Skin symptoms in bakery and auto body shop workers: associations with exposure and respiratory symptoms

Comparison of high- and low-molecular-weight sensitizing agents causing occupational asthma: an evidence-based insight

INTRODUCTION

The many substances used at the workplace that can cause sensitizer-induced occupational asthma are conventionally categorized into high-molecular-weight (HMW) agents and low-molecular-weight (LMW) agents, implying implicitly that these two categories of agents are associated with distinct phenotypic profiles and pathophysiological mechanisms.

AREAS COVERED

The authors conducted an evidence-based review of available data in order to identify the similarities and differences between HMW and LMW sensitizing agents.

EXPERT OPINION

Compared with LMW agents, HMW agents are associated with a few distinct clinical features (i.e. concomitant work-related rhinitis, incidence of immediate asthmatic reactions and increase in fractional exhaled nitric oxide upon exposure) and risk factors (i.e. atopy and smoking). However, some LMW agents may exhibit 'HMW-like' phenotypic characteristics, indicating that LMW agents are a heterogeneous group of agents and that pooling them into a single group may be misleading. Regardless of the presence of detectable specific IgE antibodies, both HMW and LMW agents are associated with a mixed Th1/Th2 immune response and a predominantly eosinophilic pattern of airway inflammation. Large-scale multicenter studies are needed that use objective diagnostic criteria and assessment of airway inflammatory biomarkers to identify the pathobiological pathways involved in OA caused by the various non-protein agents.

Exploratory study to determine if risk factors for occupational skin disease vary by type of food processing operation

BACKGROUND

Occupational skin disease (OSD) is a common health issue in the food processing sector. However, risk factors for OSD are suspected to differ according to the nature of the operation.

OBJECTIVE

To ascertain if the risk factors for OSD vary depending on the type of food processing operation, namely meat processing vs. a commercial bakery.

METHODS

Participants were asked to answer questions regarding workplace exposures and the current skin condition of their hands. Bivariate analyses were conducted to identify differences between the two participating operations.

RESULTS

The meat processing workers were more likely to have wet work exposure, used hand sanitizer more often and changed their gloves more frequently. These findings from meat processing represented a statistically significant difference compared to the commercial bakery workers. Also, workers from meat processing reported more severe skin symptoms.

CONCLUSIONS

Risk factors for OSD apparently differ between types of food processing operations. Differences in the nature of skin symptoms were also found between the two participating operations. It is therefore suggested that future studies examining OSD within the food processing sector should evaluate this health effect based on the nature of operations rather than the sector as a whole.

Exposure to additives or multigrain flour is associated with high risk of work-related allergic symptoms among bakers

OBJECTIVES

Wheat flour exposure in bakers can elicit respiratory and skin symptoms. Scarce data are available on the prevalence of such conditions in bakers. We investigated the prevalence of work-related rhinitis, asthma-like symptoms and dermatitis in bakers according to job task and type of allergens involved.

METHODS

Of the 229 traditional bakeries in Verona area who were invited to participate in a cross-sectional survey, 211 (92%) accepted; 727 employees in these bakeries answered a modified version of a questionnaire on job tasks; allergen exposure within the bakery; and work-related nasal, asthma-like and skin symptoms during 2010-2014. Determinants of work-related nasal, asthma-like or skin disorders were separately evaluated using different logistic models.

RESULTS

The prevalence of work-related nasal and asthma-like symptoms was, respectively, 15.1% and 4.2% in bakery shop assistants, increasing to 25.7% and 9.5% in bakers using only wheat flour, and further to 31.8% and 13.6% in bakers using flour and additives, and then to 34.1% and 18.2% in bakers using flour with additives and multigrain (p<0.001). The risk of work-related asthma-like symptoms was more than doubled in bakers using additives without or with multigrain than in shop assistants (OR 2.3, 95% CI 1.0 to 5.5 and OR 3.4, 95% CI 1.1 to 10.8, respectively). Making bread with additives alone or with multigrain significantly increased the risk of work-related nasal symptoms in shop assistants, while the risk of skin symptoms was not significantly affected.

CONCLUSIONS

Bakers using additives alone or with multigrain are at a high risk of experiencing nasal and asthma-like symptoms.

Recent Trends in Occupational Contact Dermatitis

Occupational contact dermatitis (OCD) remains prevalent among workers and impacts quality of life and workability. The purpose of this review is to summarize the recent advances in occupational contact dermatitis as well as potential hazardous agents in the workplaces causing OCD. The review covers new developments in the epidemiology, etiology, diagnosis, and management of occupational contact dermatitis. This article also provides updated information on the prevalence of work-related skin symptoms and on new contact allergens among working population. It is emphasized that in the context of prevention of OCD, special attention should be focused on the identified high-risk occupational groups, especially healthcare workers and hairdressers starting with the apprentices. Current approaches include working out the standards and guidelines to improve the education, knowledge, diagnosis, and management of OCD based on a multidisciplinary team of medical specialists and an employer.

Exposure-response relationships for inhalant wheat allergen exposure and asthma

BACKGROUND

A few studies have investigated exposure-response relationships for sensitisation to wheat, work-related symptoms and wheat allergen exposure. IgG4 is suggested to protect against the development of allergic sensitisation. The main aim of this current study was to explore the nature of exposure-response relationships for a range of clinically relevant endpoints among bakery workers, and to investigate the role of IgG4 in these relationships.

METHODS

A cross-sectional study of 517 supermarket bakery workers in 31 bakeries used a questionnaire, serum-specific IgE and IgG4 to wheat, and methacholine challenge testing. Exposure models were developed previously using job, bakery size, tasks and specific ingredients used. These models were used to predict average personal exposure to wheat allergens.

RESULTS

The exposure-response relationships for average exposure followed a linear relationship for sensitisation, but a bell-shaped curve for allergic symptoms and probable occupational asthma, increasing up to 10-15 µg/m(3) wheat allergen concentration after which they plateau off and decrease at higher exposure concentrations. This relationship was modified by atopic status. IgG4 levels were strongly exposure related: a clear increase in prevalence of higher IgG4 with increase in wheat allergen exposure was observed among those sensitised and non-sensitised to wheat, with IgG4 even more strongly associated with exposure than IgE to wheat.

CONCLUSIONS

The bell-shaped exposure-response relationship in the current study is consistent with the findings of previous studies. IgG4 showed no protective effect for sensitisation, confirming the findings of previous studies, suggesting that the pattern is probably related to a healthy worker effect.

Nonoccupational and occupational exposure to isocyanates

PURPOSE OF REVIEW

This review aims to update the knowledge on the burden of disease due to exposure to isocyanates. Health effects of isocyanates and their major products, polyurethanes, are mainly determined by sensitization to isocyanates. Recent studies on the genetic factors to explain individual susceptibility to sensitization are reviewed.

RECENT FINDINGS

Production of isocyanates has rapidly increased in the past and is predicted to increase at an annual rate of around 5%. Consumer products and the construction area are the main drivers of growth. This leads to increased nonoccupational exposure. The use of sprayed polyurethane foams for insulation in existing homes is one such example of nonoccupational exposure. The percentage of people exposed who show health effects is not known. Occupational exposure increases are mainly caused by the increase in the workforce. The percentage of workers exhibiting health effects remained fairly stable at 5-15% in the last decade. To explain why not all people exposed to isocyanates develop adverse health effects, recent findings on sensitization to isocyanate are reviewed. The skin is the most important route for sensitization.

SUMMARY

Increased production of isocyanates and rising use of these substances in consumer products is leading to an increased burden of disease, with an increase in nonoccupational exposure as well. Sensitization to isocyanates is the main route for adverse health effects. The skin is the major route for sensitization. Recently, several genetic factors have been identified that play a role in the individual susceptibility for sensitization.