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Pemberton MA, Arts JH, Kimber I. Identification of true chemical respiratory allergens: Current status, limitations and recommendations. Regul Toxicol Pharmacol 2024; 147:105568. [PMID: 38228280 DOI: 10.1016/j.yrtph.2024.105568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 01/06/2024] [Accepted: 01/13/2024] [Indexed: 01/18/2024]
Abstract
Asthma in the workplace is an important occupational health issue. It comprises various subtypes: occupational asthma (OA; both allergic asthma and irritant-induced asthma) and work-exacerbated asthma (WEA). Current regulatory paradigms for the management of OA are not fit for purpose. There is therefore an important unmet need, for the purposes of both effective human health protection and appropriate and proportionate regulation, that sub-types of work-related asthma can be accurately identified and classified, and that chemical respiratory allergens that drive allergic asthma can be differentiated according to potency. In this article presently available strategies for the diagnosis and characterisation of asthma in the workplace are described and critically evaluated. These include human health studies, clinical investigations and experimental approaches (structure-activity relationships, assessments of chemical reactivity, experimental animal studies and in vitro methods). Each of these approaches has limitations with respect to providing a clear discrimination between OA and WEA, and between allergen-induced and irritant-induced asthma. Against this background the needs for improved characterisation of work-related asthma, in the context of more appropriate regulation is discussed.
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Affiliation(s)
| | | | - Ian Kimber
- Faculty of Biology, Medicine and Health, University of Manchester, UK
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2
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Mason P, Liviero F, Paccagnella ER, Biasioli M, Maestrelli P, Frigo AC. Impact of occupational asthma on health and employment status: a long-term follow-up study. Occup Environ Med 2023; 80:70-76. [PMID: 36581454 DOI: 10.1136/oemed-2022-108504] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 12/03/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The aim of this study was to assess the predictors of a favourable prognosis of occupational asthma (OA) and the employment status of patients with OA at least 2 years after diagnosis. METHODS We collected data from 204 patients who had a diagnosis of OA confirmed by a positive specific inhalation challenge. We defined OA remission as meeting the following three criteria: no asthma symptoms, no antiasthma therapy for the last year and having normal lung function at the end of follow-up. A logistic regression analysis was performed to estimate the effects of the covariates. RESULTS At 10.6±7.8-year follow-up, 60 of 204 possible patients participated in the study, and among them 17 showed OA remission. When compared with the 43 patients with persistent OA, these patients exhibited at diagnosis younger age (p=0.0039), shorter duration of symptomatic exposure (p=0.0512), better lung function expressed by higher forced vital capacity (FVC%) predicted (p=0.0164), forced expiratory volume in 1 s (FEV1) % predicted (p=0.0066) and FEV1/FVC% (p=0.0132), and less bronchial hyper-responsiveness (p=0.0118). Nevertheless, in the multivariable model, no variables were significantly associated with OA remission. At follow-up, three individuals have retired; among the remaining 57 workers, 91.2% were still employed and 43.8% of them had continued working in the same factory after ceasing exposure to the causative agent. CONCLUSIONS This monocentric study did not identify a strong predictor of OA remission, but documented a high employment rate and a good job preservation over a long timeframe after diagnosis of OA mainly induced by low molecular weight agents.
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Affiliation(s)
- Paola Mason
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Università degli Studi di Padova, Padova, Italy
| | - Filippo Liviero
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Università degli Studi di Padova, Padova, Italy
| | - Eleonora Rachele Paccagnella
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Università degli Studi di Padova, Padova, Italy
| | - Marco Biasioli
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Università degli Studi di Padova, Padova, Italy
| | - Piero Maestrelli
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Università degli Studi di Padova, Padova, Italy
| | - Anna Chiara Frigo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Università degli Studi di Padova, Padova, Italy
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3
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da Paz ER, de Lima CMF, Felix SN, Schaeffer B, Galvão CES, Correia AT, Righetti RF, de Arruda Martins M, de Fátima Lopes Calvo Tibério I, Saraiva-Romanholo BM. Airway inflammatory profile among cleaning workers from different workplaces. BMC Pulm Med 2022; 22:170. [PMID: 35488256 PMCID: PMC9052628 DOI: 10.1186/s12890-022-01949-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 04/11/2022] [Indexed: 01/01/2023] Open
Abstract
Background Cleaning workers represent a significant proportion of the active population worldwide, with poor remuneration, particularly in developing countries. Despite this, they remain a relatively poorly studied occupational group. They are constantly exposed to agents that can cause symptoms and respiratory problems. This study aimed to evaluate upper airway inflammation in professional cleaning workers in three different occupational settings by comparing nasal cytology inflammation and clinical profiles. Methods We performed a cross-sectional study on the prevalence of upper airway inflammation and symptoms of asthma/rhinitis related to cleaning work, according to workplace. A total of 167 participants were divided into four groups: hospital, university, housekeeper and control. A nasal swab was collected for upper airway inflammation evaluation. Clinical profiles and respiratory symptom employee evaluations were performed using specific questionnaires (European Community Respiratory Health Survey—ECRS and the International Study of Asthma and Allergies in Childhood—ISAAC). Results Cleaning workers showed increased neutrophils and lymphocytes; the hospital and university groups showed increased macrophages compared to the housekeeper and control groups. The hospital and housekeeper groups showed increased eosinophils when they performed cleaning services for up to one year and reported having more asthma symptoms than the control group. Cleaning workers showed increased rhinitis symptoms. The university group showed increased rhinitis symptoms aggravated by the workplace compared with the hospital and housekeeper groups. Cleaning workers showed an increased affirmative response when directly asked about rhinitis symptoms compared to the control group. Conclusions Cleaning workers showed airway inflammation, asthma symptoms and rhinitis, regardless of the occupational environment to which they were exposed, as well as showed increased rhinitis and asthma symptoms. Hospital cleaning workers showed increased macrophages, lymphocytes and eosinophils compared to the others. The length of time spent performing cleaning work was not related to nasal inflammation or respiratory symptoms in this population. However, there were differences in workplaces. Registered on ClinicalTrials.gov. Trial registration number: NCT03311048. Registration date: 10.16.2017. Retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-01949-5.
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Affiliation(s)
- Edinéia Rosa da Paz
- Instituto de Assistência Médica Ao Servidor Público Estadual (IAMSPE), Hospital Do Servidor Público Do Estado de São Paulo, Sao Paulo, SP, Brazil
| | | | - Soraia Nogueira Felix
- Instituto de Assistência Médica Ao Servidor Público Estadual (IAMSPE), Hospital Do Servidor Público Do Estado de São Paulo, Sao Paulo, SP, Brazil.
| | - Bruna Schaeffer
- Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil
| | | | - Aristides Tadeu Correia
- Departamento de Cardiopneumologia, Instituto do Coração, InCor-HCFMUSP, Universidade de São Paulo, Sao Paulo, SP, Brazil.,Laboratório de Investigação Médica- LIM 61, Serviço de Cirurgia Torácica, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Renato Fraga Righetti
- Hospital Sírio-Libanês, Serviço de Reabilitação, Sao Paulo, SP, Brazil.,Laboratório de Terapêutica Experimental (LIM-20), Faculdade de Medicina da USP (FMUSP), Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Milton de Arruda Martins
- Laboratório de Terapêutica Experimental (LIM-20), Faculdade de Medicina da USP (FMUSP), Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Beatriz Mangueira Saraiva-Romanholo
- Instituto de Assistência Médica Ao Servidor Público Estadual (IAMSPE), Hospital Do Servidor Público Do Estado de São Paulo, Sao Paulo, SP, Brazil.,Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil.,Laboratório de Terapêutica Experimental (LIM-20), Faculdade de Medicina da USP (FMUSP), Universidade de Sao Paulo, Sao Paulo, Brazil
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4
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Laustsen BH, Omland Ø, Würtz ET, Sigsgaard T, Ebbehøj NE, Carstensen O, Rasmussen K, Kamath SD, Lopata AL, Bønløkke JH. Rhino Conjunctivitis and Asthma Among Seafood Processing Workers in Greenland. A Cross-Sectional Study. FRONTIERS IN ALLERGY 2022; 2:747011. [PMID: 35387025 PMCID: PMC8974787 DOI: 10.3389/falgy.2021.747011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 09/13/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction: The fishing- and the seafood processing industries are the largest industrial sectors in Greenland. Despite this, only a few cases of occupational diseases in this industry have been reported to the Danish Labor Market Insurance. Occupational asthma and allergy are well-known occupational diseases in the seafood processing industry worldwide and underreporting of occupational diseases in Greenland is suspected. Objective: The aim of the current study was to examine the associations between job exposures and occupational asthma and rhino conjunctivitis in workers in the Greenlandic seafood processing industry and to compare the prevalence of sensitization by type and degree of exposure to snow crab, shrimp, fish, and the fish parasite, Anisakis simplex. Methods: Data from 382 Greenlandic seafood processing workers were collected during 2016–2018. Data included questionnaire answers, lung function measurements, skin prick tests, and blood samples with ImmunoCAP. For all analyses, p < 0.05 was considered the level of significance. Results: 5.5% of the workers had occupational asthma and 4.6% had occupational rhino conjunctivitis. A large proportion of the workers were sensitized to allergens specific to the workplace; 18.1% to snow crab, 13.6% to shrimp, 1.4% to fish, and 32.6% to the fish parasite, A. simplex. We found a dose-response relationship between the risk of being sensitized to snow crab and A. simplex and years of exposure to the allergens in the seafood processing industry. Conclusion: This study showed that a considerable proportion of workers in the Greenlandic seafood processing industry had occupational asthma and rhino conjunctivitis. Additionally, the study showed high sensitization levels toward snow crab, shrimp, and the fish parasite, A. simplex. This supports the hypothesis of a considerable degree of underreporting of occupational allergic airway disease in the Greenlandic seafood processing industry. Prospectively, it is important to inform workers, leaders, and health care professionals of the health problems and the law on worker's compensation, and to initiate preventive actions at factory and trawler level.
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Affiliation(s)
- Birgitte Hamann Laustsen
- Department of Clinical Medicine, Danish Ramazzini Centre, Aalborg University, Aalborg, Denmark.,Institute of Nursing & Health Science, Ilisimatusarfik, University of Greenland, Nuuk, Greenland
| | - Øyvind Omland
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Else Toft Würtz
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark
| | | | - Niels E Ebbehøj
- Department of Occupational and Environmental Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | - Ole Carstensen
- Department of Occupational Medicine, Danish Ramazzini Center, Regional Hospital West Jutland, Herning, Denmark
| | - Kurt Rasmussen
- Department of Occupational Medicine, Danish Ramazzini Center, Regional Hospital West Jutland, Herning, Denmark
| | - Sandip D Kamath
- Molecular Allergy Research Laboratory, College of Public Health, Medical and Veterinary Sciences, Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia
| | - Andreas L Lopata
- Molecular Allergy Research Laboratory, College of Public Health, Medical and Veterinary Sciences, Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia
| | - Jakob Hjort Bønløkke
- Department of Occupational and Environmental Medicine, Danish Ramazzini Centre, Aalborg University Hospital, Aalborg, Denmark
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Mason P, Liviero F, Maestrelli P, Frigo AC. Long-Term Follow-Up of Cluster-Based Diisocyanate Asthma Phenotypes. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:3380-3386. [PMID: 33940214 DOI: 10.1016/j.jaip.2021.04.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Data on the outcome of occupational asthma (OA) are heterogeneous. OBJECTIVE To assess the impact of being part of a specific cluster at diagnosis on the long-term outcome of diisocyanate-induced OA. METHODS We collected data from 56 patients who had a diagnosis of OA confirmed by a positive specific inhalation challenge. Patients sensitized to toluene diisocyanate were allocated to cluster 1 or 2 based on a tree analysis, using the 3 variables relevant for cluster segregation identified in a previous study: age, body mass index, and forced expiratory volume in 1 second/forced vital capacity at diagnosis. Patients sensitized to methylene diisocyanate were allocated to cluster 3, as in previous study. We defined OA remission when a patient had met a total of 3 criteria: no asthma symptoms and no antiasthma therapy for the last year, as well as having normal lung function. RESULTS At follow-up, 16 patients showed OA remission. They exhibited better lung function, less bronchial hyperreactivity, as well as younger age at diagnosis. Twenty-eight patients were allocated to cluster 1, 10 to cluster 2, and 18 to cluster 3. The percentage of patients with OA remission was higher in cluster 2 (50% vs 25% in cluster 1 and 22.5% in cluster 3), although the difference was not statistically significant (P = .2789). CONCLUSIONS Age at diagnosis was a strong predictor of OA remission. The outcome of diisocyanate OA tended to be more favorable for patients with toluene diisocyanate OA allocated in cluster 2, but this finding needs to be validated by further data.
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Affiliation(s)
- Paola Mason
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Filippo Liviero
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Piero Maestrelli
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy.
| | - Anna Chiara Frigo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
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Burge S, Moore VC. What good came out of the Covid-19 outbreak for workers with occupational asthma? Expert Rev Respir Med 2021; 15:963-965. [PMID: 33866901 DOI: 10.1080/17476348.2021.1917388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Sherwood Burge
- Occupational Lung Disease Unit, Birmingham Heartlands Hospital, Birmingham, UK
| | - Vicky C Moore
- Occupational Lung Disease Unit, Birmingham Heartlands Hospital, Birmingham, UK
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7
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Ghosh D, Bernstein JA. Health Effects of Trimellitic Anhydride Occupational Exposure: Insights from Animal Models and Immunosurveillance Programs. Clin Rev Allergy Immunol 2021; 59:61-77. [PMID: 32594360 DOI: 10.1007/s12016-020-08801-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Acid anhydrides are used by chemical industries as plasticizers. Trimellitic acid (TMA) is an acid anhydride widely utilized in factories to produce paints, varnishes, and plastics. In addition to causing direct irritant effects, TMA can augment antibody responses in exposed factory workers leading to occupational asthma. Therefore, industries producing TMA have implemented occupational immunosurveillance programs (OISPs) to ensure early diagnosis and medical management, involving exposure reduction/ complete removal of sensitized workers from exposure areas. Multiple animal models (mice strains, rat stains, guinea pig, swine) with different exposure patterns (dermal, nasal, vapor inhalation exposures for different time frames) have been described to elucidate the pathophysiology of TMA exposure. In TMA factories, in spite of implementing advanced environmental controls and personal protective measures to limit exposure, workers become TMA-sensitized. Animal models revealed sIgG, sIgE, sIgA, and sIgM along with pulmonary lesions, cellular infiltrates, alveolar hemorrhage, and pneumonitis associated with TMA exposure. Molecular studies showed involvement of specific functional gene clusters related to cytokine and chemokine responses, lung remodeling, and arginase function. However, thus far, there is no evidence supporting fetotoxic or carcinogenic effects of TMA. OISP data showed IgG and IgE responses in exposed factory workers. Interestingly, timelines for detectable sIgG response, in conjunction with its magnitude, have been shown to be a predictor for future sIgE response. OISPs have been very successful so far at creating a healthy and safe working environment for TMA-exposed factory workers. Graphical Abstract Trimellitic Acid (TMA), used to produce paints, varnishes and plastics, can cause irritant-mediated and immune-mediated occupational health problems. NCBI pubmed search indicated that multiple animal models (different animal types, with chronic vs. acute exposure type, using TMA dust/suspension applied via dermal or other routes) have been used by investigators to elucidate the pathobiology of TMA-exposure. Several outcomes have been measured including humoral, lung/ airway, lymph nodes and dermal/ ear thickening responses. Studies on human subjects have been conducted mostly as parts of Occupational immunosurveillance programs (OISPs) implemented to identify TMA-sensitized workers (using ImmunoCAP and Skin prick testing), monitoring them longitudinally and their medical management including exposure reduction/ complete removal of sensitized workers from exposure areas. Clinical management also includes identification of irritant-induced and/ or immune-mediated outcomes of TMA occupational exposure. Collectively, these studies have led to important insights into the pathomechanism of TMA-exposure and have been very successful at creating a safe working environment for TMA-exposed factory workers.
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Affiliation(s)
- Debajyoti Ghosh
- Division of Immunology, Allergy Section, Department of Internal Medicine, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH, 45267, USA
| | - Jonathan A Bernstein
- Division of Immunology, Allergy Section, Department of Internal Medicine, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH, 45267, USA.
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8
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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.
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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
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9
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Parkes ED, Moore VC, Walters GI, Burge PS. Diagnosis of occupational asthma from serial measurements of forced expiratory volume in 1 s (FEV 1) using the Area Between Curves (ABC) score from the Oasys plotter. Occup Environ Med 2020; 77:801-805. [PMID: 32764105 DOI: 10.1136/oemed-2019-106351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 06/12/2020] [Accepted: 06/25/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To identify the changes in serial 2-hourly forced expiratory volume in 1 s (FEV1) measurements required to identify occupational asthma (OA) using the Oasys Area Between Curves (ABC) score. METHODS The ABC score from 2-hourly measurements of FEV1 was compared between workers with confirmed OA and asthmatics without occupational exposure to identify the optimum separation using receiver operator characteristic (ROC) analysis. Separate analyses were made for plots using clock time and time from waking to allow for use in shift workers. Minimum record criteria were ≥6 readings per day, >4 day shifts and >4 rest days (or >9 days for controls). RESULTS A retrospective analysis identified 22 workers with OA and 30 control asthmatics whose records reached the quality standards. Median FEV1 diurnal variation was 20.3% (IQR 16.1-32.6) for OA and 19.5% (IQR 14.5-26.1) for asthmatic controls. ROC curve analysis identified that a difference of 0.056 L/hour gave a ROC score of 0.821 for clock time and 0.768 for time from waking with a sensitivity of 73% and a specificity of 93% for the diagnosis of OA. CONCLUSIONS The diagnosis of OA requires objective confirmation. Unsupervised serial FEV1 measurements are more difficult to obtain reliably than measurements of peak expiratory flow, which are likely to remain the standard for general use. A FEV1 ABC score >0.056 L/hour provides a valid cut-off for those who wish to use FEV1 rather than peak expiratory flow.
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Affiliation(s)
- Edward D Parkes
- Department of Respiratory Sciences, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Vicky C Moore
- Occupational Lung Disease Service, University Hopitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Gareth I Walters
- Occupational Lung Disease Service, University Hopitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Peter Sherwood Burge
- Occupational Lung Disease Service, University Hopitals Birmingham NHS Foundation Trust, Birmingham, UK
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10
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Dobashi K, Usami A, Yokozeki H, Tsurikisawa N, Nakamura Y, Sato K, Okumura J, Yamaguchi M, Kunio Dobashi, Akiyama K, Usami A, Yokozeki H, Ikezawa Z, Tsurikisawa N, Nakamura Y, Sato K, Okumura J, Takayama K, Adachi M, Matsunaga K, Naito K, Nakazawa T, Ohta K, Okano M, Tohda Y, Watanabe M, Yamaguchi M. Japanese guidelines for occupational allergic diseases 2020. Allergol Int 2020; 69:387-404. [PMID: 32471740 DOI: 10.1016/j.alit.2020.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Indexed: 12/23/2022] Open
Abstract
Occupational allergic diseases are likely to worsen or become intractable as a result of continuous exposure to high concentrations of causative allergens. These are socioeconomically important diseases that can lead to work interruptions for patients and potentially job loss. We published the first guideline for managing occupational allergic diseases in Japan. The original document was published in Japanese in 2013, and the following year (2014) it was published in English. This guideline consists of six chapters about occupational asthma, occupational allergic rhinitis, occupational skin diseases, hypersensitivity pneumonitis, occupational anaphylaxis shock, and the legal aspects of these diseases. Providing general doctors with the knowledge to make evidence-based diagnoses and to understand the occupational allergic disease treatment policies, was a breakthrough in allergic disease treatment. Due to the discovery of new occupational allergens and the accumulation of additional evidence, we published a revised version of our original article in 2016, and it was published in English in 2017. In addition to including new knowledge of allergens and evidence, the 2016 revision contains a "Flowchart to Diagnosis" for the convenience of general doctors. We report the essence of the revised guidelines in this paper.
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11
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Tsui HC, Ronsmans S, De Sadeleer LJ, Hoet PHM, Nemery B, Vanoirbeek JAJ. Skin Exposure Contributes to Chemical-Induced Asthma: What is the Evidence? A Systematic Review of Animal Models. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2020; 12:579-598. [PMID: 32400126 PMCID: PMC7224990 DOI: 10.4168/aair.2020.12.4.579] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/17/2020] [Accepted: 01/21/2020] [Indexed: 12/11/2022]
Abstract
It is generally assumed that allergic asthma originates primarily through sensitization via the respiratory mucosa, but emerging clinical observations and experimental studies indicate that skin exposure to low molecular weight (LMW) agents, i.e. “chemicals,” may lead to systemic sensitization and subsequently develop asthma when the chemical is inhaled. This review aims to evaluate the accumulating experimental evidence that adverse respiratory responses can be elicited upon inhalation of an LMW chemical sensitizer after previous sensitization by dermal exposure. We systematically searched the PubMed and Embase databases up to April 15, 2017, and conducted forward and backward reference tracking. Animal studies involving both skin and airway exposure to LMW agents were included. We extracted 6 indicators of “selective airway hyper-responsiveness” (SAHR)—i.e. respiratory responses that only occurred in previously sensitized animals—and synthesized the evidence level for each indicator into strong, moderate or limited strength. The summarized evidence weight for each chemical agent was graded into high, middle, low or “not possible to assess.” We identified 144 relevant animal studies. These studies involved 29 LMW agents, with 107 (74%) studies investigating the occurrence of SAHR. Indicators of SAHR included physiological, cytological/histological and immunological responses in bronchoalveolar lavage, lung tissue and airway-draining lymph nodes. Evidence for skin exposure-induced SAHR was present for 22 agents; for 7 agents the evidence for SAHR was inconclusive, but could not be excluded. The ability of a chemical to cause sensitization via skin exposure should be regarded as constituting a risk of adverse respiratory reactions.
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Affiliation(s)
- Hung Chang Tsui
- Centre for Environment and Health, Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium
| | - Steven Ronsmans
- Centre for Environment and Health, Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium
| | - Laurens J De Sadeleer
- Department of Respiratory Diseases, Unit for Interstitial Lung Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Peter H M Hoet
- Centre for Environment and Health, Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium
| | - Benoit Nemery
- Centre for Environment and Health, Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium.
| | - Jeroen A J Vanoirbeek
- Centre for Environment and Health, Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium.
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12
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Paraskevaidou K, Porpodis K, Kontakiotis T, Kioumis I, Spyratos D, Papakosta D. Asthma and rhinitis in Greek furniture workers. J Asthma 2019; 58:170-179. [PMID: 31619088 DOI: 10.1080/02770903.2019.1674328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: The detection of asthma and rhinitis in furniture workers exposed to chemicals in the area of Thessaloniki Greece and the determination of the most useful tests for diagnosing the above occupational diseases.Methods: Eighty-three workers (76 men), 35 exposed to chemicals (CW), 23 to wood dust (WW), and 25 office workers (OW), serving as controls, filled in a specialized European Community Respiratory Health Survey (ECRHS) questionnaire for asthma and were submitted to clinical evaluation, spirometry, bronchodilation test, PEF computer algorithm OASYS-2, FeNO, skin prick tests (SPTs), rhinomanometry and methacholine inhalation challenge. Working conditions and protective measurements were also recorded. According to the results of all conducted tests, each subject was distributed to a subgroup: (a) normal, (b) asthma, (c) rhinitis, (d) asthma and rhinitis. Comparisons were performed among work groups.Results: The presence of asthma and/or rhinitis was higher among CW and WW compared to OW (p = 0.004). Significant differences among groups were observed in the questions «better weekend» (p < 0.034) and "improvement on vacation» (p < 0.000), in OASYS-2 Score (p < 0.000), in ABC Score (p < 0.000), and in methacholine score (p < 0.022). Rhinomanometry, FeNO, spirometry, and spirometry after bronchodilation had no significant differences among groups. Working conditions, ventilation system, work practice, use and type of mask revealed no significant differences.Conclusion: Asthma and rhinitis are significantly common among CW. Protective measurements used were not adequate to prevent asthma and or work related rhinitis. Early diagnosis might contribute to disease prevention and control.
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Affiliation(s)
- Katerina Paraskevaidou
- Department of Pneumonology, Aristotle University of Thessaloniki, General Hospital G.Papanikolaou, Exochi, Thessaloniki, Greece
| | - Konstantinos Porpodis
- Department of Pneumonology, Aristotle University of Thessaloniki, General Hospital G.Papanikolaou, Exochi, Thessaloniki, Greece
| | - Theodoros Kontakiotis
- Department of Pneumonology, Aristotle University of Thessaloniki, General Hospital G.Papanikolaou, Exochi, Thessaloniki, Greece
| | - Ioannis Kioumis
- Department of Pneumonology, Aristotle University of Thessaloniki, General Hospital G.Papanikolaou, Exochi, Thessaloniki, Greece
| | - Dionisios Spyratos
- Department of Pneumonology, Aristotle University of Thessaloniki, General Hospital G.Papanikolaou, Exochi, Thessaloniki, Greece
| | - Despina Papakosta
- Department of Pneumonology, Aristotle University of Thessaloniki, General Hospital G.Papanikolaou, Exochi, Thessaloniki, Greece
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13
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Henneberger PK, Patel JR, de Groene GJ, Beach J, Tarlo SM, Pal TM, Curti S. Workplace interventions for treatment of occupational asthma. Cochrane Database Syst Rev 2019; 10:CD006308. [PMID: 31593318 PMCID: PMC6781842 DOI: 10.1002/14651858.cd006308.pub4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The impact of workplace interventions on the outcome of occupational asthma is not well understood. OBJECTIVES To evaluate the effectiveness of workplace interventions on occupational asthma. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE (PubMed); EMBASE(Ovid); NIOSHTIC-2; and CISILO (CCOHS) up to July 31, 2019. SELECTION CRITERIA We included all eligible randomized controlled trials, controlled before and after studies and interrupted time-series of workplace interventions for occupational asthma. DATA COLLECTION AND ANALYSIS Two authors independently assessed study eligibility and risk of bias, and extracted data. MAIN RESULTS We included 26 non-randomized controlled before and after studies with 1,695 participants that reported on three comparisons: complete removal from exposure and reduced exposure compared to continued exposure, and complete removal from exposure compared to reduced exposure. Reduction of exposure was achieved by limiting use of the agent, improving ventilation, or using protective equipment in the same job; by changing to another job with intermittent exposure; or by implementing education programs. For continued exposure, 56 per 1000 workers reported absence of symptoms at follow-up, the decrease in forced expiratory volume in one second as a percentage of a reference value (FEV1 %) was 5.4% during follow-up, and the standardized change in non-specific bronchial hyperreactivity (NSBH) was -0.18.In 18 studies, authors compared removal from exposure to continued exposure. Removal may increase the likelihood of reporting absence of asthma symptoms, with risk ratio (RR) 4.80 (95% confidence interval (CI) 1.67 to 13.86), and it may improve asthma symptoms, with RR 2.47 (95% CI 1.26 to 4.84), compared to continued exposure. Change in FEV1 % may be better with removal from exposure, with a mean difference (MD) of 4.23 % (95% CI 1.14 to 7.31) compared to continued exposure. NSBH may improve with removal from exposure, with standardized mean difference (SMD) 0.43 (95% CI 0.03 to 0.82).In seven studies, authors compared reduction of exposure to continued exposure. Reduction of exposure may increase the likelihood of reporting absence of symptoms, with RR 2.65 (95% CI 1.24 to 5.68). There may be no considerable difference in FEV1 % between reduction and continued exposure, with MD 2.76 % (95% CI -1.53 to 7.04) . No studies reported or enabled calculation of change in NSBH.In ten studies, authors compared removal from exposure to reduction of exposure. Following removal from exposure there may be no increase in the likelihood of reporting absence of symptoms, with RR 6.05 (95% CI 0.86 to 42.34), and improvement in symptoms, with RR 1.11 (95% CI 0.84 to 1.47), as well as no considerable change in FEV1 %, with MD 2.58 % (95% CI -3.02 to 8.17). However, with all three outcomes, there may be improved results for removal from exposure in the subset of patients exposed to low molecular weight agents. No studies reported or enabled calculation of change in NSBH.In two studies, authors reported that the risk of unemployment after removal from exposure may increase compared with reduction of exposure, with RR 14.28 (95% CI 2.06 to 99.16). Four studies reported a decrease in income of 20% to 50% after removal from exposure.The quality of the evidence is very low for all outcomes. AUTHORS' CONCLUSIONS Both removal from exposure and reduction of exposure may improve asthma symptoms compared with continued exposure. Removal from exposure, but not reduction of exposure, may improve lung function compared to continued exposure. When we compared removal from exposure directly to reduction of exposure, the former may improve symptoms and lung function more among patients exposed to low molecular weight agents. Removal from exposure may also increase the risk of unemployment. Care providers should balance the potential clinical benefits of removal from exposure or reduction of exposure with potential detrimental effects of unemployment. Additional high-quality studies are needed to evaluate the effectiveness of workplace interventions for occupational asthma.
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Affiliation(s)
- Paul K Henneberger
- National Institute for Occupational Safety and HealthRespiratory Health Division1095 Willowdale RoadMorgantownWest VirginiaUSA26505
| | - Jenil R Patel
- University of Texas School of Public HealthDepartment of Epidemiology, Human Genetics and Environmental Sciences1200 Pressler ST#W1004aHoustonTexasUSATX 77030
- University of Arkansas for Medical SciencesDepartment of Epidemiology4301 W Markham St, Slot#820Little RockArkansasUSA72205
| | - Gerda J de Groene
- Coronel Institute of Occupational Health, Academic Medical CenterNetherlands Center of Occupational DiseasesPO Box 22660AmsterdamNetherlands1100 DD
| | - Jeremy Beach
- University of AlbertaDepartment of MedicineEdmontonABCanada
| | - Susan M Tarlo
- University of TorontoDepartment of Medicine, and Dalla Lana School of Public HealthToronto Western Hospital EW7‐449399 Bathurst StTorontoONCanadaM5T 2S8
| | - Teake M Pal
- Coronel Institute of Occupational Health, Academic Medical CenterNetherlands Center of Occupational DiseasesPO Box 22660AmsterdamNetherlands1100 DD
| | - Stefania Curti
- University of BolognaDepartment of Medical and Surgical SciencesUO Medicina del Lavoro ‐ Policlinico Sant'Orsola‐MalpighiVia Palagi 9BolognaItaly40138
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14
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Jeebhay MF, Moscato G, Bang BE, Folletti I, Lipińska‐Ojrzanowska A, Lopata AL, Pala G, Quirce S, Raulf M, Sastre J, Swoboda I, Walusiak‐Skorupa J, Siracusa A. Food processing and occupational respiratory allergy- An EAACI position paper. Allergy 2019; 74:1852-1871. [PMID: 30953601 DOI: 10.1111/all.13807] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 03/22/2019] [Indexed: 12/29/2022]
Abstract
Occupational exposure to foods is responsible for up to 25% of cases of occupational asthma and rhinitis. Animal and vegetable high-molecular-weight proteins present in aerosolized foods during food processing, additives, preservatives, antioxidants, and food contaminants are the main inhalant allergen sources. Most agents typically cause IgE-mediated allergic reactions, causing a distinct form of food allergy (Class 3 food allergy). The allergenicity of a food protein, allergen exposure levels, and atopy are important risk factors. Diagnosis relies on a thorough medical and occupational history, functional assessment, assessment of sensitization, including component-resolved diagnostics where appropriate, and in selected cases specific inhalation tests. Exposure assessment, including allergen determination, is a cornerstone for establishing preventive measures. Management includes allergen exposure avoidance or reduction (second best option), pharmacological treatment, assessment of impairment, and worker's compensation. Further studies are needed to identify and characterize major food allergens and define occupational exposure limits, evaluate the relative contribution of respiratory versus cutaneous sensitization to food antigens, evaluate the role of raw versus cooked food in influencing risk, and define the absolute or relative contraindication of patients with ingestion-related food allergy, pollinosis, or oral allergy syndrome continuing to work with exposure to aerosolized food allergens.
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Affiliation(s)
- Mohamed F. Jeebhay
- Occupational Medicine Division, and Centre for Environmental & Occupational Health Research, School of Public Health and Family Medicine University of Cape Town Observatory South Africa
| | - Gianna Moscato
- Department of Public Health, Forensic and Experimental Medicine, Specialization School in Occupational Medicine University of Pavia Pavia Italy
| | - Berit E. Bang
- Department of Occupational and Environmental Medicine University Hospital of North Norway Sykehusvegen, Tromsoe Norway
| | - Ilenia Folletti
- Occupational Medicine Terni Hospital, University of Perugia Perugia Italy
| | | | - Andreas L. Lopata
- Department of Molecular & Cell Biology, College of Public Health, Medical and Veterinary Sciences James Cook University Townsville Queensland Australia
| | - Gianni Pala
- Occupational Physician’s Division Healthcare Authority of Sardinia Area of Sassari Italy
| | - Santiago Quirce
- Department of Allergy Hospital La Paz Institute for Health Research (IdiPAZ), and CIBER of Respiratory Diseases CIBERES Madrid Spain
| | - Monika Raulf
- Institute of Prevention and Occupational Medicine of the German Social Accident Insurance Institute of the Ruhr University Bochum Bochum Germany
| | - Joaquin Sastre
- Allergy Department Hospital Fundación Jiménez Díazand CIBER de Enfermedades Respiratorias (CIBERES) Madrid Spain
| | - Ines Swoboda
- Molecular Biotechnology Section FH Campus Wien ‐ University of Applied Sciences Vienna Austria
| | | | - Andrea Siracusa
- Formerly professor of Occupational Medicine University of Perugia Perugia Italy
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15
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Genomic mosaicism: A neglected factor that promotes variability in asthma diagnosis. Med Hypotheses 2019; 127:112-115. [PMID: 31088633 DOI: 10.1016/j.mehy.2019.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 04/12/2019] [Indexed: 11/22/2022]
Abstract
To elucidate the genetic architecture of asthma continues to be a challenge for molecular biologists and medical researchers. However, powerful genomic technologies are at disposal to help decipher complete human genomes; the genetic variability in asthma hinders the discovery of common molecular markers for this disease. In this context, we purpose to explore genomic mosaicism on asthma cells' biology as a strategy to discover key mechanisms, which can complement or re-define asthma diagnosis. Recent evidences showed that genomic mosaicism could be a normal event. In brains, each neuron may harbor hundreds of genetic alterations, which may contribute to neuronal diversity. Thus, can mosaicism be a natural motor of diversity in asthma? Why this genetic event is little described in scientific literature? To discuss these questions, we perform a critical review about the normality of genomic mosaicism; moreover, we examine the difficulty of current experimental approaches to detect different genotypes in cell populations of one individual.
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16
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Abstract
PURPOSE OF REVIEW The outcome for workers with occupational asthma is improved for those with an earlier diagnosis. Health surveillance at work is in principle designed to identify such cases, so that the risks to the individual worker, and coworkers, can be reduced. There is recent evidence to suggest that the uptake and quality of such surveillance could be improved. This review has assessed current approaches to health surveillance for occupational asthma. RECENT FINDINGS The article covers a review of the utility of questionnaires, lung function testing, immunological investigations, and other tests, including exhaled nitric oxide, sputum eosinophilia, and exhaled breath condensate specifically in the context of workplace-based health surveillance. SUMMARY Questionnaires remain a key component of respiratory health surveillance, although maybe limited by both sensitivity and specificity for early occupational asthma. The role of lung function testing is debated, although is recommended for higher level health surveillance. Various examples of immunological testing in health surveillance are discussed, but more evidence is needed in many specific areas before more general recommendations can be made. Evidence is discussed in relation to the utility of newer approaches such as exhaled nitric oxide, sputum eosinophilia, and exhaled breath condensate.
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17
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Abstract
Despite advances in the diagnosis and management of asthma, uncontrolled disease is still associated with a substantial mortality and morbidity burden. Patients often overestimate their level of asthma control while also reporting that asthma symptoms affect their quality of life and ability to work or study. There is some evidence of success with primary prevention measures in high-risk children and the secondary prevention of asthma in sensitized individuals or those at risk of developing occupational asthma. There are challenges with diagnosis – with under- and overdiagnosis and misdiagnosis being common – and in the treatment of asthma, despite clear treatment guidelines. In particular, severe asthma presents a huge challenge to the clinician, and its complex and heterogeneous nature warrants a personalized medicine approach to match therapies to individual patients. However, the tools for this are currently lacking in primary care. This article reviews the current unmet need in the diagnosis and clinical management of asthma, and provides an overview of the limitations of current therapies.
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18
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Lau A, Tarlo SM. Update on the Management of Occupational Asthma and Work-Exacerbated Asthma. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2019; 11:188-200. [PMID: 30661311 PMCID: PMC6340795 DOI: 10.4168/aair.2019.11.2.188] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 10/25/2018] [Accepted: 10/28/2018] [Indexed: 12/16/2022]
Abstract
Work-related asthma is the most common occupational lung disease encountered in clinical practice. In adult asthmatics, work-relatedness can account for 15%-33% of cases, but delays in diagnosis remain common and lead to worse outcomes. Accurate diagnosis of asthma is the first step to managing occupational asthma, which can be sensitizer-induced or irritant-induced asthma. While latency has traditionally been recognized as a hallmark of sensitizer-induced asthma and rapid-onset a defining feature of irritant-induced asthma (as in Reactive Airway Dysfunction Syndrome), there is epidemiological evidence for irritant-induced asthma with latency from chronic moderate exposure. Diagnostic testing while the patient is still in the workplace significantly improves sensitivity. While specific inhalational challenges remain the gold-standard for the diagnosis of occupational asthma, they are not available outside of specialized centers. Commonly available tests including bronchoprovocation challenges and peak flow monitoring are important tools for practicing clinicians. Management of sensitizer-induced occupational asthma is notable for the central importance of removal from the causative agent: ideally, removal of the culprit agent; but if not feasible, this may require changes in the work process or ultimately, removal of the worker from the workplace. While workers' compensation programs may reduce income loss, these are not universal and there can be significant socio-economic impact from work-related asthma. Primary prevention remains the preferred method of reducing the burden of occupational asthma, which may include modification to work processes, better worker education and substitution of sensitizing agents from the workplace with safer compounds.
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Affiliation(s)
- Ambrose Lau
- Respiratory Division, Department of Medicine, Toronto Western Hospital and St. Michael's Hospital, Toronto, Ontario, Canada
| | - Susan M Tarlo
- Respiratory Division, Department of Medicine, Toronto Western Hospital and St. Michael's Hospital, Toronto, Ontario, Canada.
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19
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Domingos Neto J, Myung E, Murta G, Lima PR, Vieira A, Lessa LA, Carvalho BRTD, Buzzini R, Bernardo WM. Asthma and occupation: Diagnosis using serial peak flow measurements. ACTA ACUST UNITED AC 2018; 64:95-99. [PMID: 29641668 DOI: 10.1590/1806-9282.64.02.95] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2017] [Indexed: 11/22/2022]
Affiliation(s)
| | - Eduardo Myung
- Associação Nacional de Medicina do Trabalho, São Paulo, SP, Brazil
| | - Guilherme Murta
- Associação Nacional de Medicina do Trabalho, São Paulo, SP, Brazil
| | | | - Anielle Vieira
- Associação Nacional de Medicina do Trabalho, São Paulo, SP, Brazil
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20
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Plantier L, Beydon N, Chambellan A, Degano B, Delclaux C, Dewitte JD, Dinh-Xuan AT, Garcia G, Kauffmann C, Paris C, Perez T, Poussel M, Wuyam B, Zerah-Lancner F, Chenuel B. [Guidelines for methacholine provocation testing]. Rev Mal Respir 2018; 35:759-775. [PMID: 30097294 DOI: 10.1016/j.rmr.2018.02.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 02/15/2018] [Indexed: 12/01/2022]
Abstract
Bronchial challenge with the direct bronchoconstrictor agent methacholine is commonly used for the diagnosis of asthma. The "Lung Function" thematic group of the French Pulmonology Society (SPLF) elaborated a series of guidelines for the performance and the interpretation of methacholine challenge testing, based on French clinical guideline methodology. Specifically, guidelines are provided with regard to the choice of judgment criteria, the management of deep inspirations, and the role of methacholine bronchial challenge in the care of asthma, exercise-induced asthma, and professional asthma.
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Affiliation(s)
- L Plantier
- CEPR/Inserm UMR1100, CHRU de Tours, service de pneumologie et explorations fonctionnelles respiratoires, université François-Rabelais, 37044 Tours cedex 9, France.
| | - N Beydon
- Unité fonctionnelle d'exploration fonctionnelle respiratoire et du sommeil, AP-HP, hôpital Armand-Trousseau, 75012 Paris, France
| | - A Chambellan
- Inserm UMR1087, explorations fonctionnelles et réhabilitation respiratoire, l'institut du thorax, CHU, 44093 Nantes cedex 1, France
| | - B Degano
- Service d'explorations fonctionnelles, hôpital Jean-Minjoz, 25000 Besançon, France
| | - C Delclaux
- Inserm U1141, DHU PROTECT, service de physiologie explorations fonctionnelles pédiatriques-CPPS, AP-HP, hôpital Robert-Debré, université Paris Diderot, 75019 Paris, France
| | - J-D Dewitte
- Santé au travail-laboratoire d'étude et de recherche en sociologie, UFR médecine et sciences de la santé, université de Bretagne occidentale, 29238 Brest cedex 3, France
| | - A T Dinh-Xuan
- Service de physiologie-explorations fonctionnelles, université Paris Descartes, AP-HP, hôpital Cochin, 75014 Paris, France
| | - G Garcia
- Service de physiologie, Inserm UMR999, AP-HP, hôpital de Bicêtre, 94270 Le Kremlin-Bicêtre cedex, France
| | - C Kauffmann
- Service d'explorations fonctionnelles respiratoires, CHU, 63000 Clermont-Ferrand, France
| | - C Paris
- EA7892, service de pathologie professionnelle, université de Lorraine, CHU de Nancy, 54500 Vandœuvre-Les-Nancy, France
| | - T Perez
- Clinique de pneumologie, centre de compétences maladies pulmonaires rares, CHRU de Lille, hôpital Albert-Calmette, 59037 Lille, France
| | - M Poussel
- Antenne médicale de prévention du dopage, EA 3450, service des examens de la fonction respiratoire et de l'aptitude à l'exercice médecine du sport, CHRU de Nancy Brabois, 54500 Vandœuvre-lès-Nancy, France
| | - B Wuyam
- Laboratoire HP2, Inserm 1042, service sport et pathologies, CHU de Grenoble, hôpital Sud, 38130 Echirolles, France
| | - F Zerah-Lancner
- Service de physiologie-explorations fonctionnelles, AP-HP, hôpital Henri-Mondor, 94000 Créteil, France
| | - B Chenuel
- Antenne médicale de prévention du dopage, EA 3450, service des examens de la fonction respiratoire et de l'aptitude à l'exercice médecine du sport, CHRU de Nancy Brabois, 54500 Vandœuvre-lès-Nancy, France
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21
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Medical Monitoring for Occupational Asthma Among Toluene Diisocyanate Production Workers in the United States. J Occup Environ Med 2018; 59 Suppl 12:S13-S21. [PMID: 29200134 DOI: 10.1097/jom.0000000000001197] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to describe a study of medical monitoring methods and lessons learned in detecting health outcomes in U.S. plants producing toluene diisocyanate (TDI). METHODS A multidisciplinary team implemented a medical and environmental monitoring program in three TDI plants. RESULTS Of 269 eligible workers, 197 (73%) participated and 42 (21%) met symptom and/or lung function criteria that would trigger evaluation for possible asthma over 5 years of data collection. Subsequent evaluation was delayed for most, and a web-based data collection system improved timeliness. CONCLUSION Medical monitoring of TDI workers identified workers triggering further assessment per study protocol. Systems and/or personnel to ensure rapid follow-up are needed to highlight when triggering events represent potential cases of asthma needing further evaluation. Implementation of a research protocol requires resources and oversight beyond an occupational health program.
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22
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Konya’da Hayvan Yemi Fabrikası İşçilerinde Mesleksel Astım Prevalansı. JOURNAL OF CONTEMPORARY MEDICINE 2018. [DOI: 10.16899/gopctd.401228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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23
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Balogun RA, Siracusa A, Shusterman D. Occupational rhinitis and occupational asthma: Association or progression? Am J Ind Med 2018; 61:293-307. [PMID: 29411403 DOI: 10.1002/ajim.22819] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Occupational asthma is the most frequently reported occupational respiratory disease in registries, and is often co-diagnosed with occupational rhinitis. We undertook a systematic review of the English-language epidemiologic literature linking these two conditions, with emphasis on progression from occupational rhinitis to occupational asthma. METHODS PubMed and Embase were queried in a series of structured searches designed to identify studies comparing occupational asthma and occupational rhinitis incidence or prevalence in occupationally exposed individuals. RESULTS The searches yielded a total of 109 unique citations, 15 of which yielded inferential data on the occupational rhinitis-asthma relationship. Nine of fifteen studies showed statistically significant associations between the occurrence of occupational rhinitis and occupational asthma among individual workers. CONCLUSIONS Limited data support the notion that occupational rhinitis precedes the development of occupational asthma, particularly when high-molecular-weight (HMW) agents are involved. The relationship between the two conditions could not be evaluated in many relevant studies due to a lack of cross-tabulation of individual cases.
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Affiliation(s)
- Rahmat A. Balogun
- Division of Occupational and Environmental Medicine; University of California; San Francisco California
| | | | - Dennis Shusterman
- Division of Occupational and Environmental Medicine; University of California; San Francisco California
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24
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Occupational Asthma, Not a Trivial Disorder and a Source of Fatal and Near-Fatal Events. CURRENT TREATMENT OPTIONS IN ALLERGY 2018. [DOI: 10.1007/s40521-018-0161-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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25
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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.
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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
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26
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Bittner C, Garrido MV, Harth V, Preisser AM. IgE Reactivity, Work Related Allergic Symptoms, Asthma Severity, and Quality of Life in Bakers with Occupational Asthma. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 921:51-60. [PMID: 27161107 DOI: 10.1007/5584_2016_226] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In Germany, bakers with occupational asthma willing to stay in their job are included in an interdisciplinary program of the Social Accident Insurance for Foodstuff and Catering Industry (BGN). The primary aim is to reduce flour dust exposure, and to provide adequate medical treatment. Our aim was to evaluate the program's effect on the disease's course using routinely collected data. Forty three bakers with allergic occupational asthma and with the available baseline level of IgE (f4, f5) were investigated. Changes in IgE related to wheat and rye flour exposure were measured by ImmunoCAP test during follow-up visits. A questionnaire on work-related allergic complaints (WRAC), the Asthma Control Test (ACT), a 10-point scale of asthma severity grade, and quality of life instruments (EQ-5D-5L, Mini-AQLQ) were administered. We found an improvement of asthma severity in 88.4 % of the bakers. WRAC were reported by 65 %; 77 % had good asthma control (ACT ≥ 20); and 81 % had regular asthma medication. A relevant reduction of ≥2 CAP-classes for both allergens was seen in 12 % of the subjects. Health-related and asthma-specific quality of life was high. We conclude that satisfactory asthma control is probably the result of adequate medical management. In a subgroup of bakers with decreased specific IgE, it may also be attributed to reduced allergen exposure.
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Affiliation(s)
- C Bittner
- Division of Clinical Occupational Medicine, Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf, 10 Seewartenstraße, 20459, Hamburg, Germany.
| | - M V Garrido
- Division of Clinical Occupational Medicine, Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf, 10 Seewartenstraße, 20459, Hamburg, Germany
| | - V Harth
- Division of Clinical Occupational Medicine, Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf, 10 Seewartenstraße, 20459, Hamburg, Germany
| | - A M Preisser
- Division of Clinical Occupational Medicine, Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf, 10 Seewartenstraße, 20459, Hamburg, Germany
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Harber P, Redlich CA, Hines S, Filios M, Storey E. Recommendations for a Clinical Decision Support System for Work-Related Asthma in Primary Care Settings. J Occup Environ Med 2017; 59:e231-e235. [PMID: 29023337 PMCID: PMC6282164 DOI: 10.1097/jom.0000000000001182] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to describe a recommended clinical decision support (CDS) approach for work-related asthma for incorporation in electronic health records (EHRs) for primary care health care providers. METHODS Subject matter experts convened by the American Thoracic Society reviewed available guidelines and published literature to develop specific recommendations. RESULTS It is important to recognize possible work-related asthma among persons with new-onset or worsening asthma. The work group recommends incorporating three simple questions about temporal relations between asthma symptoms and work in EHR systems and identified specific clinical conditions to trigger this intervention. Patients with positive responses to the three questions should have the asthma diagnosis documented and have further evaluation, education, and possible referral. CONCLUSION An effective CDS system for improving recognition of work-related asthma may help reduce morbidity and mortality of asthma in adults.
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Affiliation(s)
- Philip Harber
- Department of Community, Environment, and Policy. Mel and Enid Zuckerman College of Public Health, University Of Arizona, Tucson, Arizona, USA
| | - Carrie A. Redlich
- Department of Medicine, Yale University School of Medicine, New Haven Connecticut USA
| | - Stella Hines
- Department of Medicine, University Of Maryland, Baltimore Maryland
| | - Margaret Filios
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention (CDC), Morgantown, WV, USA
| | - Eileen Storey
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention (CDC), Morgantown, WV, USA
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Zhao DH, Cheung JMY, Smith L, Saini B. Exploring asthma in the workplace: A triangulation of perspectives from management, employees and people with asthma. J Asthma 2017; 55:859-867. [PMID: 28858530 DOI: 10.1080/02770903.2017.1369991] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE People with asthma spend a significant amount of time in the workplace but little is known about the current state of disease management in such contexts. The aim of the current study is to explore the experiences, attitudes and perceptions of asthma across different stakeholders in the workplace to help inform potential recommendations for workplace asthma policies. METHOD Using purposive and convenience sampling methods, in-depth semi-structured interviews were conducted in Australia with 5 human resource personnel, 10 employees with asthma and 10 employees without asthma. Interviews were guided by a schedule of questions focusing on attitudes and experiences of people with asthma in the workplace, which were audio recorded, transcribed verbatim and thematically analysed. RESULTS Analysis of the qualitative dataset revealed three key themes: Beliefs and Attitudes about Asthma, Asthma Solutions in the Workplace and Workplace Obstacles. Findings suggest that employees with asthma experience problems managing their asthma at work and there is a lack of workplace support in relation to asthma emergency management. CONCLUSION Key recommendations for workplace asthma policies have been made to provide better support for employees with asthma. However, further investigation into the experience of managing asthma is required in a wider variety of occupations and work experiences to inform the development of a workplace asthma policy.
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Affiliation(s)
- Denise H Zhao
- a Faculty of Pharmacy , The University of Sydney , Sydney , NSW , Australia
| | - Janet M Y Cheung
- a Faculty of Pharmacy , The University of Sydney , Sydney , NSW , Australia.,b CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research , University of Sydney , NSW , Australia
| | - Lorraine Smith
- a Faculty of Pharmacy , The University of Sydney , Sydney , NSW , Australia
| | - Bandana Saini
- a Faculty of Pharmacy , The University of Sydney , Sydney , NSW , Australia.,b CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research , University of Sydney , NSW , Australia
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Hawley B, Cummings KJ, Mohammed M, Dimmock AE, Bascom R. Allergic sinusitis and severe asthma caused by occupational exposure to locust bean gum: Case report. Am J Ind Med 2017; 60:658-663. [PMID: 28497854 DOI: 10.1002/ajim.22725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2017] [Indexed: 01/16/2023]
Abstract
We present a case that highlights the difficulties with diagnosis and the dangers of occupational allergic sinusitis and asthma left unrecognized. We describe the case history of a man who experienced work-related symptoms 1 year after beginning work as a cheesemaker at a creamery, and whose respiratory symptoms progressively worsened over 16 years before an occupational cause of his asthma was identified. His initial discrete episodes of sinusitis and acute bronchitis evolved into persistent asthma of increasing severity with exacerbations requiring repeated emergency room treatment. The case described in our report emphasizes the importance of clinician diagnosis of OA, and subsequent removal from exposure, such that asthma severity does not progress to near-fatal or fatal asthma in the sensitized worker. As demonstrated by this case report, identification of an occupational cause of asthma relies on a high degree of suspicion and excellent detective work by the clinician.
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Affiliation(s)
- Brie Hawley
- Respiratory Health Division; National Institute for Occupational Safety and Health; Morgantown West Virginia
| | - Kristin J. Cummings
- Respiratory Health Division; National Institute for Occupational Safety and Health; Morgantown West Virginia
| | | | - Anne E. Dimmock
- Pulmonary and Critical Care Medicine; Penn State Hershey College of Medicine; Hershey Pennsylvania
| | - Rebecca Bascom
- Pulmonary and Critical Care Medicine; Penn State Hershey College of Medicine; Hershey Pennsylvania
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Guideline recommendations on the use of allergen immunotherapy in house dust mite allergy: Time for a change? J Allergy Clin Immunol 2017; 140:41-52. [PMID: 28526624 DOI: 10.1016/j.jaci.2017.01.049] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 12/15/2016] [Accepted: 01/27/2017] [Indexed: 01/15/2023]
Abstract
Guidelines on the treatment of asthma, allergic rhinitis (AR), and allergen immunotherapy (AIT) lack recommendations for house dust mite (HDM) allergy. An expert panel reviewed current guidelines in the light of new data to assess whether guidelines could be improved. Most guidelines and key position papers did not provide specific recommendations on treatment of allergic asthma (AA) caused by HDM allergy, although some included AIT as a treatment option for AA in general. Around half of the guidelines stated that AIT with HDM extract was an effective treatment for AR, with several indicating sublingual immunotherapy as an option. This heterogeneity is caused by quality issues affecting studies of AIT with perennial allergens in patients with AA and AR, including use of different diagnosis and severity criteria, lack of consistent scoring or grading systems for primary and safety outcomes, and lack of consensus on treatment parameters. There is a need for well-designed clinical trials to serve as a basis for guideline recommendations. Although results from recent studies strengthen the evidence base for the efficacy and safety of sublingual immunotherapy in patients with HDM-induced AA and AR, their effect on subsequent guideline updates will depend on the methodology and evidence model used by each guideline.
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31
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Infrequent Treatments for Occupational Asthma: Immunotherapy and Biological Therapy. CURRENT TREATMENT OPTIONS IN ALLERGY 2017. [DOI: 10.1007/s40521-017-0125-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Curti S, Mattioli S, Baldasseroni A, Farioli A, Zanardi F, Lodi V, de Groene GJ, Christiani DC, Violante FS. Interventions for primary prevention of occupational asthma. Hippokratia 2017. [DOI: 10.1002/14651858.cd009674.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Stefania Curti
- University of Bologna; Department of Medical and Surgical Sciences; UO Medicina del Lavoro - Policlinico Sant'Orsola-Malpighi Via Palagi 9 Bologna Italy 40138
| | - Stefano Mattioli
- University of Bologna; Department of Medical and Surgical Sciences; UO Medicina del Lavoro - Policlinico Sant'Orsola-Malpighi Via Palagi 9 Bologna Italy 40138
| | - Alberto Baldasseroni
- Regione Toscana; CeRIMP - Centro Regionale Infortuni e Malattie Professionali; via di S.Salvi, 12 Palazzina 14 Firenze Italy 50135
| | - Andrea Farioli
- University of Bologna; Section of Occupational Medicine, Department of Internal Medicine, Geriatrics and Nephrology; UO Medicina del Lavoro - Policlinico Sant'Orsola Malpighi Via Palagi 9 Bologna Italy 40138
| | - Francesca Zanardi
- University of Bologna; Section of Occupational Medicine, Department of Internal Medicine, Geriatrics and Nephrology; UO Medicina del Lavoro - Policlinico Sant'Orsola Malpighi Via Palagi 9 Bologna Italy 40138
| | - Vittorio Lodi
- Policlinico Sant'Orsola-Malpighi; Unità Operativa Medicina del Lavoro; Via Palagi 9 Bologna Italy 40138
| | - Gerda J de Groene
- Coronel Institute of Occupational Health, Academic Medical Center; Netherlands Center of Occupational Diseases; PO Box 22660 Amsterdam Netherlands 1100 DD
| | - David C Christiani
- Harvard School of Public Health; Environmental Health; 665 Huntington Avenue, Building I Room 1407 Boston Massachusetts USA 02115
| | - Francesco S Violante
- University of Bologna; Section of Occupational Medicine, Department of Internal Medicine, Geriatrics and Nephrology; UO Medicina del Lavoro - Policlinico Sant'Orsola Malpighi Via Palagi 9 Bologna Italy 40138
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Dobashi K, Akiyama K, Usami A, Yokozeki H, Ikezawa Z, Tsurikisawa N, Nakamura Y, Sato K, Okumura J, Takayama K. Japanese guidelines for occupational allergic diseases 2017. Allergol Int 2017; 66:265-280. [PMID: 28214136 DOI: 10.1016/j.alit.2016.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 12/21/2016] [Indexed: 12/18/2022] Open
Abstract
In 2013, a guideline for occupational allergic diseases was published for the first time in Japan. Occupational allergic diseases are likely to worsen or become intractable as a result of continuous exposure to high concentrations of causative antigens, and are socioeconomically important diseases with which the patients might sometimes lose jobs due to work interruptions. Guidelines for occupational allergic diseases have been published in many countries. This guideline consists of six chapters about occupational asthma, occupational allergic rhinitis, occupational skin diseases, hypersensitivity pneumonitis and occupational anaphylaxis shock, and legal aspects of these diseases. The guideline is characterized with the following basic structure: Clinical Questions (CQs) are set with reference to Minds (Medical Information Network Distribution Service), statements by the committee are correspondingly listed, recommended grades and evidence levels are defined, and then descriptions and references are indicated.
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Genuneit J, Seibold AM, Apfelbacher CJ, Konstantinou GN, Koplin JJ, La Grutta S, Logan K, Flohr C, Perkin MR. The state of asthma epidemiology: an overview of systematic reviews and their quality. Clin Transl Allergy 2017; 7:12. [PMID: 28400946 PMCID: PMC5387188 DOI: 10.1186/s13601-017-0146-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 03/03/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Recently, we have published an overview of systematic reviews in allergy epidemiology and identified asthma as the most commonly reviewed allergic disease. Building on this work, we aimed to investigate the quality of systematic reviews in asthma using the AMSTAR checklist and to provide a reference for future, more in-depth assessment of the extent of previous knowledge. METHODS We included all 307 systematic reviews indexed with asthma, including occupational asthma, and/or wheeze from our previous search in PubMed and EMBASE up to December 2014 for systematic reviews on epidemiological research on allergic diseases. Topics of the included systematic reviews were indexed and we applied the AMSTAR checklist for methodological quality to all. Statistical analyses include description of lower and upper bounds of AMSTAR scores and variation across publication time and topics. RESULTS Of 43 topics catalogued, family history, birth weight, and feeding of formula were only covered once in systematic reviews published from 2011 onwards. Overall, at least one meta-analysis was conducted for all topics except for "social determinants", "perinatal", "birth weight", and "climate". AMSTAR quality scores were significantly higher in more recently published systematic reviews, in those with meta-analysis, and in Cochrane reviews. There was evidence of variation of quality across topics even, after accounting for these characteristics. Genetic factors in asthma development were often covered by systematic reviews with some evidence of unsubstantiated updates or repetition. CONCLUSIONS We present a comprehensive overview with an indexed database of published systematic reviews in asthma epidemiology including quality scores. We highlight some topics including active smoking and pets, which should be considered for future systematic reviews. We propose that our search strategy and database could be a basis for topic-specific overviews of systematic reviews in asthma epidemiology.
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Affiliation(s)
- Jon Genuneit
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081 Ulm, Germany
| | - Annina M. Seibold
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081 Ulm, Germany
| | - Christian J. Apfelbacher
- Institute of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - George N. Konstantinou
- Department of Allergy and Clinical Immunology, 424 General Military Training Hospital, Thessaloniki, Greece
| | - Jennifer J. Koplin
- Murdoch Children’s Research Institute, University of Melbourne, Melbourne, Australia
| | - Stefania La Grutta
- Institute of Biomedicine and Molecular Immunology, National Research Council of Italy, Palermo, Italy
| | - Kirsty Logan
- Division of Asthma, Allergy and Lung Biology, Children’s Allergies Department, King’s College London, London, UK
| | - Carsten Flohr
- Unit for Population-Based Dermatology Research, St John’s Institute of Dermatology, King’s College London and Guy’s and St Thomas’ NHS Foundation, London, UK
| | - Michael R. Perkin
- Population Health Research Institute, St George’s, University of London, London, UK
| | - for the Task Force “Overview of Systematic Reviews in Allergy Epidemiology (OSRAE)” of the EAACI Interest Group on Epidemiology
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081 Ulm, Germany
- Institute of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
- Department of Allergy and Clinical Immunology, 424 General Military Training Hospital, Thessaloniki, Greece
- Murdoch Children’s Research Institute, University of Melbourne, Melbourne, Australia
- Institute of Biomedicine and Molecular Immunology, National Research Council of Italy, Palermo, Italy
- Division of Asthma, Allergy and Lung Biology, Children’s Allergies Department, King’s College London, London, UK
- Unit for Population-Based Dermatology Research, St John’s Institute of Dermatology, King’s College London and Guy’s and St Thomas’ NHS Foundation, London, UK
- Population Health Research Institute, St George’s, University of London, London, UK
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Casey ML, Mazurek JM. Respirator Use Among US Farm Operators With Asthma: Results From the 2011 Farm and Ranch Safety Survey. J Agromedicine 2017; 22:78-88. [PMID: 28095135 PMCID: PMC5510023 DOI: 10.1080/1059924x.2017.1282904] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The purpose of this study was to estimate the national prevalence of respirator use among farm operators with farm work-related asthma and factors associated with respirator use. METHODS The authors examined the 2011 Farm and Ranch Safety Survey, a national survey collected from 11,210 actively farming farm operators in the United States. Adjusted prevalence ratios (aPORs) of respirator use were calculated by demographic characteristics, farm characteristics, asthma characteristics, and selected exposures and hazards. RESULTS Among the estimated 2.2 million farm operators in 2011, 35.7% reported using a respirator in the past 12 months. Respirator use was significantly (P < .05) associated with age, marital status, sex, smoking status, farm value of sales, farm type, farm acreage, and geographic region. Operators who work with pesticides were 3.5 times more likely to use respirator than those who did not work with pesticides (P < .0001). Among those with current asthma, 60.8% of operators with farm work-related asthma used respirators compared with 44.4% of operators with non-farm work-related asthma (P = .03). Farm operators with farm work-related asthma who had an asthma attack at work were 11.3 times more likely to report respirator use than those who did not have an asthma attack at work (P = .03). CONCLUSIONS Personal protective equipment, including respirators, is an approach to reducing respiratory exposures in agricultural settings, in particular among those with farm work-related asthma. Education for respirator use and evaluation for respirator tolerance should be considered.
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Affiliation(s)
- Megan L Casey
- a Surveillance Branch, Respiratory Health Division , National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention , Morgantown , West Virginia , USA
| | - Jacek M Mazurek
- a Surveillance Branch, Respiratory Health Division , National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention , Morgantown , West Virginia , USA
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Fishwick D, Sen D, Barber C, Bradshaw L, Robinson E, Sumner J. Occupational chronic obstructive pulmonary disease: a standard of care. Occup Med (Lond) 2016; 65:270-82. [PMID: 25972608 DOI: 10.1093/occmed/kqv019] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Consistent evidence from population studies report that 10-15% of the total burden of chronic obstructive pulmonary disease (COPD) is associated with workplace exposures. This proportion of COPD could be eliminated if harmful workplace exposures were controlled adequately. AIMS To produce a standard of care for clinicians, occupational health professionals, employers and employees on the identification and management of occupational COPD. METHODS A systematic literature review was used to identify published data on the prevention, identification and management of occupational COPD. Scottish Intercollegiate Guidance Network grading and the Royal College of General Practitioner three star grading system were used to grade the evidence. RESULTS There are a number of specific workplace exposures that are established causes of COPD. Taking an occupational history in patients or workers with possible or established COPD will identify these. Reduction in exposure to vapours, gases, dusts and fumes at work is likely to be the most effective method for reducing occupational COPD. Identification of workers with rapidly declining lung function, irrespective of their specific exposure, is important. Individuals can be identified at work by accurate annual measures of lung function. CONCLUSIONS Early identification of cases with COPD is important so that causality can be considered and action taken to reduce causative exposures thereby preventing further harm to the individual and other workers who may be similarly exposed. This can be achieved using a combination of a respiratory questionnaire, accurate lung function measurements and control of exposures in the workplace.
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Affiliation(s)
- D Fishwick
- Centre for Workplace Health, Health and Safety Laboratory, Buxton, UK,
| | - D Sen
- Health and Safety Executive, Bootle, Merseyside, UK
| | - C Barber
- Centre for Workplace Health, Health and Safety Laboratory, Buxton, UK
| | - L Bradshaw
- Centre for Workplace Health, Health and Safety Laboratory, Buxton, UK
| | - E Robinson
- Centre for Workplace Health, Health and Safety Laboratory, Buxton, UK
| | - J Sumner
- Centre for Workplace Health, Health and Safety Laboratory, Buxton, UK
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Tarlo SM, Altman KW, Oppenheimer J, Lim K, Vertigan A, Prezant D, Irwin RS. Occupational and Environmental Contributions to Chronic Cough in Adults: Chest Expert Panel Report. Chest 2016; 150:894-907. [PMID: 27521735 DOI: 10.1016/j.chest.2016.07.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 06/15/2016] [Accepted: 07/15/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND In response to occupational and environmental exposures, cough can be an isolated symptom reflecting exposure to an irritant with little physiological consequence, or it can be a manifestation of more significant disease. This document reviews occupational and environmental contributions to chronic cough in adults, focusing on aspects not previously covered in the 2006 ACCP Cough Guideline or our more recent systematic review, and suggests an approach to investigation of these factors when suspected. METHODS MEDLINE and TOXLINE literature searches were supplemented by articles identified by the cough panel occupational and environmental subgroup members, to identify occupational and environmental aspects of chronic cough not previously covered in the 2006 ACCP Cough Guideline. Based on the literature reviews and the Delphi methodology, the cough panel occupational and environmental subgroup developed guideline suggestions that were approved after review and voting by the full cough panel. RESULTS The literature review identified relevant articles regarding: mechanisms; allergic environmental causes; chronic cough and the recreational and involuntary inhalation of tobacco and marijuana smoke; nonallergic environmental triggers; laryngeal syndromes; and occupational diseases and exposures. Consensus-based statements were developed for the approach to diagnosis due to a lack of strong evidence from published literature. CONCLUSIONS Despite increased understanding of cough related to occupational and environmental triggers, there remains a gap between the recommended assessment of occupational and environmental causes of cough and the reported systematic assessment of these factors. There is a need for further documentation of occupational and environmental causes of cough in the future.
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Affiliation(s)
- Susan M Tarlo
- Division of Respiratory Medicine, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada.
| | - Kenneth W Altman
- Department of Otolaryngology-Head & Neck Surgery, Baylor College of Medicine, Houston, TX
| | - John Oppenheimer
- Division of Allergy and Immunology, University of Medicine and Dentistry of New Jersey-Rutgers University, Newark, NJ
| | - Kaiser Lim
- Pulmonary and Critical Care Medicine, Mayo Clinic Rochester, Mayo College of Medicine, Rochester, MN
| | | | - David Prezant
- Fire Department of the City of New York, Brooklyn, NY
| | - Richard S Irwin
- Division of Pulmonary, Allergy and Critical Care Medicine, UMass Memorial Medical Center, Worcester, MA
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Burge PS, Moore VC, Burge CBSG, Vellore AD, Robertson AS, Robertson W. Can serial PEF measurements separate occupational asthma from allergic alveolitis? Occup Med (Lond) 2016; 65:251-5. [PMID: 25825508 DOI: 10.1093/occmed/kqv013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Occupational asthma commonly results in work-related changes in serial peak expiratory flow (PEF) measurements. Whether alveolitis can result in similar changes is unknown. AIMS To identify differences and similarities of serial PEF between workers with occupational alveolitis and asthma seen during an outbreak investigation in a factory with metal-working fluid exposure. METHODS Workers with respiratory symptoms and rest-day improvement were identified by questionnaire. Each was asked to measure PEF 8 times daily for 4 weeks at home and work. Alveolitis was subsequently diagnosed from a validated scoring system including radiological changes, carbon monoxide diffusing capacity, bronchoalveolar lavage and biopsy results. Occupational asthma was confirmed with a positive Oasys score >2.5 and a mean rest-work PEF >16 l/min from serial 2-hourly PEF measurements. The Oasys PEF plotter calculated differences between rest and workdays for mean PEF, diurnal variation and the scores were used to confirm an occupational effect (Oasys, area between curve and time point). Records were compared between the alveolitis group and the group with occupational asthma without alveolitis. RESULTS Forty workers with occupational asthma and 16 with alveolitis had indistinguishable PEF changes on workdays in terms of magnitude (median reduction 18.5 and 16.1 l/min, respectively) and diurnal variation. Immediate reactions were more common with occupational asthma and late reactions more common with alveolitis. CONCLUSIONS PEF responses to metal-working fluid aerosols do not distinguish occupational asthma from alveolitis except in timing. They can be used to identify the workplace as the cause of asthma and also alveolitis.
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Affiliation(s)
- P S Burge
- Occupational Lung Disease Unit, Birmingham Heartlands Hospital, Birmingham B9 5SS, UK,
| | - V C Moore
- Occupational Lung Disease Unit, Birmingham Heartlands Hospital, Birmingham B9 5SS, UK
| | - C B S G Burge
- Occupational Lung Disease Unit, Birmingham Heartlands Hospital, Birmingham B9 5SS, UK
| | - A D Vellore
- Occupational Lung Disease Unit, Birmingham Heartlands Hospital, Birmingham B9 5SS, UK
| | - A S Robertson
- Occupational Lung Disease Unit, Birmingham Heartlands Hospital, Birmingham B9 5SS, UK
| | - W Robertson
- Department of Public Health, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
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Abstract
OBJECTIVE Summarize developed evidence-based diagnostic and treatment guidelines for work-related asthma (WRA). METHODS Comprehensive literature reviews conducted with article critiquing and grading. Guidelines developed by a multidisciplinary expert panel and peer-reviewed. RESULTS Evidence supports spirometric testing as an essential early test. Serial peak expiratory flow rates measurement is moderately recommended for employees diagnosed with asthma to establish work-relatedness. Bronchial provocation testing is moderately recommended. IgE and skin prick testing for specific high-molecular weight (HMW) antigens are highly recommended. IgG testing for HMW antigens, IgE testing for low-molecular weight antigens, and nitric oxide testing for diagnosis are not recommended. Removal from exposure is associated with the highest probability of improvement, but may not lead to complete recovery. CONCLUSION Quality evidence supports these clinical practice recommendations. The guidelines may be useful to providers who diagnose and/or treat WRA.
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Vandenplas O, Froidure A, Meurer U, Rihs HP, Rifflart C, Soetaert S, Jamart J, Pilette C, Raulf M. The role of allergen components for the diagnosis of latex-induced occupational asthma. Allergy 2016; 71:840-9. [PMID: 26940537 DOI: 10.1111/all.12872] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Recombinant Hevea brasiliensis (rHev b) natural rubber latex (NRL) allergen components have been developed to assess the patients' allergen sensitization profile and to improve the diagnosis of NRL allergy. OBJECTIVE To examine whether the determination of specific IgE (sIgE) reactivity to a panel of recombinant allergen components would be helpful for diagnosing NRL-induced occupational asthma (OA) in predicting the outcome of a specific inhalation test. METHODS sIgE levels to NRL extract and 12 recombinant NRL allergen components were assessed in 82 subjects with OA ascertained by a positive specific inhalation challenge (SIC) with NRL gloves and in 25 symptomatic subjects with a negative challenge. RESULTS The sensitivity, specificity, positive predictive value, and negative predictive value of a NRL-sIgE level ≥0.35 kUA /l as compared to the result of SICs were 94%, 48%, 86%, and 71%, respectively. The positive predictive value increased above 95% when increasing the cutoff value to 5.41 kUA /l. Subjects with a positive SIC showed a significantly higher rate of sIgE reactivity to rHev b 5, 6.01, 6.02, and 11 than those with a negative SIC. A sIgE sum score against rHev b 5 plus 6.01/6.02 ≥ 1.46 kUA /l provided a positive predictive value >95% with a higher sensitivity (79%) and diagnostic efficiency (Youden index: 0.67) as compared with a NRL-sIgE ≥5.41 kUA /l (49% and 0.41, respectively). CONCLUSION In suspected OA, high levels of sIgE against rHev b 5 combined with rHev b 6.01 or 6.02 are the most efficient predictors of a bronchial response to NRL.
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Affiliation(s)
- O. Vandenplas
- Department of Chest Medicine; Centre Hospitalier Universitaire de Dinant-Godinne; Université catholique de Louvain; Yvoir Belgium
- Institut de Recherche Expérimentale et Clinique; Pôle de Pneumologie; Université catholique de Louvain; Brussels Belgium
- Walloon Institute for Excellence in Lifesciences and Biotechnology (WELBIO); Brussels Belgium
| | - A. Froidure
- Institut de Recherche Expérimentale et Clinique; Pôle de Pneumologie; Université catholique de Louvain; Brussels Belgium
- Walloon Institute for Excellence in Lifesciences and Biotechnology (WELBIO); Brussels Belgium
- Department of Chest Medicine; Cliniques Universitaires Saint-Luc; Université catholique de Louvain; Brussels Belgium
| | - U. Meurer
- IPA Institute for Prevention and Occupational Medicine of the German Social Accident Insurance; Institute of the Ruhr-Universität Bochum; Bochum Germany
| | - H.-P. Rihs
- IPA Institute for Prevention and Occupational Medicine of the German Social Accident Insurance; Institute of the Ruhr-Universität Bochum; Bochum Germany
| | - C. Rifflart
- Department of Chest Medicine; Centre Hospitalier Universitaire de Dinant-Godinne; Université catholique de Louvain; Yvoir Belgium
| | - S. Soetaert
- Prévention et Protection au Travail - Centre de Service Interentreprises (CESI); Brussels Belgium
| | - J. Jamart
- Scientific Support Unit; Centre Hospitalier Universitaire de Dinant-Godinne; Université catholique de Louvain; Yvoir Belgium
| | - C. Pilette
- Institut de Recherche Expérimentale et Clinique; Pôle de Pneumologie; Université catholique de Louvain; Brussels Belgium
- Walloon Institute for Excellence in Lifesciences and Biotechnology (WELBIO); Brussels Belgium
- Department of Chest Medicine; Cliniques Universitaires Saint-Luc; Université catholique de Louvain; Brussels Belgium
| | - M. Raulf
- IPA Institute for Prevention and Occupational Medicine of the German Social Accident Insurance; Institute of the Ruhr-Universität Bochum; Bochum Germany
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Fishwick D, Sen D, Barker P, Codling A, Fox D, Naylor S. Health surveillance for occupational asthma in the UK. Occup Med (Lond) 2016; 66:365-70. [PMID: 27085190 DOI: 10.1093/occmed/kqw028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Periodic health surveillance (HS) of workers can identify early cases of occupational asthma. Information about its uptake and its content in the UK is lacking. AIMS To identify the overall levels of uptake and quality of HS for occupational asthma within three high-risk industry sectors in the UK. METHODS A telephone survey of employers, and their occupational health (OH) professionals, carried out in three sectors with exposures potentially capable of causing occupational asthma (bakeries, wood working and motor vehicle repair). RESULTS A total of 457 organizations participated (31% response rate). About 77% employed <10 people, 17% between 10 and 50 and 6% >50. Risk assessments were common (67%) and 14% carried out some form of HS for occupational asthma, rising to 19% if only organizations reporting asthma hazards and risks were considered. HS was carried out both by in-house (31%) and external providers (69%). Organizational policies were often used to define HS approaches (80%), but infrequently shared with the OH provider. OH providers described considerable variation in practice. Record keeping was universal, but worker-held records were not reported. HS tools were generally developed in-house. Lung function was commonly measured, but only limited interpretation evident. Referral of workers to local specialist respiratory services was variable. CONCLUSIONS This study provided new insights into the real world of HS for occupational asthma. We consider that future work could and should define simpler, more practical and evidence-based approaches to HS to ensure maximal consistency and use of high-quality approaches.
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Affiliation(s)
- D Fishwick
- Centre for Workplace Health, Health and Safety Laboratory, Buxton, Derbyshire SK173JN, UK,
| | - D Sen
- Health and Safety Executive, Redgrave Court, Bootle, Merseyside L20 7HS, UK
| | - P Barker
- Health and Safety Executive, Redgrave Court, Bootle, Merseyside L20 7HS, UK
| | - A Codling
- Centre for Workplace Health, Health and Safety Laboratory, Buxton, Derbyshire SK173JN, UK
| | - D Fox
- Centre for Workplace Health, Health and Safety Laboratory, Buxton, Derbyshire SK173JN, UK
| | - S Naylor
- Centre for Workplace Health, Health and Safety Laboratory, Buxton, Derbyshire SK173JN, UK
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Fell AKM, Eikeland R, Aaseth JO. En kvinne i 30-årene med hoste, tremor, uro og synsforstyrrelser. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2016; 136:1233-5. [DOI: 10.4045/tidsskr.15.0998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Crewe J, Carey R, Glass D, Peters S, Abramson MJ, Benke G, Reid A, Driscoll T, Fritschi L. A comprehensive list of asthmagens to inform health interventions in the Australian workplace. Aust N Z J Public Health 2015; 40:170-3. [PMID: 26558880 DOI: 10.1111/1753-6405.12479] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 07/01/2015] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To develop a comprehensive list of asthmagens which may occur in occupational settings in Australia. METHODS Potential asthmagens considered for this list were identified through work health and safety classification databases in Australia and through lists developed by professional associations in other countries. Inclusion criteria were: there is evidence that the agent is asthmagenic; it is used in occupational settings; and it is available in Australia. RESULTS The final list contained 277 asthmagens in 27 groups that may be found in occupational circumstances in Australia. Three other agents that have been documented as asthmagens in Australia were included: almond dust, fluoride (in aluminium pot room fumes); and sawdust from the Australian Blackwood. CONCLUSIONS This is the first comprehensive and inclusive list of Australian occupationally relevant asthmagens to have been compiled. IMPLICATIONS This list is specific for Australian workplace exposure to asthmagens. It will help focus policy and preventative practices and reduce the burden of occupational asthma. It will also be useful in future studies to identify those who are exposed to the asthmagens and provide information to assist regulators to identify industries, occupations, specific activities and existing exposure standards that can be targeted to improve worker health and welfare.
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Affiliation(s)
- Julie Crewe
- School of Public Health, Curtin University, Western Australia
| | - Renee Carey
- School of Public Health, Curtin University, Western Australia
| | - Deborah Glass
- Monash Centre for Occupational and Environmental Health, School of Public Health & Preventive Medicine, Monash University, Victoria
| | - Susan Peters
- School of Population Health, University of Western Australia
| | - Michael J Abramson
- Monash Centre for Occupational and Environmental Health, School of Public Health & Preventive Medicine, Monash University, Victoria
| | - Geza Benke
- Monash Centre for Occupational and Environmental Health, School of Public Health & Preventive Medicine, Monash University, Victoria
| | - Alison Reid
- School of Public Health, Curtin University, Western Australia
| | - Tim Driscoll
- Sydney School of Public Health, University of Sydney, New South Wales
| | - Lin Fritschi
- School of Public Health, Curtin University, Western Australia
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Clinical aspects of work-related asthma: past achievements, persistent challenges, and emerging triggers. J Occup Environ Med 2015; 56 Suppl 10:S40-4. [PMID: 25285975 DOI: 10.1097/jom.0000000000000285] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this article was to address common clinical questions pertaining to work-related asthma (WRA). METHODS This review is based on a presentation on WRA at the American College of Chest Physicians Course on Clinical Aspects of Occupational and Environmental Lung Disease, held in Toronto in 2013, and supplemented by a PubMed search of publications to 2013. RESULTS Seven clinical questions are addressed in relation to definitions, causes, diagnosis, management and emerging triggers, and challenges of WRA. CONCLUSIONS Although knowledge is expanding in this area, there remain challenges and uncertainties, particularly in the prevention of WRA.
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Dobashi K, Akiyama K, Usami A, Yokozeki H, Ikezawa Z, Tsurikisawa N, Nakamura Y, Sato K, Okumura J. Japanese Guideline for Occupational Allergic Diseases 2014. Allergol Int 2015; 63:421-442. [PMID: 25178180 DOI: 10.2332/allergolint.14-rai-0771] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Indexed: 11/20/2022] Open
Abstract
In 2013, a guideline for occupational allergic diseases was published for the first time in Japan. Occupational allergic diseases are likely to worsen or become intractable as a result of continuous exposure to high concentrations of causative antigens, and are socioeconomically important diseases with which the patients might sometimes lose jobs due to work interruptions. Guidelines for occupational allergic diseases have been published in many countries. This guideline consists of six chapters about occupational asthma, occupational allergic rhinitis, occupational skin diseases, hypersensitivity pneumonitis and occupational anaphylaxis shock, and legal aspects of these diseases. The guideline is characterized with the following basic structure: Clinical Questions (CQs) are set with reference to Minds (Medical Information Network Distribution Service), statements by the committee are correspondingly listed, recommended grades and evidence levels are defined, and then descriptions and references are indicated.
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MESH Headings
- Alveolitis, Extrinsic Allergic/epidemiology
- Alveolitis, Extrinsic Allergic/etiology
- Alveolitis, Extrinsic Allergic/immunology
- Anaphylaxis/epidemiology
- Anaphylaxis/etiology
- Anaphylaxis/immunology
- Asthma, Occupational/epidemiology
- Asthma, Occupational/immunology
- Dermatitis, Occupational/epidemiology
- Dermatitis, Occupational/immunology
- Evidence-Based Medicine
- Humans
- Hypersensitivity/epidemiology
- Hypersensitivity/etiology
- Hypersensitivity/immunology
- Information Dissemination/legislation & jurisprudence
- Japan
- Knowledge Bases
- Occupational Exposure/adverse effects
- Rhinitis, Allergic/epidemiology
- Rhinitis, Allergic/etiology
- Rhinitis, Allergic/immunology
- Socioeconomic Factors
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Affiliation(s)
- Kunio Dobashi
- Graduate School of Health Sciences, Gunma University, Gunma, Japan
| | - Kazuo Akiyama
- National Hospital Organization, Sagamihara National Hospital, Kanagawa, Japan
| | - Atsushi Usami
- Tohkai Research Institute for Pollinosis, Shizuoka, Japan
| | - Hiroo Yokozeki
- Department of Dermatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Zenro Ikezawa
- Department of Dermatology, Yokohama City University Hospital, Kanagawa, Japan
| | - Naomi Tsurikisawa
- Department of Allergy and Respirology, National Hospital Organization, Sagamihara National Hospital, Kanagawa, Japan
| | - Yoichi Nakamura
- Medical Center for Allergic and Immune Diseases, Yokohama City Minato Red Cross Hospital, Kanagawa, Japan
| | - Kazuhiro Sato
- Department of Environmental Health, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Jiro Okumura
- Department of Environmental Medicine and Behavioural Science, Kinki University School of Medicine, Osaka, Japan
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Scarpa MC, Kulkarni N, Maestrelli P. The role of non-invasive biomarkers in detecting acute respiratory effects of traffic-related air pollution. Clin Exp Allergy 2015; 44:1100-18. [PMID: 25040251 DOI: 10.1111/cea.12373] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The role of non-invasive methods in the investigation of acute effects of traffic-related air pollution is not clearly established. We evaluated the usefulness of non-invasive biomarkers in detecting acute air pollution effects according to the age of participants, the disease status, their sensitivity compared with lung function tests and their specificity for a type of pollutant. Search terms lead to 535 titles, among them 128 had potentially relevant abstracts. Sixtynine full papers were reviewed, while 59 articles were excluded as they did not meet the selection criteria. Methods used to assess short-term effects of air pollution included analysis of nasal lavage (NAL) for the upper airways, and induced sputum (IS), exhaled breath condensate (EBC) and exhaled nitric oxide (FeNO) for central and lower airways. There is strong evidence that FeNO evaluation is useful independently from subject age, while IS analysis is suitable almost for adults. Biomarker changes are generally observed upon pollutant exposure irrespective of the disease status of the participants. None of the biomarkers identified are specific for a type of pollutant exposure. Based on experimental exposure studies, there is moderate evidence that IS analysis is more sensitive than lung function tests, whereas this is not the case for biomarkers obtained by NAL or EBC. Cells and some cytokines (IL-6, IL-8 and myeloperoxidase) have been measured both in the upper respiratory tract (NAL) and in the lower airways (IS). Overall, the response to traffic exposure seems different in the two compartments. In conclusion, this survey of current literature displays the complexity of this research field, highlights the significance of short-term studies on traffic pollution and gives important tips when planning studies to detect acute respiratory effects of air pollution in a non-invasive way.
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Affiliation(s)
- M C Scarpa
- Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
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Occupational asthma is a cause of adult-onset asthma with poor prognosis. J Allergy Clin Immunol 2015; 135:837. [PMID: 25601380 DOI: 10.1016/j.jaci.2014.11.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 11/24/2014] [Indexed: 11/21/2022]
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Abstract
As described in a recently released report of the Forum of International Respiratory Societies, four of the leading causes of death in the world are chronic obstructive pulmonary disease, acute respiratory tract infections, lung cancer, and tuberculosis. A fifth, asthma, causes enormous global morbidity. Not enough progress has been made in introducing new therapies and reducing disease burden for these illnesses in the last few decades, despite generous investments and some notable progress in biomedical research. Four external and modifiable drivers are responsible for a substantial percentage of the disease burden represented by the major lung diseases: tobacco, outdoor air pollution, household air pollution, and occupational exposures to lung toxins. Especially in low- and middle-income countries, but in highly developed economies as well, pressures for economic development and lax regulation are contributing to the continued proliferation of these drivers. Public health approaches to the most common lung diseases could have enormous effects on reducing morbidity and mortality. There must be increased advocacy from and mobilization of civil society to bring attention to the drivers of lung diseases in the world. The World Health Organization should negotiate accords similar to the Framework Convention on Tobacco Control to address air pollution and occupational exposures. Large increases in funding by government agencies and nongovernmental organizations around the world are needed to identify technologies that will reduce health risks while allowing populations to enjoy the benefits of economic development. This paradigm, focused more on public health than on individual medical treatment, has the best chance of substantial reduction in the burden of lung disease around the world in the next several years.
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