1
|
O'Byrne PM. Asthma remission. J Bras Pneumol 2024; 50:e20240004. [PMID: 38536985 PMCID: PMC11095932 DOI: 10.36416/1806-3756/e20240004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024] Open
Affiliation(s)
- Paul M O'Byrne
- Firestone Institute for Respiratory Health and the Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
2
|
Smith ML, Chi G. Spatial proximity to wildfires as a proxy for measuring PM 2.5: A novel method for estimating exposures in rural settings. THE JOURNAL OF CLIMATE CHANGE AND HEALTH 2023; 11:100219. [PMID: 38249516 PMCID: PMC10798235 DOI: 10.1016/j.joclim.2023.100219] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Background Climate change impacts humans and society both directly and indirectly. Alaska, for example, is warming twice as fast as the global mean, and researchers are starting to grapple with the varied and inter-connected ways in which climate change affects the people there. With the number of wildfires increasing in Alaska as a result of climate change, the number of asthma cases has increased, driven by exposure to small particulate matter. However, it is not clear how far away smoke from wildfires can affect health. In this study, we hope to establish a relationship between proximity to wildfires and asthma in locations where direct PM2.5 measurement is not easily accomplished. Methods In this study, we examined whether proximity to wildfire exposure is associated with regional counts of adults with asthma, calculated using Behavioral Risk Factor Surveillance System (BRFSS) survey data and US Census data. We assigned "hotspots" around population centers with a range of various distances to wildfires in Alaska. Results We found that wildfires are associated with asthma prevalence, and the association is strongest within 25 miles of fires. Conclusions This study highlights the fact that proximity to wildfires has potential as a simple proxy for actual measured wildfire smoke, which has important implications for wildfire management agencies and for policy makers who must address health issues associated with wildfires, especially in rural areas.
Collapse
Affiliation(s)
- M. Luke Smith
- Social Science Research Institute, The Pennsylvania State University, University Park, PA 16802, USA
| | - Guangqing Chi
- Social Science Research Institute, The Pennsylvania State University, University Park, PA 16802, USA
- Department of Agricultural Economics, Sociology, and Education, The Pennsylvania State University, University Park, PA 16802, USA
- Population Research Institute, The Pennsylvania State University, University Park, PA 16802, USA
| |
Collapse
|
3
|
Thunderstorms, Pollen, and Severe Asthma in a Midwestern, USA, Urban Environment, 2007-2018. Epidemiology 2022; 33:624-632. [PMID: 35580240 DOI: 10.1097/ede.0000000000001506] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Previous research has shown an association between individual thunderstorm events in the presence of high pollen, commonly called thunderstorm asthma, and acute severe asthma events, but little work has studied risk over long periods of time, using detailed measurements of storms and pollen. METHODS We estimated change in risk of asthma-related emergency room visits related to thunderstorm asthma events in the Minneapolis-St. Paul metropolitan area over the years 2007-2018. We defined thunderstorm asthma events as daily occurrence of two or more lightning strikes during high pollen periods interpolating weather and pollen monitor data and modeling lightning counts. We acquired daily counts of asthma-related emergency department visits from the Minnesota Hospital Association and used a quasi-Poisson time-series regression to estimate overall relative risk of emergency department visits during thunderstorm asthma events. RESULTS We observed a 1.047 times higher risk (95% CI:1.012,1.083) of asthma-related emergency department visits on the day of thunderstorm asthma event. Our findings are robust to adjustment for temperature, humidity, wind, precipitation, ozone, PM2.5, day of week, and seasonal variation in asthma cases. Occurrence of lightning alone or pollen alone showed no association with risk of severe asthma. A two-stage analysis combining individual zip code level results shows similar RR and we see no evidence of spatial correlation or spatial heterogeneity of effect. DISCUSSION Our results support an association between co-occurrence of lightning and pollen and risk of severe asthma events. Our approach incorporates lightning and pollen data and small-spatial area exposure and outcome counts.
Collapse
|
4
|
Association of GSTM1 and GSTT1 Null Genotypes with Toluene Diisocyanate-Induced Asthma. Can Respir J 2022; 2022:7977937. [PMID: 35186174 PMCID: PMC8856815 DOI: 10.1155/2022/7977937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 01/15/2022] [Indexed: 12/11/2022] Open
Abstract
Background. Toluene diisocyanate (TDI) causes occupational asthma by generating oxidative stress, leading to tissue injury and inflammation. Glutathione transferases (GSTs) are detoxifying enzymes that eliminate oxidative stress. We examined whether the genotypes of the GSTM1 and GSTT1 genes are associated with TDI-induced occupational asthma (TDI-OA). Methods. The study population consisted of 26 asthmatics with a positive response to the TDI challenge (TDI-PA) and 27 asthmatics with negative responses (TDI-NA). GSTM1 and GSTT1 null and wild-type genotypes were determined using multiplex PCR. The plasma GSTM1 and GSTT1 protein concentrations were determined using ELISA. Results. The GSTM1 null genotype was more frequent in the TDI-PA than in the TDI-NA (77.8 vs. 50.0%, OR = 3.5,
), while the frequency of the GSTT1 null genotype tended to be higher in the TDI-PA than in the TDI-NA (59.3 vs. 42.3%, OR = 1.98,
). When analyzed together, the GSTM1/GSTT1 null genotype was more frequent in the TDI-PA than in the TDI-NA (48.2 vs. 15.3%, OR = 6.5,
). The decline in the FEV in 1 s after TDI challenge was higher with the GSTM1/GSTT1 null than the GSTM1 wild-type/GSTT1 null genotypes (24.29% vs. 7.47%,
). The plasma GSTM1 level was lower with the GSTM1 null than with the GSTM1 wild-type genotypes both before (13.7 vs. 16.6 ng/mg,
) and after (12.9 vs. 17.1 ng/mg,
) the TDI challenge, while the GSTT1 level was not changed with either the GSTT1 null or wild-type genotype. Conclusions. The GSTM1 null genotype, but not GSTT1 alone, may confer susceptibility to TDI-OA. However, the genetic effect of the GSTM1 null genotype may be enhanced synergistically by the GSTT1 null genotype. The genetic effect of GSTM1 was validated in the plasma as the GSTM1 protein level. Therefore, the GSTM1 and GSTT1 genotypes may be useful diagnostic markers for TDI-OA.
Collapse
|
5
|
Ma R, Liang L, Kong Y, Chen M, Zhai S, Song H, Hou Y, Zhang G. Spatiotemporal variations of asthma admission rates and their relationship with environmental factors in Guangxi, China. BMJ Open 2020; 10:e038117. [PMID: 33033020 PMCID: PMC7542934 DOI: 10.1136/bmjopen-2020-038117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 08/13/2020] [Accepted: 08/21/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The study aimed to determine if and how environmental factors correlated with asthma admission rates in geographically different parts of Guangxi province in China. SETTING Guangxi, China. PARTICIPANTS This study was done among 7804 asthma patients. PRIMARY AND SECONDARY OUTCOME MEASURES Spearman correlation coefficient was used to estimate correlation between environmental factors and asthma hospitalisation rates in multiple regions. Generalised additive model (GAM) with Poisson regression was used to estimate effects of environmental factors on asthma hospitalisation rates in 14 regions of Guangxi. RESULTS The strongest effect of carbon monoxide (CO) was found on lag1 in Hechi, and every 10 µg/m3 increase of CO caused an increase of 25.6% in asthma hospitalisation rate (RR 1.26, 95% CI 1.02 to 1.55). According to the correlation analysis, asthma hospitalisations were related to the daily temperature, daily range of temperature, CO, nitrogen dioxide (NO2) and particulate matter (PM2.5) in multiple regions. According to the result of GAM, the adjusted R2 was high in Beihai and Nanning, with values of 0.29 and 0.21, which means that environmental factors are powerful in explaining changes of asthma hospitalisation rates in Beihai and Nanning. CONCLUSION Asthma hospitalisation rate was significantly and more strongly associated with CO than with NO2, SO2 or PM2.5 in Guangxi. The risk factors of asthma exacerbations were not consistent in different regions, indicating that targeted measures should differ between regions.
Collapse
Affiliation(s)
- Rui Ma
- Key Laboratory of Geospatial Technology for the Middle and Lower Yellow River Regions, Henan University, Kaifeng, China
| | - Lizhong Liang
- The Affiliated Hospital, Guangdong Medical University, Zhanjiang, China
| | - Yunfeng Kong
- Key Laboratory of Geospatial Technology for the Middle and Lower Yellow River Regions, Henan University, Kaifeng, China
| | - Mingyang Chen
- The Affiliated Hospital, Guangdong Medical University, Zhanjiang, China
| | - Shiyan Zhai
- Key Laboratory of Geospatial Technology for the Middle and Lower Yellow River Regions, Henan University, Kaifeng, China
| | - Hongquan Song
- Key Laboratory of Geospatial Technology for the Middle and Lower Yellow River Regions, Henan University, Kaifeng, China
| | - Yane Hou
- College of Computer and Information Engineering, Henan University, Kaifeng, China
| | - Guangli Zhang
- Key Laboratory of Geospatial Technology for the Middle and Lower Yellow River Regions, Henan University, Kaifeng, China
| |
Collapse
|
6
|
Hoy R, Burdon J, Chen L, Miles S, Perret JL, Prasad S, Radhakrishna N, Rimmer J, Sim MR, Yates D, Zosky G. Work-related asthma: A position paper from the Thoracic Society of Australia and New Zealand and the National Asthma Council Australia. Respirology 2020; 25:1183-1192. [PMID: 33020986 PMCID: PMC7702173 DOI: 10.1111/resp.13951] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/24/2020] [Accepted: 08/31/2020] [Indexed: 01/10/2023]
Abstract
Work-related asthma (WRA) is one of the most common occupational respiratory conditions, and includes asthma specifically caused by occupational exposures (OA) and asthma that is worsened by conditions at work (WEA). WRA should be considered in all adults with asthma, but especially those with new-onset or difficult to control asthma. Improvement in asthma symptoms when away from work is suggestive of WRA. Clinical history alone is insufficient to diagnose WRA; therefore, objective investigations are required to confirm the presence of asthma and the association of asthma with work activities. Management of WRA requires pharmacotherapy similar to that of non-WRA, however, also needs to take into account control of the causative workplace exposure. Ongoing exposure will likely lead to decline in lung function and worsening asthma control. WRA is a preventable condition but this does rely on increased awareness of WRA and thorough identification and control of all potential occupational respiratory hazards.
Collapse
Affiliation(s)
- Ryan Hoy
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Allergy, Asthma and Clinical Immunology, The Alfred Hospital, Melbourne, VIC, Australia
| | | | - Ling Chen
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia
| | - Susan Miles
- Department of Medicine, Calvary Mater Newcastle, Newcastle, NSW, Australia
| | - Jennifer L Perret
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, VIC, Australia
| | - Shivonne Prasad
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Naghmeh Radhakrishna
- Allergy, Asthma and Clinical Immunology, The Alfred Hospital, Melbourne, VIC, Australia
| | - Janet Rimmer
- Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Malcolm R Sim
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Deborah Yates
- Department of Thoracic Medicine, St Vincent's Hospital, Sydney, NSW, Australia
| | - Graeme Zosky
- Menzies Institute for Medical Research, Tasmanian School of Medicine, University of Tasmania, Hobart, TAS, Australia
| |
Collapse
|
7
|
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.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Incidence of Occupational Asthma and Exposure to Toluene Diisocyanate in the United States Toluene Diisocyanate Production Industry. J Occup Environ Med 2018; 59 Suppl 12:S22-S27. [PMID: 29200135 PMCID: PMC5763544 DOI: 10.1097/jom.0000000000000890] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective This study examines asthma risk in facilities producing toluene diisocyanate (TDI). Methods A total of 197 workers were monitored from 2007 to 2012. TDI air concentrations were used to estimate exposures. Results The incidence of cases consistent with TDI-induced asthma was 0.009 per person-years (seven cases) or consistent with TDI-induced asthma or asthma indeterminate regarding work-relatedness was 0.012 (nine cases). Increased risk of cases consistent with TDI asthma was observed for cumulative (odds ratio [OR] = 2.08, 95% confidence interval [CI] 1.07 to 4.05) per logarithm parts per billion-years and peak TDI exposures (OR = 1.18, 95% CI 1.06 to 1.32) (logarithm parts per billion). There was a weak association with cumulative and peak exposures for decline of short-term forced expiratory volume in one second (FEV1). Asthma symptoms were associated with workers noticing an odor of TDI (OR 6.02; 95% CI 1.36 to 26.68). Conclusions There is evidence that cumulative and peak exposures are associated with TDI-induced asthma.
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Vandenplas O, Suojalehto H, Cullinan P. Diagnosing occupational asthma. Clin Exp Allergy 2017; 47:6-18. [PMID: 27883240 DOI: 10.1111/cea.12858] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Making an accurate diagnosis of occupational asthma (OA) is, generally, important. The condition has not only significant health consequences for affected workers, but also substantial socio-economic impacts for workers, their employers and wider society. Missing a diagnosis of OA may lead to continued exposure to a causative agent and progressive worsening of disease; conversely, diagnosing OA when it is not present may lead to inappropriate removal from exposure and unnecessary financial and social consequences. While the most accurate investigation is specific inhalation challenge in an experienced centre, this is a scarce resource, and in many cases, reliance is on other tests. This review provides a technical dossier of the diagnostic value of the available methods which include an appropriate clinical history, the use of specific immunology and measurement of inflammatory markers, and various methods of relating functional changes in airway calibre to periods at work. It is recommended that these approaches are used iteratively and in judicious combination, in cognizance of the individual patient's circumstances and requirements. Based on available evidence, a working diagnostic algorithm is proposed that can be adapted to the suspected agent, purpose of diagnosis and available resources. For better or worse, many of the techniques - and their interpretation - are available only in specialized centres and where there is room for doubt, referral to such a centre is probably wise. Accordingly, the implementation or development of such specialized centres with appropriate equipment and expertise should greatly improve the diagnostic evaluation of work-related asthma.
Collapse
Affiliation(s)
- O Vandenplas
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - H Suojalehto
- Occupational Medicine, Finnish Institute of Occupational Health, Helsinki, Finland
| | - P Cullinan
- Department of Occupational and Environmental Medicine, Royal Brompton Hospital and Imperial College (NHLI), London, UK
| |
Collapse
|
11
|
Maher M, Olfa EM, Wided B, Souhail C, Ezzeddine G, Houda K, Houda K, Jabrane M, Ammar A, Aicha B, Mouna L, Habib HS, Khaled BK, Tasnim M, Mohamed B, Faten D, Néjib M. Epidemiology of Occupational Asthma in Tunisia: Results of a First National Study. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/odem.2016.42004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
12
|
Investigation of occupational asthma: Do clinicians fail to identify relevant occupational exposures? Can Respir J 2015; 22:341-7. [PMID: 26422401 DOI: 10.1155/2015/519123] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Specific inhalation challenges (SIC) enable the identification of the agent responsible of occupational asthma (OA). A clinician may fail to identify a specific agent in the workplace, which may potentially lead to a misdiagnosis. The expert assessment method performed by an occupational hygienist has been used to evaluate occupational exposures in epidemiological studies. OBJECTIVE The broad aim of the present study was to evaluate the contribution of an expert assessment performed by an occupational hygienist to the diagnosis of OA. The specific aim was to compare workplace exposures identified by an occupational hygienist and by chest physicians in subjects with positive SICs and subjects with asthma, but with a negative SIC. METHODS SICs were performed in 120 cases: 67 were positive and 53 were negative. A clinician assessed occupational exposures to sensitizers during a routine clinical evaluation preceding the performance of the SIC. An expert assessment of occupational exposures was performed by an occupational hygienist blind to the result of the SIC. RESULTS The occupational hygienist identified the causal agent in 96.7% of the 61 cases of positive SIC. In 33 (62.3%) cases of negative SICs, the occupational hygienist identified ≥1 sensitizing agent(s) that had not been identified by the clinician. CONCLUSION The hygienist identified the causal agent in almost all subjects with OA. In contrast, the clinician failed to identify potential exposures to sensitizers in >60% of the negative SIC subjects, which may have resulted in some subjects being misdiagnosed as not having OA.
Collapse
|
13
|
Dembe AE, Yao X, Wickizer TM, Shoben AB, Dong XS. Using O*NET to estimate the association between work exposures and chronic diseases. Am J Ind Med 2014; 57:1022-31. [PMID: 24842122 DOI: 10.1002/ajim.22342] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND A standardized process using data from the Occupational Information Network (O*NET) is applied to estimate the association between long-term aggregated occupational exposure and the risk of contracting chronic diseases later in life. We demonstrate this process by analyzing relationships between O*NET physical work demand ratings and arthritis onset over a 32-year period. METHODS The National Longitudinal Survey of Youth provided job histories and chronic disease data. Five O*NET job descriptors were used as surrogate measures of physical work demands. Logistic regression measured the association between those demands and arthritis occurrence. RESULTS The risk of arthritis was significantly associated with handling and moving objects, kneeling, crouching, and crawling, bending and twisting, working in a cramped or awkward posture, and performing general physical activities. CONCLUSION This study demonstrates the utility of using O*NET job descriptors to estimate the aggregated long-term risks for osteoarthritis and other chronic diseases when no actual exposure data is available.
Collapse
Affiliation(s)
- Allard E. Dembe
- Center for Health Outcomes, Policy and Evaluation Studies; The Ohio State University; College of Public Health; Columbus Ohio
| | - Xiaoxi Yao
- Division of Health Services, Management and Policy; The Ohio State University; College of Public Health; Columbus Ohio
| | - Thomas M. Wickizer
- Division of Health Services, Management and Policy; The Ohio State University; College of Public Health; Columbus Ohio
| | - Abigail B. Shoben
- Division of Biostatistics; The Ohio State University; College of Public Health; Columbus Ohio
| | - Xiuwen Sue Dong
- Data Center; CPWR-The Center for Construction Research and Training; Silver Spring Maryland
| |
Collapse
|
14
|
Moscato G, Pala G, Barnig C, Blay F, Del Giacco SR, Folletti I, Heffler E, Maestrelli P, Pauli G, Perfetti L, Quirce S, Sastre J, Siracusa A, Walusiak-Skorupa J, Wjik RG. EAACI consensus statement for investigation of work-related asthma in non-specialized centres. Allergy 2012; 67:491-501. [PMID: 22257175 DOI: 10.1111/j.1398-9995.2011.02784.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2011] [Indexed: 11/28/2022]
Abstract
Work-related asthma (WRA) is a relevant problem in several countries, is cause of disability and socioeconomic consequences for both the patient and the society and is probably still underdiagnosed. A correct diagnosis is extremely important to reduce or limit the consequences of the disease. This consensus document was prepared by a EAACI Task Force consisting of an expert panel of allergologists, pneumologists and occupational physicians from different European countries. This document is not intended to address in detail the full diagnostic work-up of WRA, nor to be a formal evidence-based guideline. It is written to provide an operative protocol to allergologists and physicians dealing with asthma useful for identifying the subjects suspected of having WRA to address them to in-depth investigations in a specialized centre. No evidence-based system could be used because of the low grade of evidence of published studies in this area, and instead, 'key messages' or 'suggestions' are provided based on consensus of the expert panel members.
Collapse
Affiliation(s)
- G. Moscato
- Allergy and Immunology Unit; Fondazione ‘Salvatore Maugeri’; Institute of Care and Research; Scientific Institute of Pavia; Pavia; Italy
| | - G. Pala
- Allergy and Immunology Unit; Fondazione ‘Salvatore Maugeri’; Institute of Care and Research; Scientific Institute of Pavia; Pavia; Italy
| | - C. Barnig
- Division of Asthma and Allergy; Department of Chest Diseases; University Hospital Strasbourg; Strasbourg; France
| | - F. Blay
- Division of Asthma and Allergy; Department of Chest Diseases; University Hospital Strasbourg; Strasbourg; France
| | - S. R. Del Giacco
- Department of Medical Sciences ‘M. Aresu’; University of Cagliari; Cagliari; Italy
| | - I. Folletti
- Department of Clinical and Experimental Medicine; Occupational Allergy Unit; Terni Hospital; University of Perugia; Perugia; Italy
| | - E. Heffler
- Allergy and Clinical Immunology; University of Torino; ASO Mauriziano ‘Umberto I’; Torino; Italy
| | - P. Maestrelli
- Department of Environmental Medicine and Public Health; University of Padova; Padova; Italy
| | - G. Pauli
- Division of Asthma and Allergy; Department of Chest Diseases; University Hospital Strasbourg; Strasbourg; France
| | - L. Perfetti
- Allergy and Immunology Unit; Fondazione ‘Salvatore Maugeri’; Institute of Care and Research; Scientific Institute of Pavia; Pavia; Italy
| | - S. Quirce
- Department of Allergy; Hospital La Paz-IdiPAZ and CIBER de Enfermedades Respiratorias CIBERES; Madrid; Spain
| | - J. Sastre
- CIBER de Enfermedades Respiratorias; Ciberes and Department of Allergy; Fundación Jiménez Díaz; Madrid; Spain
| | - A. Siracusa
- Department of Clinical an Experimental Medicine; University of Perugia; Perugia; Italy
| | - J. Walusiak-Skorupa
- Department of Occupational Diseases; Nofer Institute of Occupational Medicine; Lodz; Poland
| | - R. Gerth Wjik
- Section of Allergology; Department of Internal Medicine; Erasmus MC; Rotterdam; the Netherlands
| | | |
Collapse
|
15
|
Van Den Heuvel RL, Lambrechts N, Verstraelen S, Nelissen IC, Schoeters GER. Chemical sensitization and allergotoxicology. EXPERIENTIA SUPPLEMENTUM (2012) 2012; 101:289-314. [PMID: 22945573 DOI: 10.1007/978-3-7643-8340-4_10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Chemical sensitization remains an important environmental and occupational health issue. A wide range of substances have been shown to possess the ability to induce skin sensitization or respiratory sensitization. As a consequence, there is a need to have appropriate methods to identify sensitizing agents. Although a considerable investment has been made in exploring opportunities to develop methods for hazard identification and characterization, there are, as yet, no validated nonanimal methods available. A state of the art of the different in vitro approaches to identify contact and respiratory capacity of chemicals is covered in this chapter.
Collapse
Affiliation(s)
- Rosette L Van Den Heuvel
- Environmental Risk and Health Unit-Toxicology, Flemish Institute for Technological Research (VITO N.V.), Centre for Advanced R&D on Alternative Methods (CARDAM), Boeretang 200, 2400, Mol, Belgium,
| | | | | | | | | |
Collapse
|
16
|
Marks GB. The allergic paradox: a key to progress in primary prevention of asthma. J Allergy Clin Immunol 2011; 128:789-90. [PMID: 21962797 DOI: 10.1016/j.jaci.2011.08.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Accepted: 08/25/2011] [Indexed: 11/25/2022]
|
17
|
Tonini S, Perfetti L, Pignatti P, Pala G, Moscato G. Occupational asthma induced by exposure to lima bean (Phaseolus lunatus). Ann Allergy Asthma Immunol 2011; 108:66-67. [PMID: 22192973 DOI: 10.1016/j.anai.2011.10.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Revised: 09/23/2011] [Accepted: 10/13/2011] [Indexed: 11/30/2022]
Affiliation(s)
- Stefano Tonini
- Occupational Medicine Unit, Fondazione Salvatore Maugeri, Institute of Care and Research, Scientific Institute of Pavia, Pavia, Italy.
| | - Luca Perfetti
- Allergy and Immunology Unit, Fondazione Salvatore Maugeri, Institute of Care and Research, Scientific Institute of Pavia, Pavia, Italy
| | - Patrizia Pignatti
- Allergy and Immunology Unit, Fondazione Salvatore Maugeri, Institute of Care and Research, Scientific Institute of Pavia, Pavia, Italy
| | - Gianni Pala
- Allergy and Immunology Unit, Fondazione Salvatore Maugeri, Institute of Care and Research, Scientific Institute of Pavia, Pavia, Italy
| | - Gianna Moscato
- Allergy and Immunology Unit, Fondazione Salvatore Maugeri, Institute of Care and Research, Scientific Institute of Pavia, Pavia, Italy
| |
Collapse
|
18
|
Henneberger PK, Redlich CA, Callahan DB, Harber P, Lemière C, Martin J, Tarlo SM, Vandenplas O, Torén K. An official american thoracic society statement: work-exacerbated asthma. Am J Respir Crit Care Med 2011; 184:368-78. [PMID: 21804122 DOI: 10.1164/rccm.812011st] [Citation(s) in RCA: 146] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Occupational exposures can contribute to the exacerbation as well as the onset of asthma. However, work-exacerbated asthma (WEA) has received less attention than occupational asthma (OA) that is caused by work. OBJECTIVES The purpose of this Statement is to summarize current knowledge about the descriptive epidemiology, clinical characteristics, and management and treatment of WEA; propose a case definition for WEA; and discuss needs for prevention and research. METHODS Information about WEA was identified primarily by systematic searches of the medical literature. Statements about prevention and research needs were reached by consensus. MEASUREMENTS AND MAIN RESULTS WEA is defined as the worsening of asthma due to conditions at work. WEA is common, with a median prevalence of 21.5% among adults with asthma. Different types of agents or conditions at work may exacerbate asthma. WEA cases with persistent work-related symptoms can have clinical characteristics (level of severity, medication needs) and adverse socioeconomic outcomes (unemployment, reduction in income) similar to those of OA cases. Compared with adults with asthma unrelated to work, WEA cases report more days with symptoms, seek more medical care, and have a lower quality of life. WEA should be considered in any patient with asthma that is getting worse or who has work-related symptoms. Management of WEA should focus on reducing work exposures and optimizing standard medical management, with a change in jobs only if these measures are not successful. CONCLUSIONS WEA is a common and underrecognized adverse outcome resulting from conditions at work. Additional research is needed to improve the understanding of the risk factors for, and mechanisms and outcomes of, WEA, and to inform and evaluate preventive interventions.
Collapse
|
19
|
Miedinger D, Lavoie KL, L'Archeveque J, Ghezzo H, Malo JL. Identification of clinically significant psychological distress and psychiatric morbidity by examining quality of life in subjects with occupational asthma. Health Qual Life Outcomes 2011; 9:76. [PMID: 21939509 PMCID: PMC3196900 DOI: 10.1186/1477-7525-9-76] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Accepted: 09/22/2011] [Indexed: 11/13/2022] Open
Abstract
Background The Juniper Asthma Specific Quality of Life Questionnaire (AQLQ(S)) is a questionnaire that allows measurement of disease specific quality of life. We wanted to examine correlations between the (AQLQ(S)) general and different subscale scores and both psychiatric morbidity and levels of psychological distress in individuals with occupational asthma (OA) and to determine if results in the emotional function subscale allow identification of individuals with clinically significant psychological distress or current psychiatric disorders. Methods This was a cross-sectional study of individuals with OA who were assessed during a re-evaluation for permanent disability, after they were no longer exposed to the sensitizing agent. Patients underwent a general sociodemographic and medical history evaluation, a brief psychiatric interview (Primary Care Evaluation of Mental Disorders, PRIME-MD) and completed a battery of questionnaires including the AQLQ(S), the St-Georges Respiratory Questionnaire (SGRQ), and the Psychiatric Symptom Index (PSI). Results There was good internal consistency (Cronbach alpha = 0.936 for the AQLQ(S) total score) and construct validity for the AQLQ(S) (Spearman rho = -0.693 for the SGRQ symptom score and rho = -0.650 for the asthma severity score). There were medium to large correlations between the total score of the AQLQ(S) and the SGRQ symptom score (r = -.693), and PSI total (r = -.619) and subscale scores (including depression, r = -.419; anxiety, r = -.664; anger, r = -.367; cognitive disturbances, r = -.419). A cut-off of 5.1 on the AQLQ(S) emotional function subscale (where 0 = high impairment and 7 = no impairment) had the best discriminative value to distinguish individuals with or without clinically significant psychiatric distress according to the PSI, and a cut-off of 4.7 best distinguished individuals with or without a current psychiatric disorder according to the PRIME-MD. Conclusions Impaired quality of life is associated with psychological distress and psychiatric disorders in individuals with OA. Findings suggest that the AQLQ(S) questionnaire may be used to identify patients with potentially clinically significant levels of psychological distress.
Collapse
Affiliation(s)
- David Miedinger
- Division of Chest Medicine, Research Center, Department of Chest Medicine, Hôpital du Sacré-Cœur de Montréal, 5400 Gouin West, Montréal, Québec, H4J 1C5, Canada
| | | | | | | | | |
Collapse
|
20
|
Genetic variability in susceptibility to occupational respiratory sensitization. J Allergy (Cairo) 2011; 2011:346719. [PMID: 21747866 PMCID: PMC3124895 DOI: 10.1155/2011/346719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Accepted: 04/18/2011] [Indexed: 02/07/2023] Open
Abstract
Respiratory sensitization can be caused by a variety of substances at workplaces, and the health and economic burden linked to allergic respiratory diseases continues to increase. Although the main factors that affect the onset of the symptoms are the types and intensity of allergen exposure, there is a wide range of interindividual variation in susceptibility to occupational/environmental sensitizers. A number of gene variants have been reported to be associated with various occupational allergic respiratory diseases. Examples of genes include, but are not limited to, genes involved in immune/inflammatory regulation, antioxidant defenses, and fibrotic processes. Most of these variants act in combination with other genes and environmental factors to modify disease progression, severity, or resolution after exposure to allergens. Therefore, understanding the role of genetic variability and the interaction between genetic and environmental/occupational factors provides new insights into disease etiology and may lead to the development of novel preventive and therapeutic strategies. This paper will focus on the current state of knowledge regarding genetic influences on allergic respiratory diseases, with specific emphasis on diisocyanate-induced asthma and chronic beryllium disease.
Collapse
|
21
|
Vandenplas O, Lantin AC, D'Alpaos V, Larbanois A, Hoet P, Vandeweerdt M, Thimpont J, Speybroeck N. Time trends in occupational asthma in Belgium. Respir Med 2011; 105:1364-72. [PMID: 21624825 DOI: 10.1016/j.rmed.2011.05.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 05/03/2011] [Accepted: 05/04/2011] [Indexed: 12/29/2022]
Abstract
OBJECTIVES There is little information on the changes in the pattern of occupational asthma (OA) over time. The objective of this study was to evaluate the time trends in the incidence and causes of immunological OA in Belgium using workers' compensation data. METHODS Cases of OA were identified through a retrospective review of all claims submitted by salaried workers to the Belgian Workers' Compensation Board from 1993 to 2002. The likelihood of OA was categorized as definite, probable, or possible based upon the results of from diagnostic procedures. Time trends were evaluated using Spearman's rank correlation for crude numbers of cases and through the negative binomial regression for incidence rates of OA per industry. RESULTS From a total of 1852 claims, 971 were categorized as having definite, probable, or possible OA. There was a downward trend in the annual number of cases due to the main causes of OA (i.e. flour, isocyanates, woods, and enzymes) and an apparent increase in cases of latex-induced OA. The estimated average annual incidence of OA was 29.4 (95% CI: 27.6-31.3) new cases per million salaried workers during the 1993-2002 period. There was a significant decline in the overall incidence rate of OA throughout the study period from 35.5 new cases per million salaried workers in 1993 to 25.8 in 2002. CONCLUSIONS These compensation-based data indicate that there has been a global downward trend in the incidence of OA during the nineties, although the factors that determined this reduced incidence should be further investigated.
Collapse
Affiliation(s)
- Olivier Vandenplas
- Fonds des Maladies Professionnelles, Fonds voor de Beroepsziekten, Brussels, Belgium.
| | | | | | | | | | | | | | | |
Collapse
|
22
|
Talini D, Novelli F, Bacci E, Dente FL, De Santis M, Di Franco A, Melosini L, Vagaggini B, Paggiaro PL. Comparison between Airway Responses to High versus Low Molecular Weight Compounds in Occupational Asthma. J Allergy (Cairo) 2011; 2011:781470. [PMID: 21747871 PMCID: PMC3124963 DOI: 10.1155/2011/781470] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Accepted: 03/29/2011] [Indexed: 11/19/2022] Open
Abstract
Occupational asthma (OA) is a heterogeneous disease, and the characteristics of the sensitizer responsible for OA may induce different clinical, functional, and biological manifestations. We examined the characteristics of 74 patients with OA induced by low molecular weight compounds (LMWC) or by high molecular weight compounds (HMWC) and diagnosed by specific inhalation challenge (SIC). Patients with OA induced by LMWC had a longer occupational exposure before the beginning of symptoms, a lower sputum eosinophilia, and a higher prevalence of late airway response (LAR), in comparison with patients with OA induced by HMWC. Pulmonary function tended to be poorer and atopy tended to be less frequent in LMWC-induced OA than in HMWC-induced OA. These data confirm and extend previous observations showing that the characteristics of the specific sensitizer inducing OA may determine different clinical, functional, and biological features, probably related to the difference pathogenetic mechanisms underlying these different types of OA.
Collapse
Affiliation(s)
- D. Talini
- Occupational Health Unit, Prevention Department, Galleria Gerace 14, 56126 Pisa, Italy
| | - F. Novelli
- Cardio-Thoracic and Vascular Department, University of Pisa, 56126 Pisa, Italy
| | - E. Bacci
- Cardio-Thoracic and Vascular Department, University of Pisa, 56126 Pisa, Italy
| | - F. L. Dente
- Cardio-Thoracic and Vascular Department, University of Pisa, 56126 Pisa, Italy
| | - M. De Santis
- Cardio-Thoracic and Vascular Department, University of Pisa, 56126 Pisa, Italy
| | - A. Di Franco
- Cardio-Thoracic and Vascular Department, University of Pisa, 56126 Pisa, Italy
| | - L. Melosini
- Cardio-Thoracic and Vascular Department, University of Pisa, 56126 Pisa, Italy
| | - B. Vagaggini
- Cardio-Thoracic and Vascular Department, University of Pisa, 56126 Pisa, Italy
| | - P. L. Paggiaro
- Cardio-Thoracic and Vascular Department, University of Pisa, 56126 Pisa, Italy
| |
Collapse
|
23
|
Vandenplas O. Occupational asthma: etiologies and risk factors. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2011; 3:157-67. [PMID: 21738881 PMCID: PMC3121057 DOI: 10.4168/aair.2011.3.3.157] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Accepted: 04/19/2011] [Indexed: 01/10/2023]
Abstract
The purpose of this article is to critically review the available evidence pertaining to occupational, environmental, and individual factors that can affect the development of occupational asthma (OA). Increasing evidence suggests that exploration of the intrinsic characteristics of OA-causing agents and associated structure-activity relationships offers promising avenues for quantifying the sensitizing potential of agents that are introduced in the workplace. The intensity of exposure to sensitizing agents has been identified as the most important environmental risk factor for OA and should remain the cornerstone for primary prevention strategies. The role of other environmental co-factors (e.g., non-respiratory routes of exposure and concomitant exposure to cigarette smoke and other pollutants) remains to be further delineated. There is convincing evidence that atopy is an important individual risk factor for OA induced by high-molecular-weight agents. There is some evidence that genetic factors, such as leukocyte antigen class II alleles, are associated with an increased risk of OA; however, the role of genetic susceptibility factors is likely to be obscured by complex gene-environment interactions. OA, as well as asthma in general, is a complex disease that results from multiple interactions between environmental factors and host susceptibilities. Determining these interactions is a crucial step towards implementing optimal prevention policies.
Collapse
Affiliation(s)
- Olivier Vandenplas
- Department of Chest Medicine, Mont-Godinne Hospital, Université Catholique de Louvain, Yvoir, Belgium
| |
Collapse
|
24
|
Hur GY, Park HJ, Lee HY, Koh DH, Lee BJ, Choi GS, Kim SH, Ye YM, Park HS. Association of β₂-adrenergic receptor polymorphism with work-related symptoms in workers exposed to wheat flour. Yonsei Med J 2011; 52:488-94. [PMID: 21488193 PMCID: PMC3101046 DOI: 10.3349/ymj.2011.52.3.488] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Our previous study indicated that the presence of wheat-specific IgG1 and IgG4 antibodies was associated with work-related symptoms in workers exposed to wheat flour. We performed this study to investigate the genetic polymorphisms of β₂-adrenergic receptors and wheat-specific antibodies in association with the clinical parameters of baker's asthma. MATERIALS AND METHODS In total, 379 subjects working in a single industrial bakery were enrolled in this study. The skin prick test was performed with common inhalant allergens and wheat flour extract. The presence of serum- specific IgE, IgG1, and IgG4 antibodies to wheat flour were determined by ELISA. Whole blood samples were obtained for genotype analysis. Subjects were genotyped with regard to five candidate single nucleotide polymorphisms (SNPs) of the β₂-adrenergic receptor gene (ADRB2; -47 T>C, 46 A>G, 79 C>G, 252 G>A, and 523 C>A) using a single-base extension method. RESULTS No significant associations were observed between the genotype/allele frequencies of any of the SNPs tested and any clinical parameters. The haplotype of ADRB2 (GAA composed of 46 A>G, 252 G>A, and 523 C>A) was significantly associated with work-related symptoms (p<0.05). Moreover, in subjects with the AG or GG genotype at 46 A>G and haplotype [GAA] of ADRB2, the prevalence rates of wheat-specific IgG1 antibodies and lower respiratory symptoms increased significantly with exposure intensity (both p<0.05). CONCLUSION The findings of the present study suggest that ADRB2 genetic polymorphism may contribute to the development of work-related symptoms in workers exposed to wheat flour, which can lead to baker's asthma.
Collapse
Affiliation(s)
- Gyu-Young Hur
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Han-Jung Park
- Department of Internal Medicine, Seobuk Hospital, Seoul, Korea
| | - Hyun-Young Lee
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Dong-Hee Koh
- Occupational Safety and Health Research Institute, Korea Occupational Safety and Health Agency, Incheon, Korea
| | - Byung-Jae Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gil-Soon Choi
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Seung-Hyun Kim
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Young-Min Ye
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| |
Collapse
|
25
|
Nam YH, Kim JI, Um SJ, Lee SK, Son CH. Absence of hyper-responsiveness to methacholine after specific bronchial provocation tests in a worker with hydroxyapatite-induced occupational asthma. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2011; 3:135-7. [PMID: 21461255 PMCID: PMC3062794 DOI: 10.4168/aair.2011.3.2.135] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Accepted: 11/24/2010] [Indexed: 12/05/2022]
Abstract
Hydroxyapatite is commonly used as a filler to replace amputated bone or as a coating to promote bone ingrowth into prosthetic implants. Many modern implants, such as hip replacements and dental implants, are coated with hydroxyapatite. We report a patient with occupational asthma due to hydroxyapatite, proven by a specific inhalation challenge, who experienced an early asthmatic reaction after exposure to hydroxyapatite, without increased airway responsiveness to methacholine despite an increased eosinophil count in the peripheral blood. A 38-year-old male dental implant worker visited our allergy department for the evaluation of occupational asthma. He had treated dental implant titanium surfaces with hydroxyapatite for 1.5 years. One year after starting his employment, he noticed symptoms of rhinorrhea, paroxysmal cough, and chest tightness. His symptoms were aggravated during and shortly after work and subsided several hours after work. When he stopped working for 2 months because of his chest symptoms, he became asymptomatic. After restarting his work, his symptoms reappeared and were aggravated. A methacholine bronchial challenge test had a negative response. The following day, a specific bronchial provocation test with wheat powder was negative. On the third day, a specific bronchial provocation test with hydroxyapatite powder produced an early asthmatic response. On the fourth day, a methacholine bronchial challenge test was negative. Further studies are needed to evaluate the exact pathogenetic mechanism of hydroxyapatite-induced occupational asthma.
Collapse
Affiliation(s)
- Young-Hee Nam
- Department of Internal Medicine, College of Medicine, Dong-A University, Busan, Korea
| | | | | | | | | |
Collapse
|
26
|
Quirce S, Salcedo G. The role of cross-reactive carbohydrate determinants in the diagnosis of occupational allergy. Clin Exp Allergy 2010; 40:962-4. [PMID: 20642574 DOI: 10.1111/j.1365-2222.2010.03537.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
27
|
Pala G, Pignatti P, Perfetti L, Avanzini MA, Calcagno G, Preziosi D, Moscato G. Occupational rhinitis and asthma due to cabreuva wood dust. Ann Allergy Asthma Immunol 2010; 104:268-9. [PMID: 20377117 DOI: 10.1016/j.anai.2010.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
28
|
Moscato G, Pala G, Perfetti L, Frascaroli M, Pignatti P. Clinical and inflammatory features of occupational asthma caused by persulphate salts in comparison with asthma associated with occupational rhinitis. Allergy 2010; 65:784-90. [PMID: 20015325 DOI: 10.1111/j.1398-9995.2009.02288.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The relationships between asthma and rhinitis are still a crucial point in respiratory allergy and have scarcely been analysed in occupational setting. We aimed to compare the clinical and inflammatory features of subjects with occupational asthma only (OA) to subjects with OA associated to occupational rhinitis (OAR) caused by persulphate salts. METHODS The clinical charts of 26 subjects diagnosed in our Unit as respiratory allergy caused by ammonium persulphate (AP), confirmed by specific inhalation challenge (SIC), were reviewed. Twenty-two out of twenty-six patients underwent pre-SIC-induced sputum challenge test (IS) and 24/26 underwent nasal secretion collection and processing. RESULTS Twelve out of twenty-six patients received a diagnosis of OA-only and 14/26 of OAR. Duration of exposure before diagnosis, latency period between the beginning of exposure and asthma symptom onset, basal FEV(1), airway reactivity to methacholine and asthma severity did not differ in the two groups. Eosinophilic inflammation of upper and lower airways characterized both groups. Eosinophil percentage in IS tended to be higher in OAR [11.9 (5.575-13.925)%] than in OA-only [2.95 (0.225-12.5)%] (P = 0.31). Eosinophilia in nasal secretions was present both in subjects with OAR [55 (46-71)%] and in subjects with OA-only [38 (15-73.5)%], without any significant difference. DISCUSSION Our results indicate that OA because of ammonium persulphate coexists with occupational rhinitis in half of the patients. Unexpectedly, rhinitis did not seem to have an impact on the natural history of asthma. The finding of nasal inflammation in subjects with OA-only without clinical manifestations of rhinitis supports the united airway disease concept in occupational respiratory allergy as a result of persulphates.
Collapse
Affiliation(s)
- G Moscato
- Allergy and Immunology Unit, Fondazione Salvatore Maugeri, Institute of Research and Care, Scientific Institute of Pavia, Via Maugeri 10, Pavia, Italy.
| | | | | | | | | |
Collapse
|
29
|
Rémen T, Coevoet V, Acouetey DS, Guéant JL, Guéant-Rodriguez RM, Paris C, Zmirou-Navier D. Early incidence of occupational asthma among young bakers, pastry-makers and hairdressers: design of a retrospective cohort study. BMC Public Health 2010; 10:206. [PMID: 20420675 PMCID: PMC2874777 DOI: 10.1186/1471-2458-10-206] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Accepted: 04/26/2010] [Indexed: 11/25/2022] Open
Abstract
Background Occupational exposures are thought to be responsible for 10-15% of new-onset asthma cases in adults, with disparities across sectors. Because most of the data are derived from registries and cross-sectional studies, little is known about incidence of occupational asthma (OA) during the first years after inception of exposure. This paper describes the design of a study that focuses on this early asthma onset period among young workers in the bakery, pastry making and hairdressing sectors in order to assess early incidence of OA in these "at risk" occupations according to exposure duration, and to identify risk factors of OA incidence. Methods/Design The study population is composed of subjects who graduated between 2001 and 2006 in these sectors where they experience exposure to organic or inorganic allergenic or irritant compounds (with an objective of 150 subjects by year) and 250 young workers with no specific occupational exposure. A phone interview focusing on respiratory and 'Ear-Nose-Throat' (ENT) work-related symptoms screen subjects considered as "possibly OA cases". Subjects are invited to participate in a medical visit to complete clinical and lung function investigations, including fractional exhaled nitric oxide (FENO) and carbon monoxide (CO) measurements, and to collect blood samples for IgE (Immunoglobulin E) measurements (total IgE and IgE for work-related and common allergens). Markers of oxidative stress and genetic polymorphisms exploration are also assessed. A random sample of 200 "non-cases" (controls) is also visited, following a nested case-control design. Discussion This study may allow to describ a latent period between inception of exposure and the rise of the prevalence of asthma symptoms, an information that would be useful for the prevention of OA. Such a time frame would be suited for conducting screening campaigns of this emergent asthma at a stage when occupational hygiene measures and adapted therapeutic interventions might be effective. Trial registration Clinical trial registration number is NCT01096537.
Collapse
Affiliation(s)
- Thomas Rémen
- Institut National de la santé et de la Recherche Médicale U 954, School of Medicine, Nancy, France.
| | | | | | | | | | | | | |
Collapse
|
30
|
Hannaford-Turner K, Elder D, Sim MR, Abramson MJ, Johnson AR, Yates DH. Surveillance of Australian workplace Based Respiratory Events (SABRE) in New South Wales. Occup Med (Lond) 2010; 60:376-82. [PMID: 20308261 DOI: 10.1093/occmed/kqq011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The Surveillance of Australian workplace Based Respiratory Events (SABRE) New South Wales (NSW) scheme is a voluntary notification scheme established to determine the incidence of occupational lung diseases in NSW Australia. AIMS Data presented in this paper summarize the last 7 years of reporting to SABRE (June 2001 to December 2008). METHODS Every 2 months, participating occupational physicians, respiratory physicians and general practitioners (accredited by the NSW WorkCover Authority) reported new cases of occupational lung disease seen in their practices. Data collected include gender, age, causal agent and the occupations and industries believed responsible. Estimated incidence was calculated for each disease. RESULTS Three thousand six hundred and fifty-four cases were notified to the scheme, consisting of 3856 diagnoses. Most of the cases were males (76%). Pleural plaques [1218 (28%)] were the most frequently reported condition, followed by mesothelioma [919 (24%)]. Silicosis [90 (2%)] and occupational asthma [OA; 89 (2%)] were the most frequently reported non-asbestos-related diseases. Estimated rates for mesothelioma, diffuse pleural thickening (DPT) and OA were 83, 83 and 5 cases per million employed males per year, respectively. Trades such as carpenters and electricians associated with the building industry, electricity supply and asbestos product manufacture were the most common occupations and industries reported. CONCLUSIONS Asbestos-related diseases are the most frequently reported conditions to SABRE NSW. The very low incidence of OA for NSW most likely reflects under-diagnosis as well as under-reporting. Occupational lung disease is still occurring in NSW despite current preventative strategies. The SABRE scheme currently provides the only available information in this area.
Collapse
Affiliation(s)
- K Hannaford-Turner
- Workers' Compensation (Dust Diseases) Board Education & Research Unit, Sydney, New South Wales, Australia
| | | | | | | | | | | |
Collapse
|
31
|
Pala G, Pignatti P, Perfetti L, Cosentino R, Moscato G. Occupational asthma and rhinitis induced by a cephalosporin intermediate product: description of a case. Allergy 2009; 64:1390-1. [PMID: 19392996 DOI: 10.1111/j.1398-9995.2009.02062.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- G Pala
- Institute of Care and Research, Pavia, Italy.
| | | | | | | | | |
Collapse
|
32
|
Tossa P, Bohadana A, Demange V, Wild P, Michaely JP, Hannhart B, Paris C, Zmirou-Navier D. Early markers of airways inflammation and occupational asthma: rationale, study design and follow-up rates among bakery, pastry and hairdressing apprentices. BMC Public Health 2009; 9:113. [PMID: 19389222 PMCID: PMC2681469 DOI: 10.1186/1471-2458-9-113] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Accepted: 04/23/2009] [Indexed: 12/16/2022] Open
Abstract
Background Occupational asthma is a common type of asthma caused by a specific agent in the workplace. The basic alteration of occupational asthma is airways inflammation. Although most patients with occupational asthma are mature adults, there is evidence that airways inflammation starts soon after inception of exposure, including during apprenticeship. Airways hyper responsiveness to methacholine is a valid surrogate marker of airways inflammation, which has proved useful in occupational epidemiology. But it is time-consuming, requires active subject's cooperation and is not readily feasible. Other non-invasive and potentially more useful tests include the forced oscillation technique, measurement of fraction exhaled nitric oxide, and eosinophils count in nasal lavage fluid. Methods and design This study aims to investigate early development of airways inflammation and asthma-like symptoms in apprentice bakers, pastry-makers and hairdressers, three populations at risk of occupational asthma whose work-related exposures involve agents of different nature. The objectives are to (i) examine the performance of the non-invasive tests cited above in detecting early airways inflammation that might eventually develop into occupational asthma; and (ii) evaluate whether, and how, constitutional (e.g. atopy) and behavioural (e.g. smoking) risk factors for occupational asthma modulate the effects of allergenic and/or irritative substances involved in these occupations. This paper presents the study rationale and detailed protocol. Discussion Among 441 volunteers included at the first visit, 354 attended the fourth one. Drop outs were investigated and showed unrelated to the study outcome. Sample size and follow-up participation rates suggest that the data collected in this study will allow it to meet its objectives.
Collapse
Affiliation(s)
- Paul Tossa
- INSERM U954, School of Medicine, Vandoeuvre-Les-Nancy, France.
| | | | | | | | | | | | | | | |
Collapse
|
33
|
O'Byrne PM, Gauvreau GM, Brannan JD. Provoked models of asthma: what have we learnt? Clin Exp Allergy 2009; 39:181-92. [PMID: 19187330 DOI: 10.1111/j.1365-2222.2008.03172.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Asthma is a chronic inflammatory disease of the airways characterized by physiological abnormalities of variable airflow obstruction and airway hyperresponsiveness (AHR) to a wide variety of physical and inhaled chemical stimuli and the presence of symptoms. AHR is measured by challenging the airways with a variety of agonists and naturally occurring stimuli, which results in constriction of the airway smooth muscle, leading to airway narrowing and airflow limitation. There are two distinct mechanisms by which the airways can narrow to a constrictor stimulus and these are defined by the pathways they take to induce AHR. Direct stimuli are pharmacological agents administered exogenously (such as histamine or methacholine) that act 'directly' on specific receptors on the bronchial smooth muscle to cause constriction. The other mechanism by which the airway can narrow is via the inhalation of indirect stimuli, which include natural stimuli, such as allergen or exercise, and pharmacological agents such as adenosine monophosphate and hyper-osmotic agents (e.g. hypertonic saline or dry powder mannitol). These stimuli induce airway narrowing 'indirectly' by causing the endogenous release of mediators of bronchoconstriction from airway inflammatory cells. Provoked models of asthma have been extremely valuable in understanding the pathobiology of asthma, in aiding diagnosis, in helping to clarify the mechanisms of actions of effective drugs and in the development of new entities to treat asthma. Some provoked models are valuable clinically, particularly those that measure direct AHR, while others, particularly allergen challenge, have been used in animal models and in humans to study the mechanisms of allergen-induced airway inflammation and the associated physiological changes, as well in the development of new drugs for asthma. An emerging role for measurements of AHR is in the evaluation of the optimal treatment for patients with asthma.
Collapse
Affiliation(s)
- P M O'Byrne
- Firestone Institute for Respiratory Health, St Joseph's Hospital, Hamilton, ON, Canada.
| | | | | |
Collapse
|
34
|
Maestrelli P, Boschetto P, Fabbri LM, Mapp CE. Mechanisms of occupational asthma. J Allergy Clin Immunol 2009; 123:531-42; quiz 543-4. [DOI: 10.1016/j.jaci.2009.01.057] [Citation(s) in RCA: 151] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2008] [Revised: 01/23/2009] [Accepted: 01/26/2009] [Indexed: 11/29/2022]
|
35
|
Mathias CB, Freyschmidt EJ, Oettgen HC. Immunoglobulin E antibodies enhance pulmonary inflammation induced by inhalation of a chemical hapten. Clin Exp Allergy 2008; 39:417-25. [PMID: 19032356 DOI: 10.1111/j.1365-2222.2008.03140.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Occupational exposure to chemicals is an important cause of asthma. Recent studies indicate that IgE antibodies enhance sensitization to chemicals in the skin. OBJECTIVE We investigated whether IgE might similarly promote the development of airway inflammation following inhalation of a contact sensitizer. METHODS A model of chemical-induced asthma is described in which introduction of the low-molecular-weight compound, trinitrobenzene sulphonic acid (TNBS), via the respiratory tract was used for both sensitization and challenge. The role of IgE antibodies in the immune response to inhaled TNBS in this model was assessed by comparing the responses of wild-type (WT) and IgE-deficient (IgE(-/-)) mice on the BALB/c background. Reconstitution of circulating IgE levels by intravenous injection of IgE antibodies into IgE(-/-) mice before sensitization was performed to confirm the role of IgE in any differences observed between the responses of WT and IgE(-/-) mice. RESULTS Intranasal challenge of TNBS-sensitized (but not sham-sensitized control mice) induced intense pulmonary inflammation. Macrophages, eosinophils and lymphocytes, including T, B, natural killer and natural killer T cells, were recruited to the airway and the animals displayed bronchial hyperresponsiveness (BHR) to methacholine. Serum levels of murine mast cell protease-1 (mMCP-1) were elevated suggesting mast cell activation. In contrast, the development of airway inflammation, recruitment of lymphocytes, induction of BHR and production of mMCP-1 were all significantly attenuated in IgE-deficient mice. Reconstitution of IgE(-/-) mice with IgE (of unrelated antigen specificity) before sensitization partially restored these features of asthma. CONCLUSION Our data indicate that IgE antibodies non-specifically enhance the development of airway inflammation induced by exposure to chemical antigens.
Collapse
Affiliation(s)
- C B Mathias
- Division of Immunology, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, USA
| | | | | |
Collapse
|
36
|
Tarlo SM, Balmes J, Balkissoon R, Beach J, Beckett W, Bernstein D, Blanc PD, Brooks SM, Cowl CT, Daroowalla F, Harber P, Lemiere C, Liss GM, Pacheco KA, Redlich CA, Rowe B, Heitzer J. Diagnosis and management of work-related asthma: American College Of Chest Physicians Consensus Statement. Chest 2008; 134:1S-41S. [PMID: 18779187 DOI: 10.1378/chest.08-0201] [Citation(s) in RCA: 306] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND A previous American College of Chest Physicians Consensus Statement on asthma in the workplace was published in 1995. The current Consensus Statement updates the previous one based on additional research that has been published since then, including findings relevant to preventive measures and work-exacerbated asthma (WEA). METHODS A panel of experts, including allergists, pulmonologists, and occupational medicine physicians, was convened to develop this Consensus Document on the diagnosis and management of work-related asthma (WRA), based in part on a systematic review, that was performed by the University of Alberta/Capital Health Evidence-Based Practice and was supplemented by additional published studies to 2007. RESULTS The Consensus Document defined WRA to include occupational asthma (ie, asthma induced by sensitizer or irritant work exposures) and WEA (ie, preexisting or concurrent asthma worsened by work factors). The Consensus Document focuses on the diagnosis and management of WRA (including diagnostic tests, and work and compensation issues), as well as preventive measures. WRA should be considered in all individuals with new-onset or worsening asthma, and a careful occupational history should be obtained. Diagnostic tests such as serial peak flow recordings, methacholine challenge tests, immunologic tests, and specific inhalation challenge tests (if available), can increase diagnostic certainty. Since the prognosis is better with early diagnosis and appropriate intervention, effective preventive measures for other workers with exposure should be addressed. CONCLUSIONS The substantial prevalence of WRA supports consideration of the diagnosis in all who present with new-onset or worsening asthma, followed by appropriate investigations and intervention including consideration of other exposed workers.
Collapse
Affiliation(s)
| | - John Balmes
- University of California San Francisco, San Francisco, CA
| | | | | | - William Beckett
- University of Rochester School of Medicine and Dentistry, Rochester, NY
| | | | - Paul D Blanc
- University of California San Francisco, San Francisco, CA
| | | | | | | | - Philip Harber
- University of California, Los Angeles, Los Angeles, CA
| | | | | | | | | | - Brian Rowe
- University of Alberta, Calgary, AB, Canada
| | - Julia Heitzer
- American College of Chest Physicians, Northbrook, IL
| |
Collapse
|
37
|
Yacoub MR, Perfetti L, Pignatti P, Frascaroli M, Caminati M, Moscato G. Usefulness of induced sputum in investigating occupational asthma with normal responsiveness to methacholine: a case report. J Allergy Clin Immunol 2008; 122:831-832. [PMID: 18789817 DOI: 10.1016/j.jaci.2008.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2008] [Revised: 06/20/2008] [Accepted: 07/08/2008] [Indexed: 10/21/2022]
Affiliation(s)
- Mona-Rita Yacoub
- Allergy and Immunology Unit, Fondazione "Salvatore Maugeri," Institute of Care and Research, Scientific Institute of Pavia, Pavia, Italy.
| | - Luca Perfetti
- Allergy and Immunology Unit, Fondazione "Salvatore Maugeri," Institute of Care and Research, Scientific Institute of Pavia, Pavia, Italy
| | - Patrizia Pignatti
- Allergy and Immunology Unit, Fondazione "Salvatore Maugeri," Institute of Care and Research, Scientific Institute of Pavia, Pavia, Italy; Occupational Immunology and Allergy Laboratory, ISPESL, Rome, Italy
| | - Mary Frascaroli
- Allergy and Immunology Unit, Fondazione "Salvatore Maugeri," Institute of Care and Research, Scientific Institute of Pavia, Pavia, Italy
| | - Marco Caminati
- Allergy and Immunology Unit, Fondazione "Salvatore Maugeri," Institute of Care and Research, Scientific Institute of Pavia, Pavia, Italy
| | - Gianna Moscato
- Allergy and Immunology Unit, Fondazione "Salvatore Maugeri," Institute of Care and Research, Scientific Institute of Pavia, Pavia, Italy; Occupational Immunology and Allergy Laboratory, ISPESL, Rome, Italy
| |
Collapse
|
38
|
Cell types involved in allergic asthma and their use in in vitro models to assess respiratory sensitization. Toxicol In Vitro 2008; 22:1419-31. [PMID: 18603401 DOI: 10.1016/j.tiv.2008.05.008] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2008] [Revised: 05/02/2008] [Accepted: 05/23/2008] [Indexed: 11/22/2022]
Abstract
This review first describes the mechanism and cell types involved in allergic asthma, which is a complex clinical disease characterized by airway obstruction, airway inflammation and airway hyperresponsiveness to a variety of stimuli. The development of allergic asthma exists of three phases, namely the induction phase, the early-phase asthmatic reaction (EAR) and the late-phase asthmatic reaction (LAR). In the induction phase, antigen-presenting cells play a major role. Most important cells in the EAR are mast cells, and during the LAR, various cell types, such as eosinophils, neutrophils, T cells, macrophages, dendritic cells (DCs), and cells that endow structure are involved. In occupational asthma, this immunological mechanism is involved in 90% of the cases. The second part of this review gives an overview of in vitro models to assess the hazardous potential of high- and low-molecular weight chemicals on the respiratory system. In order to develop a good in vitro model for respiratory allergy, the choice of appropriate cell types is important. Epithelial cells, macrophages and DCs are currently the most used models in this field of research.
Collapse
|
39
|
van Kampen V, Rabstein S, Sander I, Merget R, Brüning T, Broding HC, Keller C, Müsken H, Overlack A, Schultze-Werninghaus G, Walusiak J, Raulf-Heimsoth M. Prediction of challenge test results by flour-specific IgE and skin prick test in symptomatic bakers. Allergy 2008; 63:897-902. [PMID: 18588556 DOI: 10.1111/j.1398-9995.2008.01646.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Wheat and rye flours are among the most important allergens causing occupational asthma. Usually, the diagnosis of baker's asthma is based on inhalation challenge tests with flours. AIMS OF THE STUDY To evaluate the relevance of flour-specific serum immunoglobulin E (IgE) and skin prick test (SPT) in the diagnosis of baker's asthma and to define flour-specific IgE concentrations and wheal sizes that allow a prediction of the outcome of challenge testing. METHODS Bronchial and nasal challenge tests with wheat (rye) flour were performed in 71 (95) symptomatic bakers. Determinations of flour-specific IgE as well as SPTs were performed in all subjects. Analyses included the calculation of sensitivity, specificity, positive (PPV) and negative predictive values (NPV) at different IgE concentrations and different wheal sizes, and receiver-operating characteristics (ROC) plots with the challenge result as gold standard. RESULTS Thirty-seven bakers were positive in the challenge with wheat flour, while 63 were positive with rye flour. Depending on the flour-specific IgE concentrations (wheal size), PPV was 74-100% (74-100%) for wheat and 82-100% (91-100%) for rye flour, respectively. The minimal cut-off values with a PPV of 100% were 2.32 kU/l (5.0 mm) for wheat flour and 9.64 kU/l (4.5 mm) for rye flour. The shapes of the ROC plots were similar for wheat and rye flour. CONCLUSION High concentrations of flour-specific IgE and clear SPT results in symptomatic bakers are good predictors for a positive challenge test. Challenge tests with flours may be avoided in strongly sensitized bakers.
Collapse
Affiliation(s)
- V van Kampen
- BGFA - Research Institute of Occupational Medicine, German Social Accident Insurance, Ruhr-University Bochum, Germany
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Bernstein IL, Li JT, Bernstein DI, Hamilton R, Spector SL, Tan R, Sicherer S, Golden DBK, Khan DA, Nicklas RA, Portnoy JM, Blessing-Moore J, Cox L, Lang DM, Oppenheimer J, Randolph CC, Schuller DE, Tilles SA, Wallace DV, Levetin E, Weber R. Allergy diagnostic testing: an updated practice parameter. Ann Allergy Asthma Immunol 2008; 100:S1-148. [PMID: 18431959 DOI: 10.1016/s1081-1206(10)60305-5] [Citation(s) in RCA: 291] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
41
|
Asthma in the workplace: a Canadian contribution and perspective. Can Respir J 2008; 14:407-13. [PMID: 17948141 DOI: 10.1155/2007/753724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
42
|
Holness DL, Tabassum S, Tarlo SM, Liss GM, Silverman F, Manno M. Practice Patterns of Pulmonologists and Family Physicians for Occupational Asthma. Chest 2007; 132:1526-31. [PMID: 17890481 DOI: 10.1378/chest.06-2224] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The longer the duration of symptoms of occupational asthma (OA) before diagnosis, the poorer the outcome. Physicians can play a key role in the early recognition of occupational lung diseases (OLDs), including OA. Our objective was to document and compare the practice patterns, barriers, and needs for early diagnosis of OA among pulmonologists and family physicians. METHODS Based on information from the literature and interviews with pulmonologists and family physicians, a survey was developed to obtain information on practice patterns. The survey was sent to all pulmonologists and a random sample of 600 family physicians in Ontario. RESULTS Eight percent of pulmonologists and 7% of family physicians report seeing >20 patients a year with OLD. The majority report taking a workplace exposure history. The most commonly stated barrier to obtaining a workplace exposure history was time constraints. Main reasons for referral to specialists for diagnosis include personal lack of expertise, testing facilities, and knowledge about workers' compensation, while lack of timely access to specialists is a barrier for referral. While most physicians identified a need for further education, those who did not identify a need for further occupational respiratory education cited low volume of patients, access to specialists, and time constraints as reasons for not wanting further education. CONCLUSIONS Opportunities are identified to improve health services delivery and educational initiatives for OA, with approaches tailored to each particular physician group.
Collapse
Affiliation(s)
- D Linn Holness
- Gage Occupational and Environmental Health Unit, St Michael's Hospital, University of Toronto, ON, Canada M5B 1W8.
| | | | | | | | | | | |
Collapse
|
43
|
Asthma in the Workplace. J Occup Environ Med 2007. [DOI: 10.1097/jom.0b013e31802ec251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
44
|
Quirce S, Fernández-Nieto M, Escudero C, Cuesta J, de Las Heras M, Sastre J. Bronchial responsiveness to bakery-derived allergens is strongly dependent on specific skin sensitivity. Allergy 2006; 61:1202-8. [PMID: 16942570 DOI: 10.1111/j.1398-9995.2006.01189.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Quantitative relationships between immunological reactivity, non-specific bronchial responsiveness and bronchial responsiveness to allergens have scarcely been investigated in occupational asthma. METHODS We assessed the above relationships in 24 subjects with baker's asthma. The skin endpoint titration to bakery allergens as a measure of immunological reactivity, together with the methacholine PC20 and allergen PC20 during early asthmatic reaction were determined. RESULTS All patients had positive skin tests to some bakery allergens (wheat and rye flour, soybean flour, fungal enzymes and egg white proteins) and bronchial hyperresponsiveness to methacholine. Specific inhalation challenge (SIC) tests were performed with aqueous allergen extracts of cereal flour (n = 14), soybean (n = 8), baking enzymes (n = 12), and egg white proteins (n = 8) in sensitized workers. A positive asthmatic reaction was observed in 84% of the inhalation challenges. SIC elicited isolated early asthmatic reactions in 62%, dual reactions in 32% and isolated late reactions in 5%. Multiple linear regression analysis showed allergen PC20 as a function of skin sensitivity to allergen and methacholine PC20, yielding the following highly significant regression formula: log-allergen PC20 = 0.18 + 0.99 log(skin sensitivity) + 0.343 log(methacholine PC20) (r = 0.89, P < 0.001). This formula predicted allergen PC20 to within one double concentration in 67%, to within two double concentrations in 85% and within three double concentrations in 97%. CONCLUSION The main determinant of bronchial responsiveness to allergen in patients with baker's asthma is the degree of sensitization to occupational allergens as determined by skin reactivity, modulated to a lesser extent by non-specific bronchial hyperresponsiveness.
Collapse
Affiliation(s)
- S Quirce
- Allergy Department, Fundación Jiménez Díaz, Madrid, Spain
| | | | | | | | | | | |
Collapse
|
45
|
Abstract
PURPOSE OF REVIEW Hairdressers have an increased prevalence of respiratory diseases and are at high risk of occupational asthma. In this paper we aim to review the most recent findings in respiratory diseases related to the occupation of hairdressing to provide a background for management and prevention. RECENT FINDINGS Recent studies have described several cases of occupational asthma and occupational rhinitis in hairdressers. Persulphate salts are the major causal agents. Sensitization to persulphate salts seems more related to an individual hypersusceptibility than to environmental factors. An underlying immunologic mechanism is strongly suggested but not definitively demonstrated. The diagnosis of persulphate asthma is based on the specific challenge, for which standardized methods have been described. Some data show the presence of respiratory disorders in an early stage in apprentices and demonstrate that after diagnosis a proportion of hairdressers with occupational asthma remain symptomatic despite cessation of exposure. SUMMARY Careful medical surveillance is recommended for hairdressers and for hairdressing apprentices. Further studies are needed to evaluate the mechanism of persulphate asthma and to determine the relative role of individual risk factors compared with environmental factors in the development of the disease.
Collapse
Affiliation(s)
- Gianna Moscato
- Allergy and Immunology Unit, Fondazione Salvatore Maugeri, Institute of Care and Research, Scientific Institute of Pavia, Italy.
| | | |
Collapse
|
46
|
Mounier-Geyssant E, Oury V, Mouchot L, Paris C, Zmirou-Navier D. Exposure of hairdressing apprentices to airborne hazardous substances. Environ Health 2006; 5:23. [PMID: 16893447 PMCID: PMC1562408 DOI: 10.1186/1476-069x-5-23] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2006] [Accepted: 08/07/2006] [Indexed: 05/11/2023]
Abstract
BACKGROUND Few studies have investigated exposure of hairdressing apprentices to airborne irritants. This study describes exposure levels of apprentices to chemical products used in hairdressing salons in relation with their activity. METHODS Following a two stages study design, a group of 300 students completed a questionnaire on their work activities and environment. Among these, a group of 28 subjects volunteered to undergo personal exposure and workplace concentrations measurements over a work shift, during a cold and a hot season, with the agreement of the salon owners. Three chemical substances were studied (ammonia, hydrogen peroxide and persulfates) because they are respiratory tract irritants and because their concentrations could be quantified within a 5 to 8 hour shift period. RESULTS Personal exposure values for H2O2 and NH3 (averages [standard deviations] are 0.05 [0.04] and 0.90 [0.76] mg.m(-3), respectively) were greater than workplace ambient air concentrations (corresponding values of 0.04 [0.03] and 0.68 [0.42] mg.m(-3)) for H2O2 and NH3, with no significant seasonal variation. By contrast, workplace concentrations of persulfates (0.019 [0.018] mg.m(-3)) were greater than personal exposure (0.016 [0.021] mg.m(-3), a finding that is consistent with the fact that bleaching is more often undertaken by senior hairdressers. However, all exposure values were lower than the current TLV TWA values. This study also shows that over half of technical spaces where chemical substances used for dying, permanenting or bleaching are manipulated, have no ventilation system, and not even a door or a window opening outside. CONCLUSION The study hairdressing salons, on average, were small, the most probable reason why occupational hygiene measures such as appropriate ventilation were too seldom implemented. As a consequence, young apprentices and senior hairdressers experience substantial exposure to known airways irritants.
Collapse
Affiliation(s)
| | - Véronique Oury
- INRS, Department of exposure assessment, Vandoeuvre-les-Nancy, France
| | - Lory Mouchot
- INSERM Research unit ERI n°11, Vandoeuvre-les-Nancy, France
| | - Christophe Paris
- INSERM Research unit ERI n°11, Vandoeuvre-les-Nancy, France
- School of Medicine, Nancy University; France
| | - Denis Zmirou-Navier
- INSERM Research unit ERI n°11, Vandoeuvre-les-Nancy, France
- School of Medicine, Nancy University; France
| |
Collapse
|
47
|
Magnusson LL, Wennborg H, Bonde JP, Olsen J. Wheezing, asthma, hay fever, and atopic eczema in relation to maternal occupations in pregnancy. Occup Environ Med 2006; 63:640-6. [PMID: 16757508 PMCID: PMC2078155 DOI: 10.1136/oem.2005.024422] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To examine whether prenatal occupational exposures, especially to organic solvents, are associated with atopic diseases in childhood. METHODS The study comprised children born in Odense or Aalborg, Denmark between 1984 and 1987. Occupational job titles were derived from questionnaires filled out by the mothers when attending midwife centres. Assessment of organic solvent exposures was based on job titles selected by occupational specialists. A follow up questionnaire to the parents provided data on medical diagnoses as well as wheezing symptoms for 7844 children aged 14-18. Multivariate logistic regression analyses were performed to estimate the cumulative risk for wheezing (early wheezing not diagnosed as asthma), asthma, hay fever, and atopic eczema during childhood by means of odds ratios (OR) and 95% confidence intervals (CI). RESULTS Explorative analyses by maternal job titles in pregnancy showed elevated odds ratios concerning different atopic diseases for occupational groups such as "bakers, pastry cooks, and confectionary makers", "dental assistants", "electrical and electronic assemblers", "sewers and embroiders", and "bookbinders and related workers". An excess risk ratio for hay fever (OR 2.8, CI 1.1 to 7.5) was found following maternal gestational exposure to organic solvents. Furthermore, a slightly raised odds ratio for asthma was observed in children of shift workers (OR 1.2, CI 1.0 to 1.5). CONCLUSION The data suggest links between certain maternal occupations during pregnancy and atopic diseases, which merits further scrutiny. However, no consistent pattern was seen across the different atopic diseases.
Collapse
Affiliation(s)
- L L Magnusson
- Department of Biosciences and Nutrition, Karolinska Institutet at Novum, Huddinge, Sweden.
| | | | | | | |
Collapse
|
48
|
Nielsen J, Welinder H, Bensryd I, Rylander L, Skerfving S. Ocular and airway symptoms related to organic acid anhydride exposure--a prospective study. Allergy 2006; 61:743-9. [PMID: 16677245 DOI: 10.1111/j.1398-9995.2006.01028.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Organic acid anhydrides (OAA) are used as hardeners in epoxy resin systems. They are powerful sensitizers giving frequent rhinitis and asthma in exposed workers. Incidence of symptoms is unknown. Here we present the first prospective study on the associations between OAA exposure, symptoms, and effects of confounding factors. METHODS All new employees in three plants handling OAA were followed for up to 8.5 years. Before the employment, a questionnaire reporting about symptoms of eyes and airways, smoking habits, and atopy was answered. The subjects were asked at regular medical examinations about work tasks and work-related symptoms. Serum was analysed for specific OAA antibodies. RESULTS Mean exposures varied between 6 and 39 microg/m3. The incidence for work-related symptoms of the eyes, nose, pharynx, and lower airways was 91, 64, 46, and 31 per 1000 years of exposure, respectively. Symptoms were found frequently, even at mean exposure level at <10 microg/m3. Smoking and atopy increased the risk of symptoms. Immunoglobulin (Ig)E sensitized workers had a significant increased risk for symptoms of the eyes and pharynx and for running nose/sneezing. CONCLUSIONS Organic acid anhydrides exposure is associated with frequent ocular and airway symptoms even at mean exposure levels at <10 microg/m3. There is an important need for establishment of an occupational threshold limit. A limit value of below 5 microg/m3 is proposed.
Collapse
Affiliation(s)
- J Nielsen
- Department of Occupational and Environmental Medicine, University Hospital Lund, Lund, Sweden
| | | | | | | | | |
Collapse
|
49
|
Malo JL. Future advances in work-related asthma and the impact on occupational health. Occup Med (Lond) 2006; 55:606-11. [PMID: 16314332 DOI: 10.1093/occmed/kqi185] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Work-related asthma (WRA) and WRA-like conditions refer to all situations in which asthma or asthma-like syndromes occur or worsen in the workplace. This occurs in approximately 10% of all adult-onset asthma subjects. Occupational asthma (OA) is a specific type of WRA that is 'caused' by the workplace, being mediated either by an allergic process with a latency period or by a non-allergic irritant-induced mechanism. Personal asthma can also 'worsen' at work (work-aggravated or exacerbated asthma), the reasons, mechanisms, extent and consequences of this situation being unknown. The author reviews various aspects of WRA with an emphasis on OA (about which more is known) and proposes key issues that need to be further studied, proposed and applied in at-risk workplaces in order to improve recognition, diagnosis and management of this condition. OA represents a unique situation that, unfortunately, is only very rarely provided to health-care providers: affected workers can be cured with minimal impact on quality of life. All efforts should be made to achieve this goal at an affordable socio-economic cost.
Collapse
Affiliation(s)
- Jean-Luc Malo
- Department of Chest Medicine, Hôpital du Sacré-Coeur de Montréal, 5400 West, Gouin Boulevard, Montréal, Québec, Canada H4J 1C5.
| |
Collapse
|
50
|
Marks GB. Environmental factors and gene-environment interactions in the aetiology of asthma. Clin Exp Pharmacol Physiol 2006; 33:285-9. [PMID: 16487276 DOI: 10.1111/j.1440-1681.2006.04360.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The importance of early life environmental influences on the aetiology of asthma is implied by the observed geographic and temporal variation in the prevalence of the disease among children. 2. There is evidence pointing to the role of exposure to allergen, various aspects of diet and hygiene-related factors in the aetiology of asthma. 3. There is also evidence that heritable factors influence the impact of hygiene-related exposures on the risk of having asthma. Polymorphism within genes coding for the toll-like receptor-lipopolysaccharide (TLR-LPS) signalling pathway may underlie variations in effects of hygiene-related exposures, including specifically endotoxin, on the risk of developing allergic sensitization and allergic disease. 4. At present there is no unifying theory to explain the childhood origins of asthma and, hence, no solid basis for developing preventative interventions. Progress towards this goal requires better understanding of the heterogeneous nature of the disease in early childhood, improved characterization of relevant environmental exposures and long-term follow up of birth cohorts with reliable and valid measures of allergy and asthma outcomes.
Collapse
Affiliation(s)
- Guy B Marks
- Woolcock Institute of Medical Research and South Western Sydney Clinical School, University of New South Wales, New South Wales, Australia.
| |
Collapse
|