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Chuang YC, Tsai HH, Lin MC, Wu CC, Lin YC, Wang TN. Cluster analysis of phenotypes, job exposure, and inflammatory patterns in elderly and nonelderly asthma patients. Allergol Int 2024; 73:214-223. [PMID: 38290901 DOI: 10.1016/j.alit.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 12/03/2023] [Accepted: 12/17/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Asthma has been identified as different phenotypes due to various risk factors. Age differences may have potential effects on asthma phenotypes. Our study aimed to identify potential asthma phenotypes among adults divided by age as either younger or older than 65 years. We also compared differences in blood granulocyte patterns, occupational asthmagens, and asthma control-related outcomes among patient phenotype clusters. METHODS We recruited nonelderly (<65 years old) (n = 726) and elderly adults (≥65 years old) (n = 201) with mild-to-severe asthma. We conducted a factor analysis to select 17 variables. A two-step cluster analysis was used to classify subjects with asthma phenotypes, and a discriminant analysis was used to verify the classification of cluster results. RESULTS There were three clusters with different characteristics identified in both the nonelderly and elderly asthmatic adults. In the nonelderly patient group, cluster 2 (obese, neutrophilic phenotypes) had a 1.85-fold significantly increased risk of asthma exacerbations. Cluster 3 (early-onset, atopy, and smoker with an eosinophil-predominant pattern) had a 2.37-fold risk of asthma exacerbations and higher oral corticosteroid (OCS) use than cluster 1 (late-onset and LMW exposure with paucigranulocytic blood pattern). Among elderly patients, cluster 2 had poor lung function and more ex-smokers. Cluster 3 (early-onset, long asthma duration) had the lowest paucigranulocytic blood pattern percentages in the elderly group. CONCLUSIONS The novelty of the clusters was found in age-dependent clusters. We identified three distinct phenotypes with heterogeneous characteristics, asthma exacerbations and medicine use in nonelderly and elderly asthmatic patients, respectively. Classification of age-stratified asthma phenotypes may lead to precise identification of patients, which provides personalized disease management.
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Affiliation(s)
- Yung-Chi Chuang
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsin-Hua Tsai
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Meng-Chih Lin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chao-Chien Wu
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yuan-Chung Lin
- Institute of Environmental Engineering, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Tsu-Nai Wang
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
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2
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Smith AM, Sastre J. The Role of Immunotherapy and Biologic Treatments in Occupational Allergic Disease. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:3322-3330. [PMID: 32781049 DOI: 10.1016/j.jaip.2020.07.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/07/2020] [Accepted: 07/22/2020] [Indexed: 02/08/2023]
Abstract
Occupational exposures are estimated to account for 15% to 25% of all adult asthma in the general population. In some cases, workplace allergen exposures can be reduced but not entirely eliminated. Given the potentially significant impact of job change, some workers may choose to continue working in a job in which there is an ongoing occupational allergen exposure. In these cases, a combined approach including personal safety measures, pharmacotherapy, and allergen immunotherapy may result in the best clinical outcomes. This review presents existing evidence for the use of immunotherapy and biologic treatments in occupational allergic disease for various occupational allergens, including wheat flour, mammalian proteins, natural rubber latex, and Hymenoptera venom. There is increasing but modest evidence on beneficial short-term and long-term effects of allergen immunotherapy and safety in worker populations. Available data suggest that allergen immunotherapy can reduce skin and respiratory symptoms and therefore allow workers to continue their current occupation.
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Affiliation(s)
| | - Joaquín Sastre
- Department of Allergy, Fundación Jiménez Díaz, Madrid, Spain; Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain; CIBERES, Instituto de Salud Carlos III, Madrid, Spain
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3
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Blackley BH, Gibbs JL, Cummings KJ, Stefaniak AB, Park JY, Stanton M, Abbas Virji M. A field evaluation of a single sampler for respirable and inhalable indium and dust measurements at an indium-tin oxide manufacturing facility. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2019; 16:66-77. [PMID: 30325716 PMCID: PMC6419101 DOI: 10.1080/15459624.2018.1536826] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Indium-tin oxide production has increased greatly in the last 20 years subsequent to increased global demand for touch screens and photovoltaics. Previous studies used measurements of indium in blood as an indicator of indium exposure and observed associations with adverse respiratory outcomes. However, correlations between measurements of blood indium and airborne respirable indium are inconsistent, in part because of the long half-life of indium in blood, but also because respirable indium measurements do not incorporate inhalable indium that can contribute to the observed biological burden. Information is lacking on relationships between respirable and inhalable indium exposure, which have implications for biological indicators like blood indium. The dual IOM sampler includes the foam disc insert and can simultaneously collect respirable and inhalable aerosol. Here, the field performance of the dual IOM sampler was evaluated by comparing performance with the respirable cyclone and traditional IOM for respirable and inhalable indium and dust exposure, respectively. Side-by-side area air samples were collected throughout an indium-tin oxide manufacturing facility. Cascade impactors were used to determine particle size distribution. Several statistical methods were used to evaluate the agreement between the pairs of samplers including calculating the concordance correlation coefficient and its accuracy and precision components. One-way ANOVA was used to evaluate the effect of dust concentration on sampler differences. Respirable indium measurements showed better agreement (concordance correlation coefficient: 0.932) compared to respirable dust measurements (concordance correlation coefficient: 0.777) with significant differences observed in respirable dust measurements. The dual IOM measurements had high agreement with the traditional IOM for inhalable indium (concordance correlation coefficient: 0.997) but lower agreement for inhalable dust (concordance correlation coefficient: 0.886 and accuracy: 0.896) with a significantly large mean bias (-146.9 µg/m3). Dust concentration significantly affected sampler measurements of inhalable dust and inhalable indium. Results from this study suggest that the dual IOM is a useful single sampler for simultaneous measurements of occupational exposure to respirable and inhalable indium.
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Affiliation(s)
- Brie Hawley Blackley
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia
| | - Jenna L. Gibbs
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia
- Department of Occupational and Environmental Health, The University of Iowa, Iowa City, Iowa
| | - Kristin J. Cummings
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia
| | - Aleksandr B. Stefaniak
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia
| | - Ji Young Park
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia
- Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
| | - Marcia Stanton
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia
| | - M. Abbas Virji
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia
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4
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Hawley B, Casey M, Virji MA, Cummings KJ, Johnson A, Cox-Ganser J. Respiratory Symptoms in Hospital Cleaning Staff Exposed to a Product Containing Hydrogen Peroxide, Peracetic Acid, and Acetic Acid. Ann Work Expo Health 2018; 62:28-40. [PMID: 29077798 DOI: 10.1093/annweh/wxx087] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 10/02/2017] [Indexed: 11/13/2022] Open
Abstract
Cleaning and disinfecting products consisting of a mixture of hydrogen peroxide (HP), peracetic acid (PAA), and acetic acid (AA) are widely used as sporicidal agents in health care, childcare, agricultural, food service, and food production industries. HP and PAA are strong oxidants and their mixture is a recognized asthmagen. However, few exposure assessment studies to date have measured HP, PAA, and AA in a health care setting. In 2015, we performed a health and exposure assessment at a hospital where a new sporicidal product, consisting of HP, PAA, and AA was introduced 16 months prior. We collected 49 full-shift time-weighted average (TWA) air samples and analyzed samples for HP, AA, and PAA content. Study participants were observed while they performed cleaning duties, and duration and frequency of cleaning product use was recorded. Acute upper airway, eye, and lower airway symptoms were recorded in a post-shift survey (n = 50). A subset of 35 cleaning staff also completed an extended questionnaire that assessed symptoms reported by workers as regularly occurring or as having occurred in the previous 12 months. Air samples for HP (range: 5.5 to 511.4 ppb) and AA (range: 6.7 to 530.3 ppb) were all below established US occupational exposure limits (OEL). To date, no full-shift TWA OEL for PAA has been established in the United States, however an OEL of 0.2 ppm has been suggested by several research groups. Air samples for PAA ranged from 1.1 to 48.0 ppb and were well below the suggested OEL of 0.2 ppm. Hospital cleaning staff using a sporicidal product containing HP, PAA, and AA reported work-shift eye (44%), upper airway (58%), and lower airway (34%) symptoms. Acute nasal and eye irritation were significantly positively associated with increased exposure to the mixture of the two oxidants: HP and PAA, as well as the total mixture (TM)of HP, PAA, and AA. Shortness of breath when hurrying on level ground or walking up a slight hill was significantly associated with increased exposure to the oxidant mixture (P = 0.017), as well as the TM (P = 0.026). Our results suggest that exposure to a product containing HP, PAA, and AA contributed to eye and respiratory symptoms reported by hospital cleaning staff at low levels of measured exposure.
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Affiliation(s)
- Brie Hawley
- Respiratory Health Division, National Institute for Occupational Safety and Health, CDC, USA
| | - Megan Casey
- Respiratory Health Division, National Institute for Occupational Safety and Health, CDC, USA
| | - Mohammed Abbas Virji
- Respiratory Health Division, National Institute for Occupational Safety and Health, CDC, USA
| | - Kristin J Cummings
- Respiratory Health Division, National Institute for Occupational Safety and Health, CDC, USA
| | | | - Jean Cox-Ganser
- Respiratory Health Division, National Institute for Occupational Safety and Health, CDC, USA
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Reza Masjedi M, Saeedfar K, Masjedi J. Occupational Allergies: A Brief Review. EUROPEAN MEDICAL JOURNAL 2016. [DOI: 10.33590/emj/10313903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Occupational allergies are groups of work-related disorders that are accompanied by immunologic reaction to workplace allergens and include occupational asthma, rhinitis, hypersensitivity pneumonitis, dermatitis, and anaphylaxis. This mini review presents a brief analysis of the more important aspects of occupational allergic disorders.
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Affiliation(s)
- Mohammad Reza Masjedi
- Pulmonary Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Tobacco Control Research Center, Iranian Anti-Tobacco Association, Tehran, Iran
| | - Kayvan Saeedfar
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Javid Masjedi
- Tobacco Control Research Center, Iranian Anti-Tobacco Association, Tehran, Iran
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Raherison C, Bourdin A, Bonniaud P, Deslée G, Garcia G, Leroyer C, Taillé C, De Blic J, Dubus JC, Tillié-Leblond I, Chanez P. Updated guidelines (2015) for management and monitoring of adult and adolescent asthmatic patients (from 12 years and older) of the Société de Pneumologie de Langue Française (SPLF) (Full length text). Rev Mal Respir 2016; 33:279-325. [PMID: 27147308 DOI: 10.1016/j.rmr.2016.03.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- C Raherison
- Inserm U1219, ISPED, service des maladies respiratoires, pôle cardio-thoracique, CHU de Bordeaux, université de Bordeaux, 33000 Bordeaux, France.
| | - A Bourdin
- Inserm U1046, département de pneumologie et addictologie, hôpital Arnaud-de-Villeneuve, CHU de Montpellier, université Montpellier 1, 34000 Montpellier, France
| | - P Bonniaud
- Inserm U866, service de pneumologie et soins intensifs respiratoires, CHU de Bourgogne, université de Bourgogne, 21079 Dijon, France
| | - G Deslée
- Service de pneumologie, CHU Maison-Blanche, université de Reims - Champagne-Ardennes, 51000 Reims, France
| | - G Garcia
- Inserm, UMRS 999, service de pneumologie, département hospitalo-universitaire (DHU) thorax innovation, hôpital de Bicêtre, Centre national de référence de l'hypertension pulmonaire sévère, faculté de médecine, université Paris-Sud, AP-HP, 94270 Le Kremlin-Bicêtre, France
| | - C Leroyer
- Département de médecine interne et de pneumologie, CHU de la Cavale-Blanche, université de Bretagne Occidentale, 29000 Brest, France
| | - C Taillé
- Service de pneumologie, département hospitalo-universitaire FIRE, centre de compétence des maladies pulmonaires rares, hôpital Bichat, université Paris-Diderot, AP-HP, 75018 Paris, France
| | - J De Blic
- Service de pneumologie et allergologie pédiatriques, hôpital Necker-Enfants-Malades, 75743 Paris, France
| | - J-C Dubus
- Unité de pneumologie et médecine infantile, hôpital Nord, 13000 Marseille, France
| | - I Tillié-Leblond
- Service de pneumo-allergologie, CHRU de Lille, 59000 Lille, France
| | - P Chanez
- UMR 7333 Inserm U 1067, service de pneumologie, hôpital Nord, université Aix Marseille, AP-HM, 13000 Marseille, France
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7
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Attarchi M, Dehghan F, Yazdanparast T, Mohammadi S, Golchin M, Sadeghi Z, Moafi M, Seyed Mehdi SM. Occupational asthma in a cable manufacturing company. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e9105. [PMID: 25558389 PMCID: PMC4270639 DOI: 10.5812/ircmj.9105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 10/07/2013] [Accepted: 08/31/2014] [Indexed: 11/17/2022]
Abstract
Background: During the past decade, incidence of asthma has increased, which might have been due to environmental exposures. Objectives: Considering the expansion of cable manufacturing industry in Iran, the present study was conducted to evaluate the prevalence of occupational asthma in a cable manufacturing company in Iran as well as its related factors. Patients and Methods: This study was conducted on employees of a cable manufacturing company in Yazd, Iran, in 2012. The workers were divided into two groups of exposure (to toluene diisocyanate, polyvinyl chloride, polyethylene or polypropylene) and without exposure. Diagnosis of occupational asthma was made based on the subjects’ medical history, spirometry and peak flowmetry, and its frequency was compared between the two groups. Results: The overall prevalence of occupational asthma was 9.7%. This rate was 13.8% in the exposed group. Logistic regression analysis showed that even after adjustment for confounding factors, a significant correlation existed between the frequency of occupational asthma and exposure to the produced dust particles (P < 0.05). In addition, age, work experience, body mass index, cigarette smoking and shift work had significant correlations with the prevalence of occupational asthma (P < 0.05). Conclusions: Considering the high prevalence of occupational asthma among cable manufacturing company workers in Iran, this issue needs to be addressed immediately in addition to reduction of exposure among subjects. Reduction in work shift duration, implementation of tobacco control and cessation programs for the personnel, and performing spirometry tests and respiratory examinations in shorter periods may be among effective measures for reducing the incidence of occupational asthma in this industry.
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Affiliation(s)
- Mirsaeed Attarchi
- Department of Occupational Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Faezeh Dehghan
- Department of Occupational Medicine, School of Medicine, AJA University of Medical Sciences, Tehran, IR Iran
| | - Taraneh Yazdanparast
- Research Center of Chronic Respiratory Disease, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Saber Mohammadi
- Department of Occupational Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Mahdie Golchin
- Department of Occupational Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Zargham Sadeghi
- Research Center of Work and Environment, Petroleum Industry Health Organization (PIHO), Tehran, IR Iran
| | - Masoud Moafi
- Department of Occupational Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Seyed Mohammad Seyed Mehdi
- Research Center of Chronic Respiratory Disease, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Seyed Mohammad Seyed Mehdi, Research Center of Chronic Respiratory Disease, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel: +98-217123000, Fax: +98-2126109484,, E-mail:
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8
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Montano D. Chemical and biological work-related risks across occupations in Europe: a review. J Occup Med Toxicol 2014; 9:28. [PMID: 25071862 PMCID: PMC4113130 DOI: 10.1186/1745-6673-9-28] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 07/17/2014] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Work-related health inequalities are determined to some extent by an unequal exposure to chemical and biological risk factors of disease. Although their potential economic burden in the European Union (EU-25) might be substantial, comprehensive reviews focusing on the distribution of these risks across occupational groups are limited. Thus, the main objective of this review is to provide a synopsis of the exposure to chemical and biological hazards across occupational groups. In addition, main industrial applications of hazardous substances are identified and some epidemiological evidence is discussed regarding societal costs and incidence rates of work-related diseases. METHODS Available lists of carcinogens, sensitisers, mutagens, reprotoxic substances and biological hazards were consulted. For each work-related hazard the main industrial application was identified in order to assess which ISCO occupational groups may be associated with direct exposure. Where available, information on annual tonnage production, risk assessment of the substances and pathogens, and other relevant data were collected and reported. RESULTS Altogether 308 chemical and biological hazards were identified which may account to at least 693 direct exposures. These hazards concentrate on the following major occupational groups: technicians (ISCO 3), operators (ISCO 8), agricultural workers (ISCO 6) and workers in elementary occupations (ISCO 9). Common industrial applications associated with increased exposure rates relate among others to: (1) production or application of pigments, resins, cutting fluids, adhesives, pesticides and cleaning products, (2) production of rubber, plastics, textiles, pharmaceuticals and cosmetics, and (3) in agriculture, metallurgy and food processing industry, Societal costs of the unequal distribution of chemical and biological hazards across occupations depend on the corresponding work-related diseases and may range from 2900 EUR to 126000 EUR per case/year. CONCLUSIONS Risk of exposure to chemical and biological risks and work-related disease incidence are highly concentrated on four occupational groups. The unequal burden of exposure across occupations is an important contributing factor leading to health inequalities in society. The bulk of societal costs, however, are actually being borne by the workers themselves. There is an urgent need of taking into account the health impact of production processes and services on workers' health.
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Affiliation(s)
- Diego Montano
- Faculty of Medicine, Senior professorship “Work Stress Research”, Duesseldorf University, Universitaetsstr. 1, Duesseldorf, Germany
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Abstract
BACKGROUND The link between asthma and inhaled workplace exposures has been long appreciated, and yet aggravation of asthma symptoms by work conditions, known as work-aggravated asthma (WAA), remains relatively common. SOURCES OF DATA A review of the literature published over the last 3 years was carried out, and additional key articles were included from outside this timeframe. AGREEMENT WAA is commonly reported by workers with asthma. One published assessment of 12 studies identified a median prevalence of 21.5% among workers with asthma. Commonly reported causes included a variety of inhaled dusts, smoke, vapours, fumes, gases and mists, common and workplace-specific aeroallergens, physical environmental factors including temperature and humidity and physical activity at work. CONTROVERSY Remains in relation to definition, and how to distinguish WAA from occupational asthma in which there is sensitization to an agent in the workplace. Both these areas, and the development of workplace interventions to reduce WAA, are timely topics for future research.
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Affiliation(s)
- David Fishwick
- Centre for Workplace Health, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, S5 7AU, UK
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10
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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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Wiszniewska M, Walusiak-Skorupa J. Diagnosis and frequency of work-exacerbated asthma among bakers. Ann Allergy Asthma Immunol 2013; 111:370-5. [PMID: 24125143 DOI: 10.1016/j.anai.2013.08.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 08/02/2013] [Accepted: 08/12/2013] [Indexed: 01/18/2023]
Abstract
BACKGROUND Work-exacerbated asthma (WEA) is asthma worsened by workplace exposures, although the asthma is not caused by sensitizers in the work environment. OBJECTIVES To evaluate the frequency of WEA in bakers reporting work-related respiratory symptoms and the usefulness of diagnostic tests in differentiating WEA from occupational asthma (OA). METHODS The study group included 393 bakers reporting respiratory symptoms at the workplace. In all patients, questionnaire, spirometry, skin prick tests (SPTs), and evaluation of serum total and specific IgE levels were performed. Recognition of OA was based on a specific inhalation challenge test. RESULTS Occupational asthma was found in 44.5% of patients, whereas WEA was recognized in 16%. The latency period was 11.2 ± 8.2 years in patients with OA vs 13.3 ± 9.7 years in those with WEA. Sixty percent of patients with OA and 50.8% of those with WEA had positive SPT reactions to common allergens; occupational SPT results were positive in 74.9% and 34.9%, respectively. Specific IgE to flours were found in 61.7% of patients with OA and 28.6% of those with WEA. In addition, OA frequently coexisted with occupational rhinitis (53.7% of patients), whereas WEA and rhinitis were found in 31.7% of patients. CONCLUSION Work-exacerbated asthma was diagnosed in 16% of bakers who reported allergic respiratory symptoms. The specific challenge test for occupational allergens should be performed in bakers with suspected work-related asthma, because an assessment of sensitization (SPT to occupational allergens, evaluation of specific IgE) is not specific enough to differentiate OA from WEA.
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Affiliation(s)
- Marta Wiszniewska
- Department of Occupational Diseases, Nofer Institute of Occupational Medicine, Lodz, Poland.
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12
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Byrns G, Nelson AK, Bradbury JW. Case study. The importance of good chemical management in health care. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2013; 10:D86-D93. [PMID: 23706128 DOI: 10.1080/15459624.2013.795806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- George Byrns
- Illinois State University, Normal, IL 61790, USA.
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13
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Fajt ML, Wenzel SE. Asthma phenotypes in adults and clinical implications. Expert Rev Respir Med 2011; 3:607-25. [PMID: 20477351 DOI: 10.1586/ers.09.57] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
It is becoming increasingly recognized that asthma is a heterogeneous disease, whether based on clinical factors, including the patient's age at diagnosis, symptom spectrum and treatment response, triggering factors, or the level and type of inflammation. Attempts to analyze the importance of these characteristics to the clinical presentation of asthma have led to the appreciation of numerous separate and overlapping asthma phenotypes. However, these approaches are 'biased' and based on the clinician/scientist's own experience. Recently, unbiased approaches have also been attempted using both molecular and statistical tools. Early results from these approaches have supported and expanded on the clinician's concepts. However, until specific biologic markers are identified for any of these proposed phenotypes, the definitive nature of any phenotype will remain speculative.
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Affiliation(s)
- Merritt L Fajt
- Division of Pulmonary Allergy and Critical Care Medicine, University of Pittsburgh Asthma Institute, School of Medicine, UPMC Montefiore, NW 931 Montefiore, 3459 Fifth Avenue, Pittsburgh, PA 15213, USA.
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14
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Abstract
PURPOSE OF REVIEW To discuss gene association studies conducted in workers diagnosed with occupational asthma. RECENT FINDINGS Human leukocyte antigen studies conducted in European workers have defined major histocompatibility complex class II alleles and haplotypes associated with diisocyanate asthma. Recently, certain glutathione S-transferase genotypes (e.g. the GSTM1 null genotype) and N-acetyltransferase genotypes associated with slow acetylation phenotypes have been reported to be associated with diisocyanate asthma. Genotype combinations of IL-4 receptor-α and CD14 single nucleotide polymorphisms (SNPs) were significantly associated with diisocyanate asthma, but only in workers exposed to hexamethylene diisocyanate. A recent genome-wide association study (GWAS) conducted in Korea identified several SNPs of the α-T-catenin gene that were significantly associated with diisocyanate asthma. SUMMARY Although candidate gene association studies have yet to identify reliable predictors of occupational asthma, future investigations including GWAS studies may identify high-risk genotypes allowing identification of workers at risk.
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Wang TN, Lin MC, Wu CC, Leung SY, Huang MS, Chuang HY, Lee CH, Wu DC, Ho PS, Ko AMS, Chang PY, Ko YC. Risks of exposure to occupational asthmogens in atopic and nonatopic asthma: a case-control study in Taiwan. Am J Respir Crit Care Med 2010; 182:1369-76. [PMID: 20639444 DOI: 10.1164/rccm.200906-0969oc] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Asthma is often work-related and can be classified as atopic or nonatopic on the basis of its pathogenesis. Few studies have reported an association between exposure to occupational asthmogens and asthma with and without atopy. OBJECTIVES We investigated, in adults with asthma, whether occupational exposure to asthmogens influenced the risk of having atopic or nonatopic asthma, and their level of lung function. METHODS We recruited 504 hospital-based adults with current asthma, 504 community-based control subjects, and 504 hospital-based control subjects in southern Taiwan. Asthma with atopy was defined as having asthma in combination with an increase in total IgE (≥100 U/ml) or a positive Phadiatop test (≥0.35 Pharmacia arbitrary unit/L) (Pharmacia ImmunoCAP; Pharmacia, Uppsala, Sweden). Occupational exposure to asthmogens was assessed with an asthma-specific job exposure matrix. MEASUREMENTS AND MAIN RESULTS We found a significant association between atopic asthma and exposure to high molecular weight asthmogens (adjusted odds ratio [AOR], 4.0; 95% confidence interval [CI], 1.8-8.9). Nonatopic asthma was significantly associated with exposure to low molecular weight asthmogens (AOR, 2.6; 95% CI, 1.6-4.3), including industrial cleaning agents and metal sensitizers. Agriculture was associated with both atopic and nonatopic asthma (AOR, 7.8; 95% CI, 2.8-21.8; and AOR, 4.1; 95% CI, 1.3-13.0, respectively). The ratio of FEV₁ to FVC in the high-risk group was significantly lower than in the no-risk group (P = 0.026) in currently employed patients with asthma. CONCLUSIONS In adults with asthma, occupational exposure to high and low molecular weight asthmogens appears to produce differential risks for atopic and nonatopic asthma.
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Affiliation(s)
- Tsu-Nai Wang
- Department of Public Health, Kaohsiung Medical University, Taiwan
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Peden DB, Bush RK. Advances in environmental and occupational respiratory diseases in 2009. J Allergy Clin Immunol 2010; 125:559-62. [PMID: 20138350 DOI: 10.1016/j.jaci.2010.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Accepted: 01/06/2010] [Indexed: 10/19/2022]
Abstract
The year 2009 led to a number of significant advances in environmental and occupational allergic diseases. The role of exposure to environmental pollutants, respiratory viruses, and allergen exposure showed significant advances. New allergens were identified. Occupational asthma and the relationship of complementary and alternative medicine to allergic diseases were extensively reviewed. New approaches to immunotherapy, novel vaccine techniques, and methods to reduce risks for severe allergic disease were addressed.
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Affiliation(s)
- David B Peden
- Division of Pediatric Allergy, Immunology Rheumatology and Infectious Diseases and the Center for Environmental Medicine, Asthma, and Lung Biology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
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Bush RK. Current perspectives in occupational asthma. J Allergy Clin Immunol 2009; 123:567-8. [PMID: 19281903 DOI: 10.1016/j.jaci.2008.12.1109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Accepted: 12/04/2008] [Indexed: 12/01/2022]
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