonary Division, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY
| | - Camille King
- Department of Medicine, Pulmonary Division, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY
| | | | - Mayris P Webber
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, NY; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY.
| | - Rachel Zeig-Owens
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, NY
| | - William Moir
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, NY
| | - Anna Nolan
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, NY; Department of Medicine, New York University School of Medicine, New York, NY
| | - Kerry J Kelly
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, NY
| | - David J Prezant
- Department of Medicine, Pulmonary Division, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY; Bureau of Health Services, Fire Department of the City of New York, Brooklyn, NY
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Abstract
Asthma is one of the most frequent chronic respiratory diseases worldwide, with an increase in its prevalence in the last decade. Ongoing studies continue to search for better diagnostic tools and advanced treatment options in an effort to decrease the morbidity and mortality associated with it. Unfortunately, many asthmatic patients still suffer from poorly controlled asthma, which may lead to life-threatening situations. This article reviews the basics of asthma and highlights the current guidelines in making accurate diagnosis and initiating therapeutic plan.
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183
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Leal A, Caselles I, Rodriguez-Bayarri MJ, Muñoz X. Non-IgE-Mediated Asthma after Zinc Exposure. Arch Bronconeumol 2016; 53:346-347. [PMID: 27818026 DOI: 10.1016/j.arbres.2016.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 09/05/2016] [Accepted: 09/14/2016] [Indexed: 11/24/2022]
Affiliation(s)
- Angelica Leal
- Servicio de Neumología, Hospital Vall d'Hebron, Barcelona, España
| | - Irene Caselles
- Servicio de Neumología, Hospital Vall d'Hebron, Barcelona, España
| | | | - Xavier Muñoz
- Servicio de Neumología, Hospital Vall d'Hebron, Barcelona, España; CIBER de enfermedades respiratorias (CIBERes); Departament de Biologia Ce·lular, Fisiologia i d'Immunologia, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, España.
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184
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Work-Related Asthma: the Dawn of Knowledge? Arch Bronconeumol 2016; 53:180-181. [PMID: 27771153 DOI: 10.1016/j.arbres.2016.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 08/16/2016] [Accepted: 08/27/2016] [Indexed: 11/21/2022]
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185
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Quirce S, Campo P, Domínguez-Ortega J, Fernández-Nieto M, Gómez-Torrijos E, Martínez-Arcediano A, Mur P, Delgado J. New developments in work-related asthma. Expert Rev Clin Immunol 2016; 13:271-281. [PMID: 27653257 DOI: 10.1080/1744666x.2017.1239529] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Work-related asthma includes two subtypes: occupational asthma or asthma caused by specific agents (sensitizers or irritants) in the workplace, and work-exacerbated asthma or pre-existing asthma worsened by workplace exposures. Areas covered: This review provides an update on the definitions and the clinical features of the different work-related asthma subtypes as well as new insights into their etiology and the pathophysiological mechanisms involved. The diagnosis of work-related asthma should be made on objective basis using a constellation of clinical, physiologic and allergologic tests. Specific inhalation challenge with the suspected occupational agent(s) remains as the reference standard for diagnosis. A literature search was performed using the following terms: work-related asthma, occupational asthma, work-exacerbated asthma, irritant-induced asthma and etiological agents. Expert commentary: Studies focusing on the biological effects and mechanisms of environmental exposures in the development of sensitizer-induced or irritant-induced asthma in various workplace settings are of greatest interest. An integrative approach that combines clinical parameters with component-resolved diagnosis as well as inflammatory biomarkers appears to be very promising. Occupational allergy provides a good opportunity to understand the complex relationships between exposure to allergens in the workplace, interaction with genes and the co-exposures to other factors in the working environment.
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Affiliation(s)
- Santiago Quirce
- a Department of Allergy , Hospital La Paz Institute for Health Research and CIBER of Respiratory Diseases, CIBERES , Madrid , Spain
| | - Paloma Campo
- b Unidad de Gestión Clínica Allergy-IBIMA , Hospital Regional Universitario , Malaga , Spain
| | - Javier Domínguez-Ortega
- a Department of Allergy , Hospital La Paz Institute for Health Research and CIBER of Respiratory Diseases, CIBERES , Madrid , Spain
| | | | | | | | - Pilar Mur
- f Allergy Unit , Hospital Santa Barbara , Puertollano , Spain
| | - Julio Delgado
- g Unidad de Gestión Clínica Alergología , Hospital Virgen Macarena , Sevilla , Spain
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186
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Lipsa D, Leva P, Barrero-Moreno J, Coelhan M. Inflammatory effects induced by selected limonene oxidation products: 4-OPA, IPOH, 4-AMCH in human bronchial (16HBE14o-) and alveolar (A549) epithelial cell lines. Toxicol Lett 2016; 262:70-79. [PMID: 27575568 DOI: 10.1016/j.toxlet.2016.08.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 08/24/2016] [Accepted: 08/25/2016] [Indexed: 12/24/2022]
Abstract
Limonene, a monoterpene abundantly present in most of the consumer products (due to its pleasant citrus smell), easily undergoes ozonolysis leading to several limonene oxidation products (LOPs) such as 4-acetyl-1-methylcyclohexene (4-AMCH), 4-oxopentanal (4-OPA) and 3-isopropenyl-6-oxoheptanal (IPOH). Toxicological studies have indicated that human exposure to limonene and ozone can cause adverse airway effects. However, little attention has been paid to the potential health impact of specific LOPs, in particular of IPOH, 4-OPA and 4-AMCH. This study evaluates the cytotoxic effects of the selected LOPs on human bronchial epithelial (16HBE14o-) and alveolar epithelial (A549) cell lines by generating concentration-response curves using the neutral red uptake assay and analyzing the inflammatory response with a series of cytokines/chemokines. The cellular viability was mostly reduced by 4-OPA [IC50=1.6mM (A549) and 1.45mM (16HBE14o-)] when compared to IPOH [IC50=3.5mM (A549) and 3.4mM (16HBE14o-)] and 4-AMCH [IC50 could not be calculated]. As a result from the inflammatory response, IPOH [50μM] induced an increase of both IL-6 and IL-8 secretion in A549 (1.5-fold change) and in 16HBE14o- (2.8- and 7-fold change respectively). 4-OPA [50μM] treatment of A549 increased IL-6 (1.4-times) and IL-8 (1.3-times) levels, while in 16HBE14o- had an opposite effect. A549 treated with 4-AMCH [50μM] elevate both IL-6 and IL-8 levels by 1.2-times, while in 16HBE14o- had an opposite effect. Based on our results, lung cellular injury characterized by inflammatory cytokine release was observed for both cell lines treated with the selected chemicals at concentrations that did not affect their cellular viability.
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Affiliation(s)
- Dorelia Lipsa
- Technische Universität München, Research Center Weihenstephan for Brewing and Food Quality, Alte Akademie 3, Freising-Weihenstephan, Germany; European Commission, Joint Research Centre, Institute for Health and Consumer Protection, Chemical Assessment and Testing Unit, Ispra (VA), Italy.
| | - Paolo Leva
- European Commission, Joint Research Centre, Institute for Health and Consumer Protection, Chemical Assessment and Testing Unit, Ispra (VA), Italy
| | - Josefa Barrero-Moreno
- European Commission, Joint Research Centre, Institute for Health and Consumer Protection, Chemical Assessment and Testing Unit, Ispra (VA), Italy
| | - Mehmet Coelhan
- Technische Universität München, Research Center Weihenstephan for Brewing and Food Quality, Alte Akademie 3, Freising-Weihenstephan, Germany
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187
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Gotzev S, Lipszyc JC, Connor D, Tarlo SM. Trends in Occupations and Work Sectors Among Patients With Work-Related Asthma at a Canadian Tertiary Care Clinic. Chest 2016; 150:811-818. [PMID: 27445094 DOI: 10.1016/j.chest.2016.07.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 06/07/2016] [Accepted: 07/05/2016] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Work-related asthma (WRA) is the most common chronic occupational lung disease in the developed world. Several factors including sociodemographic status and occupation/industry increase the risks of developing WRA. In this study, we sought to identify changes in patterns and characteristics among patients with WRA over a 15-year period in an occupational lung disease clinic. METHODS We performed a retrospective analysis of patients with WRA charts at the Occupational Lung Disease Clinic of a University Hospital in Toronto, Canada. Patients were divided into two periods classified by first attendance at the clinic 2000 through 2007 and 2008 through 2015. Comparisons between the two periods included: sociodemographic characteristics, smoking status, occupations, exposures, and submitted workers' compensation claims. RESULTS Fewer occupational asthma cases were seen in the more recent period vs the earlier period (40 vs 74 cases), with a smaller reduction in work-exacerbated asthma cases (40 vs 58). The recent period included a significantly smaller proportion employed in the manufacturing industry and isocyanate-induced cases compared with the earlier period. An increased proportion were employed in health-care and education industries (primarily cleaners and teachers) in the recent period, consistent with a corresponding increased frequency of cleaning agents and dust exposures. CONCLUSIONS The changes observed in work sectors in the patients with WRA in this clinic in Toronto are consistent with reductions reported in Ontario workers' compensation claims for occupational asthma and may relate to preventive measures. Cleaners and teachers should be a focus of further intervention measures for work-related asthma.
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Affiliation(s)
- Simeon Gotzev
- Department of Medicine, Institute of Medical Science, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Joshua C Lipszyc
- Department of Medicine, Institute of Medical Science, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada; Department of Medicine, St Michael's Hospital, Toronto, ON, Canada
| | - Dale Connor
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Susan M Tarlo
- Department of Medicine, St Michael's Hospital, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
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188
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Developing a framework for assessing chemical respiratory sensitization: A workshop report. Regul Toxicol Pharmacol 2016; 80:295-309. [PMID: 27396307 DOI: 10.1016/j.yrtph.2016.06.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 06/10/2016] [Indexed: 12/29/2022]
Abstract
Respiratory tract sensitization can have significant acute and chronic health implications. While induction of respiratory sensitization is widely recognized for some chemicals, validated standard methods or frameworks for identifying and characterizing the hazard are not available. A workshop on assessment of respiratory sensitization was held to discuss the current state of science for identification and characterization of respiratory sensitizer hazard, identify information facilitating development of validated standard methods and frameworks, and consider the regulatory and practical risk management needs. Participants agreed on a predominant Th2 immunological mechanism and several steps in respiratory sensitization. Some overlapping cellular events in respiratory and skin sensitization are well understood, but full mechanism(s) remain unavailable. Progress on non-animal approaches to skin sensitization testing, ranging from in vitro systems, -omics, in silico profiling, and structural profiling were acknowledged. Addressing both induction and elicitation phases remains challenging. Participants identified lack of a unifying dose metric as increasing the difficulty of interpreting dosimetry across exposures. A number of research needs were identified, including an agreed list of respiratory sensitizers and other asthmagens, distinguishing between adverse effects from immune-mediated versus non-immunological mechanisms. A number of themes emerged from the discussion regarding future testing strategies, particularly the need for a tiered framework respiratory sensitizer assessment. These workshop present a basis for moving towards a weight-of-evidence assessment.
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189
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Biologics and the lung: TSLP and other epithelial cell-derived cytokines in asthma. Pharmacol Ther 2016; 169:104-112. [PMID: 27365223 DOI: 10.1016/j.pharmthera.2016.06.009] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 06/13/2016] [Indexed: 12/21/2022]
Abstract
Asthma is a chronic airway inflammatory disorder with characteristic symptoms of dyspnea, wheeze, chest tightness and cough, and physiological abnormalities of variable airway obstruction, airway hyperresponsiveness, and in some patients with chronic long standing disease reduced lung function. The physiological abnormalities are due to chronic airway inflammation and underlying structural changes to the airway wall. The interaction between the airway epithelium and the environment is crucial to the pathobiology of asthma. Several recent discoveries have highlighted a crucial role of airway epithelial derived cytokines such as interleukin (IL)-25, IL-33 and thymic stromal lymphopoietin (TSLP). These cytokines are collectively known as epithelial "alarmins", which act solely or in concert to activate and potentiate the innate and humoral arms of the immune system in the presence of actual or perceive damage. Understanding the role of alarmins and how they are activated and released may allow the development of novel new therapeutics to treat asthma. This review describes the interactions between inhaled air, the pulmonary microbiome, airway epithelial cell layer and the alarmins, IL-25, IL-33 and TSLP. There is already compelling evidence for a role of TSLP in the airway responses to environmental allergens in allergic asthmatics, as well as in maintaining airway eosinophilic inflammation in these subjects. Further work is required to develop human monoclonal antibodies (hMabs) directed against IL-25 and IL-33 or their receptors, to help understand their role in the initiation and/or persistence of asthma.
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190
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Matulonga B, Rava M, Siroux V, Bernard A, Dumas O, Pin I, Zock JP, Nadif R, Leynaert B, Le Moual N. Women using bleach for home cleaning are at increased risk of non-allergic asthma. Respir Med 2016; 117:264-71. [PMID: 27492540 DOI: 10.1016/j.rmed.2016.06.019] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 06/10/2016] [Accepted: 06/24/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Bleach is widely used for household cleaning. Although it is recognized that occupational use of bleach may have adverse respiratory health effects, it is unknown whether common domestic use of bleach may be a risk factor for asthma. AIM To assess whether the domestic use of bleach for home cleaning is associated with asthma and other respiratory outcomes. METHODS Questionnaire-based information on respiratory symptoms and cleaning habits and data from skin prick-tests, bronchial responsiveness challenge and white blood cells were analyzed in 607 women participating in the follow-up of the Epidemiological Study on the Genetics and Environment of Asthma (EGEA). Bleach use was evaluated in 3 categories (<1 day/week; 1-3 days/week; 4-7 days/week "frequent"). RESULTS Overall, 37% of the women reported using bleach weekly. Women using bleach frequently (11%) were more likely to have current asthma as compared to non-users (adjusted Odds-Ratio (aOR) = 1.7; 95% Confidence Interval (95%CI) 1.0-3.0). Among women with asthma, frequent use of bleach was significantly associated with higher blood neutrophil cell counts. Bleach use was significantly associated with non-allergic asthma (aOR 3.3; 95%CI 1.5-7.1), and more particularly with non-allergic adult-onset asthma (aOR 4.9; 95%CI 2.0-11.6). Consistently, among women without allergic sensitization, significant positive associations were found between use of bleach and bronchial hyperresponsiveness, asthma like-symptoms and chronic cough. No association was observed for allergic asthma. CONCLUSIONS Frequent use of bleach for home-cleaning is associated with non-allergic adult-onset asthma, elevated neutrophil counts and lower-airway symptoms in women.
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Affiliation(s)
- Bobette Matulonga
- Inserm, UMR 1152, Pathophysiology and Epidemiology of Respiratory Diseases, Epidemiology Team, F-75890, Paris, France; Univ Paris-Saclay, Faculty of Medicine, Kremlin-Bicêtre, France
| | - Marta Rava
- Inserm, U1168, VIMA: Aging and Chronic Diseases, Epidemiological and Public Health Approaches, F-94807, Villejuif, France; Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, F-78180, Montigny le Bretonneux, France; Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (CNIO), Madrid, Spain
| | - Valérie Siroux
- University Grenoble Alpes, IAB, Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, F-38042, Grenoble, France; Inserm U823, IAB, Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, F-38042, Grenoble, France
| | - Alfred Bernard
- Louvain Center for Toxicology and Applied Pharmacology (LTAP), Catholic University of Louvain, 1200, Brussels, Belgium
| | - Orianne Dumas
- Inserm, U1168, VIMA: Aging and Chronic Diseases, Epidemiological and Public Health Approaches, F-94807, Villejuif, France; Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, F-78180, Montigny le Bretonneux, France
| | - Isabelle Pin
- University Grenoble Alpes, IAB, Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, F-38042, Grenoble, France; Inserm U823, IAB, Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, F-38042, Grenoble, France; CHU de Grenoble, La Tronche, F-38043, Grenoble, France
| | - Jan-Paul Zock
- Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Rachel Nadif
- Inserm, U1168, VIMA: Aging and Chronic Diseases, Epidemiological and Public Health Approaches, F-94807, Villejuif, France; Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, F-78180, Montigny le Bretonneux, France
| | - Bénédicte Leynaert
- Inserm, UMR 1152, Pathophysiology and Epidemiology of Respiratory Diseases, Epidemiology Team, F-75890, Paris, France; University Paris Diderot Paris 7, UMR 1152, F-75890, Paris, France.
| | - Nicole Le Moual
- Inserm, U1168, VIMA: Aging and Chronic Diseases, Epidemiological and Public Health Approaches, F-94807, Villejuif, France; Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, F-78180, Montigny le Bretonneux, France
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Cruz MJ, Olle-Monge M, Vanoirbeek JA, Assialioui A, Gomez-Olles S, Muñoz X. Persistence of respiratory and inflammatory responses after dermal sensitization to persulfate salts in a mouse model of non-atopic asthma. Allergy Asthma Clin Immunol 2016; 12:26. [PMID: 27222656 PMCID: PMC4878079 DOI: 10.1186/s13223-016-0131-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 04/22/2016] [Indexed: 01/09/2023] Open
Abstract
Background Exposure to ammonium persulfate (AP) has been reported to be the main cause of occupational asthma in hairdressers. The aim of this study is to assess how long the asthmatic response to AP can be induced after dermal sensitization in a mouse model. Methods BALB/c mice received dermal applications of AP or dimethylsulfoxide (DMSO) (control) on days 1 and 8. They then received a single nasal instillation (challenge) of AP or saline on days 15, 22, 29, 36, 45, 60 and 90. Respiratory responsiveness to methacholine was measured 24 h after the challenge using a non-specific methacholine provocation test. Pulmonary inflammation was analysed in bronchoalveolar lavage (BAL), and total serum immunoglobulin (Ig) E, IgG1 and IgG2a were measured in serum samples. Histological analysis of lung slides was performed. Results Mice dermally sensitized and intranasally challenged with AP showed respiratory responsiveness to methacholine as long as 45 days after initial sensitization, as well as increased percentage of neutrophils in BAL compared with the control group. At day 60, dermally sensitized mice still presented bronchial hyperresponsiveness, while the percentage of neutrophils returned to baseline levels similar to those of controls. Total serum IgE increased significantly on day 22 after dermal sensitization. Total serum IgG1 and IgG2a increased from 45 days after dermal sensitization and remained high at 90 days. Conclusions Both respiratory responsiveness to methacholine and airway inflammation responses decrease with increasing time between sensitization and challenge. Respiratory responsiveness to methacholine tends to persist longer than inflammation.
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Affiliation(s)
- M J Cruz
- Servicio de Neumologia, Hospital Universitario Vall d'Hebron, Passeig Vall d'Hebron, 119, 08035 Barcelona, Spain ; CIBER Enfermedades Respiratorias (CibeRes), Barcelona, Spain
| | - M Olle-Monge
- Servicio de Neumologia, Hospital Universitario Vall d'Hebron, Passeig Vall d'Hebron, 119, 08035 Barcelona, Spain ; CIBER Enfermedades Respiratorias (CibeRes), Barcelona, Spain ; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J A Vanoirbeek
- Centre of Environment and Health, KU Leuven, Leuven, Belgium
| | - A Assialioui
- Servicio de Neumologia, Hospital Universitario Vall d'Hebron, Passeig Vall d'Hebron, 119, 08035 Barcelona, Spain
| | - S Gomez-Olles
- Servicio de Neumologia, Hospital Universitario Vall d'Hebron, Passeig Vall d'Hebron, 119, 08035 Barcelona, Spain ; CIBER Enfermedades Respiratorias (CibeRes), Barcelona, Spain
| | - X Muñoz
- Servicio de Neumologia, Hospital Universitario Vall d'Hebron, Passeig Vall d'Hebron, 119, 08035 Barcelona, Spain ; CIBER Enfermedades Respiratorias (CibeRes), Barcelona, Spain ; Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Barcelona, Spain
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An official American Thoracic Society Workshop Report: presentations and discussion of the fifth Jack Pepys Workshop on Asthma in the Workplace. Comparisons between asthma in the workplace and non-work-related asthma. Ann Am Thorac Soc 2016. [PMID: 26203621 DOI: 10.1513/annalsats.201505-281st] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The fifth Jack Pepys Workshop on Asthma in the Workplace focused on the similarities and differences of work-related asthma (WRA) and non-work-related asthma (non-WRA). WRA includes occupational asthma (OA) and work-exacerbated asthma (WEA). There are few biological differences in the mechanisms of sensitization to environmental and occupational allergens. Non-WRA and OA, when due to high-molecular-weight agents, are both IgE mediated; it is uncertain whether OA due to low-molecular-weight agents is also IgE mediated. Risk factors for OA include female sex, a history of upper airway symptoms, and a history of bronchial hyperresponsiveness. Atopy is a risk factor for OA due to high-molecular-weight agents, and exposure to cleaning agents is a risk factor for both OA and non-WRA. WEA is important among workers with preexisting asthma and may overlap with irritant-induced asthma, a type of OA. Induced sputum cytology can confirm airway inflammation, but specific inhalation challenge is the reference standard diagnostic test. Inhalation challenges are relatively safe, with the most severe reactions occurring with low-molecular-weight agents. Indirect health care costs account for about 50% of total asthma costs. Workers with poor asthma control (WRA or non-WRA) are less likely to be employed. Income loss is a major contributor to the indirect costs of WRA. Overall, asthma outcomes probably are worse for adult-onset than for childhood-onset asthma but better for OA than adult-onset non-WRA. Important aspects of management of OA are rapid and proper confirmation of the diagnosis and reduction of exposure to sensitizers or irritants at work and home.
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193
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Devos FC, Boonen B, Alpizar YA, Maes T, Hox V, Seys S, Pollaris L, Liston A, Nemery B, Talavera K, Hoet PHM, Vanoirbeek JAJ. Neuro-immune interactions in chemical-induced airway hyperreactivity. Eur Respir J 2016; 48:380-92. [PMID: 27126687 DOI: 10.1183/13993003.01778-2015] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 03/02/2016] [Indexed: 01/07/2023]
Abstract
Asthma may be induced by chemical sensitisers, via mechanisms that are still poorly understood. This type of asthma is characterised by airway hyperreactivity (AHR) and little airway inflammation. Since potent chemical sensitisers, such as toluene-2,4-diisocyanate (TDI), are also sensory irritants, it is suggested that chemical-induced asthma relies on neuro-immune mechanisms.We investigated the involvement of transient receptor potential channels (TRP) A1 and V1, major chemosensors in the airways, and mast cells, known for their ability to communicate with sensory nerves, in chemical-induced AHR.In vitro intracellular calcium imaging and patch-clamp recordings in TRPA1- and TRPV1-expressing Chinese hamster ovarian cells showed that TDI activates murine TRPA1, but not TRPV1. Using an in vivo model, in which an airway challenge with TDI induces AHR in TDI-sensitised C57Bl/6 mice, we demonstrated that AHR does not develop, despite successful sensitisation, in Trpa1 and Trpv1 knockout mice, and wild-type mice pretreated with a TRPA1 blocker or a substance P receptor antagonist. TDI-induced AHR was also abolished in mast cell deficient Kit(Wsh) (/Wsh) mice, and in wild-type mice pretreated with the mast cell stabiliser ketotifen, without changes in immunological parameters.These data demonstrate that TRPA1, TRPV1 and mast cells play an indispensable role in the development of TDI-elicited AHR.
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Affiliation(s)
- Fien C Devos
- Centre for Environment and Health, Dept of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Brett Boonen
- Laboratory for Ion Channel Research and TRP Research Platform (TRPLe), Dept of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Yeranddy A Alpizar
- Laboratory for Ion Channel Research and TRP Research Platform (TRPLe), Dept of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Tania Maes
- Laboratory of Pneumology, Dept of Respiratory Medicine, Ghent University, Ghent, Belgium
| | - Valérie Hox
- Laboratory of Clinical Immunology, Dept of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Sven Seys
- Laboratory of Clinical Immunology, Dept of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Lore Pollaris
- Centre for Environment and Health, Dept of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Adrian Liston
- Laboratory of Genetics of Autoimmunity, Dept of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Benoit Nemery
- Centre for Environment and Health, Dept of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Karel Talavera
- Laboratory for Ion Channel Research and TRP Research Platform (TRPLe), Dept of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Peter H M Hoet
- Centre for Environment and Health, Dept of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Jeroen A J Vanoirbeek
- Centre for Environment and Health, Dept of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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Abstract
UNLABELLED Medical devices and innovative technology promise to revolutionize health care. Despite the importance of involving nurses in the collaborative medical device development processes, there are few learning opportunities in nursing programs. The purpose of this article is to provide a conceptual guide for nurse educators and researchers to engage nursing expertise in medical device development processes. METHOD A review of the literature guided the creation of the "Strengthening the Role of Nurses in Medical Device Development Roadmap" model. The model was used to describe how nurses can be engaged in multidisciplinary design of medical devices. An academic transdisciplinary team piloted the application of the model. RESULTS The model includes the stages of needs assessment, planned brainstorm, feasibility determination, concept design, and prototype building. A transdisciplinary team case study of improving an asthma home-monitoring devices illustrates effective application of the model. CONCLUSION Nurse leaders in the academic setting can effectively use the "Strengthening the Role of Nurses in Medical Device Development Roadmap" to inform their engagement of nurses in early medical device development and innovation processes.
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Abstract
OBJECTIVES To illustrate the utility of crowdsourcing for occupational health surveillance. METHODS Amazon Mechanical Turk was used to recruit and obtain information from employed persons with asthma, who answered questions about work-asthma interactions. RESULTS Data collection from 60 subjects required only a few hours. Participants spent on average 7 minutes responding to seven questions (one optional) and used an average of 708 words. Work exacerbation, interference of asthma with work, and suggested workplace accommodation are frequent (83% reported at least one interaction). CONCLUSIONS The full spectrum of work-asthma interactions should be considered. Modern crowdsourcing methods have considerable potential as occupational health surveillance tools because of their effectiveness; efficiency and financial viability are additional important advantages.
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196
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Descatha A, Despreaux T. Work or environment-related disorders? Three triage steps for physicians. Br J Hosp Med (Lond) 2015; 76:728. [PMID: 26646340 DOI: 10.12968/hmed.2015.76.12.728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Alexis Descatha
- Head/Chief Resident Occupational Health Unit CHU Poincaré 92380 Garches France
| | - Thomas Despreaux
- Head/Chief Resident Occupational Health Unit CHU Poincaré 92380 Garches France
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197
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Ham JE, Jackson SR, Harrison JC, Wells J. Gas-phase reaction products and yields of terpinolene with ozone and nitric oxide using a new derivatization agent. ATMOSPHERIC ENVIRONMENT (OXFORD, ENGLAND : 1994) 2015; 122:520. [PMID: 31814795 PMCID: PMC6896996 DOI: 10.1016/j.atmosenv.2015.10.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
The new derivatization agent, O-tert-butylhydroxylamine hydrochloride (TBOX) was used to investigate the carbonyl reaction products from terpinolene ozonolysis. With ozone (O3) as the limiting reagent, four carbonyl compounds were detected: methylglyoxal (MG), 4-methylcyclohex-3-en-1-one, (4MCH), 6-oxo-3-(propan-2-ylidene) heptanal (6OPH), and 3,6-dioxoheptanal (36DOH). The tricarbonyl 36DOH has not been previously observed. Using cyclohexane as a hydroxyl radical (OH•) scavenger, the yields of 6OPH and 36DOH were reduced indicating the influence secondary OH• radicals have on terpinolene ozonolysis products. However, the MG yield increased and the 4MCH yield was unchanged when OH•radicals were scavenged suggesting they are only made by the terpinolene + O3 reaction. The detection of 36DOH using TBOX highlights the advantages of a smaller molecular weight derivatization agent for the detection of multi-carbonyl compounds. The product yields from terpinolene ozonolysis experiments conducted in the presence of 20 ppb nitric oxide (NO) remained unchanged except for MG which decreased. However, in experiments where O3 was kept constant at 50 ppb and NO was varied (20, 50, 100 ppb) MG, 6OPH, 36DOH decreased with increasing NO while 4MCH increased with increasing NO. The use of TBOX derivatization if combined with other derivatization agents may address a recurring need to simply and accurately detect multi-functional oxygenated species in air.
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Affiliation(s)
- Jason E. Ham
- Exposure Assessment Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, 1095 Willowdale Road, Morgantown, WV 26505, United States
| | - Stephen R. Jackson
- Exposure Assessment Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, 1095 Willowdale Road, Morgantown, WV 26505, United States
| | - Joel C. Harrison
- Exposure Assessment Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, 1095 Willowdale Road, Morgantown, WV 26505, United States
| | - J.R. Wells
- Exposure Assessment Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, 1095 Willowdale Road, Morgantown, WV 26505, United States
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Rabell-Santacana V, Panadès-Valls R, Vila-Rigat R, Hernandez-Huet E, Sivecas-Maristany J, Blanché-Prat X, Prieto G, Muñoz L, Torán P. Prevalence of Work-Related Asthma in Primary Health Care: Study Rationale and Design. Open Respir Med J 2015; 9:127-39. [PMID: 26865884 PMCID: PMC4740970 DOI: 10.2174/1874306401509010127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 10/01/2015] [Accepted: 10/01/2015] [Indexed: 11/22/2022] Open
Abstract
Background : Occupational Asthma (OA) is the most frequent origin of occupational respiratory diseases in industrialized countries and accounts for between 5% and 25% of asthmatic patients. The correct and early diagnosis of OA is of great preventive and socio-economic importance. However, few studies exist on OA’s prevalence in Catalonia and in Spain and those affected are mainly treated by the public health services and not by the occupational health services, which are private. Objective : To determine the prevalence of OA in patients diagnosed with asthma in the Primary Healthcare system and to evaluate the socio-economic impact of OA in the Primary Healthcare system. Methods/Design : We will carry out an observational, transversal and multi-center study in the Primary Healthcare Service in the Barcelona region (Catalonia, Spain), with 385 asthmatic workers aged between 16 and 64 who are currently working or have been working in the past. We will confirm the asthma diagnosis in each patient, and those meeting the inclusion criteria will be asked to answer a questionnaire that aims to link asthma to the patient’s past employment history. The resulting diagnosis will be of either occupational asthma, work-aggravated asthma or common asthma. We will also collect socio-demographic information about the patients, about their smoking status, their exposure outside of the workplace, their work situation at the onset of the symptoms, their employment history, their symptoms of asthma, their present and past medical asthma treatment, and, in order to estimate the economic impact in the Primary Healthcare system, where they have been attended to and treated. Prevalence will link OA or work-aggravated asthma to the total of patients participating in the study with a asthma diagnosis. Discussion : The results will show the prevalence of OA and work-aggravated asthma, and shall provide valuable information to set out and apply the necessary personal and technical measures, either in the public or in the occupational health services. No studies evaluating the costs generated by the OA in the Primary Healthcare system have been carried out.
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Affiliation(s)
- Ventura Rabell-Santacana
- Primary Healthcare Centre Vallès Oriental, Catalan Health Institute, Carrer del Museu, 19, 08401 Granollers, Spain
| | - Rafael Panadès-Valls
- Health and Safety Occupational Centre, Department of Business and Occupation, Plaça Eusebi Güell 4-5, 08034 Barcelona, Spain
| | - Rosa Vila-Rigat
- Primary Healthcare Centre La Garriga, Catalan Health Institute, Carrer Torrent de la Sínia 7, 08530 La Garriga, Spain
| | - Enric Hernandez-Huet
- Primary Healthcare Centre Les Franqueses del Vallès, Catalan Health Institute, Carrer de Girona 290, 08520 Les Franqueses del Vallès, Spain
| | - Joan Sivecas-Maristany
- Primary Healthcare Centre Can Borràs, Catalan Health Institute Carrer, Balmes 51, 08440 Cardedeu, Spain
| | - Xavier Blanché-Prat
- Primary Healthcare Centre Llinars del Vallès, Catalan Health Institute Carrer, Frederic Marès, s/n. 08450 Llinars del Vallès
| | - Gemma Prieto
- Primary Care Management of Health of Ávila, Castilla y León (SACYL), Avenida de Portugal 47, 05001 Ávila, Spain
| | - Laura Muñoz
- Primary Healthcare Research Support Unit Metropolitana Nord.IDIAP Jordi Gol, Carrer Major 49-53, 08921 Santa Coloma de Gramenet, Spain
| | - Pere Torán
- Primary Healthcare Research Support Unit Metropolitana Nord.IDIAP Jordi Gol, Carrer Major 49-53, 08921 Santa Coloma de Gramenet, Spain
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Lefkowitz D, Pechter E, Fitzsimmons K, Lumia M, Stephens AC, Davis L, Flattery J, Weinberg J, Harrison RJ, Reilly MJ, Filios MS, White GE, Rosenman KD. Isocyanates and work-related asthma: Findings from California, Massachusetts, Michigan, and New Jersey, 1993-2008. Am J Ind Med 2015; 58:1138-49. [PMID: 26351141 DOI: 10.1002/ajim.22527] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND Isocyanates remain a leading cause of work-related asthma (WRA). METHODS Two independent data systems were analyzed for the period 1993-2008: (1) State-based WRA case surveillance data on persons with isocyanate-induced WRA from four states, and (2) Occupational Safety and Health Administration (OSHA) Integrated Management Information System (IMIS) isocyanate air sampling results. RESULTS We identified 368 cases of isocyanate-induced WRA from 32 industries and 678 OSHA isocyanate air samples with detectable levels from 31 industries. Seventeen industries were unique to one or the other dataset. CONCLUSION Isocyanate-induced WRA continues to occur in a wide variety of industries. Two data systems uncovered industries with isocyanate exposures and/or illness. Improved control measures and standards, including medical surveillance, are needed. More emphasis is needed on task-specific guidance, spill clean-up procedures, skin and respiratory protection, and targeted medical monitoring to mitigate the hazards of isocyanate use.
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Affiliation(s)
- Daniel Lefkowitz
- Environmental & Occupational Health Surveillance Program; New Jersey Department of Health; Trenton New Jersey
| | - Elise Pechter
- Occupational Health Surveillance Program; Massachusetts Department of Public Health; Boston Massachusetts
| | - Kathleen Fitzsimmons
- Occupational Health Surveillance Program; Massachusetts Department of Public Health; Boston Massachusetts
| | - Margaret Lumia
- Environmental & Occupational Health Surveillance Program; New Jersey Department of Health; Trenton New Jersey
| | - Alicia C. Stephens
- Environmental & Occupational Health Surveillance Program; New Jersey Department of Health; Trenton New Jersey
| | - Letitia Davis
- Occupational Health Surveillance Program; Massachusetts Department of Public Health; Boston Massachusetts
| | - Jennifer Flattery
- Occupational Health Branch; California Department of Public Health; Richmond California
| | - Justine Weinberg
- Public Health Institute; Contractor to California Department of Public Health; Richmond California
| | - Robert J. Harrison
- Occupational Health Branch; California Department of Public Health; Richmond California
| | - Mary Jo Reilly
- Division of Occupational and Environmental Medicine; Michigan State University; East Lansing Michigan
| | - Margaret S. Filios
- Division of Respiratory Disease Studies; National Institute for Occupational Safety and Health; Centers for Disease Control and Prevention; Morgantown West Virginia
| | - Gretchen E. White
- Division of Respiratory Disease Studies; National Institute for Occupational Safety and Health; Centers for Disease Control and Prevention; Morgantown West Virginia
- University of Pittsburgh Graduate School of Public Health; Department of Epidemiology; Pittsburgh Pennsylvania
| | - Kenneth D. Rosenman
- Division of Occupational and Environmental Medicine; Michigan State University; East Lansing Michigan
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200
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Abstract
Obstructive lung disease includes asthma and chronic obstructive pulmonary disease (COPD). Because a previous issue of Medical Clinics of North America (2012;96[4]) was devoted to COPD, this article focuses on asthma in adults, and addresses some topics about COPD not addressed previously. Asthma is a heterogeneous disease marked by variable airflow obstruction and bronchial hyperreactivity. Onset is most common in early childhood, although many people develop asthma later in life. Adult-onset asthma presents a particular challenge in the primary care clinic because of incomplete understanding of the disorder, underreporting of symptoms, underdiagnosis, inadequate treatment, and high rate of comorbidity.
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Affiliation(s)
- Michael J Lenaeus
- Department of General Internal Medicine, University of Washington Medical Center, 1959 Northeast Pacific Street, Box 356429, Seattle, WA 98195-6429, USA.
| | - Jan Hirschmann
- Department of General Internal Medicine, Puget Sound VA Medical Center, University of Washington School of Medicine, 1660 South Columbian Way, Seattle, WA 98108, USA
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