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Sack C, Reeb-Whitaker CK, Todorov D, Darby PS. Toxic inhalation of sodium metabisulphite by-products from a shipping container. Occup Med (Lond) 2023; 73:219-222. [PMID: 36799032 PMCID: PMC10195189 DOI: 10.1093/occmed/kqad009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Logistics workers who handle cargo containers are at risk of toxic inhalation injuries, although prevalence and severities of these injuries are not well characterized. We report on a previously healthy 37-year-old supervisor who was acutely exposed to sodium metabisulphite and its thermal degradation by-products during a routine inspection of a shipping container. The employee developed chemical pneumonitis with acute non-cardiogenic pulmonary oedema and subsequent severe reactive airway dysfunction syndrome.
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Affiliation(s)
- C Sack
- Department of Medicine and Department of Environmental and Occupational Health Sciences, The University of Washington, Seattle, WA 98195, USA
| | - C K Reeb-Whitaker
- Washington State Department of Labor and Industries, Safety and Health Assessment and Research for Prevention (SHARP) Program, Olympia, WA 98501, USA
| | - D Todorov
- Washington State Department of Labor and Industries, Safety and Health Assessment and Research for Prevention (SHARP) Program, Olympia, WA 98501, USA
| | - P S Darby
- Virginia Mason Franciscan Occupational Medicine Associates, Tacoma, WA 98003, USA
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA 98195, USA
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2
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Woolery S, Willner J, Prahlow JA, Douglas E. Death After Poison Ivy Smoke Inhalation. Am J Forensic Med Pathol 2022; 43:359-362. [PMID: 35703240 DOI: 10.1097/paf.0000000000000777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Urushiol, the active antigen in poison ivy ( Toxicodendron radicans ), is frequently associated with type I and type III hypersensitivity reactions. These reactions most often result in cutaneous symptoms that vary in severity and may at times require medical interventions. Injuries involving other body systems associated with urushiol exposure are far less common. Here, we present 2 unrelated cases of urushiol respiratory exposure status after burning of poison ivy that resulted in cardiopulmonary arrest and ultimately death. In both cases, the history, circumstances, and autopsy findings are consistent with urushiol smoke inhalation having either caused or contributed to death. The cases are unique in that they represent the first cases of death related to poison ivy smoke exposure. Clinicians and forensic pathologists should be aware of the fact that urushiol smoke exposure may lead to morbidity and mortality.
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Affiliation(s)
- Samantha Woolery
- From the Department of Pathology, Western Michigan University Homer Stryker School of Medicine, Kalamazoo, MI
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3
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Lemiere C, Lavoie G, Doyen V, Vandenplas O. Irritant-Induced Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:2799-2806. [PMID: 35820617 DOI: 10.1016/j.jaip.2022.06.045] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/30/2022] [Accepted: 06/30/2022] [Indexed: 06/15/2023]
Abstract
Irritant-induced asthma (IIA) is a phenotype of asthma caused by the inhalation of irritant agents. Definite, probable, or possible IIA have been described, depending on the concentration of the inhaled irritants and the onset of respiratory symptoms respective to the time of exposure. Definite IIA represents approximately 4% to 14% of all cases of new-onset work-related asthma. Agents responsible for IIA can be encountered as fumes, gases, aerosols, or dusts. The most frequent are chlorine, nitrogen oxides, sulfur dioxide, ammonia, acetic acid, solvents, and cleaning materials. Although the diagnosis of definite IIA is based on a suggestive clinical history along with evidence of reversible airflow limitation and/or nonspecific bronchial hyperresponsiveness, possible IIA cannot be diagnosed with certainty because the relationship between exposure and the onset of symptoms is difficult to establish. This article reviews the epidemiology, pathophysiology, diagnostic approach, and management of IIA.
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Affiliation(s)
- Catherine Lemiere
- Department of Chest Medicine, CIUSSS du Nord de l' Île de Montréal, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada.
| | - Gabriel Lavoie
- Department of Chest Medicine, CIUSSS du Nord de l' Île de Montréal, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada
| | - Virginie Doyen
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - Olivier Vandenplas
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
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4
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Grunig G, Durmus N, Zhang Y, Lu Y, Pehlivan S, Wang Y, Doo K, Cotrina-Vidal ML, Goldring R, Berger KI, Liu M, Shao Y, Reibman J. Molecular Clustering Analysis of Blood Biomarkers in World Trade Center Exposed Community Members with Persistent Lower Respiratory Symptoms. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:8102. [PMID: 35805759 PMCID: PMC9266229 DOI: 10.3390/ijerph19138102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/25/2022] [Accepted: 06/29/2022] [Indexed: 11/30/2022]
Abstract
The destruction of the World Trade Center (WTC) on September 11, 2001 (9/11) released large amounts of toxic dusts and fumes into the air that exposed many community members who lived and/or worked in the local area. Many community members, defined as WTC survivors by the federal government, developed lower respiratory symptoms (LRS). We previously reported the persistence of these symptoms in patients with normal spirometry despite treatment with inhaled corticosteroids and/or long-acting bronchodilators. This report expands upon our study of this group with the goal to identify molecular markers associated with exposure and heterogeneity in WTC survivors with LRS using a selected plasma biomarker approach. Samples from WTC survivors with LRS (n = 73, WTCS) and samples from healthy control participants of the NYU Bellevue Asthma Registry (NYUBAR, n = 55) were compared. WTCS provided information regarding WTC dust exposure intensity. Hierarchical clustering of the linear biomarker data identified two clusters within WTCS and two clusters within NYUBAR controls. Comparison of the WTCS clusters showed that one cluster had significantly increased levels of circulating matrix metalloproteinases (MMP1, 2, 3, 8, 12, 13), soluble inflammatory receptors (receptor for advanced glycation end-products-RAGE, Interleukin-1 receptor antagonist (IL-1RA), suppression of tumorigenicity (ST)2, triggering receptor expressed on myeloid cells (TREM)1, IL-6Ra, tumor necrosis factor (TNF)RI, TNFRII), and chemokines (IL-8, CC chemokine ligand- CCL17). Furthermore, this WTCS cluster was associated with WTC exposure variables, ash at work, and the participant category workers; but not with the exposure variable WTC dust cloud at 9/11. A comparison of WTC exposure categorial variables identified that chemokines (CCL17, CCL11), circulating receptors (RAGE, TREM1), MMPs (MMP3, MMP12), and vascular markers (Angiogenin, vascular cell adhesion molecule-VCAM1) significantly increased in the more exposed groups. Circulating biomarkers of remodeling and inflammation identified clusters within WTCS and were associated with WTC exposure.
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Affiliation(s)
- Gabriele Grunig
- Department of Environmental Medicine, New York University Grossman School of Medicine, New York, NY 10010, USA
- Division of Pulmonary Medicine, Department of Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA; (N.D.); (S.P.); (M.L.C.-V.); (R.G.); (K.I.B.)
| | - Nedim Durmus
- Division of Pulmonary Medicine, Department of Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA; (N.D.); (S.P.); (M.L.C.-V.); (R.G.); (K.I.B.)
- World Trade Center Environmental Health Center, NYC Health + Hospitals, New York, NY 10016, USA; (Y.Z.); (Y.L.); (Y.W.); (M.L.)
| | - Yian Zhang
- World Trade Center Environmental Health Center, NYC Health + Hospitals, New York, NY 10016, USA; (Y.Z.); (Y.L.); (Y.W.); (M.L.)
- Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Yuting Lu
- World Trade Center Environmental Health Center, NYC Health + Hospitals, New York, NY 10016, USA; (Y.Z.); (Y.L.); (Y.W.); (M.L.)
- Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Sultan Pehlivan
- Division of Pulmonary Medicine, Department of Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA; (N.D.); (S.P.); (M.L.C.-V.); (R.G.); (K.I.B.)
| | - Yuyan Wang
- World Trade Center Environmental Health Center, NYC Health + Hospitals, New York, NY 10016, USA; (Y.Z.); (Y.L.); (Y.W.); (M.L.)
- Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Kathleen Doo
- Pulmonary, Kaiser Permanente East Bay, Oakland, CA 94611, USA;
| | - Maria L. Cotrina-Vidal
- Division of Pulmonary Medicine, Department of Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA; (N.D.); (S.P.); (M.L.C.-V.); (R.G.); (K.I.B.)
| | - Roberta Goldring
- Division of Pulmonary Medicine, Department of Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA; (N.D.); (S.P.); (M.L.C.-V.); (R.G.); (K.I.B.)
| | - Kenneth I. Berger
- Division of Pulmonary Medicine, Department of Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA; (N.D.); (S.P.); (M.L.C.-V.); (R.G.); (K.I.B.)
| | - Mengling Liu
- World Trade Center Environmental Health Center, NYC Health + Hospitals, New York, NY 10016, USA; (Y.Z.); (Y.L.); (Y.W.); (M.L.)
- Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Yongzhao Shao
- Department of Environmental Medicine, New York University Grossman School of Medicine, New York, NY 10010, USA
- World Trade Center Environmental Health Center, NYC Health + Hospitals, New York, NY 10016, USA; (Y.Z.); (Y.L.); (Y.W.); (M.L.)
- Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Joan Reibman
- Department of Environmental Medicine, New York University Grossman School of Medicine, New York, NY 10010, USA
- Division of Pulmonary Medicine, Department of Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA; (N.D.); (S.P.); (M.L.C.-V.); (R.G.); (K.I.B.)
- World Trade Center Environmental Health Center, NYC Health + Hospitals, New York, NY 10016, USA; (Y.Z.); (Y.L.); (Y.W.); (M.L.)
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5
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Thá EL, Canavez ADPM, Schuck DC, Gagosian VSC, Lorencini M, Leme DM. Beyond dermal exposure: The respiratory tract as a target organ in hazard assessments of cosmetic ingredients. Regul Toxicol Pharmacol 2021; 124:104976. [PMID: 34139277 DOI: 10.1016/j.yrtph.2021.104976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 05/30/2021] [Accepted: 06/11/2021] [Indexed: 10/21/2022]
Abstract
Dermal contact is the main route of exposure for most cosmetics; however, inhalation exposure could be significant for some formulations (e.g., aerosols, powders). Current cosmetic regulations do not require specific tests addressing respiratory irritation and sensitisation, and despite the prohibition of animal testing for cosmetics, no alternative methods have been validated to assess these endpoints to date. Inhalation hazard is mainly determined based on existing human and animal evidence, read-across, and extrapolation of data from different target organs or tissues, such as the skin. However, because of mechanistic differences, effects on the skin cannot predict effects on the respiratory tract, which indicates a substantial need for the development of new approach methodologies addressing respiratory endpoints for inhalable chemicals in general. Cosmetics might present a particularly significant need for risk assessments of inhalation exposure to provide a more accurate toxicological evaluation and ensure consumer safety. This review describes the differences in the mechanisms of irritation and sensitisation between the skin and the respiratory tract, the progress that has already been made, and what still needs to be done to fill the gap in the inhalation risk assessment of cosmetic ingredients.
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Affiliation(s)
- Emanoela Lundgren Thá
- Graduate Program in Genetics, Department of Genetics - Federal University of Paraná (UFPR), Curitiba, PR, Brazil.
| | | | | | | | - Márcio Lorencini
- Grupo Boticário, Product Safety Management- Q&PP, São José dos Pinhais, PR, Brazil
| | - Daniela Morais Leme
- Department of Genetics - Federal University of Paraná (UFPR), Curitiba, PR, Brazil.
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6
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Sandage MJ, Ostwalt ES, Allison LH, Cutchin GM, Morton ME, Odom SC. Irritant-Induced Chronic Cough Triggers: A Scoping Review and Clinical Checklist. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:1261-1291. [PMID: 33989029 DOI: 10.1044/2021_ajslp-20-00362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose The primary aim of this review was to identify environmental irritants known to trigger chronic cough through the life span and develop a comprehensive clinically useful irritant checklist. Method A scoping review was conducted using the Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Reviews, checklist, and explanation. English-language, full-text resources were identified through Medline, PsycINFO, SPORTDiscus, Web of Science, and ProQuest Dissertations and Theses Global. Results A total of 1,072 sources were retrieved; of these, 109 were duplicates. Titles of abstracts of 963 articles were screened, with 295 selected for full-text review. Using the exclusion and inclusion criteria listed, 236 articles were considered eligible and 214 different triggers were identified. Triggers were identified from North America, Europe, Africa, Asia, and Australia. Occupational exposures were also delineated. Conclusions A clinically useful checklist of both frequently encountered triggers and idiosyncratic or rare triggers was developed. The clinical checklist provides a unique contribution to streamline and standardize clinical assessment of irritant-induced chronic cough. The international scope of this review extends the usefulness of the clinical checklist to clinicians on most continents.
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Affiliation(s)
- Mary J Sandage
- Department of Speech, Language, and Hearing Sciences, Auburn University, AL
| | | | - Lauren H Allison
- Department of Speech, Language, and Hearing Sciences, Auburn University, AL
| | - Grace M Cutchin
- Department of Speech, Language, and Hearing Sciences, Auburn University, AL
| | | | - Shelby C Odom
- Department of Speech, Language, and Hearing Sciences, Auburn University, AL
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Classification of chemicals as respiratory allergens based on human data: Requirements and practical considerations. Regul Toxicol Pharmacol 2021; 123:104925. [PMID: 33831493 DOI: 10.1016/j.yrtph.2021.104925] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/23/2021] [Accepted: 04/01/2021] [Indexed: 02/01/2023]
Abstract
Occupational asthma is an important health problem that can include exacerbation of existing asthma, or induce new asthma either through allergic sensitisation, or non-immunological mechanisms. While allergic sensitisation of the respiratory tract can be acquired to proteins, or to low molecular weight chemicals (chemical respiratory allergens) this article is on the latter exclusively. Chemical respiratory allergy resulting in occupational asthma is associated with high levels of morbidity and there is a need, therefore, that chemicals which can cause sensitisation of the respiratory tract are identified accurately. However, there are available no validated, or even widely accepted, predictive test methods (in vivo, in vitro or in silico) that have achieved regulatory acceptance for identifying respiratory sensitising hazards. For this reason there is an important reliance on human data for the identification of chemical respiratory allergens, and for distinguishing these from chemicals that cause occupational asthma through non-immunological mechanisms. In this article the reasons why it is important that care is taken in designating chemicals as respiratory allergens are reviewed. The value and limitations of human data that can aid the accurate identification of chemical respiratory allergens are explored, including exposure conditions, response characteristics in specific inhalation challenge tests, and immunological investigations.
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Low-dose chlorine exposure impairs lung function, inflammation and oxidative stress in mice. Life Sci 2020; 267:118912. [PMID: 33338503 DOI: 10.1016/j.lfs.2020.118912] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 12/04/2020] [Accepted: 12/09/2020] [Indexed: 12/11/2022]
Abstract
AIM To explore the different consequences of acute and chronic exposure to chlorine gas (Cl2) on the functional and histological parameters of health mice. MAIN METHODS Firstly, male BALB/c mice were acute exposed to 3.3 or 33.3 or 70.5 mg/m3 Cl2. We analyzed the lung function, the inflammatory cells in the bronchoalveolar lavage, cell influx in the peribrochoalveolar space and mucus production. In a second phase, mice were chronic exposed to 70.5 mg/m3 Cl2. Besides the first phase analyses, we also evaluated the epithelial cells thickness, collagen deposition in the airways, immunohistochemistry stain for IL-1β, iNOS, IL-17 and ROCK-2 and the levels of IL-5, IL-13, IL-17, IL-1β and TNF-α in lung homogenate. KEY FINDINGS Acute exposure to chlorine impaired the lung function, increased the number of inflammatory cells in the BALF and in the airways, also increased the mucus production. Furthermore, when chlorine was exposed chronically, increased the airway remodeling with collagen deposition and epithelial cells thickness, positive cells for IL-1β, iNOS, IL-17 in the airways and in the alveolar walls and ROCK-2 in the alveolar walls, lung inflammation with increased levels of IL-5, IL-13, IL-1β and TNF-α in the lung homogenate, and also, induced the acid mucus production by the nasal epithelium. SIGNIFICANCE Acute and chronic exposure to low dose of chlorine gas worsens lung function, induces oxidative stress activation and mucus production and contributes to augmenting inflammation in health mice.
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Van Den Broucke S, Vanoirbeek J, Alfaro-Moreno E, Hoet P. Contribution of mast cells in irritant-induced airway epithelial barrier impairment in vitro. Toxicol Ind Health 2020; 36:823-834. [PMID: 32840447 DOI: 10.1177/0748233720948771] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The airway epithelium is continuously exposed to environmental irritants, which can cause adverse effects such as irritant-induced asthma (IIA). Mast cells are located near airway epithelia and are able to respond to a variety of stimuli. We aimed to investigate whether mast cells influence the response of the epithelium upon irritant exposure. Two cell lines and three different seeding conditions, that is, bronchial epithelial cells (16HBE) only, 16HBE with mast cells (HMC-1's) basolaterally, and 16HBE with HMC-1's apically, were established. Upon exposure to the environmental irritants, graphene (G), graphene oxide (GO), diesel exhaust particles (DEPs) or hypochlorite (ClO-), transepithelial electrical resistance (TEER) and paracellular flux of fluorescent-labeled dextrans were determined, along with the release of mediators. Identical experiments were conducted with the Ca2+ ionophore ionomycin. Exposure to G and GO induced a significant and permanent decrease of approximately 70% in TEER after 3 h of exposure, whereas DEP and ClO- exposure resulted in a transient decrease of approximately 20% in TEER. This response pattern was similar in all the different seeding conditions. After 24 h of exposure, fluorescein isothiocyanate-dextran transport was 10-fold greater for G and 5-fold greater for GO in each of the tested seeding conditions, while DEP and ClO- induced no change compared to the control. Upon exposure to the irritants, 16HBE did not release thymic stromal lymphopoietin, interleukin 33 (IL-33), or IL-1α, and HMC-1 cells did not release histamine, IL-6, or IL-8. Epithelial barrier integrity upon treatment with ionomycin was not affected by the presence of HMC-1 cells. A limited amount of IL-6 and IL-8 was released by ionomycin-exposed HMC-1 cells. To conclude, we found that the studied environmental irritants do not directly or indirectly activate HMC-1 cells. These mast cells did not influence the epithelial barrier function upon environmental exposure, and thus currently do not provide additional information for the underlying mechanism of IIA.
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Affiliation(s)
- Sofie Van Den Broucke
- Department of Public Health and Primary Care, Centre for Environment and Health, 26657KU Leuven, Leuven, Belgium
| | - Jeroen Vanoirbeek
- Department of Public Health and Primary Care, Centre for Environment and Health, 26657KU Leuven, Leuven, Belgium
| | | | - Peter Hoet
- Department of Public Health and Primary Care, Centre for Environment and Health, 26657KU Leuven, Leuven, Belgium
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Pougnet R, Lucas D, Durand-Moreau Q, Dewitte JD, Loddé B. Occupational bronchial disease caused by peracetic acid-hydrogen peroxide mixture: discussion about reactive airways dysfunction syndrome. Occup Med (Lond) 2020; 69:635-636. [PMID: 32058573 DOI: 10.1093/occmed/kqz130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
Occupational exposures are a major cause of lung disease and disability worldwide. This article reviews the broad range of types of occupational lung diseases, including airways disease, pneumoconioses, and cancer. Common causes of occupational lung disease are reviewed with specific examples and clinical features. Emphasis on the importance of a detailed history to make an accurate diagnosis of an occupational lung disease is discussed.
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Affiliation(s)
- David M Perlman
- Division of Pulmonary and Critical Care Medicine, University of Minnesota, MMC # 276, 420 Delaware Street Southeast, Minneapolis, MN 55045, USA
| | - Lisa A Maier
- Division of Environmental and Occupational Health Sciences, National Jewish Health, 1400 Jackson Street, G212, Denver, CO 80206, USA; Division of Pulmonary and Critical Care Sciences, Environmental Occupational Health Department, School of Medicine, Colorado School of Public Health, University of Colorado, Denver, CO, USA.
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Elfsmark L, Ågren L, Akfur C, Wigenstam E, Bergström U, Jonasson S. Comparisons of acute inflammatory responses of nose-only inhalation and intratracheal instillation of ammonia in rats. Inhal Toxicol 2019; 31:107-118. [PMID: 31039646 DOI: 10.1080/08958378.2019.1606367] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective: To establish a rat model with respiratory and pulmonary responses caused by inhalation exposure to non-lethal concentrations of ammonia (NH3) that can be used for evaluation of new medical countermeasure strategies for NH3-induced acute lung injury (ALI). This is of great value since no specific antidotes of NH3-induced injuries exist and medical management relies on supportive and symptomatically relieving efforts. Methods: Female Sprague-Dawley rats (8-9 weeks old, 213g ± 2g) were exposed to NH3 using two different exposure regimens; nose-only inhalation or intratracheal instillation. The experiment was terminated 5 h, 24 h, 14 and 28 days post-exposure. Results: Nose-only inhalation of NH3 (9000-15 000 ppm) resulted in increased salivation and labored breathing directly post-exposure. Exposure did not increase inflammatory cells in bronchoalveolar lavage fluid but exposure to 12 000 ppm NH3 during 15 min reduced body weight and induced coagulation abnormalities by increasing serum fibrinogen levels. All animals were relatively recovered by 24 h. Intratracheal instillation of NH3 (1%) caused early symptoms of ALI including airway hyperresponsiveness, neutrophilic lung inflammation and altered levels of coagulation factors (increased fibrinogen and PAI-1) and early biomarkers of ALI (IL-18, MMP-9, TGFβ) which was followed by increased deposition of newly produced collagen 14 days later. Histopathology analysis at 5 h revealed epithelial desquamation and that most lesions were healed after 14 days. Conclusions: This study demonstrates that intratracheal instillation can reproduce several early hallmarks of ALI. Our findings therefore support that the intratracheal instillation exposure regimen can be used for new medical countermeasure strategies for NH3-induced ALI.
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Affiliation(s)
- Linda Elfsmark
- a CBRN Defence and Security , Swedish Defence Research Agency , Umeå , Sweden
| | - Lina Ågren
- a CBRN Defence and Security , Swedish Defence Research Agency , Umeå , Sweden
| | - Christine Akfur
- a CBRN Defence and Security , Swedish Defence Research Agency , Umeå , Sweden
| | - Elisabeth Wigenstam
- a CBRN Defence and Security , Swedish Defence Research Agency , Umeå , Sweden
| | - Ulrika Bergström
- a CBRN Defence and Security , Swedish Defence Research Agency , Umeå , Sweden
| | - Sofia Jonasson
- a CBRN Defence and Security , Swedish Defence Research Agency , Umeå , Sweden
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Jude J, Botelho D, Karmacharya N, Cao GY, Jester W, Panettieri RA. Salicylic acid amplifies Carbachol-induced bronchoconstriction in human precision-cut lung slices. Respir Res 2019; 20:72. [PMID: 30971247 PMCID: PMC6458705 DOI: 10.1186/s12931-019-1034-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 03/26/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Asthma exacerbations evoke emergency room visits, progressive loss of lung function and increased mortality. Environmental and industrial toxicants exacerbate asthma, although the underlying mechanisms are unknown. We assessed whether 3 distinct toxicants, salicylic acid (SA), toluene diisocyanate (TDI), and 1-chloro-2,4-dinitrobenzene (DNCB) induced airway hyperresponsiveness (AHR) through modulating excitation-contraction coupling in human airway smooth muscle (HASM) cells. The toxicants include a non-sensitizing irritant (SA), respiratory sensitizer (TDI) and dermal sensitizer (DNCB), respectively. We hypothesized that these toxicants induce AHR by modulating excitation-contraction (EC) coupling in airway smooth muscle (ASM) cells. METHODS Carbachol-induced bronchoconstriction was measured in precision-cut human lung slices (hPCLS) following exposure to SA, TDI, DNCB or vehicle. Culture supernatants of hPCLS were screened for mediator release. In HASM cells treated with the toxicants, surrogate readouts of EC coupling were measured by phosphorylated myosin light chain (pMLC) and agonist-induced Ca2+ mobilization ([Ca2+]i). In addition, Nrf-2-dependent antioxidant response was determined by NAD(P) H quinone oxidoreductase 1 (NQO1) expression in HASM cells. RESULTS In hPCLS, SA, but not TDI or DNCB, potentiated carbachol-induced bronchoconstriction. The toxicants had little effect on release of inflammatory mediators, including IL-6, IL-8 and eotaxin from hPCLS. In HASM cells, TDI amplified carbachol-induced MLC phosphorylation. The toxicants also had little effect on agonist-induced [Ca2+]i. CONCLUSION: SA, a non-sensitizing irritant, amplifies agonist-induced bronchoconstriction in hPCLS via mechanisms independent of inflammation and Ca2+ homeostasis in HASM cells. The sensitizers TDI and DNCB, had little effect on bronchoconstriction or inflammatory mediator release in hPCLS. IMPLICATIONS Our findings suggest that non-sensitizing irritant salicylic acid may evoke AHR and exacerbate symptoms in susceptible individuals or in those with underlying lung disease.
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Affiliation(s)
- Joseph Jude
- Rutgers Institute for Translational Medicine and Science (RITMS), Rutgers, The State University of New Jersey, Rm# 4276, 89 French Street, New Brunswick, NJ08901, USA.
| | - Danielle Botelho
- Research Institute for Fragrance Materials (RIFM), Woodcliff Lake, New Jersey, USA
| | - Nikhil Karmacharya
- Rutgers Institute for Translational Medicine and Science (RITMS), Rutgers, The State University of New Jersey, Rm# 4276, 89 French Street, New Brunswick, NJ08901, USA
| | - Gao Yuan Cao
- Rutgers Institute for Translational Medicine and Science (RITMS), Rutgers, The State University of New Jersey, Rm# 4276, 89 French Street, New Brunswick, NJ08901, USA
| | - William Jester
- Rutgers Institute for Translational Medicine and Science (RITMS), Rutgers, The State University of New Jersey, Rm# 4276, 89 French Street, New Brunswick, NJ08901, USA
| | - Reynold A Panettieri
- Rutgers Institute for Translational Medicine and Science (RITMS), Rutgers, The State University of New Jersey, Rm# 4276, 89 French Street, New Brunswick, NJ08901, USA
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Kim BG, Lee PH, Lee SH, Hong J, Jang AS. Claudins, VEGF, Nrf2, Keap1, and Nonspecific Airway Hyper-Reactivity Are Increased in Mice Co-Exposed to Allergen and Acrolein. Chem Res Toxicol 2019; 32:139-145. [PMID: 30608172 DOI: 10.1021/acs.chemrestox.8b00239] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Acrolein, an α/β-unsaturated aldehyde, is volatile at room temperature. It is a respiratory irritant found in environmental tobacco smoke, which can be generated during cooking or endogenously at sites of injury. An acute high concentration of uncontrolled irritant exposure can lead to an asthma-like syndrome known as reactive airways dysfunction syndrome (RADS). However, whether acrolein can induce RADS remains poorly understood. The aim of study is to develop a RADS model of acrolein inhalation in mice and to clarify the mechanism of RADS. Mice were treated with ovalbumin (OVA) and exposed to acrolein (5 ppm/10 min). Airway hyper-responsiveness (AHR) was measured on days 24 and 56, and samples were collected on days 25 and 57. Tight junction protein, antioxidant-associated protein, and vascular endothelial growth factor (VEGF) levels were estimated by Western blotting and immunohistochemical staining. Reactive oxygen species (ROS) was calculated using enzyme linked immunosorbent assays. Acrolein or OVA groups exhibited an increase in airway inflammatory cells and AHR compared to a sham group. These effects were further increased in mice in the OVA + acrolein exposure group than in the OVA exposure group and persisted in the acrolein exposure group for 8 weeks. CLDNs, carbonyls, VEGF, Nrf2, and Keap1 were observed in the lungs. Our data demonstrate that acrolein induces RADS and that ROS, angiogenesis, and tight junction proteins are involved in RADS in a mouse model.
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Affiliation(s)
- Byeong-Gon Kim
- Division of Allergy and Respiratory Medicine, Department of Internal Medicine , Soonchunhyang University Bucheon Hospital , Bucheon , Gyeonggi-do Republic of Korea 14584
| | - Pureun-Haneul Lee
- Division of Allergy and Respiratory Medicine, Department of Internal Medicine , Soonchunhyang University Bucheon Hospital , Bucheon , Gyeonggi-do Republic of Korea 14584
| | - Sun-Hye Lee
- Division of Allergy and Respiratory Medicine, Department of Internal Medicine , Soonchunhyang University Bucheon Hospital , Bucheon , Gyeonggi-do Republic of Korea 14584
| | - Jisu Hong
- Division of Allergy and Respiratory Medicine, Department of Internal Medicine , Soonchunhyang University Bucheon Hospital , Bucheon , Gyeonggi-do Republic of Korea 14584
| | - An-Soo Jang
- Division of Allergy and Respiratory Medicine, Department of Internal Medicine , Soonchunhyang University Bucheon Hospital , Bucheon , Gyeonggi-do Republic of Korea 14584
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Chai R, Xie H, Zhang J, Ma Z. Sulfur dioxide exposure reduces the quantity of CD19 + cells and causes nasal epithelial injury in rats. J Occup Med Toxicol 2018; 13:22. [PMID: 30065773 PMCID: PMC6062972 DOI: 10.1186/s12995-018-0205-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 07/18/2018] [Indexed: 11/10/2022] Open
Abstract
Background Reactive airway dysfunction syndrome (RADS), also called irritant-induced asthma, is a type of occupational asthma that can occur within a very short period of latency. The study sought to investigate the influence of sulfur dioxide (SO2) exposure on CD19+ cells and nasal epithelial injury. Methods We investigated the effects of SO2 on CD19 expression and morphological changes of nasal epithelia in rats. In the study, 20 rats were randomly divided into the SO2 exposure group that were exposed to 600 ppm SO2, 2 h/day for consecutive 7 days, and the control group that were exposed to filtered air). Results Inhalation of high concentration of SO2significantly reduced CD19 expression at both the mRNA transcript and protein levels, and reduced the percentages of CD19+ cells and CD19+/CD23+ cells in the nasal septum. However, inhalation of high concentration of SO2 did not affect immunoglobulin (Ig) G, IgA and IgE levels in the serum and nasal septum. More importantly, SO2 exposure also caused mild structural changes of the nasal septum. Conclusion Our results reveal that inhalation of a high concentration of SO2 reduces CD19 expression and causes structural change of the nasal septum in rats.
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Affiliation(s)
- Ruonan Chai
- Department of Respiratory Medicine, General Hospital of Shenyang Military Command, No. 83 Wenhua Road, Shenhe District, Shenyang, 110016 China
| | - Hua Xie
- Department of Respiratory Medicine, General Hospital of Shenyang Military Command, No. 83 Wenhua Road, Shenhe District, Shenyang, 110016 China
| | - Junli Zhang
- Department of Respiratory Medicine, General Hospital of Shenyang Military Command, No. 83 Wenhua Road, Shenhe District, Shenyang, 110016 China
| | - Zhuang Ma
- Department of Respiratory Medicine, General Hospital of Shenyang Military Command, No. 83 Wenhua Road, Shenhe District, Shenyang, 110016 China
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17
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Occupational exposure and asthma. Ann Allergy Asthma Immunol 2018; 120:468-475. [PMID: 29580845 DOI: 10.1016/j.anai.2018.03.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 03/20/2018] [Accepted: 03/20/2018] [Indexed: 11/24/2022]
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Irritant-induced asthma to hypochlorite in mice due to impairment of the airway barrier. Arch Toxicol 2018; 92:1551-1561. [PMID: 29368146 DOI: 10.1007/s00204-018-2161-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 01/17/2018] [Indexed: 12/14/2022]
Abstract
Inhalation of commonly present irritants, such as chlorine and chlorine derivatives, can cause adverse respiratory effects, including irritant-induced asthma (IIA). We hypothesize that due to airway barrier impairment, exposure to hypochlorite (ClO-) can result in airway hypersensitivity. C57Bl/6 mice received an intra-peritoneal (i.p.) injection of the airway damaging agent naphthalene (NA, 200 mg/kg body weight) or vehicle (mineral oil, MO). In vivo micro-computed tomography (CT) images of the lungs were acquired before and at regular time points after the i.p. TREATMENT After a recovery period of 14 days an intranasal (i.n.) challenge with 0.003% active chlorine (in ClO-) or vehicle (distilled water, H2O) was given, followed by assessment of the breathing frequency. One day later, pulmonary function, along with pulmonary inflammation was determined. Lung permeability was assessed by means of total broncho-alveolar lavage (BAL) protein content and plasma surfactant protein (SP)-D levels. In vivo micro-CT imaging revealed enlargement of the lungs and airways early after NA treatment, with a return to normal at day 14. When challenged i.n. with ClO-, NA-pretreated mice immediately responded with a sensory irritant response. Twenty-four hours later, NA/ClO- mice showed airway hyperreactivity (AHR), accompanied by a neutrophilic and eosinophilic inflammation. NA administration followed by ClO- induced airway barrier impairment, as shown by increased BAL protein and plasma SP-D concentrations; histology revealed epithelial denudation. These data prove that NA-induced lung impairment renders the lungs of mice more sensitive to an airway challenge with ClO-, confirming the hypothesis that incomplete barrier repair, followed by irritant exposure results in airway hypersensitivity.
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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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Summerhill EM, Hoyle GW, Jordt SE, Jugg BJ, Martin JG, Matalon S, Patterson SE, Prezant DJ, Sciuto AM, Svendsen ER, White CW, Veress LA. An Official American Thoracic Society Workshop Report: Chemical Inhalational Disasters. Biology of Lung Injury, Development of Novel Therapeutics, and Medical Preparedness. Ann Am Thorac Soc 2017; 14:1060-1072. [PMID: 28418689 PMCID: PMC5529138 DOI: 10.1513/annalsats.201704-297ws] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
This report is based on the proceedings from the Inhalational Lung Injury Workshop jointly sponsored by the American Thoracic Society (ATS) and the National Institutes of Health (NIH) Countermeasures Against Chemical Threats (CounterACT) program on May 21, 2013, in Philadelphia, Pennsylvania. The CounterACT program facilitates research leading to the development of new and improved medical countermeasures for chemical threat agents. The workshop was initiated by the Terrorism and Inhalational Disasters Section of the Environmental, Occupational, and Population Health Assembly of the ATS. Participants included both domestic and international experts in the field, as well as representatives from U.S. governmental funding agencies. The meeting objectives were to (1) provide a forum to review the evidence supporting current standard medical therapies, (2) present updates on our understanding of the epidemiology and underlying pathophysiology of inhalational lung injuries, (3) discuss innovative investigative approaches to further delineating mechanisms of lung injury and identifying new specific therapeutic targets, (4) present promising novel medical countermeasures, (5) facilitate collaborative research efforts, and (6) identify challenges and future directions in the ongoing development, manufacture, and distribution of effective and specific medical countermeasures. Specific inhalational toxins discussed included irritants/pulmonary toxicants (chlorine gas, bromine, and phosgene), vesicants (sulfur mustard), chemical asphyxiants (cyanide), particulates (World Trade Center dust), and respirable nerve agents.
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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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22
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Tagiyeva N, Teo E, Fielding S, Devereux G, Semple S, Douglas G. Occupational exposure to asthmagens and adult onset wheeze and lung function in people who did not have childhood wheeze: A 50-year cohort study. ENVIRONMENT INTERNATIONAL 2016; 94:60-68. [PMID: 27209001 DOI: 10.1016/j.envint.2016.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 05/04/2016] [Accepted: 05/04/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND There are few prospective studies that relate the development of adult respiratory disease with exposure to occupational asthmagens. OBJECTIVE To evaluate the risk of adult onset wheeze (AOW) and obstructive lung function associated with occupational exposures over 50years. METHODS A population-based randomly selected cohort of children who had not had asthma or wheezing illness, recruited in 1964 at age 10-15years, was followed-up in 1989, 1995, 2001 and 2014 by spirometry and respiratory questionnaire. Occupational histories were obtained in 2014 and occupational exposures determined with an asthma-specific job exposure matrix. The risk of AOW and lung function impairment was analysed in subjects without childhood wheeze using logistic regression and linear mixed effects models. RESULTS All 237 subjects (mean age: 61years, 47% male, 52% ever smoked) who took part in the 2014 follow-up had completed spirometry. Among those who did not have childhood wheeze, spirometry was measured in 93 subjects in 1989, in 312 in 1995 and in 270 subjects in 2001 follow-up. For longitudinal analysis of changes in FEV1 between 1989 and 2014 spirometry records were available on 191 subjects at three time points and on 45 subjects at two time points, with a total number of 663 records. AOW and FEV1<LLN were associated with occupational exposure to food-related asthmagens (adjusted odds ratios (adjORs) 95% CI: 2.7 [1.4, 5.1] and 2.9 [1.1, 7.7]) and biocides/fungicides (adjOR 95% CI: 1.8 [1.1, 3.1] and 3.4 [1.1, 10.8]), with evident dose-response effect (p-trends<0.05). Exposure to food-related asthmagens was also associated with reduced FEV1, FVC and FEF25-75% (adjusted regression coefficients 95% CI: -7.2 [-12.0, -2.4], -6.2 [-10.9, -1.4], and -13.3[-23.4, -3.3]). Exposure to wood dust was independently associated with AOW, obstructive lung function and reduced FEF25-75%. Excess FEV1 decline of 6-8ml/year was observed with occupational exposure to any asthmagen, biocides/fungicides and food-related asthmagens (p<0.05). CONCLUSIONS This longitudinal study confirmed previous findings of increased risks of adult onset wheezing illness with occupational exposure to specific asthmagens. A novel finding was the identification of food-related asthmagens and biocides/fungicides as potential new occupational risk factors for lung function impairment in adults without childhood wheeze.
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Affiliation(s)
- Nara Tagiyeva
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
| | - Edmund Teo
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Shona Fielding
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Graham Devereux
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Sean Semple
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Graham Douglas
- Respiratory Unit, Aberdeen Royal Infirmary, Aberdeen, UK
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McGovern TK, Goldberger M, Allard B, Farahnak S, Hamamoto Y, O'Sullivan M, Hirota N, Martel G, Rousseau S, Martin JG. Neutrophils mediate airway hyperresponsiveness after chlorine-induced airway injury in the mouse. Am J Respir Cell Mol Biol 2016; 52:513-22. [PMID: 25192041 DOI: 10.1165/rcmb.2013-0430oc] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Chlorine gas (Cl2) inhalation causes oxidative stress, airway epithelial damage, airway hyperresponsiveness (AHR), and neutrophilia. We evaluated the effect of neutrophil depletion on Cl2-induced AHR and its effect on the endogenous antioxidant response, and if eosinophils or macrophages influence Cl2-induced AHR. We exposed male Balb/C mice to 100 ppm Cl2 for 5 minutes. We quantified inflammatory cell populations in bronchoalveolar lavage (BAL), the antioxidant response in lung tissue by quantitative PCR, and nuclear factor (erythroid-derived 2)-like 2 (NRF2) nuclear translocation by immunofluorescence. In vitro, NRF2 nuclear translocation in response to exogenous hypochlorite was assessed using a luciferase assay. Anti-granulocyte receptor-1 antibody or anti-Ly6G was used to deplete neutrophils. The effects of neutrophil depletion on IL-13 and IL-17 were measured by ELISA. Eosinophils and macrophages were depleted using TRFK5 or clodronate-loaded liposomes, respectively. AHR was evaluated with the constant-phase model in response to inhaled aerosolized methacholine. Our results show that Cl2 exposure induced neutrophilia and increased expression of NRF2 mRNA, superoxide dismutase-1, and heme-oxygenase 1. Neutrophil depletion abolished Cl2-induced AHR in large conducting airways and prevented increases in antioxidant gene expression and NRF2 nuclear translocation. Exogenous hypochlorite administration resulted in increased NRF2 nuclear translocation in vitro. After Cl2 exposure, neutrophils occupied 22 ± 7% of the luminal space in large airways. IL-17 in BAL was increased after Cl2, although this effect was not prevented by neutrophil depletion. Neither depletion of eosinophils nor macrophages prevented Cl2-induced AHR. Our data suggest the ability of neutrophils to promote Cl2-induced AHR is dependent on increases in oxidative stress and occupation of luminal space in large airways.
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Affiliation(s)
- Toby K McGovern
- Meakins-Christie Laboratories, Department of Medicine, McGill University, Montreal, Quebec, Canada
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Auger L, Mailhot-Larouche S, Tremblay F, Poirier M, Farah C, Bossé Y. The contractile lability of smooth muscle in asthmatic airway hyperresponsiveness. Expert Rev Respir Med 2015; 10:19-27. [PMID: 26561333 DOI: 10.1586/17476348.2016.1111764] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The contractile capacity of airway smooth muscle is not fixed but modulated by an impressive number of extracellular inflammatory mediators. Targeting the transient component of airway hyperresponsiveness ascribed to this contractile lability of ASM is a quest of great promises in order to alleviate asthma symptoms during inflammatory flares. However, owing to the plethora of mediators putatively involved and the molecular heterogeneity of asthma, it is more likely that many mediators conspire to increase the contractile capacity of ASM, each of which contributing to a various extent and in a time-varying fashion in individuals suffering from asthma. The task of identifying a common mend for a tissue rendered hypercontractile by imponderable assortments of inflammatory mediators is puzzling.
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Affiliation(s)
- Laurence Auger
- a Institut Universitaire de Cardiologie et de Pneumologie de Québec , Université Laval , Québec , Canada
| | - Samuel Mailhot-Larouche
- a Institut Universitaire de Cardiologie et de Pneumologie de Québec , Université Laval , Québec , Canada
| | - Francis Tremblay
- a Institut Universitaire de Cardiologie et de Pneumologie de Québec , Université Laval , Québec , Canada
| | - Mathilde Poirier
- a Institut Universitaire de Cardiologie et de Pneumologie de Québec , Université Laval , Québec , Canada
| | - Claude Farah
- a Institut Universitaire de Cardiologie et de Pneumologie de Québec , Université Laval , Québec , Canada
| | - Ynuk Bossé
- a Institut Universitaire de Cardiologie et de Pneumologie de Québec , Université Laval , Québec , Canada
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Ilmarinen P, Tuomisto LE, Kankaanranta H. Phenotypes, Risk Factors, and Mechanisms of Adult-Onset Asthma. Mediators Inflamm 2015; 2015:514868. [PMID: 26538828 PMCID: PMC4619972 DOI: 10.1155/2015/514868] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 06/26/2015] [Accepted: 07/02/2015] [Indexed: 12/11/2022] Open
Abstract
Asthma is a heterogeneous disease with many phenotypes, and age at disease onset is an important factor in separating the phenotypes. Genetic factors, atopy, and early respiratory tract infections are well-recognized factors predisposing to childhood-onset asthma. Adult-onset asthma is more often associated with obesity, smoking, depression, or other life-style or environmental factors, even though genetic factors and respiratory tract infections may also play a role in adult-onset disease. Adult-onset asthma is characterized by absence of atopy and is often severe requiring treatment with high dose of inhaled and/or oral steroids. Variety of risk factors and nonatopic nature of adult-onset disease suggest that variety of mechanisms is involved in the disease pathogenesis and that these mechanisms differ from the pathobiology of childhood-onset asthma with prevailing Th2 airway inflammation. Recognition of the mechanisms and mediators that drive the adult-onset disease helps to develop novel strategies for the treatment. The aim of this review was to summarize the current knowledge on the pathogenesis of adult-onset asthma and to concentrate on the mechanisms and mediators involved in establishing adult-onset asthma in response to specific risk factors. We also discuss the involvement of these mechanisms in the currently recognized phenotypes of adult-onset asthma.
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Affiliation(s)
- Pinja Ilmarinen
- Department of Respiratory Medicine, Seinäjoki Central Hospital, 60220 Seinäjoki, Finland
| | - Leena E. Tuomisto
- Department of Respiratory Medicine, Seinäjoki Central Hospital, 60220 Seinäjoki, Finland
| | - Hannu Kankaanranta
- Department of Respiratory Medicine, Seinäjoki Central Hospital, 60220 Seinäjoki, Finland
- Department of Respiratory Medicine, University of Tampere, 33014 Tampere, Finland
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The TRPA1 channel in inflammatory and neuropathic pain and migraine. Rev Physiol Biochem Pharmacol 2015; 167:1-43. [PMID: 24668446 DOI: 10.1007/112_2014_18] [Citation(s) in RCA: 157] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The transient receptor potential ankyrin 1 (TRPA1), a member of the TRP superfamily of channels, is primarily localized to a subpopulation of primary sensory neurons of the trigeminal, vagal, and dorsal root ganglia. This subset of nociceptors produces and releases the neuropeptides substance P (SP) and calcitonin gene-related peptide (CGRP), which mediate neurogenic inflammatory responses. TRPA1 is activated by a number of exogenous compounds, including molecules of botanical origin, environmental irritants, and medicines. However, the most prominent feature of TRPA1 resides in its unique sensitivity for large series of reactive byproducts of oxidative and nitrative stress. Here, the role of TRPA1 in models of different types of pain, including inflammatory and neuropathic pain and migraine, is summarized. Specific attention is paid to TRPA1 as the main contributing mechanism to the transition of mechanical and cold hypersensitivity from an acute to a chronic condition and as the primary transducing pathway by which oxidative/nitrative stress produces acute nociception, allodynia, and hyperalgesia. A series of migraine triggers or medicines have been reported to modulate TRPA1 activity and the ensuing CGRP release. Thus, TRPA1 antagonists may be beneficial in the treatment of inflammatory and neuropathic pain and migraine.
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Redemption of asthma pharmaceuticals among stainless steel and mild steel welders: a nationwide follow-up study. Int Arch Occup Environ Health 2014; 88:743-50. [PMID: 25408460 DOI: 10.1007/s00420-014-1000-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 11/10/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE The purpose was to examine bronchial asthma according to cumulative exposure to fume particulates conferred by stainless steel and mild steel welding through a proxy of redeemed prescribed asthma pharmaceuticals. METHODS A Danish national company-based historical cohort of 5,303 male ever-welders was followed from 1995 to 2011 in the Danish Medicinal Product Registry to identify the first-time redemption of asthma pharmaceuticals including beta-2-adrenoreceptor agonists, adrenergic drugs for obstructive airway diseases and inhalable glucocorticoids. Lifetime exposure to welding fume particulates was estimated by combining questionnaire data on welding work with a welding exposure matrix. The estimated exposure accounted for calendar time, welding intermittence, type of steel, welding methods, local exhaustion and welding in confined spaces. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using a Cox proportional hazards model adjusting for potential confounders and taking modifying effects of smoking into account. RESULTS The average incidence of redemption of asthma pharmaceuticals in the cohort was 16 per 1,000 person year (95% CI 10-23 per 1,000 person year). A moderate nonsignificant increased rate of redemption of asthma medicine was observed among high-level exposed stainless steel welders in comparison with low-level exposed welders (HR 1.54, 95% CI 0.76-3.13). This risk increase was driven by an increase risk among non-smoking stainless steel welders (HR 1.46, 95% CI 1.06-2.02). Mild steel welding was not associated with increased risk of use asthma pharmaceuticals. CONCLUSION The present study indicates that long-term exposure to stainless steel welding is related to increased risk of asthma in non-smokers.
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Transient receptor potential channels and occupational exposure. Curr Opin Allergy Clin Immunol 2014; 14:77-83. [PMID: 24451914 DOI: 10.1097/aci.0000000000000040] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE OF REVIEW The discovery that a number of transient receptor potential (TRP) channels are expressed in a subpopulation of primary sensory neurons innervating the upper and lower airways as well as in nonneuronal cells in the airways and lungs has initiated a quest for the understanding of their role in the physiology and pathophysiology of the respiratory tract. RECENT FINDINGS Various members of the TRP vanilloid subfamily (TRPV1, TRPV4) and the TRP ankyrin 1 (TRPA1), because of their localization in peptidergic sensory neurons, promote airway neurogenic inflammation. In particular, TRPA1, which is gated by oxidative and nitrative stress byproducts, has been found to mediate inflammatory responses produced by an unprecedented series of toxic and irritant agents produced by air pollution, contained in cigarette smoke, and produced by accidental events at the workplace. The observation that reactive molecules endogenously produced in the airways/lungs of asthma, work-related asthma, and chronic obstructive pulmonary disease target TRPA1 underscores the primary role of the TRPA1 channel in these conditions. SUMMARY Identification of TRP channels, and especially TRPA1, as major targets of oxidative/nitrative stress and a variety of irritant environmental agents supports the hypothesis that neurogenic inflammation plays an important role in work-related inflammatory diseases and that antagonists for such channels may be novel therapeutic options for the treatment of these diseases.
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Vandenplas O, Wiszniewska M, Raulf M, de Blay F, Gerth van Wijk R, Moscato G, Nemery B, Pala G, Quirce S, Sastre J, Schlünssen V, Sigsgaard T, Siracusa A, Tarlo SM, van Kampen V, Zock JP, Walusiak-Skorupa J. EAACI position paper: irritant-induced asthma. Allergy 2014; 69:1141-53. [PMID: 24854136 DOI: 10.1111/all.12448] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2014] [Indexed: 01/18/2023]
Abstract
The term irritant-induced (occupational) asthma (IIA) has been used to denote various clinical forms of asthma related to irritant exposure at work. The causal relationship between irritant exposure(s) and the development of asthma can be substantiated by the temporal association between the onset of asthma symptoms and a single or multiple high-level exposure(s) to irritants, whereas this relationship can only be inferred from epidemiological data for workers chronically exposed to moderate levels of irritants. Accordingly, the following clinical phenotypes should be distinguished within the wide spectrum of irritant-related asthma: (i) definite IIA, that is acute-onset IIA characterized by the rapid onset of asthma within a few hours after a single exposure to very high levels of irritant substances; (ii) probable IIA, that is asthma that develops in workers with multiple symptomatic high-level exposures to irritants; and (iii) possible IIA, that is asthma occurring with a delayed-onset after chronic exposure to moderate levels of irritants. This document prepared by a panel of experts summarizes our current knowledge on the diagnostic approach, epidemiology, pathophysiology, and management of the various phenotypes of IIA.
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Affiliation(s)
- O. Vandenplas
- Department of Chest Medicine; Centre Hospitalier Universitaire de Mont-Godinne; Université Catholique de Louvain; Yvoir Belgium
| | - M. Wiszniewska
- Department of Occupational Diseases and Clinical Toxicology; Nofer Institute of Occupational Medicine; Lodz Poland
| | - M. Raulf
- IPA Institute for Prevention and Occupational Medicine of the German Social Accident Insurance; Institute of the Ruhr-Universität Bochum; Bochum Germany
| | - F. de Blay
- Division of Asthma and Allergy; Department of Chest Diseases; University Hospital; Fédération de Médecine Translationnelle de Strasbourg; Strasbourg University; Strasbourg France
| | - R. Gerth van Wijk
- Section of Allergology; Department of Internal Medicine; Erasmus MC; Rotterdam The Netherlands
| | - G. Moscato
- Department of Public Health; Experimental and Forensic Medicine of the University of Pavia; Pavia Italy
| | - B. Nemery
- Department of Public Health and Primary Care; KU Leuven; Leuven Belgium
| | - G. Pala
- Occupational Physician's Division; Local Health Authority of Sassari; Sassari Italy
| | - S. Quirce
- Department of Allergy; Hospital La Paz Institute for Health Research (IdiPAZ); CIBER de Enfermedades Respiratorias (CIBERES); Madrid Spain
| | - J. Sastre
- Department of Allergy; Fundación Jiménez Díaz; CIBER de Enfermedades Respiratorias (CIBERES); Madrid Spain
| | - V. Schlünssen
- Section of Environment, Occupation and Health; Department of Public Health; University of Aarhus; Aarhus Denmark
| | - T. Sigsgaard
- Section of Environment, Occupation and Health; Department of Public Health; University of Aarhus; Aarhus Denmark
| | - A. Siracusa
- Formerly Department of Clinical and Experimental Medicine; University of Perugia; Perugia Italy
| | - S. M. Tarlo
- Department of Medicine and Dalla Lana School of Public Health; University of Toronto; Toronto ON Canada
- Respiratory Division; Toronto Western Hospital; Toronto ON Canada
- Gage Occupational and Environmental Health Unit; St Michael's Hospital; Toronto ON Canada
| | - V. van Kampen
- IPA Institute for Prevention and Occupational Medicine of the German Social Accident Insurance; Institute of the Ruhr-Universität Bochum; Bochum Germany
| | - J.-P. Zock
- Centre for Research in Environmental Epidemiology (CREAL); Barcelona Spain
- Universitat Pompeu Fabra (UPF); Barcelona Spain
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP); Madrid Spain
- Netherlands Institute of Health Services Research (NIVEL); Utrecht the Netherlands
| | - J. Walusiak-Skorupa
- Department of Occupational Diseases and Clinical Toxicology; Nofer Institute of Occupational Medicine; Lodz Poland
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Abstract
Irritant-induced asthma in the workplace has been the focus of several articles in the past few years, and reviewed here. A clinical case definition is most readily associated with a single acute/accidental exposure to a presumed high concentration of an agent or agents expected to be irritant to the airways, as was initially reported with the subgroup Reactive Airways Dysfunction Syndrome (RADS). When most but not all criteria for RADS are met, then a diagnosis of irritant-induced asthma may also be considered to be "more probable than not". However, in addition, there is evolving understanding from epidemiological studies that chronic exposures may be associated with an increased risk of developing asthma. Despite this recognition, the mechanisms and clinical case definitions of work-related asthma that might be caused by chronic exposures to irritants (vs. new-onset asthma that begins coincidentally to work exposures), remain unclear at present.
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Affiliation(s)
- Susan M Tarlo
- Toronto Western Hospital, University Health Network, Toronto Western Hospital EW7-449, 399 Bathurst St., Toronto, ON, M5T 2S8, Canada,
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Assessment of immunotoxicity induced by chemicals in human precision-cut lung slices (PCLS). Toxicol In Vitro 2014; 28:588-99. [PMID: 24412833 DOI: 10.1016/j.tiv.2013.12.016] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 12/17/2013] [Accepted: 12/23/2013] [Indexed: 11/23/2022]
Abstract
Occupational asthma can be induced by a number of chemicals at the workplace. Risk assessment of potential sensitizers is mostly performed in animal experiments. With increasing public demand for alternative methods, human precision-cut lung slices (PCLS) have been developed as an ex vivo model. Human PCLS were exposed to increasing concentrations of 20 industrial chemicals including 4 respiratory allergens, 11 contact allergens, and 5 non-sensitizing irritants. Local respiratory irritation was characterized and expressed as 75% (EC25) and 50% (EC50) cell viability with respect to controls. Dose-response curves of all chemicals except for phenol were generated. Local respiratory inflammation was quantified by measuring the production of cytokines and chemokines. TNF-α and IL-1α were increased significantly in human PCLS after exposure to the respiratory sensitizers trimellitic anhydride (TMA) and ammonium hexachloroplatinate (HClPt) at subtoxic concentrations, while contact sensitizers and non-sensitizing irritants failed to induce the release of these cytokines to the same extent. Interestingly, significant increases in T(H)1/T(H)2 cytokines could be detected only after exposure to HClPt at a subtoxic concentration. In conclusion, allergen-induced cytokines were observed but not considered as biomarkers for the differentiation between respiratory and contact sensitizers. Our preliminary results show an ex vivo model which might be used for prediction of chemical-induced toxicity, but is due to its complex three-dimensional structure not applicable for a simple screening of functional and behavior changes of certain cell populations such as dendritic cells and T-cells in response to allergens.
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Roth R, Schatz M. Allergic bronchopulmonary aspergillosis presenting as chronic cough in an elderly woman without previously documented asthma. Perm J 2013; 17:e103-8. [PMID: 23704852 DOI: 10.7812/tpp/12-051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
A nonsmoking woman in her mid-70s presents to the allergist for consultation of a chronic cough of almost 3-years' duration without a specific diagnosis as to etiology in spite of numerous diagnostic tests and therapeutic trials. This is a case report from a specialist point of view that includes a comprehensive review of her clinical course pre- and postconsultation along with a brief but pertinent review of the literature as it relates to this particular unusual and protracted case, which was ultimately successfully diagnosed and treated.
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Affiliation(s)
- Richard Roth
- Southern California Permanente Medical Group Orange County Service Area, USA.
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Bernstein DI. Management of the individual worker with occupational asthma. Ann Allergy Asthma Immunol 2013; 111:167-9. [PMID: 23987189 DOI: 10.1016/j.anai.2013.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 07/12/2013] [Accepted: 07/13/2013] [Indexed: 11/16/2022]
Affiliation(s)
- David I Bernstein
- Division of Immunology, Allergy and Rheumatology, Department of Internal Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio, USA.
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Bavbek S. Turkish Thoracic Society 16th Annual Congress: while I breathe, I hope. Expert Rev Respir Med 2013; 7:447-9. [PMID: 24090072 DOI: 10.1586/17476348.2013.837745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Turkish Thoracic Society Meeting Antalya, Turkey, 3-7 April 2013 This year, the 16th Annual Congress of Turkish Thoracic Society took place in Antalya, Turkey, on 3-7 April 2013. The Turkish Thoracic Society has successfully organized 15 congresses starting in 1996, but it has been held annually since 2000. Considerable effort, dedication and enthusiasm behind the scenes are the major reasons for the national success and high quality of the congress. Each national congress of the Turkish Thoracic Society represents an outstanding collaboration between headquarters and the chief committee, all the members, specialists, residents and sponsors. It was officially reported that this year the congress had attracted over 1500 participants from different parts of Turkey along with 23 international faculties. A total of 815 abstracts have been sent to the scientific program committee and 153 abstracts among them have been accepted as oral presentations and the remaining have ended up as poster presentation.
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Affiliation(s)
- Sevim Bavbek
- Department of Pulmonary Diseases, Ankara University, School of Medicine, Division of Allergy and Clinical Immunology, Ankara 06100, Turkey +90 312 595 6581
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Jonasson S, Wigenstam E, Koch B, Bucht A. Early treatment of chlorine-induced airway hyperresponsiveness and inflammation with corticosteroids. Toxicol Appl Pharmacol 2013; 271:168-74. [DOI: 10.1016/j.taap.2013.04.037] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 04/16/2013] [Accepted: 04/27/2013] [Indexed: 12/16/2022]
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Jares EJ, Baena-Cagnani CE, Gómez RM. Diagnosis of occupational asthma: an update. Curr Allergy Asthma Rep 2013; 12:221-31. [PMID: 22467203 DOI: 10.1007/s11882-012-0259-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Work-related asthma (WRA) includes patients with sensitizer- and/or irritant-induced asthma in the workplace, as well as patients with preexisting asthma that is worsened by work factors. WRA is underdiagnosed; thus, the diagnosis is critical to prevent disease progression and its potential for morbidity and mortality. The interview is the first diagnostic tool to be used by physicians, and the question, "Does asthma improve away from work?" is of the highest sensitivity. However, history can show numerous false positives, and the relationships between asthma worsening and work should be confirmed by objective methods such as peak expiratory flow (PEF) at and away from work. PEF sensitivity and specificity can be enhanced in combination with nonspecific bronchial hyperresponsiveness to histamine/methacholine (NSBP) before and after 2 weeks at work and a similar period off work. Immunologic testing, especially skin prick test (SPT) or specific IgE, is useful for high molecular weight allergens and some low molecular weight agents. Other immunologic tests, as well as induced sputum, measurement of exhaled nitric oxide, exhaled breath condensate, and specific inhalation challenge (SIC) are methods that contribute to the diagnosis and are typically performed at specialized facilities. A diagnosis of occupational asthma (OA) should no longer be based on a compatible history only but should be confirmed by means of objective testing. SIC is the diagnostic gold standard. When SIC is not available, the combination of PEF measurement, NSBP test , a specific SPT, or specific IgE may be an appropriate alternative in diagnosing OA.
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Affiliation(s)
- Edgardo J Jares
- Immunology and Allergy Unit, Hospital Nacional Alejandro Posadas, Pcia de Buenos Aires, Argentina.
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Jonasson S, Koch B, Bucht A. Inhalation of chlorine causes long-standing lung inflammation and airway hyperresponsiveness in a murine model of chemical-induced lung injury. Toxicology 2013; 303:34-42. [DOI: 10.1016/j.tox.2012.10.022] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 10/23/2012] [Accepted: 10/25/2012] [Indexed: 02/06/2023]
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Balmes JR. Can we predict who will develop chronic sequelae of acute inhalational injury? Chest 2012; 142:278-279. [PMID: 22871748 DOI: 10.1378/chest.12-0126] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- John R Balmes
- Division of Occupational and Environmental Medicine, University of California, San Francisco and School of Public Health, University of California, Berkeley, San Francisco, CA.
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The transient receptor potential channel TRPA1: from gene to pathophysiology. Pflugers Arch 2012; 464:425-58. [DOI: 10.1007/s00424-012-1158-z] [Citation(s) in RCA: 262] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 09/06/2012] [Accepted: 09/06/2012] [Indexed: 12/13/2022]
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Abstract
PURPOSE OF REVIEW To describe the recent insights into the definition, causes, natural outcome, and key elements of irritant-induced asthma (IIA) management. RECENT FINDINGS IIA is a subtype of occupational asthma without immunologic sensitization and includes the typical reactive airway dysfunction syndrome (RADS) and a more gradual form called not-so-sudden IIA, when onset of asthma follows repeated low-dose exposure to irritants. The World Trade Center tragedy brought new insight in the understanding of IIA, suggesting that it can exhibit a prolonged interval between exposure and recognition of clinical symptoms and disease. Dimethyl sulfate has been recently reported to cause RADS and repeated diesel exhaust exposure to cause not-so-sudden IIA in patients who worked in a bus garage. Cleaning workers who are exposed to a large variety of irritants and sensitizers are especially at risk of occupational asthma and IIA. SUMMARY IIA includes RADS and not-so-sudden IIA. Outcome of IIA is as poor as occupational asthma with sensitization. Treatment of IIA does not differ from standard asthma treatment, but high-dose vitamin D could be assessed further for possible therapeutic benefit.
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