Occupational obstructive airway diseases in Germany: Frequency and causes in an international comparison

Environmental Substances Associated with Chronic Obstructive Pulmonary Disease-A Scoping Review

Chronic obstructive pulmonary disease (COPD) is a slowly developing non-communicable disease (NCD), causing non-reversible obstruction and leading to marked morbidity and mortality. Besides traditional risk factors such as smoking, some environmental substances can augment the risk of COPD. The European Human Biomonitoring Initiative (HBM4EU) is a program evaluating citizens’ exposure to various environmental substances and their possible health impacts. Within the HBM4EU, eighteen priority substances or substance groups were chosen. In this scoping review, seven of these substances or substance groups are reported to have an association or a possible association with COPD. Main exposure routes, vulnerable and high-exposure risk groups, and matrices where these substances are measured are described. Pesticides in general and especially organophosphate and carbamate insecticides, and some herbicides, lead (Pb), and polycyclic aromatic hydrocarbons (PAHs) showed an association, and cadmium (Cd), chromium (Cr and CrVI), arsenic (As), and diisocyanates, a possible association with COPD and/or decreased lung function. Due to long latency in COPD’s disease process, the role of chemical exposure as a risk factor for COPD is probably underestimated. More research is needed to support evidence-based conclusions. Generally, chemical exposure is a growing issue of concern, and prompt action is needed to safeguard public health.

Assessment of the Level of Organic Dust and Mould Spores in the Work Environment of Baker

Aim:

This study was conducted to determine the level of fungal contamination of the air in bakeries to assess health hazards for workers.

Materials and Methods:

Six bakeries producing traditionally baked goods were selected for the study. After a background survey, samples of exhaled air were collected to test for fungal aerosols. The inhalable and respirable fraction in the bakery air environment was measured by the gravimetric method.

Statistical Analysis Used:

All data analyses were performed using Statistica software (v 8.0).

Results:

The mean concentration of fungi and particles in the bakeries did not exceed the recommended levels. The air in the bakeries had a low level of microbial contamination. The identified fungi included biological agents from hazard group 2.

Conclusions:

Proper employee training and the introduction of preventive measures (including both individual and group protection) can significantly reduce employees’ exposure and thus their occupational risk.

Gender-related aspects in occupational allergies - Secondary publication and update

For years occupational allergies have been among the most frequently recorded occupational diseases, and both the skin as well as the respiratory tract may be affected. An estimated 9 to 15% of adult asthma is (partially) caused by work-related exposure. Gender-specific differences in exposure cause different risks in the workplace which affect the health of employees. This also applies to exposure and working conditions when handling sensitizing working substances. The presented gender-specific analysis of the German documentation of confirmed occupational respiratory allergic diseases and occupational skin diseases reveals clear differences between men and women in the number of diseases and also in exposure conditions and working areas.

Azodicarbonamide (ADCA): A reconsideration of classification as a respiratory sensitiser

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.

High occurrence of rhinitis symptoms in hairdressing apprentices

BACKGROUND

Little is known about the occurrence of respiratory symptoms among hairdressing apprentices during their training. Therefore, in this study, we examined whether hairdressing apprentices are at increased risk of rhinitis and asthma symptoms when compared with other young adults from the general population.

METHODS

A questionnaire was completed by 504 hairdressing apprentices and 1400 control participants from the general population with a similar age, gender, and geographic distribution.

RESULTS

The 1-year prevalence of rhinitis symptoms was higher in hairdressing apprentices than in controls (58.1% vs 46.6%; odds ratio, 1.59; 95% confidence interval, 1.30-1.98), and the prevalence was higher among hairdressing apprentices in the last years of training compared with apprentices in the first year of training (62.4% vs 41.8%, p = 0.003). Current smoking was more common in hairdressing apprentices (28.4% vs 17.2%, p < 0.001). Asthma symptoms were equally common in the 2 groups; however, hairdressing apprentices had a later age of onset of wheezing than did the controls (18 years vs 14 years, p < 0.00001) and a decreased risk of wheezing (odds ratio, 0.72; 95% confidence interval, 0.54 to 0.95) after adjusting for smoking, education level, and degree of rurality. Bleaching products were the most frequently reported cause of rhinitis and asthma symptoms in hairdressing apprentices.

CONCLUSIONS

Hairdressing apprentices seem to have an increased risk of occupational rhinitis, and bleaching products are the main cause of respiratory symptoms. In addition, our findings suggest that a healthy worker effect exists in relation to asthma among hairdressing apprentices.

Evaluation of Dust Exposure among the Workers in Agricultural Industries in North-East India

This study aims to quantify dust exposure among the workers in four different industrial settings: rice mills, flour mills, oil mills, and tea factories and to compare the obtained data with the permissible exposure limit (PEL) of Indian Union Ministry of Labour as well as to compare the dust exposure across activities and seasons. RespiCon(TM) particle sampler was used for collecting dust concentration in the breathing zone of the workers. In total, 149 workers participated in the study and 204 samples were collected. Samples were collected in the vicinity of different processing operations. Samples in the rice mills were collected for two consecutive years in two seasons; however samples from other industries were collected for 1 year. The results indicate that geometric mean (GM) of dust exposure was significantly (P < 0.0001) different among industrial settings. Respirable dust were 8.22, 5.76, 2.98, and 6.34mg m(-3) and total dust exposure were 81.05, 111.02, 56.68, and 39.85mg m(-3) in the rice mills, oil mills, flour mills, and tea factories, respectively. Considerable variations in dust exposure were observed in different activities in the rice and oil mills; however variation was relatively less in the flour mills and tea factories. In the rice mills, dust concentration was higher in winter than those obtained in autumn and it is significantly different (P < 0.05) for inhalable dust and total dust. Positive correlation was obtained in thoracic dust (r (2) = 0.94) and inhalable dust (r (2) = 0.97) with total dust and thoracic dust with inhalable dust (r (2) = 0.89). The results show that majority of the workers are exposed to higher level of respirable dust as compared to the PEL, while total dust exposure to all the workers were higher than the PEL; thus, immediate reduction of dust exposure among the workers is necessary for preventing respiratory system impairment.

Is the analysis of histamine and/or interleukin-4 release after isocyanate challenge useful in the identification of patients with IgE-mediated isocyanate asthma?

Isocyanates are a well-known and frequent cause of occupational asthma. The implementation of specific inhalation challenges (SICs) is the gold standard in asthma diagnosis supporting occupational case history, lung function testing, specific skin prick tests and the detection of specific IgE. However, the diagnosis is not always definitive. An interesting new approach, analyses of individual genetic susceptibilities, requires discrimination between a positive SIC reaction arising from IgE-mediated immune responses and one from other pathophysiological mechanisms. Hence, additional refinement tools would be helpful in defining sub-classes of occupational asthma and diagnosis. We used total IgE levels, specific IgE and SIC results for sub-classification of 27 symptomatic isocyanate workers studied. Some mutations in glutathione S-transferases (GSTs) are suspected either to enhance or to decrease the individual risk in the development of isocyanate asthma. Our patient groups were assessed for the point mutations GSTP1*I105V and GSTP1*A114V as well as deletions (null mutations) of GSTM1 and GSTT1. There seems to be a higher risk in developing IgE-mediated reactions when GSTM1 is deleted, while GSTT1 deletions were found more frequently in the SIC positive group. Blood samples taken before SIC, 30-60 min and 24h after SIC, were analyzed for histamine and IL-4, classical markers for the IgE-mediated antigen-specific activation of basophils or mast cells. We suggest that the utility of histamine measurements might provide an additional useful marker reflecting isocyanate-induced cellular reactions (although the sampling times require optimization). The promising measurement of IL-4 is not feasible at present due to the lack of a reliable, validated assay.

Chemical and biological work-related risks across occupations in Europe: a review

BACKGROUND

Work-related health inequalities are determined to some extent by an unequal exposure to chemical and biological risk factors of disease. Although their potential economic burden in the European Union (EU-25) might be substantial, comprehensive reviews focusing on the distribution of these risks across occupational groups are limited. Thus, the main objective of this review is to provide a synopsis of the exposure to chemical and biological hazards across occupational groups. In addition, main industrial applications of hazardous substances are identified and some epidemiological evidence is discussed regarding societal costs and incidence rates of work-related diseases.

METHODS

Available lists of carcinogens, sensitisers, mutagens, reprotoxic substances and biological hazards were consulted. For each work-related hazard the main industrial application was identified in order to assess which ISCO occupational groups may be associated with direct exposure. Where available, information on annual tonnage production, risk assessment of the substances and pathogens, and other relevant data were collected and reported.

RESULTS

Altogether 308 chemical and biological hazards were identified which may account to at least 693 direct exposures. These hazards concentrate on the following major occupational groups: technicians (ISCO 3), operators (ISCO 8), agricultural workers (ISCO 6) and workers in elementary occupations (ISCO 9). Common industrial applications associated with increased exposure rates relate among others to: (1) production or application of pigments, resins, cutting fluids, adhesives, pesticides and cleaning products, (2) production of rubber, plastics, textiles, pharmaceuticals and cosmetics, and (3) in agriculture, metallurgy and food processing industry, Societal costs of the unequal distribution of chemical and biological hazards across occupations depend on the corresponding work-related diseases and may range from 2900 EUR to 126000 EUR per case/year.

CONCLUSIONS

Risk of exposure to chemical and biological risks and work-related disease incidence are highly concentrated on four occupational groups. The unequal burden of exposure across occupations is an important contributing factor leading to health inequalities in society. The bulk of societal costs, however, are actually being borne by the workers themselves. There is an urgent need of taking into account the health impact of production processes and services on workers' health.

Trends in occupational airway diseases in German hairdressers: frequency and causes

BACKGROUND

Hairdressers are exposed to several allergens and irritants known to cause obstructive airway diseases (OAD). In the early 1990s, high incidence rates of OAD were observed in German hairdressers. It was expected that modification of formulations would resolve the problem of high OAD rates in hairdressers.

METHODS

The numbers of confirmed cases are reported of allergen-, latex- and irritant-induced OAD in German hairdressers, as registered by the responsible compensation board during 1998 and 2007. Hairdressing components reported as causative for OAD in hairdressers were analyzed. The incidence rates of OAD in hairdressers were compared with rates in healthcare professionals, as both occupations had high rates of OAD in the 1990s.

RESULTS

From 1998 until 2003, the total number of confirmed cases of allergen-, latex- and irritant-induced OAD stayed at a plateau of 60 cases annually in hairdressers, after which a downward trend was apparent. The number of irritant-induced OAD cases did not fall during this overall downward trend. Hair dyes and acid perms were most often identified as the substances causing OAD in hairdressers. In healthcare professionals, the downward trend in OAD is more pronounced than in hairdressers, mainly due to a decrease in latex-induced cases.

CONCLUSIONS

The number of allergen- and irritant-induced cases of OAD in German hairdressers is still high. Exposure to known airway irritants is still occurring in spite of modification of the formulations. Continuous medical surveillance of hairdressers is recommended, in order to detect individual susceptibility, especially in apprentices.

Fertility disorders and pregnancy complications in hairdressers - a systematic review

BACKGROUND

Hairdressers often come into contact with various chemical substances which can be found in hair care products for washing, dyeing, bleaching, styling, spraying and perming. This exposure can impair health and may be present as skin and respiratory diseases. Effects on reproduction have long been discussed in the literature.

METHOD

A systematic review has been prepared in which publications from 1990 to 2010 were considered in order to specifically investigate the effects on fertility and pregnancy. The results of the studies were summarised separately in accordance with the type of study and the examined events.

RESULTS

A total of 2 reviews and 26 original studies on fertility disorders and pregnancy complications in hairdressers were found in the relevant databases, as well as through hand searches of reference lists. Nineteen different outcomes concerning fertility and pregnancy are analysed in the 26 original studies. Most studies looked into malformation (n = 7), particularly orofacial cleft. Two of them found statistically significant increased risks compared to five that did not. Small for gestational age (SGA), low birth weight (LBW) and spontaneous abortions were frequently investigated but found different results. Taken together the studies are inconsistent, so that no clear statements on an association between the exposure as a hairdresser and the effect on reproduction are possible. The different authors describe increased risks of infertility, congenital malformations, SGA, LBW, cancer in childhood, as well as effects from single substances.

CONCLUSION

On the basis of the identified epidemiological studies, fertility disorders and pregnancy complications in hairdressers cannot be excluded. Although the evidence for these risks is low, further studies on reproductive risks in hairdressers should be performed as there is a high public health interest.

Trends in suspected and recognized occupational respiratory diseases in Germany between 1970 and 2005

BACKGROUND

Respiratory diseases represent a major proportion of occupational diseases in many countries. Little information is available about their incidences over the past several decades.

METHODS

Based on the reports of the three German federal accident insurance agencies, the numbers of suspected and recognized cases of occupational respiratory diseases between 1970 and 2005 were collected and combined. The trends in the rates per 100,000 insured workers were calculated.

RESULTS

In total, a decline in occupational respiratory diseases since 1998 could be observed. This trend is mainly based on the decrease in non-malignant respiratory diseases due to silica and obstructive airway diseases. In contrast, asbestos-induced diseases showed a leveling off or an increase (mesothelioma) during the last 10years.

CONCLUSIONS

Although trends in occupational disease may be influenced by several factors, the presented data indicate that prevention has been effective in reducing some ofthe most frequent occupational respiratory diseases in Germany.

Identification of wheat gliadins as an allergen family related to baker's asthma

BACKGROUND

Flour is still one of the most common causes of occupational asthma worldwide. Thus far, little is known about the relevant allergens causing baker's asthma. Therefore the reliability of current diagnostic procedures is insufficient. Only few of the suspected causative wheat allergens have been hitherto characterized on the molecular level.

OBJECTIVE

The aim was to identify and characterize unknown wheat allergens related to baker's asthma to improve the reliability of diagnostic procedures.

METHODS

A wheat pJuFo cDNA phage display library was created and screened for IgE binding to wheat proteins with pooled sera from patients with baker's asthma. After identifying an alphabeta-gliadin, the frequency of sensitization was investigated by means of ELISA screening of 153 bakers' sera with the recombinant alphabeta-gliadin. Furthermore, the allergenicity of native total gliadin (alphabeta, gamma, omega) was analyzed by means of ImmunoCAP.

RESULTS

One cDNA clone was identified as an alphabeta-gliadin. Serum IgE antibodies to the recombinant allergen were found in 12% of bakers with occupational asthma. Of the asthmatic bakers, 33% showed sensitization to native total gliadin; 4% of them had negative results on routine IgE testing with wheat extract.

CONCLUSIONS

Gliadins represent a newly discovered family of inhalable allergens in baker's asthma. This finding demonstrates that water-insoluble proteins might also represent causative allergens.

Approaches to the diagnosis and management of occupational asthma amongst UK respiratory physicians

This study aimed to assess the approach to the diagnosis and management of occupational asthma amongst general (non-specialist) respiratory consultants in the UK. A random sample of 100 UK general respiratory physicians were invited to participate, and asked to provide information on their diagnostic approach to a case scenario of a patient with possible occupational asthma relating to flour exposure. Participation rates were 42% for the main part of the study. Less than half of consultants specifically reported they would ask whether symptoms improved away from work, and just over a third mentioned examining the patient. All of those interviewed recommended a chest X-ray, and 98% simple spirometry. Eighty-six per cent suggested measurement of serial peak flows, recorded for between 2 and 8 weeks, with measurements taken half-twelve hourly. Less than half advocated a specific flour allergy test, and almost one-quarter (23%) would not perform any immunological test at all. Once a diagnosis of occupational asthma was confirmed, less than two-thirds of those interviewed commented they would recommend some form of exposure reduction, and only 28% specifically stated they would offer compensation advice. The diagnosis of occupational asthma by general respiratory physicians within the UK lacks standardisation, and in some cases falls short of evidence-based best practise.

Dermal, inhalation, and internal exposure to 1,6-HDI and its oligomers in car body repair shop workers and industrial spray painters

OBJECTIVES

To study inhalation and dermal exposure to hexamethylene diisocyanate (HDI) and its oligomers as well as personal protection equipment (PPE) use during task performance in conjunction with urinary hexamethylene diamine (HDA) in car body repair shop workers and industrial spray painters.

METHODS

Personal task based inhalation samples (n = 95) were collected from six car body repair shops and five industrial painting companies using impingers with di-n-butylamine (DBA) in toluene. In parallel, dermal exposure was assessed using nitril rubber gloves. Gloves were submerged into DBA in toluene after sampling. Analysis for HDI and its oligomers was performed by LC-MS/MS. Urine samples were collected from 55 workers (n = 291) and analysed for HDA by GC-MS.

RESULTS

Inhalation exposure was strongly associated with tasks during which aerosolisation occurs. Dermal exposure occurred during tasks that involve direct handling of paint. In car body repair shops associations were found between detectable dermal exposure and glove use (odds ratio (OR) 0.22, 95% confidence interval (CI) 0.09 to 0.57) and inhalation exposure level (OR 1.34, 95% CI 0.97 to 1.84 for a 10-fold increase). HDA in urine could be demonstrated in 36% and 10% of car body repair shop workers and industrial painting company workers respectively. In car body repair shops, the frequency of detectable HDA was significantly elevated at the end of the working day (OR 2.13, 95% CI 1.07 to 4.22 for 3-6 pm v 0-8 am). In both branches HDA was detected in urine of approximately 25% of the spray painters. In addition HDA was detected in urine of a large proportion of non-spray painters in car body repair shops.

CONCLUSION

Although (spray) painting with lacquers containing isocyanate hardeners results in the highest external exposures to HDI and oligomers, workers that do not perform paint related tasks may also receive a considerable internal dose.