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Zamora-Sifuentes J, Poole JA. Occupational Rhinitis: An Update. Curr Allergy Asthma Rep 2023; 23:579-587. [PMID: 37452992 PMCID: PMC10896593 DOI: 10.1007/s11882-023-01103-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE OF REVIEW Occupational rhinitis is an underdiagnosed disease with significant morbidity and implications in the workplace. Multiple factors associated with this disease continue to pose a challenge to investigators. This review aims to summarize recent literature in occupational rhinitis, including classifications, pathogenesis, diagnosis, and treatment, as well as the impact of occupational rhinitis on individuals. Additionally, it identifies areas in need of further research and investigation. RECENT FINDINGS We highlight current research on the association between occupational rhinitis and occupational asthma and the role of immunotherapy in this disease. Discussion includes the impact of social trends on workers and the wider consequences of occupational rhinitis including decreased work productivity, absenteeism, and socioeconomic burden. Occupational rhinitis remains a challenging disease entity due to the numerous potential causative factors, reduced recognition, morbidity in asthma, and therapeutic limitations. Additional research is needed to better identify disease predictors and develop effective management strategies.
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Affiliation(s)
- Jose Zamora-Sifuentes
- Division of Allergy and Immunology, Department of Internal Medicine, Medical Center, University of Nebraska, University of Nebraska Medical Center, Omaha, NE, 68198-5990, USA.
| | - Jill A Poole
- Division of Allergy and Immunology, Department of Internal Medicine, Medical Center, University of Nebraska, University of Nebraska Medical Center, Omaha, NE, 68198-5990, USA
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Blackley BH, Nett RJ, Cox-Ganser JM, Harvey RR, Virji MA. Eye and airway symptoms in hospital staff exposed to a product containing hydrogen peroxide, peracetic acid, and acetic acid. Am J Ind Med 2023; 66:655-669. [PMID: 37221450 PMCID: PMC10431326 DOI: 10.1002/ajim.23488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/10/2023] [Accepted: 05/10/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Sporicidal products containing hydrogen peroxide (HP), peracetic acid (PAA), and acetic acid (AA) are used widely in multiple industries, including healthcare. Despite widespread use in healthcare, few studies have assessed associations between exposures to HP, PAA, and AA, and work-related symptoms in these settings. METHODS In 2018, we performed a health and exposure assessment at a hospital where a sporicidal product consisting of HP, PAA, and AA, was used as the primary cleaner on hospital surfaces. We collected 56 personal and mobile air samples for HP, PAA, and AA on participants while they performed their regular cleaning duties; collected area samples for HP (n = 28), PAA (n = 28), and AA (n = 70) in multiple hospital locations where cleaning was performed; and administered a postshift survey to assess eye, skin, and upper and lower airway symptoms that occurred cross-shift or in the previous 4 weeks. RESULTS Full-shift exposure levels for HP (range: <3-559 ppb), PAA (range: <0.2-8 ppb), and AA (range: <5-915 ppb) were all below US occupational exposure limits. We observed positive associations (p < 0.05) between shift, departmental average, and departmental 95th percentile exposures to HP, PAA, and AA vapors, and work-related acute (cross-shift) and chronic (previous 4 weeks) eye, upper airway, and lower airway symptoms after adjusting for age, gender, smoking status, use of other cleaning products containing sensitizers and irritants, allergic status, and stress. CONCLUSIONS Our observations of work-related upper and lower airway symptoms among hospital workers exposed to vapors from a sporicidal product containing HP, PAA, and AA indicate a need for a combination of engineering, administrative, and PPE controls to reduce exposure. Additionally, alternative nonchemical disinfection technologies should be further investigated as a means to simultaneously reduce healthcare workers' exposure to disinfectants while also minimizing costly healthcare-acquired infections.
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Affiliation(s)
- Brie Hawley Blackley
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Randall J. Nett
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Fort Collins, Colorado, USA
| | - Jean M. Cox-Ganser
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Robert Reid Harvey
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Mohammed Abbas Virji
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
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3
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Berufsasthma. ALLERGO JOURNAL 2021. [DOI: 10.1007/s15007-021-4934-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Olivieri M, Malerba M, Spiteri G, Torroni L, Biscardo CA, Valenza D, Malinovschi A. Fractional exhaled nitric oxide levels in relation to work-related respiratory burden and sensitization to wheat flour and multigrain in bakers. Clin Transl Allergy 2021; 11:e12018. [PMID: 34708942 PMCID: PMC8694179 DOI: 10.1002/clt2.12018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/25/2021] [Accepted: 03/17/2021] [Indexed: 01/26/2023] Open
Abstract
Background Work‐related lower airway symptoms (WR‐LAS), rhinitis (WRR), and asthma (WRA) are very common among bakers, due to airborne exposure to wheat flour and multigrain. Limited data is available regarding fractional exhaled nitric oxide (FeNO) in bakers in relation to respiratory burden and occupational sensitization in a real‐life situation. Objective To analyze FeNO levels in relation to WRR, WR‐LAS, and WRA with regard to allergic sensitization to occupational allergen in bakers. Methods Cross‐sectional, observational study of 174 bakers employed in traditional small bakeries in the Verona District. Subjects did FeNO measurements, spirometry, methacholine challenge, and skin prick test to common inhalant aeroallergens and bakeries occupational allergens. Results FeNO levels were higher in subjects sensitized to occupational allergens compared with bakers not sensitized to occupational allergens (22.8 ppb (18.9, 27.6) vs. 12.0 ppb (9.9, 14.5), p < 0.05). FeNO levels were higher in bakers with WRR and occupational sensitization (25.4 (20.6, 31.3)) than in bakers with WRR without occupational sensitization compared and bakers without respiratory burden (13.4 (9.6, 18.6) and 11.9 (9.8, 14.5), both p < 0.001). Similar findings were found for WR‐LAS with regard to the same categories (31.2 (24.1, 40.4) vs 13.3 (11.4, 15.6) and 15.3 (8.5, 27.5), p < 0.001 and p = 0.005). Bakers with WRA, with or without occupational allergic sensitization, had higher levels of FeNO than bakers without respiratory burden (both p ≤ 0.001). These findings were consistent after adjustments for gender, age, height, weight, smoking, and sensitization to common inhalant aeroallergens and lung function. Conclusions WRR and lower airway symptoms in bakers sensitized to occupational allergens relate to increased FeNO. Our study suggests that FeNO is associated with work‐related allergic inflammation in occupational sensitized bakers, but future studies are needed to assess how FeNO should be integrated in the diagnostic work‐up of occupational disease in bakers.
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Affiliation(s)
- Mario Olivieri
- Unit of Occupational Medicine, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Mario Malerba
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Gianluca Spiteri
- Unit of Occupational Medicine, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Lorena Torroni
- Unit of Epidemiology and Medical Statistics, Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - Carlo Alberto Biscardo
- Unit of Occupational Medicine, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Dario Valenza
- Unit of Occupational Medicine, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Andrei Malinovschi
- Department of Medical Sciences Clinical Physiology, Uppsala University, Uppsala, Sweden
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Ogi K, Liu S, Ramezanpour M, Cooksley C, Javadiyan S, Fujieda S, Wormald PJ, Vreugde S, Psaltis AJ. Trimellitic anhydride facilitates transepithelial permeability disrupting tight junctions in sinonasal epithelial cells. Toxicol Lett 2021; 353:27-33. [PMID: 34627954 DOI: 10.1016/j.toxlet.2021.09.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/30/2021] [Accepted: 09/30/2021] [Indexed: 11/27/2022]
Abstract
Trimellitic anhydride (TMA) is a chemical agent classified as a low molecular weight (LMW) agent causing occupational rhinitis (OR) or asthma. Although TMA is recognized as a respiratory sensitizer, the direct and non-immunologic effects of TMA remain unclear. Air- liquid interface (ALI) cultured human nasal epithelial cells (HNECs) derived from control subjects were treated with TMA, followed by measurement of the transepithelial electrical resistance (TEER), paracellular permeability of fluorescein isothiocyanate (FITC)-dextran and immunofluorescence of tight junction proteins claudin-1 and zonula occludens-1 (ZO-1). The cytotoxicity of TMA was evaluated by lactate dehydrogenase (LDH) assay. TMA at concentrations of 2 and 4 mg/mL significantly reduced the TEER within 10 min (p = 0.0177 on 2 mg/mL; p < 0.0001 on 4 mg/mL). The paracellular permeability of FITC-dextran was significantly increased upon challenge with 4 mg/mL TMA for 3 h (p = 0.0088) and 6 h (p = 0.0004). TMA treatment induced a reduction in the fluorescence intensity of claudin-1 and ZO-1 in a dose-dependent manner. LDH assay revealed 4 mg/mL TMA induced cytotoxicity only after 6 h incubation, while 1 or 2 mg/mL TMA caused no cytotoxicity. Our results suggest that TMA has a potential to penetrate the epithelial barrier by disrupting claudin-1 and ZO-1, indicating an important role for sensitization and OR development.
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Affiliation(s)
- Kazuhiro Ogi
- Department of Surgery-Otolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, South Australia, Australia; Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia; Division of Otorhinolaryngology-Head and Neck Surgery, Department of Sensory and Locomotor Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Sha Liu
- Department of Surgery-Otolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, South Australia, Australia; Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Mahnaz Ramezanpour
- Department of Surgery-Otolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, South Australia, Australia; Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Clare Cooksley
- Department of Surgery-Otolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, South Australia, Australia; Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Shari Javadiyan
- Department of Surgery-Otolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, South Australia, Australia; Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Shigeharu Fujieda
- Division of Otorhinolaryngology-Head and Neck Surgery, Department of Sensory and Locomotor Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Peter-John Wormald
- Department of Surgery-Otolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, South Australia, Australia; Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Sarah Vreugde
- Department of Surgery-Otolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, South Australia, Australia; Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Alkis James Psaltis
- Department of Surgery-Otolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, South Australia, Australia; Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia.
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Abstract
Allergic rhinitis is a common disorder that regularly occurs in children and adolescents. The disease is associated with other allergic diseases, such as asthma, and it carries a heavy burden, with effects on sleep, school performance, and quality of life. Classic symptoms include sneezing, rhinorrhea, nasal obstruction, and nasal itching. When the eyes are involved, the term allergic rhinoconjunctivitis is used. Triggers may include airborne pollens, molds, dust mites, and animals. Skin or blood allergy testing can be a useful diagnostic modality that may guide therapy. Immunotherapy can prevent the development of further allergic sensitizations as well as subsequent asthma.
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Affiliation(s)
- Charles Frank Schuler Iv
- Division of Allergy and Clinical Immunology, University of Michigan, Domino's Farms, 24 Frank Lloyd Wright Drive, PO Box 442, Suite H-2100, Ann Arbor, MI 48105, USA.
| | - Jenny Maribel Montejo
- Division of Allergy and Clinical Immunology, University of Michigan, Domino's Farms, 24 Frank Lloyd Wright Drive, PO Box 442, Suite H-2100, Ann Arbor, MI 48105, USA
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Rhinitis Phenotypes. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 8:1492-1503. [PMID: 32389274 DOI: 10.1016/j.jaip.2020.02.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 02/11/2020] [Accepted: 02/11/2020] [Indexed: 02/08/2023]
Abstract
Rhinitis is an umbrella term of a group of upper airway diseases with nasal symptoms and signs with different etiologies and various clinical features or traits. It can be classified into different "phenotypes," based on these observable traits. A proper differential diagnosis is necessary to adequately manage the disease. The objective of this review is to clarify the concept of rhinitis phenotypes while analyzing the clinical features and/or traits of each in order to determine a proper differential diagnosis and appropriate treatment.
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Abstract
Work-related rhinitis and laryngeal disorders are common and can significantly contribute to work absences and presenteeism. Each can cause respiratory symptoms that may be misdiagnosed as asthma symptoms, and each may occur as an isolated disorder or may also accompany asthma. Suspicion of these disorders and correct management require a careful medical and occupational history. Investigations for work-related rhinitis include examination of the nose, allergy skin tests, and in some cases, monitoring of peak inspiratory nasal flows at work and off work, or specific challenge tests. Work-related laryngeal disorders require assistance from an otolaryngologist and speech language pathologist.
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Affiliation(s)
- Ambrose Lau
- Department of Medicine, Toronto Western Hospital, St Michael's Hospital, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada
| | - Susan M Tarlo
- Department of Medicine, Dalla Lana School of Public Health, University of Toronto, Toronto Western Hospital, St Michael's Hospital, EW7-449, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada.
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Abstract
Occupational rhinitis (OR) has so far received little attention even though it shares common pathophysiological features and trigger factors and is closely associated with occupational asthma (OA). Work-related exposure to certain substances, such as animal dander, is considered to be the main factor for the development of OR. The new EAACI definition of OR stresses the causal relationship between workplace exposure and onset of rhinitis symptoms as opposed to previous definitions that mainly focused on a temporal relationship between workplace exposure and occurrence of nasal symptoms. Also, it has been suggested to use the term “work-related rhinitis” for classifying the different forms of rhinitis associated with the workplace. These forms can be subdivided into allergic or non-allergic OR, which is due to causes and conditions related to a particular work environment, as well as work-exacerbated rhinitis, which is defined as a pre-existing rhinitis exacerbated by exposure at the workplace. Even though taking a detailed patient history is especially important when it comes to diagnosing OR, the gold standard for confirming the diagnosis is nasal provocation testing. Best possible symptomatic relief and prevention of development of OA constitute the main therapeutic objectives in OR. Treatment options consist of total avoidance of trigger substances (main goal), reduction of exposure to certain substances, and pharmacotherapy. Furthermore, it is important to note that allergic OR is an occupational disease in Germany (Berufskrankheit No 4301) and needs to be reported to health authorities.
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Jungewelter S, Airaksinen L, Pesonen M. Occupational buckwheat allergy as a cause of allergic rhinitis, asthma, contact urticaria and anaphylaxis-An emerging problem in food-handling occupations? Am J Ind Med 2020; 63:1047-1053. [PMID: 32944967 DOI: 10.1002/ajim.23185] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 09/01/2020] [Accepted: 09/01/2020] [Indexed: 11/11/2022]
Abstract
Buckwheat is a known, though uncommon, allergen in occupational settings. It has recently gained popularity as healthy food and as an ingredient in gluten-free diets. We describe a series of six patient cases with occupational immediate allergy to buckwheat. Three cooks, two bakers, and a worker in a grocery store were occupationally exposed to buckwheat flour and developed immediate allergy to buckwheat, which was confirmed by skin prick testing and measurement of specific immunoglobulin E antibodies. Four of the patients were diagnosed with occupational asthma, four with occupational rhinitis, and two with occupational contact urticaria caused by buckwheat. Three of the six patients suffered anaphylaxis as consequence of their occupational buckwheat allergy after ingestion of food that contained buckwheat. The high rate of life-threatening reactions, together with a short exposure time to buckwheat before sensitization occurred in these cases, highlights the importance of a detailed occupational history and a high index of suspicion for occupational food allergens.
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Affiliation(s)
- Soile Jungewelter
- Occupational Medicine Finnish Institute of Occupational Health (FIOH) Helsinki Finland
| | - Liisa Airaksinen
- Occupational Medicine Finnish Institute of Occupational Health (FIOH) Helsinki Finland
| | - Maria Pesonen
- Occupational Medicine Finnish Institute of Occupational Health (FIOH) Helsinki Finland
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Olivieri M, Murgia N, Spiteri G, Biscardo CA, Marchetti P, Folletti I, Verlato G. Exposure to additives or multigrain flour is associated with high risk of work-related allergic symptoms among bakers. Occup Environ Med 2020; 78:112-116. [PMID: 32855346 DOI: 10.1136/oemed-2019-106052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 06/08/2020] [Accepted: 08/01/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Wheat flour exposure in bakers can elicit respiratory and skin symptoms. Scarce data are available on the prevalence of such conditions in bakers. We investigated the prevalence of work-related rhinitis, asthma-like symptoms and dermatitis in bakers according to job task and type of allergens involved. METHODS Of the 229 traditional bakeries in Verona area who were invited to participate in a cross-sectional survey, 211 (92%) accepted; 727 employees in these bakeries answered a modified version of a questionnaire on job tasks; allergen exposure within the bakery; and work-related nasal, asthma-like and skin symptoms during 2010-2014. Determinants of work-related nasal, asthma-like or skin disorders were separately evaluated using different logistic models. RESULTS The prevalence of work-related nasal and asthma-like symptoms was, respectively, 15.1% and 4.2% in bakery shop assistants, increasing to 25.7% and 9.5% in bakers using only wheat flour, and further to 31.8% and 13.6% in bakers using flour and additives, and then to 34.1% and 18.2% in bakers using flour with additives and multigrain (p<0.001). The risk of work-related asthma-like symptoms was more than doubled in bakers using additives without or with multigrain than in shop assistants (OR 2.3, 95% CI 1.0 to 5.5 and OR 3.4, 95% CI 1.1 to 10.8, respectively). Making bread with additives alone or with multigrain significantly increased the risk of work-related nasal symptoms in shop assistants, while the risk of skin symptoms was not significantly affected. CONCLUSIONS Bakers using additives alone or with multigrain are at a high risk of experiencing nasal and asthma-like symptoms.
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Affiliation(s)
- Mario Olivieri
- Diagnostics and Public Health-Unit of Occupational Medicine, University of Verona, Verona, Italy
| | - Nicola Murgia
- Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Perugia, Italy
| | - Gianluca Spiteri
- Diagnostics and Public Health-Unit of Occupational Medicine, University of Verona, Verona, Italy
| | - Carlo Alberto Biscardo
- Diagnostics and Public Health-Unit of Occupational Medicine, University of Verona, Verona, Italy
| | - Pierpaolo Marchetti
- Diagnostics and Public Health-Unit of Epidemiology and Medical Statistics, University of Verona, Verona, Italy
| | - Ilenia Folletti
- Clinical and Experimental Medicine, Occupational Medicine, University of Perugia, Terni, Italy
| | - Giuseppe Verlato
- Diagnostics and Public Health-Unit of Epidemiology and Medical Statistics, University of Verona, Verona, Italy
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Vandenplas O, Hox V, Bernstein D. Occupational Rhinitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:3311-3321. [PMID: 32653647 DOI: 10.1016/j.jaip.2020.06.047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/25/2020] [Indexed: 11/28/2022]
Abstract
There is convincing evidence that tight relationships between the upper and lower airways also apply to the workplace context. Most patients with occupational asthma (OA) also suffer from occupational rhinitis (OR), although OR is 2 to 3 times more common than OA. OR most often precedes the development of OA, especially when high-molecular-weight protein agents are involved, and longitudinal cohort studies have confirmed that OR is associated with an increased risk for the development of OA. The level of exposure to sensitizing agents at the workplace is the most important determinant for the development of IgE-mediated sensitization and OR. Atopy is a risk factor for the development of IgE-mediated sensitization only to high-molecular-weight agents. In workers with work-related rhinitis symptoms, documentation of IgE-mediated sensitization to a workplace agent via skin prick testing or serum specific IgE confirms a diagnosis of probable OR, whereas specific nasal provocation testing in the laboratory remains the reference method to establish a definite diagnosis of OR. Complete avoidance of exposure to the causal agent is the most effective therapeutic option for controlling work-related nasal symptoms and preventing the development of OA. If complete elimination of exposure is expected to induce meaningful adverse socioeconomic consequences, reduction of exposure can be considered as an alternative approach, but it is important to consider the individual risk factors for the development of OA to implement a more personalized management of OR.
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Affiliation(s)
- Olivier Vandenplas
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium.
| | - Valérie Hox
- Department of Otorhinolaryngology, Cliniques Universitaires Saint-Luc and Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, Université Catholique de Louvain, Brussels, Belgium
| | - David Bernstein
- Division of Immunology, Allergy and Rheumatology, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Vandenplas O, Suarthana E, Rifflart C, Lemière C, Le Moual N, Bousquet J. The Impact of Work-Related Rhinitis on Quality of Life and Work Productivity: A General Workforce-Based Survey. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:1583-1591.e5. [DOI: 10.1016/j.jaip.2019.12.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 11/05/2019] [Accepted: 12/23/2019] [Indexed: 12/01/2022]
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14
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Abstract
Allergic rhinitis is a common disorder that regularly occurs in children and adolescents. The disease is associated with other allergic diseases, such as asthma, and it carries a heavy burden, with effects on sleep, school performance, and quality of life. Classic symptoms include sneezing, rhinorrhea, nasal obstruction, and nasal itching. When the eyes are involved, the term allergic rhinoconjunctivitis is used. Triggers may include airborne pollens, molds, dust mites, and animals. Skin or blood allergy testing can be a useful diagnostic modality that may guide therapy. Immunotherapy can prevent the development of further allergic sensitizations as well as subsequent asthma.
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Affiliation(s)
- Charles Frank Schuler Iv
- Division of Allergy and Clinical Immunology, University of Michigan, Domino's Farms, 24 Frank Lloyd Wright Drive, PO Box 442, Suite H-2100, Ann Arbor, MI 48105, USA.
| | - Jenny Maribel Montejo
- Division of Allergy and Clinical Immunology, University of Michigan, Domino's Farms, 24 Frank Lloyd Wright Drive, PO Box 442, Suite H-2100, Ann Arbor, MI 48105, USA
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15
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Rodríguez-Zamora MG, Zock JP, van Wendel de Joode B, Mora AM. Respiratory Health Outcomes, Rhinitis, and Eczema in Workers from Grain Storage Facilities in Costa Rica. Ann Work Expo Health 2019; 62:1077-1086. [PMID: 30016387 DOI: 10.1093/annweh/wxy068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 07/02/2018] [Indexed: 11/13/2022] Open
Abstract
Objectives To examine the associations of inhalable grain dust exposure with respiratory health outcomes, rhinitis, and eczema reported by workers from rice, wheat, and maize storage facilities. Methods A cross-sectional study of 136 workers (73 operators and 63 administrative staff and other workers) from eight Costa Rican grain storage facilities was conducted in 2014-2015. Full-shift personal inhalable dust samples from all workers were collected. Study participants were administered a short version of the European Community Respiratory Health Survey questionnaire to identify symptoms of asthma, chronic bronchitis, rhinitis, and eczema. Associations between grain dust exposure and health outcomes were assessed using multivariable logistic and negative binomial regression models adjusted for age, smoking history, grain type, and presence of pets or farm animals in the home. Results The median inhalable grain dust concentration was 2.0 (25th to 75th percentile: 0.3-7.0) mg m-3. Higher concentrations of inhalable dust were associated with increased odds of (i) asthma symptoms or medication use [adjusted Odds ratio (ORa) per 10-fold increase in dust concentration 2.7; 95% confidence interval (CI): 1.3-6.7]; (ii) a score of at least two out of five symptoms suggestive of asthma (ORa 1.2; 95% CI: 1.0-1.3); and (iii) eczema (ORa 3.6; 95% CI: 1.7-9.6). No associations of inhalable grain dust exposure with chronic bronchitis and rhinitis were observed. Conclusions High exposure to inhalable dust in Costa Rican grain storage facilities was associated to asthma symptoms and eczema in workers.
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Affiliation(s)
- María G Rodríguez-Zamora
- Escuela de Ingeniería en Seguridad Laboral e Higiene Ambiental (EISLHA), Instituto Tecnológico de Costa Rica, Cartago, Costa Rica
| | - Jan-Paul Zock
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,University Pompeu Fabra (UPF), Barcelona, Spain.,Biomedical Research Center Network for Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Berna van Wendel de Joode
- Central American Institute for Studies on Toxic Substances (IRET), Omar Dengo Campus, Universidad Nacional, Heredia, Costa Rica
| | - Ana M Mora
- Central American Institute for Studies on Toxic Substances (IRET), Omar Dengo Campus, Universidad Nacional, Heredia, Costa Rica.,Center for Environmental Research and Children's Health (CERCH), School of Public Health, University of California, Berkeley, Berkeley, CA, USA
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Scadding GK, Kariyawasam HH, Scadding G, Mirakian R, Buckley RJ, Dixon T, Durham SR, Farooque S, Jones N, Leech S, Nasser SM, Powell R, Roberts G, Rotiroti G, Simpson A, Smith H, Clark AT. BSACI guideline for the diagnosis and management of allergic and non-allergic rhinitis (Revised Edition 2017; First edition 2007). Clin Exp Allergy 2019; 47:856-889. [PMID: 30239057 DOI: 10.1111/cea.12953] [Citation(s) in RCA: 135] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 05/01/2017] [Accepted: 05/04/2017] [Indexed: 12/12/2022]
Abstract
This is an updated guideline for the diagnosis and management of allergic and non-allergic rhinitis, first published in 2007. It was produced by the Standards of Care Committee of the British Society of Allergy and Clinical Immunology, using accredited methods. Allergic rhinitis is common and affects 10-15% of children and 26% of adults in the UK, it affects quality of life, school and work attendance, and is a risk factor for development of asthma. Allergic rhinitis is diagnosed by history and examination, supported by specific allergy tests. Topical nasal corticosteroids are the treatment of choice for moderate to severe disease. Combination therapy with intranasal corticosteroid plus intranasal antihistamine is more effective than either alone and provides second line treatment for those with rhinitis poorly controlled on monotherapy. Immunotherapy is highly effective when the specific allergen is the responsible driver for the symptoms. Treatment of rhinitis is associated with benefits for asthma. Non-allergic rhinitis also is a risk factor for the development of asthma and may be eosinophilic and steroid-responsive or neurogenic and non- inflammatory. Non-allergic rhinitis may be a presenting complaint for systemic disorders such as granulomatous or eosinophilic polyangiitis, and sarcoidoisis. Infective rhinitis can be caused by viruses, and less commonly by bacteria, fungi and protozoa.
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Affiliation(s)
- G K Scadding
- The Royal National Throat Nose and Ear Hospital, London, UK
| | - H H Kariyawasam
- The Royal National Throat Nose and Ear Hospital, London, UK.,UCLH NHS Foundation Trust, London, UK
| | - G Scadding
- Department of Upper Respiratory Medicine, Imperial College NHLI, London, UK
| | - R Mirakian
- The Royal National Throat Nose and Ear Hospital, London, UK
| | - R J Buckley
- Vision and Eye Research Unit, Anglia Ruskin University, Cambridge, UK
| | - T Dixon
- Royal Liverpool and Broad green University Hospital NHS Trust, Liverpool, UK
| | - S R Durham
- Department of Upper Respiratory Medicine, Imperial College NHLI, London, UK
| | - S Farooque
- Chest and Allergy Department, St Mary's Hospital, Imperial College NHS Trust, London, UK
| | - N Jones
- The Park Hospital, Nottingham, UK
| | - S Leech
- Department of Child Health, King's College Hospital, London, UK
| | - S M Nasser
- Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - R Powell
- Department of Clinical Immunology and Allergy, Nottingham University, Nottingham UK
| | - G Roberts
- Department of Child Health, University of Southampton Hospital, Southampton, UK
| | - G Rotiroti
- The Royal National Throat Nose and Ear Hospital, London, UK
| | - A Simpson
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, UK
| | - H Smith
- Division of Primary Care and Public Health, University of Sussex, Brighton, UK
| | - A T Clark
- Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
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Kimber I, Agius R, Basketter DA, Corsini E, Cullinan P, Dearman RJ, Gimenez-Arnau E, Greenwell L, Hartung T, Kuper F, Maestrelli P, Roggen E, Rovida C. Chemical Respiratory Allergy: Opportunities for Hazard Identification and Characterisation. Altern Lab Anim 2019; 35:243-65. [PMID: 17559314 DOI: 10.1177/026119290703500212] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Ian Kimber
- Syngenta Central Toxicology Laboratory, Macclesfield, UK.
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Jungewelter S, Airaksinen L, Pesonen M. Occupational rhinitis, asthma, and contact urticaria from IgE-mediated allergy to pork. Am J Ind Med 2019; 62:80-84. [PMID: 30474282 DOI: 10.1002/ajim.22921] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2018] [Indexed: 01/20/2023]
Abstract
We describe four cases of slaughterhouse workers with occupational immediate allergy to raw pork allergens, confirmed by positive skin prick testing and specific immunoglobulin E (IgE) antibodies. Our first patient was diagnosed with occupational asthma from raw pork allergens. Two patients were diagnosed with occupational rhinitis caused by raw pork allergens, which was confirmed by a nasal provocation test. One of these also had occupational contact urticaria caused by raw pork meat. We were unable to diagnose an occupational respiratory or skin disease in the fourth patient, despite signs of immediate sensitization to raw pork meat from occupational exposure. Based on proper diagnoses, measures to prevent allergen exposure were taken, which led to the improvement of symptoms in these four patients. The present patient cases highlight the importance of recognition of early signs of occupational allergy and identification of causative allergens in order to allow avoidance of allergens, with the aim of preventing persistence and worsening of symptoms.
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Affiliation(s)
| | | | - Maria Pesonen
- Finnish Institute of Occupational Health (FIOH)HelsinkiFinland
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19
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Balogun RA, Siracusa A, Shusterman D. Occupational rhinitis and occupational asthma: Association or progression? Am J Ind Med 2018; 61:293-307. [PMID: 29411403 DOI: 10.1002/ajim.22819] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Occupational asthma is the most frequently reported occupational respiratory disease in registries, and is often co-diagnosed with occupational rhinitis. We undertook a systematic review of the English-language epidemiologic literature linking these two conditions, with emphasis on progression from occupational rhinitis to occupational asthma. METHODS PubMed and Embase were queried in a series of structured searches designed to identify studies comparing occupational asthma and occupational rhinitis incidence or prevalence in occupationally exposed individuals. RESULTS The searches yielded a total of 109 unique citations, 15 of which yielded inferential data on the occupational rhinitis-asthma relationship. Nine of fifteen studies showed statistically significant associations between the occurrence of occupational rhinitis and occupational asthma among individual workers. CONCLUSIONS Limited data support the notion that occupational rhinitis precedes the development of occupational asthma, particularly when high-molecular-weight (HMW) agents are involved. The relationship between the two conditions could not be evaluated in many relevant studies due to a lack of cross-tabulation of individual cases.
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Affiliation(s)
- Rahmat A. Balogun
- Division of Occupational and Environmental Medicine; University of California; San Francisco California
| | | | - Dennis Shusterman
- Division of Occupational and Environmental Medicine; University of California; San Francisco California
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20
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Parsel SM, Riley CA, McCoul ED. Combat zone exposure and respiratory tract disease. Int Forum Allergy Rhinol 2018; 8:964-969. [PMID: 29601152 DOI: 10.1002/alr.22123] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 02/10/2018] [Accepted: 03/06/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND The impact of deployment to combat zones on the respiratory and sinonasal health of U.S. soldiers is an emerging public health concern. Retrospective studies have shown a correlation between deployment and development of post-deployment pathology, particularly of the aerodigestive system. Respiratory disease, including sinusitis, allergic rhinitis, and asthma, are commonly reported in soldiers deployed to the Middle East and Southwest Asia. METHODS Current literature pertaining to combat zone exposure and development of respiratory disease was retrieved using PubMed, Embase, Web of Science, and Google Scholar. RESULTS Several types of combat zone exposures exist that may play an influential role in the development of upper and lower respiratory tract diseases. Exposures including foreign dusts, harsh environments, particulate size, and close living quarters may play a causative role. The effect of combat zone exposures has been better examined for lower respiratory tract diseases; however, with the theory of the unified airway, the upper respiratory tract may also be involved. There is evidence that the upper respiratory tract is susceptible, with an increased risk for development of sinusitis and sinonasal disease; however, the quality of evidence of the present literature is generally low. CONCLUSION More research is necessary to determine a pathophysiologic mechanism between combat zone exposure and the development of sinonasal disease. Practicing otolaryngologists should be aware of the possibility of combat zone exposures that could contribute to rhinologic symptomatology.
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Affiliation(s)
- Sean M Parsel
- Department of Otolaryngology-Head and Neck Surgery, Tulane University, New Orleans, LA
| | - Charles A Riley
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, New York, NY
| | - Edward D McCoul
- Department of Otorhinolaryngology-Head and Neck Surgery, Ochsner Health System, New Orleans, LA
- Ochsner Clinical School, University of Queensland School of Medicine, Brisbane, Queensland, Australia
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21
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Wise SK, Lin SY, Toskala E, Orlandi RR, Akdis CA, Alt JA, Azar A, Baroody FM, Bachert C, Canonica GW, Chacko T, Cingi C, Ciprandi G, Corey J, Cox LS, Creticos PS, Custovic A, Damask C, DeConde A, DelGaudio JM, Ebert CS, Eloy JA, Flanagan CE, Fokkens WJ, Franzese C, Gosepath J, Halderman A, Hamilton RG, Hoffman HJ, Hohlfeld JM, Houser SM, Hwang PH, Incorvaia C, Jarvis D, Khalid AN, Kilpeläinen M, Kingdom TT, Krouse H, Larenas-Linnemann D, Laury AM, Lee SE, Levy JM, Luong AU, Marple BF, McCoul ED, McMains KC, Melén E, Mims JW, Moscato G, Mullol J, Nelson HS, Patadia M, Pawankar R, Pfaar O, Platt MP, Reisacher W, Rondón C, Rudmik L, Ryan M, Sastre J, Schlosser RJ, Settipane RA, Sharma HP, Sheikh A, Smith TL, Tantilipikorn P, Tversky JR, Veling MC, Wang DY, Westman M, Wickman M, Zacharek M. International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis. Int Forum Allergy Rhinol 2018; 8:108-352. [PMID: 29438602 PMCID: PMC7286723 DOI: 10.1002/alr.22073] [Citation(s) in RCA: 218] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 12/01/2017] [Accepted: 12/01/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Critical examination of the quality and validity of available allergic rhinitis (AR) literature is necessary to improve understanding and to appropriately translate this knowledge to clinical care of the AR patient. To evaluate the existing AR literature, international multidisciplinary experts with an interest in AR have produced the International Consensus statement on Allergy and Rhinology: Allergic Rhinitis (ICAR:AR). METHODS Using previously described methodology, specific topics were developed relating to AR. Each topic was assigned a literature review, evidence-based review (EBR), or evidence-based review with recommendations (EBRR) format as dictated by available evidence and purpose within the ICAR:AR document. Following iterative reviews of each topic, the ICAR:AR document was synthesized and reviewed by all authors for consensus. RESULTS The ICAR:AR document addresses over 100 individual topics related to AR, including diagnosis, pathophysiology, epidemiology, disease burden, risk factors for the development of AR, allergy testing modalities, treatment, and other conditions/comorbidities associated with AR. CONCLUSION This critical review of the AR literature has identified several strengths; providers can be confident that treatment decisions are supported by rigorous studies. However, there are also substantial gaps in the AR literature. These knowledge gaps should be viewed as opportunities for improvement, as often the things that we teach and the medicine that we practice are not based on the best quality evidence. This document aims to highlight the strengths and weaknesses of the AR literature to identify areas for future AR research and improved understanding.
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Affiliation(s)
| | | | | | | | - Cezmi A. Akdis
- Allergy/Asthma, Swiss Institute of Allergy and Asthma Research, Switzerland
| | | | - Antoine Azar
- Allergy/Immunology, Johns Hopkins University, USA
| | | | | | | | | | - Cemal Cingi
- Otolaryngology, Eskisehir Osmangazi University, Turkey
| | | | | | | | | | | | | | - Adam DeConde
- Otolaryngology, University of California San Diego, USA
| | | | | | | | | | | | | | - Jan Gosepath
- Otorhinolaryngology, Helios Kliniken Wiesbaden, Germany
| | | | | | | | - Jens M. Hohlfeld
- Respiratory Medicine, Hannover Medical School, Airway Research Fraunhofer Institute for Toxicology and Experimental Medicine, German Center for Lung Research, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | - Amber U. Luong
- Otolaryngology, McGovern Medical School at the University of Texas Health Science Center Houston, USA
| | | | | | | | - Erik Melén
- Pediatric Allergy, Karolinska Institutet, Sweden
| | | | | | - Joaquim Mullol
- Otolaryngology, Universitat de Barcelona, Hospital Clinic, IDIBAPS, Spain
| | | | | | | | - Oliver Pfaar
- Rhinology/Allergy, Medical Faculty Mannheim, Heidelberg University, Center for Rhinology and Allergology, Wiesbaden, Germany
| | | | | | - Carmen Rondón
- Allergy, Regional University Hospital of Málaga, Spain
| | - Luke Rudmik
- Otolaryngology, University of Calgary, Canada
| | - Matthew Ryan
- Otolaryngology, University of Texas Southwestern, USA
| | - Joaquin Sastre
- Allergology, Hospital Universitario Fundacion Jiminez Diaz, Spain
| | | | | | - Hemant P. Sharma
- Allergy/Immunology, Children's National Health System, George Washington University School of Medicine, USA
| | | | | | | | | | | | - De Yun Wang
- Otolaryngology, National University of Singapore, Singapore
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Abstract
PURPOSE OF REVIEW Asthma due to cleaning products has been known for 20 years, and the interest in this topic is still large because of the number of cleaning workers with respiratory problems. In this review, we sought to highlight the most recent findings on the relationship between exposure to cleaning products and asthma and to summarize the specific literature published between 2013 and 2016. RECENT FINDINGS Women are confirmed as most of workers exposed to cleaning products and have a higher frequency than men of work-related respiratory symptoms and diseases. Many cases of asthma due to cleaning products occur in healthcare occupations. The increased risk of asthma has been shown to be related to the number of years in the job and to early life disadvantage. Recent evidence suggests that predisposition to adult-onset asthma may be related to interaction between genes and occupational exposure to low-molecular weight agents/irritants. There is some evidence that an irritant mechanism is more common, although several case reports showed animmunologic mechanism (e.g. disinfectants, amine compounds, aldehydes and fragrances). SUMMARY The review updated recent findings on epidemiology, cleaning agents and their mechanism, and prevention of asthma due to cleaning agents. This article provides new information on the level of exposure, which is still high in professional cleaners and even more in domestic cleaners, and on the frequency of asthma in professional and domestic cleaners. An irritant mechanism is more common, although an immunological mechanism is possible, especially in healthcare workers exposed to disinfectants.
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Abstract
Healthcare workers (HCWs) are exposed to a range of high and low molecular weight agents that are allergic sensitizers or irritants including cleaners and disinfectants, natural rubber latex, and various medications. Studies have shown that exposed HCWs are at risk for work-related rhinitis and asthma (WRA). Work-related rhinitis may precede development of WRA and should be considered as an early marker of WRA. Avoidance of causative exposures through control strategies such as elimination, substitution, engineering controls, and process modification is the preferred primary prevention strategy for preventing development of work-related allergic diseases. There is limited evidence for the effectiveness of respirators in preventing occupational asthma. If sensitizer-induced WRA is diagnosed, it is important to avoid further exposure to the causative agent, preferably by more rigorous application of exposure control strategies to the workplace. This review focuses on allergic occupational respiratory diseases in HCWs.
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Hawley B, Cummings KJ, Mohammed M, Dimmock AE, Bascom R. Allergic sinusitis and severe asthma caused by occupational exposure to locust bean gum: Case report. Am J Ind Med 2017; 60:658-663. [PMID: 28497854 DOI: 10.1002/ajim.22725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2017] [Indexed: 01/16/2023]
Abstract
We present a case that highlights the difficulties with diagnosis and the dangers of occupational allergic sinusitis and asthma left unrecognized. We describe the case history of a man who experienced work-related symptoms 1 year after beginning work as a cheesemaker at a creamery, and whose respiratory symptoms progressively worsened over 16 years before an occupational cause of his asthma was identified. His initial discrete episodes of sinusitis and acute bronchitis evolved into persistent asthma of increasing severity with exacerbations requiring repeated emergency room treatment. The case described in our report emphasizes the importance of clinician diagnosis of OA, and subsequent removal from exposure, such that asthma severity does not progress to near-fatal or fatal asthma in the sensitized worker. As demonstrated by this case report, identification of an occupational cause of asthma relies on a high degree of suspicion and excellent detective work by the clinician.
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Affiliation(s)
- Brie Hawley
- Respiratory Health Division; National Institute for Occupational Safety and Health; Morgantown West Virginia
| | - Kristin J. Cummings
- Respiratory Health Division; National Institute for Occupational Safety and Health; Morgantown West Virginia
| | | | - Anne E. Dimmock
- Pulmonary and Critical Care Medicine; Penn State Hershey College of Medicine; Hershey Pennsylvania
| | - Rebecca Bascom
- Pulmonary and Critical Care Medicine; Penn State Hershey College of Medicine; Hershey Pennsylvania
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Lifetime allergic rhinitis prevalence among US primary farm operators: findings from the 2011 Farm and Ranch Safety survey. Int Arch Occup Environ Health 2017; 90:507-515. [PMID: 28341882 DOI: 10.1007/s00420-017-1217-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 03/14/2017] [Indexed: 12/31/2022]
Abstract
PURPOSE Allergic rhinitis is associated with decreased quality of life, and reduced workplace performance and productivity. This study investigated the prevalence of lifetime allergic rhinitis and factors associated with allergic rhinitis among US primary farm operators. METHODS The 2011 Farm and Ranch Safety Survey data collected from 11,210 active farm operators were analyzed. Survey respondents were determined to have lifetime allergic rhinitis based on a "yes" response to the question: "Have you ever been told by a doctor, nurse, or other health professional that you had hay fever, seasonal allergies, or allergic rhinitis?" Data were weighted to produce nationally representative estimates. RESULTS An estimated 30.8% of the 2.1 million active farm operators had lifetime allergic rhinitis in 2011. The allergic rhinitis prevalence varied by demographic and farm characteristics. Farm operators with allergic rhinitis were 1.38 (95% CI 1.22-1.56) times more likely to be exposed to pesticides compared with operators with no allergic rhinitis. The association with pesticide exposure for allergic rhinitis and current asthma, and allergic rhinitis alone was statistically significant and greater than that for current asthma alone. CONCLUSION Certain groups of farm operators may be at increased risk of allergic rhinitis. Studies should further investigate the association of allergic rhinitis with specific pesticide exposure.
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Kirkeleit J, Hollund BE, Riise T, Eduard W, Bråtveit M, Storaas T. Bakers' exposure to flour dust. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2017; 14:81-91. [PMID: 27540715 DOI: 10.1080/15459624.2016.1225156] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
We aimed to characterize bakers' personal exposure to airborne flour dust with respect to the health-related aerosol fractions inhalable, extrathoracic, and thoracic dust, and to examine possible production-related determinants of dust exposure. Sixty-eight bakers from 7 bakeries in Bergen, Norway (2009-2012) participated in the exposure assessment, comprising full-shift personal samples of inhalable dust (n = 107) and thoracic dust (n = 61). The relation between possible determinants and exposure was estimated using mixed effects models, while associations between the various aerosol fractions across task groups and type of bakeries were described by Pearson's correlation coefficients. Bakers' overall geometric mean personal exposure to inhalable, extrathoracic, and thoracic dust were 2.6 mg/m3 (95% CI: 2.0, 3.2), 2.2 mg/m3 (95% CI: 1.9, 2.7), and 0.33 mg/m3 (95% CI 0.3, 0.4), respectively. A total of 29% of the measurements of inhalable dust were above the Norwegian Occupational Exposure Limit of 3 mg/m3. The exposure variability of inhalable dust could not be explained by any of the examined production-related determinants, while the daily production volume explained 18% of the variance in thoracic dust exposure. Overall, the thoracic dust represented 15% of the inhalable dust, being rather stable across the production-related determinants. The overall correlation between inhalable and thoracic dust was nevertheless moderate (r = 0.52, p < 0.001), with the highest correlation for craft bakers (r = 0.62) and no correlation during dough forming (r = 0.01). Bakers are exposed to flour dust at a level that most likely represents an excess risk of developing chronic diseases of the respiratory system, and a decrease of present exposure level is imperative. Extrathoracic dust-likely the most relevant sub-fraction in respect to flour-induced sensitization and occupational rhinitis-represented the main proportion of the measured inhalable dust. The variation in correlation coefficients between the dust fractions across bakery types and task groups underlines the need of more knowledge about how these aerosol fractions are distributed across the production process and bakery types.
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Affiliation(s)
- Jorunn Kirkeleit
- a Department of Occupational Medicine , Haukeland University Hospital , Bergen , Norway
- b Department of Clinical Science , University of Bergen , Bergen , Norway
| | - Bjørg Eli Hollund
- a Department of Occupational Medicine , Haukeland University Hospital , Bergen , Norway
- b Department of Clinical Science , University of Bergen , Bergen , Norway
| | - Trond Riise
- c Department of Global Public Health and Primary Care , University of Bergen , Bergen , Norway
| | - Wijnand Eduard
- d Department of Chemical and Biological Working Environment , National Institute of Occupational Health , Oslo , Norway
| | - Magne Bråtveit
- a Department of Occupational Medicine , Haukeland University Hospital , Bergen , Norway
- c Department of Global Public Health and Primary Care , University of Bergen , Bergen , Norway
| | - Torgeir Storaas
- a Department of Occupational Medicine , Haukeland University Hospital , Bergen , Norway
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Ogi K, Takabayashi T, Yamada T, Sakashita M, Kanno M, Narita N, Fujieda S. Trimellitic anhydride induces low-grade mast cell degranulation without specific IgE. Toxicol Rep 2016; 3:701-707. [PMID: 28959595 PMCID: PMC5616080 DOI: 10.1016/j.toxrep.2016.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 09/01/2016] [Accepted: 09/02/2016] [Indexed: 11/26/2022] Open
Abstract
Objectives Low-molecular-weight (LMW) substances are known to be causative agents of occupational asthma (OA) and occupational rhinitis (OR). Although most LMW substances are irritants or allergens, some can cause immediate type immunoglobulin E (IgE)-mediated allergic reactions. Trimellitic anhydride (TMA) is one such LMW substance, which is known as an immunological sensitizer. However, the exact molecular biological details of the effects of TMA remain unclear. Methods We measured the β-hexosaminidase release from mast cells after directly exposing the cells to various LMW substances. The tyrosine phosphorylation of whole cellular molecules and the phosphorylation of extracellular signal-regulated kinase (ERK) were assessed by immunoblot assay. Results Among the LMW substances tested, only TMA induced β-hexosaminidase release. However, the mast cell degranulation induced by TMA was lower than that induced by an antigen or a calcium ionophore. Moreover, the pattern of tyrosine phosphorylation of whole cellular molecules was quite different between IgE-mediated antigen stimulation and TMA exposure. The TMA effect on mast cells was independent of not only IgE but also Ca2+ influx. ERK phosphorylation was not detected in mast cells exposed to TMA. Conclusions TMA induced mild degranulation of mast cells without IgE, even though the phosphorylation of ERK was not detected. This reaction suggests that TMA affects humans even upon first exposure. Therefore, it is imperative to avoid human exposure to high concentrations of TMA. In order to stop the development of severe asthma in individuals with OR, we need to be able to identify cases of OR caused by TMA as soon as possible.
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Key Words
- BSA, bovine serum albumin
- DNP, dinitrophenylated
- HMW, high molecular weight
- IL, interleukin
- IgE, immediate immunoglobulin E
- IgE, immunoglobulin E
- LMW, low molecular weight
- Mast cell
- OA, occupational asthma
- OR, occupational rhinitis
- Occupational rhinitis
- PD, piecemeal degranulation
- Respiratory hypersensitivity
- TMA, trimellitic anhydride
- Trimellitic anhydride
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Affiliation(s)
- Kazuhiro Ogi
- Division of Otorhinolaryngology Head and Neck Surgery, Department of Sensory and Locomotor Medicine, Faculty of Medical Sciences, University of Fukui, Fukui 910-1193, Japan
| | - Tetsuji Takabayashi
- Division of Otorhinolaryngology Head and Neck Surgery, Department of Sensory and Locomotor Medicine, Faculty of Medical Sciences, University of Fukui, Fukui 910-1193, Japan
| | - Takechiyo Yamada
- Division of Otorhinolaryngology Head and Neck Surgery, Department of Sensory and Locomotor Medicine, Faculty of Medical Sciences, University of Fukui, Fukui 910-1193, Japan
| | - Masafumi Sakashita
- Division of Otorhinolaryngology Head and Neck Surgery, Department of Sensory and Locomotor Medicine, Faculty of Medical Sciences, University of Fukui, Fukui 910-1193, Japan
| | - Masafumi Kanno
- Division of Otorhinolaryngology Head and Neck Surgery, Department of Sensory and Locomotor Medicine, Faculty of Medical Sciences, University of Fukui, Fukui 910-1193, Japan
| | - Norihiko Narita
- Division of Otorhinolaryngology Head and Neck Surgery, Department of Sensory and Locomotor Medicine, Faculty of Medical Sciences, University of Fukui, Fukui 910-1193, Japan
| | - Shigeharu Fujieda
- Division of Otorhinolaryngology Head and Neck Surgery, Department of Sensory and Locomotor Medicine, Faculty of Medical Sciences, University of Fukui, Fukui 910-1193, Japan
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Ballal SG. Occupational Rhinitis Revisited: Emphasis on the Risk Factors in Saudi Industry. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2016; 4:154-163. [PMID: 30787722 PMCID: PMC6298352 DOI: 10.4103/1658-631x.188254] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The European Academy of Allergy and Clinical Immunology (EAACI) Task Force defines occupational rhinitis (OR) as "an inflammatory disease of the nose, which is characterized by intermittent or persistent symptoms (i.e., nasal congestion, sneezing, rhinorrea, itching), and/or variable nasal airflow limitation and/or hypersecretion arising out of causes and conditions attributable to a particular work environment and not to stimuli encountered outside the workplace." The objectives of this review are to highlight the causes of OR in industrial settings in Saudi Arabia in order to alert primary healthcare physicians and other healthcare providers of the importance of diagnosing and managing OR to prevent further complications and present to the General Organization for Social Insurance (GOSI) evidence of the existence of OR in Saudi industrial sector. The literature search yielded no publications from Saudi Arabia that have investigated the prevalence of OR, but it is expected to be high judging from the high prevalence of allergic rhinitis in the country. The occupational groups that are at risk of developing OR include workers in the petrochemical industry, healthcare personnel, livestock and bird breeders, bakers, farmers, housewives and other occupations all of which are present in Saudi Arabia. Clinic and industry based research within Saudi Arabia is recommended to determine the prevalence of OR and to alert healthcare providers to suspect OR in all symptomatic working adults, including housewives and domestic helpers. Use of EAACI algorithm for the diagnosis and management of this condition will help to manage the condition and prevent the deterioration and further complications. Furthermore, diagnosis using internationally recognized guidelines and the results of the suggested epidemiologic surveys may convince GOSI to recognize OR as an occupational disease.
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Affiliation(s)
- Seifeddin G. Ballal
- Department of Family and Community Medicine, College of Medicine, University of Dammam, Dammam, Saudi Arabia
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Toujani S, Hedhli A, Mjid M, Ben Salah N, Ouahchy Y, Louzir B, Daghfous J, Mhiri N, Cherif J, Beji M. [Occupational asthma: Clinical and professional profile of the Tunisian asthmatic worker]. REVUE DE PNEUMOLOGIE CLINIQUE 2016; 72:228-233. [PMID: 27349827 DOI: 10.1016/j.pneumo.2016.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 03/08/2016] [Accepted: 03/16/2016] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Asthma takes up a great importance in occupational diseases but remains underestimated as it is insufficiently diagnosed. OBJECTIVE We aimed to access the clinical and professional profile of the Tunisian asthmatic worker. MATERIALS AND METHODS It was a retrospective descriptive study in a professional pathology unit in a university hospital. All patients referred by their doctor for symptoms suggestive of occupational asthma, during a period from 2000 to 2008, were included. RESULTS Forty-eight patients were selected from 172. The mean age was 40 years, with a male predominance (56 %). In 2/3 of the cases, it was the textile workers, food and chemical industry. The etiological agents incriminated were textile dust in 18.8 % of cases followed by isocyanates and flour. Typical episodes of wheezing dyspnea were present in 52 % and atopy in 54.2 % of workers. In 2 % of cases, symptoms disappeared and worsened in 18.8 %. CONCLUSIONS The prognosis of OA depends on early end accurate diagnosis. The physician's role is to initiate the appropriate diagnostic approach, which must comply with the Tunisian conditions.
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Affiliation(s)
- S Toujani
- Service de pneumologie-allergologie, CHU La Rabta, unité de recherche 12SP06, faculté de médecine de Tunis, université de Tunis El Manar, 1007, Tunis, Tunisie.
| | - A Hedhli
- Service de pneumologie-allergologie, CHU La Rabta, unité de recherche 12SP06, faculté de médecine de Tunis, université de Tunis El Manar, 1007, Tunis, Tunisie
| | - M Mjid
- Service de pneumologie-allergologie, CHU La Rabta, unité de recherche 12SP06, faculté de médecine de Tunis, université de Tunis El Manar, 1007, Tunis, Tunisie
| | - N Ben Salah
- Service de pneumologie-allergologie, CHU Mongi Slim, faculté de médecine de Tunis, université de Tunis El Manar, 2070, Sidi Daoud, La Marsa, Tunisie
| | - Y Ouahchy
- Service de pneumologie-allergologie, CHU La Rabta, unité de recherche 12SP06, faculté de médecine de Tunis, université de Tunis El Manar, 1007, Tunis, Tunisie
| | - B Louzir
- Service de pneumologie-allergologie, CHU Mongi Slim, faculté de médecine de Tunis, université de Tunis El Manar, 2070, Sidi Daoud, La Marsa, Tunisie
| | - J Daghfous
- Service de pneumologie-allergologie, CHU La Rabta, unité de recherche 12SP06, faculté de médecine de Tunis, université de Tunis El Manar, 1007, Tunis, Tunisie
| | - N Mhiri
- Service de pneumologie-allergologie, CHU La Rabta, unité de recherche 12SP06, faculté de médecine de Tunis, université de Tunis El Manar, 1007, Tunis, Tunisie
| | - J Cherif
- Service de pneumologie-allergologie, CHU La Rabta, unité de recherche 12SP06, faculté de médecine de Tunis, université de Tunis El Manar, 1007, Tunis, Tunisie
| | - M Beji
- Service de pneumologie-allergologie, CHU La Rabta, unité de recherche 12SP06, faculté de médecine de Tunis, université de Tunis El Manar, 1007, Tunis, Tunisie
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Muhamad NA, Faizal Bakhtiar M, Mustapha N, Adon MY, Airaksinen L, Bakon SK, Mohamad ZA, Aris T. Workplace interventions for treating work-related rhinitis and rhinosinusitis. Hippokratia 2015. [DOI: 10.1002/14651858.cd011815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Mohamed Faizal Bakhtiar
- Institute for Medical Research; National institutes of Health, Ministry of Health; Shah Alam Malaysia
| | - Normi Mustapha
- Faculty Science and Technology; Open University Malaysia; Kuala Lumpur Malaysia
| | | | - Liisa Airaksinen
- Occupational Medicine; Finnish Institute of Occupational Health; Helsinki Finland
| | - Sophia K Bakon
- Institute for Medical Research; National Institutes of Health, Ministry of Health; Shah Alam Malaysia
| | - Zuraifah Asrah Mohamad
- Institute for Medical Research; National Institutes of Health, Ministry of Health; Shah Alam Malaysia
| | - Tahir Aris
- Institute for Medical Research; National Institutes of Health, Ministry of Health; Shah Alam Malaysia
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Muhamad NA, Faizal Bakhtiar M, Mustapha N, Adon MY, Arip M, Aris T. Workplace interventions for preventing work-related rhinitis and rhinosinusitis. Hippokratia 2015. [DOI: 10.1002/14651858.cd011816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | - Mohamed Faizal Bakhtiar
- Institute for Medical Research; National institutes of Health, Ministry of Health; Shah Alam Malaysia
| | - Normi Mustapha
- Faculty Science and Technology; Open University Malaysia; Kuala Lumpur Malaysia
| | | | - Masita Arip
- Institute for Medical Research; National Institutes of Health, Ministry of Health; Shah Alam Malaysia
| | - Tahir Aris
- Institute for Medical Research; National Institutes of Health, Ministry of Health; Shah Alam Malaysia
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Stoleski S, Minov J, Mijakoski D, Karadzinska-Bislimovska J. Chronic Respiratory Symptoms and Lung Function in Agricultural Workers - Influence of Exposure Duration and Smoking. Open Access Maced J Med Sci 2015; 3:158-65. [PMID: 27275215 PMCID: PMC4877777 DOI: 10.3889/oamjms.2015.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 01/11/2015] [Accepted: 01/12/2015] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Job exposure in agricultural workers often leads to respiratory impairment. AIM To assess the influence of exposure duration and smoking on chronic respiratory symptoms and ventilatory capacity in agricultural workers. METHODS A cross-sectional study covered 75 agricultural workers, compared with an equal number of office workers matched by age, exposure duration and smoking status. Standardized questionnaire was used to obtain data on chronic respiratory symptoms, job and smoking history. Lung functional testing was performed by spirometry. RESULTS The prevalence of respiratory symptoms was higher in agricultural workers, with significant difference for cough (P = 0.034), and dyspnea (P = 0.028). Chronic respiratory symptoms among agricultural workers were significantly associated with duration of exposure (P < 0.05) and daily smoking (P < 0.01), as well as with daily smoking in controls (P < 0.01). The average values of spirometric parameters in exposed workers were significantly different for MEF50 (P = 0.002), MEF75 (P = 0.000), and MEF25-75 (P = 0.049). Obstructive changes in small airways in exposed workers were strongly related to exposure duration (P < 0.05) and smoking (P < 0.01). Agricultural workers with job exposure more than 15 years had more expressed adverse respiratory symptoms and lung function decline. CONCLUSION The results confirmed the influence of agricultural exposure and daily smoking on chronic respiratory symptoms and airflow limitation, primarily targeting the small airways.
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Affiliation(s)
- Saso Stoleski
- Institute for Occupational Health of Republic of Macedonia - Skopje, WHO Collaborating Center, Ga2len Collaborating Center, Skopje, Republic of Macedonia
| | - Jordan Minov
- Institute for Occupational Health of Republic of Macedonia - Skopje, WHO Collaborating Center, Ga2len Collaborating Center, Skopje, Republic of Macedonia
| | - Dragan Mijakoski
- Institute for Occupational Health of Republic of Macedonia - Skopje, WHO Collaborating Center, Ga2len Collaborating Center, Skopje, Republic of Macedonia
| | - Jovanka Karadzinska-Bislimovska
- Institute for Occupational Health of Republic of Macedonia - Skopje, WHO Collaborating Center, Ga2len Collaborating Center, Skopje, Republic of Macedonia
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Perečinský S, Legáth L, Varga M, Javorský M, Bátora I, Klimentová G. Occupational rhinitis in the Slovak Republic--a long-term retrospective study. Cent Eur J Public Health 2015; 22:257-61. [PMID: 25622484 DOI: 10.21101/cejph.a3925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Allergic and non-allergic rhinitis ranks among the common occupational health problems. However, data on the incidence of occupational rhinitis are lacking, since comprehensive studies are rare. METHODS The study includes a group of patients in the Slovak Republic who were reported as having occupational rhinitis in the years 1990-2011. The following parameters were tracked in the investigated sample: age, gender, number of cases by individual years, occupations, causative factors and the length of exposure to the given agent. Possible progression of rhinitis to bronchial asthma was evaluated as well. The diagnostic algorithm was also analysed retrospectively, which included skin tests, the examination of specific IgE antibodies and nasal provocation tests. RESULTS A total of 70 cases of occupational rhinitis were reported. The disease most often occurred in food industry workers (50% of cases). The most common aetiological factor was flour. Among other relatively common allergens were synthetic textile, wool, cotton and different types of moulds. Significant agents were also different chemical factors causing allergic and irritant rhinitis. The average length of exposure was 14.8 years. Exposure was shorter in men than in women (11 years vs. 16 years) (p = 0.04). Bronchial asthma as a comorbidity was diagnosed in 13 patients (19.7%). The critical diagnostic method on the basis of which the causal association between rhinitis and work environments was confirmed in 59% of cases was skin test; confirmation of the occupational cause using nasal provocation test was less frequent (18%). CONCLUSION Food industry, textile industry and agriculture were the most risky occupational environments. Workers in these sectors require preventive intervention. In case of showing rhinitis symptoms it is necessary to confirm the occupational aetiology of the disease by the objective diagnostic methods. Since occupational rhinitis mostly precedes the occupational asthma, the elimination from the workplace is necessary.
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Al-Abri R, Bharghava D, Kurien M, Chaly V, Al-Badaai Y, Bharghava K. Allergic rhinitis and associated comorbidities: prevalence in oman with knowledge gaps in literature. Oman Med J 2015; 29:414-8. [PMID: 25584158 DOI: 10.5001/omj.2014.111] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 11/02/2014] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Allergic rhinitis (AR) is a global health problem and its impact on health related quality of life for patients is substantial, and the economic impact often underestimated. The prevalence of allergic rhinitis in Oman is unknown. This study aimed to estimate the prevalence of AR and associated co-morbidities among adults in Oman. Its secondary objective was to identify knowledge gaps in the literature with the aim of directing future research. METHODS A prospective, cross-sectional study of patients who presented to the outpatient otolaryngology clinic at Sultan Qaboos University Hospital with nasal symptoms between June 2010 and June 2011 was conducted. RESULTS A total of 887 patients were seen with nasal complaints. Among them 127 patients were diagnosed with non-infective rhinitis, the mean age of presentation was 27 years. AR was noted in 48% of patients, and non-allergic rhinitis in 52%. The prevalence of AR was 7%, with females being more affected than males, and age ranging from 18 to 51 years. Prevalence of perennial AR was 84% compared to seasonal AR which was 16%. The most common perennial antigens were house dust mites (80%) followed by cockroaches (67%). All patients diagnosed with seasonal AR were found to be sensitive to Russian thistle. The prevalence of chronic rhinosinusitis in patients with AR was 34%. CONCLUSION The prevalence of AR in the adult population presenting with nasal symptoms was found to be 7%, with associated chronic rhinosinusitis present in a third of these patients. However, there appears to be substantial knowledge gaps regarding the association of other comorbidities, like otitis media, bronchitis and bronchial asthma, the long-term outcomes of medical management, and indication of surgical intervention in patients with AR. Future research in AR among Omani patients should aim to address these issues.
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Affiliation(s)
- Rashid Al-Abri
- ENT Division, Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman
| | - Deepa Bharghava
- ENT Division, Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman
| | - Mary Kurien
- ENT Division, Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman
| | - Vivek Chaly
- ENT Division, Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman
| | - Yahya Al-Badaai
- ENT Division, Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman
| | - Kamlesh Bharghava
- Department of Family Medicine, Sultan Qaboos University Hospital, Muscat, Oman
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Abstract
The upper airway (extending from the nares to larynx) fulfills essential physiologic functions, including sensation, air conditioning, filtration, and communication. As the portal of entry for the respiratory tract, the upper airway's sentinel function is performed by the olfactory and trigeminal nerves. Sensory (eye, nose and throat) irritation figures prominently in symptom reporting in so-called "problem buildings," as well as in industrial exposures to irritant gases, vapors, and smokes. Both irritants and allergens can alter function in the upper airway, leading to loss of air conditioning and filtering due to airflow obstruction and hypersecretion. Increasing evidence points to a "unified airway" model of pathogenesis (in which rhinitis may precede the development of asthma). The spectrum of occupational irritant- and allergen-related upper airway health effects-including sensory irritation, olfactory dysfunction, rhinitis, sinusitis, nasal septal perforation, and sinonasal cancer-is reviewed in this article.
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Affiliation(s)
- Dennis Shusterman
- Division of Occupational and Environmental Medicine, University of California, San Francisco, CA, USA,
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Hox V, Steelant B, Fokkens W, Nemery B, Hellings PW. Occupational upper airway disease: how work affects the nose. Allergy 2014; 69:282-91. [PMID: 24397491 DOI: 10.1111/all.12347] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2013] [Indexed: 01/24/2023]
Abstract
Chronic inflammation of the upper airways is common and can arbitrarily be divided into rhinitis and rhinosinusitis. Infection and allergy represent two well-characterized and most frequently diagnosed etiologies of upper airway inflammation. Persistent upper airway inflammation caused by agents inhaled in the work environment represents a diagnostic challenge in clinical practice, and its pathophysiology has been little studied. Occupational rhinitis is a recognized medical condition with diagnostic and therapeutic guidelines. In contrast, only limited evidence is available about the relationship between work exposures and rhinosinusitis. This review aims at providing a comprehensive overview of the available literature on occupational upper airway disease with a focus on pathophysiological mechanisms and with an emphasis on the current unmet needs in work-related upper airway disease.
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Affiliation(s)
- V. Hox
- Department of Otorhinolaryngology, Head and Neck Surgery; University Hospitals Leuven; Leuven Belgium
- Laboratory of Clinical Immunology; Department of Microbiology and Immunology; KU Leuven; Leuven Belgium
| | - B. Steelant
- Laboratory of Clinical Immunology; Department of Microbiology and Immunology; KU Leuven; Leuven Belgium
| | - W. Fokkens
- Department of Otorhinolaryngology; Academic Medical Centre; Amsterdam the Netherlands
| | - B. Nemery
- Research Unit of Lung Toxicology; Department of Public Health and Primary Care; KU Leuven; Leuven Belgium
| | - P. W. Hellings
- Department of Otorhinolaryngology, Head and Neck Surgery; University Hospitals Leuven; Leuven Belgium
- Laboratory of Clinical Immunology; Department of Microbiology and Immunology; KU Leuven; Leuven Belgium
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Helaskoski E, Suojalehto H, Virtanen H, Airaksinen L, Kuuliala O, Aalto-Korte K, Pesonen M. Occupational asthma, rhinitis, and contact urticaria caused by oxidative hair dyes in hairdressers. Ann Allergy Asthma Immunol 2014; 112:46-52. [DOI: 10.1016/j.anai.2013.10.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 08/29/2013] [Accepted: 10/03/2013] [Indexed: 10/26/2022]
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Folletti I, Zock JP, Moscato G, Siracusa A. Asthma and rhinitis in cleaning workers: a systematic review of epidemiological studies. J Asthma 2013; 51:18-28. [PMID: 23931651 DOI: 10.3109/02770903.2013.833217] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This article presents a systematic review of epidemiological studies linking cleaning work and risk of asthma and rhinitis. METHODS Published reports were identified from PubMed covering the years from 1976 through June 30, 2012. In total, we identified 24 papers for inclusion in the review. The quality of studies was evaluated using the Strengthening of the Reporting of Observational Studies in Epidemiology (STROBE) statement checklist of 22 items for cross-sectional, cohort and case-control studies. RESULTS Increased risk of asthma or rhinitis has been shown in 79% of included epidemiological studies. In four studies the increased risk of asthma in cleaning workers was confirmed by objective tests, such as bronchial hyper-reactivity or airflow obstruction. Level of exposure to cleaning products, cleaning sprays, bleach, ammonia, mixing products and specific job tasks has been identified as specific causes of asthma and rhinitis. CONCLUSIONS Possible preventive measures encompass the substitution of cleaning sprays, bleach and ammonia, avoidance of mixing products, the use of respiratory protective devices, worker education and medical surveillance.
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Affiliation(s)
- Ilenia Folletti
- Occupational Allergology Unit, Department of Clinical and Experimental Medicine, University of Perugia , Perugia , Italy
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Abstract
PURPOSE OF REVIEW Recently there has been growing interest in non-IgE-mediated and irritant-induced occupational rhinitis due to old and new low-molecular-weight and irritant agents. The purpose of this review is to summarize the scientific evidence on agents and work activities responsible for non-IgE-mediated and irritant-induced occupational rhinitis and work-exacerbated rhinitis published in 2011 and 2012. RECENT FINDINGS Several epidemiological, surveillance and experimental studies, case reports and reviews showed that workers exposed to drugs, wood dust, chemicals, metals and biocides are at high risk of non-IgE-mediated and irritant-induced occupational rhinitis; among activities at risk are healthcare, antibiotic manufacturing and cleaning workers. Work-exacerbated rhinitis has not been specifically studied, but it is reasonable to expect that it is frequently associated with work-exacerbated asthma. Recently, work-related anosmia/microsmia, nasal polyps and sinusitis have also been described. Reducing or eliminating workplace exposure to the specific agent has been confirmed to be effective in preventing symptoms of nonallergic occupational rhinitis. SUMMARY In consideration of the relevance of non-IgE-mediated and irritant-induced work-related rhinitis, physicians should recognize work-related rhinitis symptoms due to old and new low-molecular-weight and irritant agents. The mechanisms of non-IgE-mediated and irritant-induced occupational rhinitis remain largely unclear and need to be studied further. Substitution of responsible agents, reduction or elimination of exposure at the workplace should be enforced as effective measures.
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Quandt SA, Kucera KL, Haynes C, Klein BG, Langley R, Agnew M, Levin JL, Howard T, Nussbaum MA. Occupational health outcomes for workers in the agriculture, forestry and fishing sector: implications for immigrant workers in the southeastern US. Am J Ind Med 2013; 56:940-59. [PMID: 23450720 DOI: 10.1002/ajim.22170] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2013] [Indexed: 11/05/2022]
Abstract
BACKGROUND Workers in the Agriculture, Forestry, and Fisheries (AgFF) sector experience exposures directly related to the work itself, as well as the physical environment in which the work occurs. Health outcomes vary from immediate to delayed, and from acute to chronic. METHODS We reviewed existing literature on the health outcomes of work in the AgFF sector and identified areas where further research is needed to understand the impact of these exposures on immigrant Latino workers in the southeastern US. RESULTS Outcomes related to specific body systems (e.g., musculoskeletal, respiratory) as well as particular exposure sources (e.g., pesticides, noise) were reviewed. The most extensive evidence exists for agriculture, with a particular focus on chemical exposures. Little research in the southeastern US has examined health outcomes of exposures of immigrant workers in forestry or fisheries. CONCLUSION As the AgFF labor force includes a growing number of Latino immigrants, more research is needed to characterize a broad range of exposures and health outcomes experienced by this population, particularly in forestry and fisheries.
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Affiliation(s)
| | - Kristen L. Kucera
- Division of Occupational and Environmental Medicine; Department of Community and Family Medicine; Duke University; Durham; North Carolina
| | - Courtney Haynes
- Department of Industrial and Systems Engineering; School of Biomedical Engineering and Sciences; Virginia Tech; Blacksburg, Virginia
| | - Bradley G. Klein
- Department of Biomedical Sciences and Pathobiology; Virginia-Maryland Regional College of Veterinary Medicine; Virginia Tech; Blacksburg, Virginia
| | - Ricky Langley
- Division of Public Health; North Carolina Department of Health and Human Services; Raleigh; North Carolina
| | - Michael Agnew
- Department of Industrial and Systems Engineering; School of Biomedical Engineering and Sciences; Virginia Tech; Blacksburg, Virginia
| | - Jeffrey L. Levin
- Department of Occupational Health Sciences; University of Texas Health Science Center at Tyler; Tyler; Texas
| | | | - Maury A. Nussbaum
- Department of Industrial and Systems Engineering; School of Biomedical Engineering and Sciences; Virginia Tech; Blacksburg, Virginia
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Akpinar-Elci M, White SK, Siegel PD, Park JH, Visotcky A, Kreiss K, Cox-Ganser JM. Markers of upper airway inflammation associated with microbial exposure and symptoms in occupants of a water-damaged building. Am J Ind Med 2013; 56:522-30. [PMID: 23390064 DOI: 10.1002/ajim.22165] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2013] [Indexed: 11/12/2022]
Abstract
BACKGROUND Water damage in buildings has been associated with reports of upper airway inflammation among occupants. METHODS This survey included a questionnaire, allergen skin testing, nasal nitric oxide, and nasal lavage on 153 participants. We conducted exposure assessments of 297 workstations and analyzed collected dust for fungi, endotoxin, and (1 → 3)-β-D-glucan to create floor-specific averages. RESULTS Males had higher levels of nasal inflammatory markers, and females reported more symptoms. ECP, IL-8, and MPO were significantly associated with nasal symptoms, flu-like achiness, or chills. Fungi and glucan were positively associated with blowing out thick mucus. Endotoxin was significantly associated with ECP in overall models, and with ECP, IL-8, MPO, and neutrophils among non-atopic females. CONCLUSIONS In this study, we documented an association between endotoxin and nasal inflammatory markers among office workers. The results of our study suggest that a non-allergic response may contribute to symptoms occurring among occupants in this water-damaged building.
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Affiliation(s)
| | - Sandra K. White
- Division of Respiratory Disease Studies; National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention; Morgantown, WV
| | - Paul D. Siegel
- Health Effects Laboratory Division; National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention; Morgantown, WV
| | - Ju-Hyeong Park
- Division of Respiratory Disease Studies; National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention; Morgantown, WV
| | - Alexis Visotcky
- Division of Respiratory Disease Studies; National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention; Morgantown, WV
| | - Kathleen Kreiss
- Division of Respiratory Disease Studies; National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention; Morgantown, WV
| | - Jean M. Cox-Ganser
- Division of Respiratory Disease Studies; National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention; Morgantown, WV
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Zhao YA, Shusterman D. Occupational rhinitis and other work-related upper respiratory tract conditions. Clin Chest Med 2013; 33:637-47. [PMID: 23153606 DOI: 10.1016/j.ccm.2012.09.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The nose and upper airways form the initial area of impact for air pollutants and allergens. The development of nasal allergies in the workplace (occupational rhinitis) may herald subsequent development of occupational asthma. Exposure controls, periodic surveillance, and early intervention may circumvent work-related airways disease and prevent unnecessary worker impairment and disability.
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Affiliation(s)
- Yu A Zhao
- Division of Occupational and Environmental Medicine, University of California, San Francisco, CA 94143, USA
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Antolin-Amerigo D, Rodríguez-Rodríguez M, Barbarroja Escudero J, Pérez Bustamante M, Jimeno Nogales L, Guerrero Ríos J, Mohedano-Vicente E, Alvarez-Mon M. Occupational rhinitis caused by rice flour in a pizzeria worker. Allergol Immunopathol (Madr) 2013; 41:130-3. [PMID: 22503558 DOI: 10.1016/j.aller.2012.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Revised: 01/18/2012] [Accepted: 01/20/2012] [Indexed: 10/28/2022]
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Ameille J, Hamelin K, Andujar P, Bensefa-Colas L, Bonneterre V, Dupas D, Garnier R, Loddé BA, Rinaldo M, Descatha A, Lasfargues G, Pairon JC. Occupational asthma and occupational rhinitis: the united airways disease model revisited. Occup Environ Med 2013; 70:471-5. [PMID: 23390199 DOI: 10.1136/oemed-2012-101048] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Whereas accumulating evidence indicates close associations between rhinitis and asthma, little is known about the relationships between occupational rhinitis (OR) and occupational asthma (OA). This study analyses the prevalence of OR associated with OA, globally and according to the various causal agents, and investigates the temporal relationships between these two conditions. METHODS Data on incident cases of OA (2008-2010) were collected through the French national occupational disease surveillance and prevention network, using a standardised form including information on occupation, causal agents, presence of OR, and respective dates of occurrence of rhinitis and asthma. RESULTS Among the 596 reported OA cases with latency period, 555 could be attributed to identified agents: high molecular weight (HMW) agents (n=174); low molecular weight (LMW) agents (n=381). Overall, OR was associated with OA in 324 (58.4%) cases. The frequency of association was significantly higher for HMW agents than for LMW agents (72.2% vs 51.5%, p<0.001). OR occurred before OA significantly more frequently for HMW agents than for LMW agents (p<0.01). CONCLUSIONS These results show that OR is frequently associated with OA, especially when HMW agents are involved. They are consistent with the hypothesis that OR, in conjunction with OA, is more likely to be caused by sensitisers that cause disease via IgE-mediated mechanisms and suggest that symptoms of OR should be taken into account in the medical surveillance of workers exposed to HMW agents.
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Affiliation(s)
- Jacques Ameille
- AP-HP, Occupational Health Department, Unité de pathologie professionnelle, Hôpital Raymond Poincaré, Garches, France.
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Nam YH, Kim JE, Kim SH, Jin HJ, Hwang EK, Shin YS, Ye YM, Park HS. Identifying genetic susceptibility to sensitization to cephalosporins in health care workers. J Korean Med Sci 2012; 27:1292-9. [PMID: 23166408 PMCID: PMC3492661 DOI: 10.3346/jkms.2012.27.11.1292] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 08/27/2012] [Indexed: 12/21/2022] Open
Abstract
Exposure to cephalosporins could cause occupational allergic diseases in health care workers (HCWs). We evaluated the prevalence of serum specific IgE and IgG antibodies to cephalosporin-human serum albumin (HSA) conjugate and to identify potential genetic risk factors associated with sensitization to cephalosporins in exposed HCWs. The study population consisted of 153 HCWs who had been exposed to antibiotics in a single university hospital and 86 unexposed healthy controls. A questionnaire survey of work-related symptoms (WRS) was administered. A skin-prick test (SPT) was performed, and serum-specific IgE and IgG antibodies to 3 commonly prescribed cephalosporins were measured by ELISA. Four single-nucleotide polymorphisms of the candidate genes related to IgE sensitization were genotyped. The prevalence of WRS to cephalosporins was 2.6%. The prevalence rates of serum-specific IgE and IgG antibodies to cephalosporins were 20.3% and 14.7%, respectively. The FcεR1β-109T > C polymorphism was significantly associated with IgE sensitization to cephalosporins in HCWs (P = 0.036, OR = 3.553; CI, 1.324-9.532). The in vitro functional assay demonstrated that the T allele of FcεR1β-109T had greater promoter activity than did the C allele (P < 0.001). The FcεR1β-109T > C polymorphism may be a potential genetic risk factor for increased IgE sensitization to cephalosporins.
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Affiliation(s)
- Young-Hee Nam
- Department of Allergy & Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Jeong-Eun Kim
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Seung-Hyun Kim
- Department of Allergy & Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Hyun Jung Jin
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Eui-Kyung Hwang
- Department of Allergy & Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Yoo-Seob Shin
- Department of Allergy & Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Young-Min Ye
- Department of Allergy & Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Hae-Sim Park
- Department of Allergy & Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
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48
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Ochmann U, Nowak D. Berufsbedingte Allergien der Atemwege. ALLERGO JOURNAL 2012. [DOI: 10.1007/s15007-012-0354-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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49
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Hox V, Delrue S, Scheers H, Adams E, Keirsbilck S, Jorissen M, Hoet PH, Vanoirbeek JA, Nemery B, Hellings PW. Negative impact of occupational exposure on surgical outcome in patients with rhinosinusitis. Allergy 2012; 67:560-5. [PMID: 22229752 DOI: 10.1111/j.1398-9995.2011.02779.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is a frequent condition that is treated by functional endoscopic sinus surgery (FESS) when medical treatment fails. Endogenous as well as exogenous factors may be responsible for persisting symptoms after FESS. The role of occupational exposures on success of FESS has never been investigated. METHODS In this case-control study, we tested the hypothesis that the outcome of FESS procedures is related to exposures at work. Questionnaires were sent to 890 patients who had undergone one or more FESS procedures and to 182 controls. Three independent experts assessed blindly the reported work exposures to inhaled agents. The relationship between exposure and the number of FESS procedures was analyzed. RESULTS Relevant occupational exposure was reported by 25% of all responding patients undergoing FESS (n = 467) and 12% of controls (n = 69). The prevalence of occupational exposures increased linearly with the number of FESS procedures from 21% in those who had one FESS to 44% in those who had four or more FESS (χ(2) = 12.74, P < 0.001). Logistic regression analysis with adjustments for potential confounders, including smoking, atopy, and asthma, confirmed that the odds ratio (OR) for reporting occupational exposures was significantly higher in those needing more than one FESS (OR = 1.64) or more than two FESS (OR = 1.97). These results were mainly driven by exposure to low molecular weight agents. CONCLUSION Exposure at work appears to be a risk factor for the occurrence of CRS and for its recurrence or persistence, as evidenced by the need for revision surgery.
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Affiliation(s)
| | - S. Delrue
- Department of Otorhinolaryngology, Head and Neck Surgery; University Hospitals Leuven; Leuven; Belgium
| | - H. Scheers
- Department of Public Health; Research Unit of Lung Toxicology; University of Leuven; Leuven; Belgium
| | - E. Adams
- Division of Pneumology; Clinic of Occupational and Environmental Medicine; University Hospitals Leuven; Leuven; Belgium
| | - S. Keirsbilck
- Division of Pneumology; Clinic of Occupational and Environmental Medicine; University Hospitals Leuven; Leuven; Belgium
| | - M. Jorissen
- Department of Otorhinolaryngology, Head and Neck Surgery; University Hospitals Leuven; Leuven; Belgium
| | - P. H. Hoet
- Department of Public Health; Research Unit of Lung Toxicology; University of Leuven; Leuven; Belgium
| | - J. A. Vanoirbeek
- Department of Public Health; Research Unit of Lung Toxicology; University of Leuven; Leuven; Belgium
| | | | - P. W. Hellings
- Department of Otorhinolaryngology, Head and Neck Surgery; University Hospitals Leuven; Leuven; Belgium
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50
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Abstract
Work-related rhinitis, which includes work-exacerbated rhinitis and occupational rhinoconjunctivitis (OR), is two to three times more common than occupational asthma. High molecular weight proteins and low molecular weight chemicals have been implicated as causes of OR. The diagnosis of work-related rhinitis is established based on occupational history and documentation of immunoglobulin E (IgE) mediated sensitization to the causative agent if possible. Management of work-related rhinitis is similar to that of other causes of rhinitis and includes elimination or reduction of exposure to causative agents combined with pharmacotherapy. If allergens are commercially available, allergen immunotherapy can be considered.
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Affiliation(s)
- J Wesley Sublett
- Division of Immunology, Allergy and Rheumatology, University of Cincinnati College of Medicine, 3255 Eden Avenue, Cincinnati, OH 45267-0563, USA
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