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Mihaicuta S, Udrescu L, Militaru A, Nadasan V, Tiotiu A, Bikov A, Ursoniu S, Birza R, Popa AM, Frent S. Multivariate analysis and data mining help predict asthma exacerbations. J Asthma 2024; 61:608-618. [PMID: 38112563 DOI: 10.1080/02770903.2023.2297366] [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: 06/22/2023] [Accepted: 12/16/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Work-related asthma has become a highly prevalent occupational lung disorder. OBJECTIVE Our study aims to evaluate occupational exposure as a predictor for asthma exacerbation. METHOD We performed a retrospective evaluation of 584 consecutive patients diagnosed and treated for asthma between October 2017 and December 2019 in four clinics from Western Romania. We evaluated the enrolled patients for their asthma control level by employing the Asthma Control Test (ACT < 20 represents uncontrolled asthma), the medical record of asthma exacerbations, occupational exposure, and lung function (i.e. spirometry). Then, we used statistical and data mining methods to explore the most important predictors for asthma exacerbations. RESULTS We identified essential predictors by calculating the odds ratios (OR) for the exacerbation in a logistic regression model. The average age was 45.42 ± 11.74 years (19-85 years), and 422 (72.26%) participants were females. 42.97% of participants had exacerbations in the past year, and 31.16% had a history of occupational exposure. In a multivariate model analysis adjusted for age and gender, the most important predictors for exacerbation were uncontrolled asthma (OR 4.79, p < .001), occupational exposure (OR 4.65, p < .001), and lung function impairment (FEV1 < 80%) (OR 1.15, p = .011). The ensemble machine learning experiments on combined patient features harnessed by our data mining approach reveal that the best predictor is professional exposure, followed by ACT. CONCLUSIONS Machine learning ensemble methods and statistical analysis concordantly indicate that occupational exposure and ACT < 20 are strong predictors for asthma exacerbation.
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Affiliation(s)
- Stefan Mihaicuta
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, Department of Pulmonology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Lucretia Udrescu
- Department I-Drug Analysis, Faculty of Pharmacy, "Victor Babes" University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Adrian Militaru
- Department of Computer and Information Technology, Politehnica University Timisoara, Timisoara, Romania
| | - Valentin Nadasan
- Department of Hygiene, "G.E. Palade" University of Medicine, Pharmacy, Science and Technology of Targu Mures, Targu Mures, Romania
| | - Angelica Tiotiu
- Department of Pulmonology, Nancy University Hospital, Nancy, France
| | - Andras Bikov
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Division of Infection, Immunity & Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Sorin Ursoniu
- Department of Public Health and Health Management, "Victor Babes" University of Medicine and Pharmacy Timisoara, Timisoara, Romania
- Center for Translational Research and Systems Medicine, Timisoara, Romania
| | - Romina Birza
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, Department of Pulmonology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Alina Mirela Popa
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, Department of Pulmonology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Stefan Frent
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, Department of Pulmonology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Timisoara, Romania
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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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3
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Lommatzsch M, Criée CP, de Jong CCM, Gappa M, Geßner C, Gerstlauer M, Hämäläinen N, Haidl P, Hamelmann E, Horak F, Idzko M, Ignatov A, Koczulla AR, Korn S, Köhler M, Lex C, Meister J, Milger-Kneidinger K, Nowak D, Nothacker M, Pfaar O, Pohl W, Preisser AM, Rabe KF, Riedler J, Schmidt O, Schreiber J, Schuster A, Schuhmann M, Spindler T, Taube C, Christian Virchow J, Vogelberg C, Vogelmeier CF, Wantke F, Windisch W, Worth H, Zacharasiewicz A, Buhl R. [Diagnosis and treatment of asthma: a guideline for respiratory specialists 2023 - published by the German Respiratory Society (DGP) e. V.]. Pneumologie 2023; 77:461-543. [PMID: 37406667 DOI: 10.1055/a-2070-2135] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
The management of asthma has fundamentally changed during the past decades. The present guideline for the diagnosis and treatment of asthma was developed for respiratory specialists who need detailed and evidence-based information on the new diagnostic and therapeutic options in asthma. The guideline shows the new role of biomarkers, especially blood eosinophils and fractional exhaled NO (FeNO), in diagnostic algorithms of asthma. Of note, this guideline is the first worldwide to announce symptom prevention and asthma remission as the ultimate goals of asthma treatment, which can be achieved by using individually tailored, disease-modifying anti-asthmatic drugs such as inhaled steroids, allergen immunotherapy or biologics. In addition, the central role of the treatment of comorbidities is emphasized. Finally, the document addresses several challenges in asthma management, including asthma treatment during pregnancy, treatment of severe asthma or the diagnosis and treatment of work-related asthma.
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Affiliation(s)
- Marek Lommatzsch
- Zentrum für Innere Medizin, Abt. für Pneumologie, Universitätsmedizin Rostock
| | | | - Carmen C M de Jong
- Abteilung für pädiatrische Pneumologie, Abteilung für Pädiatrie, Inselspital, Universitätsspital Bern
| | - Monika Gappa
- Klinik für Kinder und Jugendliche, Evangelisches Krankenhaus Düsseldorf
| | | | | | | | - Peter Haidl
- Abteilung für Pneumologie II, Fachkrankenhaus Kloster Grafschaft GmbH, Schmallenberg
| | - Eckard Hamelmann
- Kinder- und Jugendmedizin, Evangelisches Klinikum Bethel, Bielefeld
| | | | - Marco Idzko
- Abteilung für Pulmologie, Universitätsklinik für Innere Medizin II, Medizinische Universität Wien
| | - Atanas Ignatov
- Universitätsklinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum Magdeburg
| | - Andreas Rembert Koczulla
- Schön-Klinik Berchtesgadener Land, Berchtesgaden
- Klinik für Innere Medizin Schwerpunkt Pneumologie, Universitätsklinikum Marburg
| | - Stephanie Korn
- Pneumologie und Beatmungsmedizin, Thoraxklinik, Universitätsklinikum Heidelberg
| | - Michael Köhler
- Deutsche Patientenliga Atemwegserkrankungen, Gau-Bickelheim
| | - Christiane Lex
- Klinik für Kinder- und Jugendmedizin, Universitätsmedizin Göttingen
| | - Jochen Meister
- Klinik für Kinder- und Jugendmedizin, Helios Klinikum Aue
| | | | - Dennis Nowak
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, LMU München
| | - Monika Nothacker
- Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V
| | - Oliver Pfaar
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Hals-Chirurgie, Sektion für Rhinologie und Allergie, Universitätsklinikum Marburg, Philipps-Universität Marburg, Marburg
| | - Wolfgang Pohl
- Gesundheitszentrum Althietzing, Karl Landsteiner Institut für klinische und experimentelle Pneumologie, Wien
| | - Alexandra M Preisser
- Zentralinstitut für Arbeitsmedizin und Maritime Medizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Klaus F Rabe
- Pneumologie, LungenClinic Großhansdorf, UKSH Kiel
| | - Josef Riedler
- Abteilung für Kinder- und Jugendmedizin, Kardinal Schwarzenberg Klinikum Schwarzach
| | | | - Jens Schreiber
- Universitätsklinik für Pneumologie, Universitätsklinikum Magdeburg
| | - Antje Schuster
- Klinik für Allgemeine Pädiatrie, Neonatologie und Kinderkardiologie, Universitätsklinikum Düsseldorf
| | | | | | - Christian Taube
- Klinik für Pneumologie, Universitätsmedizin Essen-Ruhrlandklinik
| | | | - Christian Vogelberg
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus, Dresden
| | | | | | - Wolfram Windisch
- Lungenklinik Köln-Merheim, Lehrstuhl für Pneumologie, Universität Witten/Herdecke
| | - Heinrich Worth
- Pneumologische & Kardiologische Gemeinschaftspraxis, Fürth
| | | | - Roland Buhl
- Klinik für Pneumologie, Zentrum für Thoraxerkrankungen, Universitätsmedizin Mainz
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Kang WY, Kim EY, Choi S, Choi BS. Acute exacerbation of chronic obstructive pulmonary disease in a slaughterhouse. Occup Med (Lond) 2023; 73:49-52. [PMID: 36282619 DOI: 10.1093/occmed/kqac111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We describe the case of a 52-year-old male who presented with two episodes of acute exacerbations (AE) of chronic obstructive pulmonary disease (COPD) during work, while suspending live chickens for slaughter. The patient was exposed to high levels of bioaerosols, including endotoxins and microorganisms. Endotoxins can induce bronchoconstriction and airway inflammation, and COPD patients are more vulnerable to airway infections caused by microorganisms inhaled with bioaerosols. This study suggests that a high level of bioaerosols may induce airway infections, resulting in acute exacerbations of COPD.
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Affiliation(s)
- W Y Kang
- Department of Research for Occupational Health, Institute of Occupation and Environment, Korea Workers' Compensation & Welfare Service, Incheon, 21417, Republic of Korea
| | - E Y Kim
- Department of Research for Occupational Health, Institute of Occupation and Environment, Korea Workers' Compensation & Welfare Service, Incheon, 21417, Republic of Korea
| | - S Choi
- Department of Research for Occupational Health, Institute of Occupation and Environment, Korea Workers' Compensation & Welfare Service, Incheon, 21417, Republic of Korea
| | - B S Choi
- Department of Research for Occupational Health, Institute of Occupation and Environment, Korea Workers' Compensation & Welfare Service, Incheon, 21417, Republic of Korea
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5
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The Impact of Ambient Environmental and Occupational Pollution on Respiratory Diseases. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052788. [PMID: 35270479 PMCID: PMC8910713 DOI: 10.3390/ijerph19052788] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/22/2022] [Accepted: 02/25/2022] [Indexed: 11/16/2022]
Abstract
Ambient pollutants and occupational pollutants may cause and exacerbate various lung and respiratory diseases. This review describes lung and respiratory diseases in relation to ambient pollutants, particularly particulate matter (PM2.5), and occupational air pollutants, excluding communicable diseases and indoor pollutants, including tobacco smoke exposure. PM2.5 produced by combustion is an important ambient pollutant. PM2.5 can cause asthma attacks and exacerbations of chronic obstructive pulmonary disease in the short term. Further, it not only carries a risk of lung cancer and death, but also hinders the development of lung function in children in the long term. It has recently been suggested that air pollution, such as PM2.5, is a risk factor for severe coronavirus disease (COVID-19). Asbestos, which causes asbestosis, lung cancer, and malignant mesothelioma, and crystalline silica, which cause silicosis, are well-known traditional occupational pollutants leading to pneumoconiosis. While work-related asthma (WRA) is the most common occupational lung disease in recent years, many different agents cause WRA, including natural and synthetic chemicals and irritant gases. Primary preventive interventions that increase awareness of pollutants and reduce the development and exacerbation of diseases caused by air pollutants are paramount to addressing ambient and occupational pollution.
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de Carvalho-Pinto RM, Cançado JED, Pizzichini MMM, Fiterman J, Rubin AS, Cerci A, Cruz ÁA, Fernandes ALG, Araujo AMS, Blanco DC, Cordeiro G, Caetano LSB, Rabahi MF, de Menezes MB, de Oliveira MA, Lima MA, Pitrez PM. 2021 Brazilian Thoracic Association recommendations for the management of severe asthma. J Bras Pneumol 2021; 47:e20210273. [PMID: 34932721 PMCID: PMC8836628 DOI: 10.36416/1806-3756/e20210273] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/05/2021] [Indexed: 12/20/2022] Open
Abstract
Advances in the understanding that severe asthma is a complex and heterogeneous disease and in the knowledge of the pathophysiology of asthma, with the identification of different phenotypes and endotypes, have allowed new approaches for the diagnosis and characterization of the disease and have resulted in relevant changes in pharmacological management. In this context, the definition of severe asthma has been established, being differentiated from difficult-to-control asthma. These recommendations address this topic and review advances in phenotyping, use of biomarkers, and new treatments for severe asthma. Emphasis is given to topics regarding personalized management of the patient and selection of biologicals, as well as the importance of evaluating the response to treatment. These recommendations apply to adults and children with severe asthma and are targeted at physicians involved in asthma treatment. A panel of 17 Brazilian pulmonologists was invited to review recent evidence on the diagnosis and management of severe asthma, adapting it to the Brazilian reality. Each of the experts was responsible for reviewing a topic or question relevant to the topic. In a second phase, four experts discussed and structured the texts produced, and, in the last phase, all experts reviewed and approved the present manuscript and its recommendations.
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Affiliation(s)
- Regina Maria de Carvalho-Pinto
- . Divisão de Pneumologia, Instituto do Coração − InCor − Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | | | | | - Jussara Fiterman
- . Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul − PUCRS − Porto Alegre (RS) Brasil
| | - Adalberto Sperb Rubin
- . Universidade Federal de Ciências da Saúde de Porto Alegre − UFCSPA − Porto Alegre (RS) Brasil
- . Santa Casa de Misericórdia de Porto Alegre, Porto Alegre (RS) Brasil
| | - Alcindo Cerci
- . Universidade Estadual de Londrina − UEL − Londrina (PR) Brasil
- . Pontifícia Universidade Católica do Paraná − PUCPR − Londrina (PR) Brasil
| | - Álvaro Augusto Cruz
- . Universidade Federal da Bahia − UFBA − Salvador (BA) Brasil
- . Fundação ProAR, Salvador (BA) Brasil
| | | | - Ana Maria Silva Araujo
- . Instituto de Doenças do Tórax, Universidade Federal do Rio de Janeiro − IDT/UFRJ − Rio de Janeiro (RJ) Brasil
| | - Daniela Cavalet Blanco
- . Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul − PUCRS − Porto Alegre (RS), Brasil
| | - Gediel Cordeiro
- . Hospital Júlia Kubitschek, Fundação Hospitalar do Estado de Minas Gerais - FHEMIG - Belo Horizonte (MG) Brasil
- . Hospital Madre Teresa, Belo Horizonte (MG) Brasil
| | | | - Marcelo Fouad Rabahi
- . Faculdade de Medicina, Universidade Federal de Goiás − UFG − Goiânia (GO) Brasil
| | - Marcelo Bezerra de Menezes
- . Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto (SP) Brasil
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Singh T, Bello B, Jeebhay MF. Characterizing Inflammatory Cell Asthma Associated Phenotypes in Dental Health Workers Using Cytokine Profiling. FRONTIERS IN ALLERGY 2021; 2:747591. [PMID: 35387066 PMCID: PMC8974759 DOI: 10.3389/falgy.2021.747591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/11/2021] [Indexed: 11/24/2022] Open
Abstract
Cytokines elicit a pro-inflammatory response by modifying the airway microenvironment in patients with acute or chronic asthma. The expression pattern of several distinct cytokines could be a useful discriminator in asthma. This study aimed to identify asthma subject groupings based on common inflammatory patterns and to determine the relationship between these identified patterns and asthma-associated clinical indices. A sub-group of 76 dental healthcare workers (HCWs) identified from a larger cross-sectional study of 454 dental HCWs in five dental institutions were evaluated further. A self-administered questionnaire elicited the health and employment history of subjects. Sera were analyzed for atopic status, latex sensitization, and 12 cytokines (IL-1β, 3, 4, 5, 6, 7, 8, 10, 12p70, eotaxin, GM-CSF, TNF-α). Pre and post-bronchodilator spirometry was performed on all HCWs. Data clustering and factor analysis were used to identify inflammatory cluster patterns of cytokines. Associations between the cytokine cluster groupings and relevant asthma-associated clinical indices were determined using multivariate logistic regression. The classification of asthma subtype based on cytokine patterns demonstrated both eosinophilic and neutrophilic inflammatory responses. Four phenotypically distinct subgroups relating to the severity of inflammation (acute or chronic) of the cell types were identified. Cytokine determinants for the neutrophilic subtype included IL-1β, 6, 8, 10, 12p70, and TNF-α whereas for the eosinophilic subtype these included IL-3, 4, 5, 7, eotaxin, and GM-CSF. The multivariate models showed a significant association between work-related chest symptoms and all four inflammatory patterns. However, stronger associations were observed for the acute neutrophilic (OR = 6.00, p < 0.05) compared to acute and chronic eosinophilic responses (OR = 4.30, p < 0.05; OR = 4.93, p < 0.05), respectively. Subjects with airway obstruction were more likely to have a mixed cellular infiltrate. The odds of work-exacerbated asthma were increased in acute or chronic eosinophilia (OR = 7.75 and 8.12; p < 0.05), respectively as well as with acute neutrophilia (OR = 6) sub-type. This study demonstrated that neutrophilic inflammatory cell asthma phenotypes coexist with eosinophilic inflammatory phenotypes suggesting a possible dual pathway for asthma in dental health workers, probably due to mixed exposures to high molecular weight (e.g., latex) and low molecular weight (e.g., acrylates) agents.
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Affiliation(s)
- Tanusha Singh
- Immunology & Microbiology, National Institute for Occupational Health, National Health Laboratory Service, Johannesburg, South Africa
- Department of Environmental Health, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
- Department of Clinical Microbiology and Infectious Diseases, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
- *Correspondence: Tanusha Singh
| | - Braimoh Bello
- Immunology & Microbiology Department, Centre for Statistical Analysis and Research, Johannesburg, South Africa
| | - Mohamed F. Jeebhay
- Division of Occupational Medicine and Centre for Environmental & Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Roio LCD, Mizutani RF, Pinto RC, Terra-Filho M, Santos UP. Work-related asthma. ACTA ACUST UNITED AC 2021; 47:e20200577. [PMID: 34406224 PMCID: PMC8352763 DOI: 10.36416/1806-3756/e20200577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 04/05/2021] [Indexed: 11/17/2022]
Abstract
Work-related asthma (WRA) is highly prevalent in the adult population. WRA includes occupational asthma (OA), which is asthma caused by workplace exposures, and work-exacerbated asthma (WEA), also known as work-aggravated asthma, which is preexisting or concurrent asthma worsened by workplace conditions. In adults, the estimated prevalence of OA is 16.0%, whereas that of WEA is 21.5%. An increasing number of chemicals used in industrial production, households, and services are associated with the incidence of adult-onset asthma attributable to exposure to chemicals. This review article summarizes the different types of WRA and describes diagnostic procedures, treatment, prevention, and approaches to patient management. It is not always easy to distinguish between OA and WEA. It is important to establish a diagnosis (of sensitizer-/irritant-induced OA or WEA) in order to prevent worsening of symptoms, as well as to prevent other workers from being exposed, by providing early treatment and counseling on social security and work-related issues.
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Affiliation(s)
- Lavinia Clara Del Roio
- . Programa de Pós-Graduação em Pneumologia, Faculdade de Medicina, Universidade de São Paulo - FMUSP - São Paulo (SP) Brasil
| | - Rafael Futoshi Mizutani
- . Grupo de Doenças Respiratórias Ocupacionais, Ambientais e de Cessação de Tabagismo, Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - FMUSP - São Paulo (SP) Brasil
| | - Regina Carvalho Pinto
- . Grupo de Doenças Obstrutivas, Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - FMUSP - São Paulo (SP) Brasil
| | - Mário Terra-Filho
- . Disciplina de Pneumologia, Faculdade de Medicina, Universidade de São Paulo - FMUSP - São Paulo (SP) Brasil
| | - Ubiratan Paula Santos
- . Grupo de Doenças Respiratórias Ocupacionais, Ambientais e de Cessação de Tabagismo, Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - FMUSP - São Paulo (SP) Brasil
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Khong MT, Berl V, Kuhn L, Hammann P, Lepoittevin JP. Chemical Modifications Induced by Phthalic Anhydride, a Respiratory Sensitizer, in Reconstructed Human Epidermis: A Combined HRMAS NMR and LC-MS/MS Proteomic Approach. Chem Res Toxicol 2021; 34:2087-2099. [PMID: 34370447 DOI: 10.1021/acs.chemrestox.1c00172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Chemical skin and respiratory allergies are becoming a major health problem. To date our knowledge on the process of protein haptenation is still limited and mainly derived from studies performed in solution using model nucleophiles. In order to better understand chemical interactions between chemical allergens and the skin, we have investigated the reactivity of phthalic anhydride 1 (PA), a chemical respiratory sensitizer, toward reconstructed human epidermis (RHE). This study was performed using a new approach combining HRMAS NMR to investigate the in situ chemical reactivity and LC-MS/MS to identify modified epidermal proteins. In RHE, the reaction of PA appeared to be quite fast and the major product formed was phthalic acid. Two amide type adducts on lysine residues were observed and after 8h of incubation, we also observed the formation of an imide type cyclized adducts with lysine. In parallel, RHE samples topically exposed to phthalic anhydride (13C)-1 were analyzed using the shotgun proteomics method. Thus, 948 different proteins were extracted and identified, 135 of which being modified by PA, i.e., 14.2% of the extracted proteome. A total of 211 amino acids were modified by PA and validated by fragmentation spectra. We thus identified 154 modified lysines, 22 modified histidines, 30 modified tyrosines, and 5 modified arginines. The rate of modified residues, as a proportion of the total number of modifiable nucleophilic residues in RHE, was rather low (1%). At the protein level, modified proteins were mainly type I and type II keratins and other proteins which are abundant in the epidermis such as protein S100A, Caspase 14, annexin A2, serpin B3, fatty-acid binding protein 5, histone H2, H3, H4, etc. However, the most modified protein, mainly on histidine residues, was filaggrin, a protein that is of low abundance (0.0266 mol %) and rich in histidine.
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Affiliation(s)
- Minh-Thuong Khong
- University of Strasbourg, CNRS, Institute of Chemistry UMR 7177, F-67000 Strasbourg, France
| | - Valérie Berl
- University of Strasbourg, CNRS, Institute of Chemistry UMR 7177, F-67000 Strasbourg, France
| | - Lauriane Kuhn
- Plateforme Protéomique Strasbourg-Esplanade, Institut de Biologie Moléculaire et Cellulaire, CNRS FRC1589, Université de Strasbourg, F-67000 Strasbourg, France
| | - Philippe Hammann
- Plateforme Protéomique Strasbourg-Esplanade, Institut de Biologie Moléculaire et Cellulaire, CNRS FRC1589, Université de Strasbourg, F-67000 Strasbourg, France
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Lin CC, Law BF, Hettick JM. Acute 4,4'-Methylene Diphenyl Diisocyanate Exposure-Mediated Downregulation of miR-206-3p and miR-381-3p Activates Inducible Nitric Oxide Synthase Transcription by Targeting Calcineurin/NFAT Signaling in Macrophages. Toxicol Sci 2021; 173:100-113. [PMID: 31609387 DOI: 10.1093/toxsci/kfz215] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Exposure to 4,4'-methylene diphenyl diisocyanate (MDI) in the occupational setting may lead to development of occupational asthma (OA), and the underlying molecular mechanisms of MDI-induced disease pathogenesis remain an active area of research. Using a nose-only mouse inhalation model, we find that circulating microRNA (miR)-206-3p and miR-381-3p are downregulated after MDI exposure; however, cellular miR-206-3p and miR-381-3p responses after MDI aerosol exposure and their pathophysiological roles in MDI-OA are unknown. We hypothesize that miR-206-3p and miR-381-3p-regulated mechanisms cause increased expression of the inducible nitric oxide synthase (iNOS) after MDI aerosol exposure. We examined cellular miR-206-3p and miR-381-3p, calcineurins, nuclear factors of activated T cells (NFATs), and iNOS levels from both nose-only exposed murine bronchoalveolar lavage cells (BALCs) and differentiated THP-1 macrophages treated with MDI-glutathione (GSH) conjugates. Both in vivo murine MDI aerosol exposure and in vitro MDI-GSH exposures in THP-1 macrophages result in downregulation of endogenous miR-206-3p and miR-381-3p and upregulation of PPP3CA and iNOS expression. Transfection of THP-1 macrophages with miR-inhibitor-206-3p and miR-inhibitor-381-3p resulted in the upregulation of PPP3CA and iNOS. Using RNA-induced silencing complex immunoprecipitation and translational reporter assays, we verified that PPP3CA, but not iNOS, is directly targeted by both miR-206-3p and miR-381-3p. Downregulation of miR-206-3p and miR-381-3p following by MDI exposure induces calcineurin/NFAT signaling-mediated iNOS transcription in macrophages and BALCs.
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Affiliation(s)
- Chen-Chung Lin
- Allergy and Clinical Immunology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia
| | - Brandon F Law
- Allergy and Clinical Immunology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia
| | - Justin M Hettick
- Allergy and Clinical Immunology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia
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11
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O’Toole C, Joyce M, McGrath JA, O’Sullivan A, Byrne MA, MacLoughlin R. Fugitive aerosols in the intensive care unit: a narrative review. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:592. [PMID: 33987290 PMCID: PMC8105852 DOI: 10.21037/atm-20-2280] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 07/10/2020] [Indexed: 12/20/2022]
Abstract
The risk of unintended inhalation of fugitive aerosols is becoming a topic of increasing interest in the healthcare arena. These fugitive aerosols may be bioaerosols, generated by the patient themselves through cough or sneeze, or they may be therapeutic medical aerosols, generated by therapeutic medical aerosol generators with the intent of delivery to a specific patient's respiratory tract. This review focus' on therapeutic aerosols in the intensive care unit (ICU) only, those typically generated by nebulisers. In the intensive care environment, patients are generally in receipt of ventilatory support, and the literature suggests that these different support interventions influence fugitive therapeutic medical aerosol emissions in a variety of ways. Predominant ventilatory support interventions include, but are not limited to, invasive mechanical ventilation (MV), non-invasive mechanical ventilation (NIV), high flow nasal therapy (HFNT), and supplemental oxygen delivery in spontaneously breathing patients. Further, factors such as nebuliser type, patient interface, patient breathing pattern, nebuliser position in the patient breathing circuit and medication formulation characteristics also have been shown to exert influence on aerosol concentrations and distance from the source. Here we present the state of the art knowledge in this, as yet, poorly described field of research, and identify the key risks, and subsequently, opportunities to mitigate the risks of unintended exposure of both patients and bystanders during and for periods following the administration of therapeutic aerosols.
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Affiliation(s)
- Ciarraí O’Toole
- School of Physics & Ryan Institute’s Centre for Climate & Air Pollution Studies, National University of Ireland Galway, Galway, Ireland
| | - Mary Joyce
- Aerogen, IDA Business Park, Dangan, Galway, Ireland
| | - James A. McGrath
- School of Physics & Ryan Institute’s Centre for Climate & Air Pollution Studies, National University of Ireland Galway, Galway, Ireland
| | | | - Miriam A. Byrne
- School of Physics & Ryan Institute’s Centre for Climate & Air Pollution Studies, National University of Ireland Galway, Galway, Ireland
| | - Ronan MacLoughlin
- Aerogen, IDA Business Park, Dangan, Galway, Ireland
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons, Dublin, Ireland
- School of Pharmacy and Pharmaceutical Sciences, Trinity College, Dublin, Ireland
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12
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Association Between Depression, Lung Function, and Inflammatory Markers in Patients with Asthma and Occupational Asthma. J Occup Environ Med 2020; 61:453-460. [PMID: 30855523 DOI: 10.1097/jom.0000000000001562] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Depression is associated with autonomic and immune dysregulation, yet this remains poorly explored in asthma. We assessed associations between depressive disorder, lung function, and inflammatory markers in patients under investigation for occupational asthma (OA). METHODS One hundred twelve patients under investigation for OA (60% men) underwent a psychiatric interview to assess depressive disorder, and spirometry, a methacholine test, sputum induction, and specific inhalation challenge (SIC) to assess OA. Blood and sputum inflammatory markers were assessed. RESULTS There was a statistically significant association between depressive disorder (P = 0.0195) and forced expiratory volume in 1 second (FEV1) responses, with the drop in FEV1 post-SIC smaller in patients with OA and depression, versus OA with no depression (P < 0.001). CONCLUSION The presence of depressive disorder may influence FEV1 in patients with OA, which may be via autonomic pathways. However, further studies are warranted in order to determine the mechanisms that underlie these effects.
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13
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Occupational diisocyanate asthma of a female professional driver - the importance of allergological diagnostics. Allergol Select 2020; 4:124-128. [PMID: 33326508 PMCID: PMC7734869 DOI: 10.5414/alx02133e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 01/10/2020] [Indexed: 11/18/2022] Open
Abstract
Diisocyanates continue to be one of the most frequent causes of occupational asthma worldwide. They are still indispensable in industrial use as components of coatings, glues, and polyurethane foams. In Germany, respiratory diseases due to diisocyanates can be compensated by the statutory accident insurance (according to BK-Nr. 1315). The present case report shows a rare case of sensitization against diisocyanates verified by skin prick test and serological testing. Due to these findings, a modified inhalation test with an extremely low initial diisocyanate concentration in the laboratory was performed, and a positive reaction could be detected already after an extremely low diisocyanate concentration. In addition, increases of fractional exhaled nitric oxide (FeNO) and eosinophils in induced sputum after inhalation testing were seen. The present case constellation underlines the particular importance of allergological tests for diagnostic clarification of the diagnosis of diisocyanate asthma.
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14
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Stoleski S, Minov J, Karadzinska-Bislimovska J, Mijakoski D, Atanasovska A, Bislimovska D. Work-related Asthma in Crop Farmers. Open Access Maced J Med Sci 2020. [DOI: 10.3889/oamjms.2020.5255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM: The objective of the study was to evaluate the influence of occupational exposure on asthma development among crop farmers.
METHODS: A cross-sectional study was performed, comprising 87 crop farmers, and 80 office workers, matched by gender and age. Evaluation of subjects included completion of a standard questionnaire on chronic respiratory symptoms, spirometry tests, histamine challenge, serial peak expiratory flow rates (PEFR) measurements, and skin prick tests to occupational and common inhalant allergens.
RESULTS: The prevalence of chronic respiratory symptoms in the past 12 months was higher, while the mean values of spirometric parameters were lower in crop farmers. Sensitization to workplace and common inhalant allergens was similar in both groups, whereas frequencies of bronchial hyperresponsiveness (BHR) and asthma were non-significantly higher in crop farmers. The prevalence of allergic was significantly higher compared to non-allergic asthma in both groups. Asthma was registered in 8% of crop farmers and was significantly associated with atopy, and positive family history of asthma. Occupational allergic asthma (OA) was registered in 2.3% of crop farmers, while the frequency of work-aggravated asthma was 5.7%. A causal relationship between workplace and asthma, suggesting allergic OA, was documented in two crop farmers with asthma, based on serial PEFR monitoring, but specific workplace agent causing asthma in the affected subjects was not identified.
CONCLUSION: The obtained results can contribute in the detection of critical points for action, and serve as a predictive factor in the development of work-related asthma, indicating the need for reduction of adverse occupational exposures through adequate preventive measures, regular health examinations, obligatory use of respiratory protective equipment, and implementation of engineering controls.
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15
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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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16
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Lin J, Xing B, Chen P, Huang M, Zhou X, Wu C, Yang D, Yin K, Cai S, Cheng X, Hao C, Wang C, Liu C. Chinese expert consensus-based guideline on assessment and management of asthma exacerbation. J Thorac Dis 2019; 11:4918-4935. [PMID: 32030208 DOI: 10.21037/jtd.2019.12.67] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Jiangtao Lin
- Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - Bin Xing
- Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - Ping Chen
- Department of Respiratory Medicine, General Hospital of Shenyang Military Region, Shenyang 110015, China
| | - Mao Huang
- Department of Respiratory Medicine, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Xin Zhou
- Department of Respiratory Medicine, First People's Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
| | - Changgui Wu
- Department of Respiratory Medicine, Xijing Hospital of Fourth Military Medical University, Xi'an 710032, China
| | - Dong Yang
- Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Kaisheng Yin
- Department of Respiratory Medicine, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Shaoxi Cai
- Department of Respiratory Medicine, Nanfang Hospital of Southern Medical University, Guangzhou 510515, China
| | - Xiaoming Cheng
- Department of Respiratory Medicine, Xinqiao Hospital of Third Military Medical University, Chongqing 400037, China
| | - Chuangli Hao
- Department of Respiratory Medicine, Children's Hospital of Soochow University, Suzhou 215000, China
| | - Changzheng Wang
- Department of Respiratory Medicine, Xinqiao Hospital of Third Military Medical University, Chongqing 400037, China
| | - Chuntao Liu
- Department of Respiratory Medicine, West China Hospital of Sichuan University, Chengdu 610041, China
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17
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Su WC, Chen Y, Bezerra M, Wang J. Respiratory deposition of ultrafine welding fume particles. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2019; 16:694-706. [PMID: 31461396 DOI: 10.1080/15459624.2019.1652306] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The inhalation and the deposition of welding-generated ultrafine particles in welders' respiratory tracts have been linked to severe pulmonary impairments. In the present study, a mobile aerosol lung deposition apparatus (MALDA) was developed and applied to study the respiratory deposition of ultrafine welding fume particles. The MALDA was constructed with a set of physiologically representative human tracheobronchial airway replicas made with high-resolution 3D printers. Ultrafine welding fume particles were generated in a welding fume chamber and delivered to the MALDA. A series of respiratory deposition experiments were carried out using the MALDA to investigate the deposition of ultrafine welding fume particles in different airway generations of the tracheobronchial airways. The results showed that the fractional deposition of ultrafine welding fume particle in the human tracheobronchial airways down to the 9th airway generation could be readily and systematically measured by the MALDA. The estimated cumulative respiratory deposition ranged from approximately 9-31% for ultrafine welding fume particles between 10 and 100 nm in diameter. The results acquired demonstrated that the MALDA developed has the potential to become a useful apparatus in the future to estimate the respiratory deposition of ultrafine particles in real workplaces.
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Affiliation(s)
- Wei-Chung Su
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston , Houston , Texas , USA
| | - Yi Chen
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston , Houston , Texas , USA
| | - Marcio Bezerra
- Department of Occupational and Environmental Health, Hudson College of Public Health, University of Oklahoma Health Sciences Center , Oklahoma City , Oklahoma , USA
| | - Jun Wang
- Department of Occupational and Environmental Health, Hudson College of Public Health, University of Oklahoma Health Sciences Center , Oklahoma City , Oklahoma , USA
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18
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Zainab R, Akram M, Daniyal M, Riaz M. Awareness and Current Therapeutics of Asthma. Dose Response 2019; 17:1559325819870900. [PMID: 31523203 PMCID: PMC6728691 DOI: 10.1177/1559325819870900] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 03/11/2019] [Accepted: 06/18/2019] [Indexed: 01/21/2023] Open
Abstract
Introduction: Asthma is a serious allergic disorder of the respiratory system. It affects
about 300 million people worldwide. This has a great burden on medical
treatment. Several medicines are available, but they have many serious side
effects. Therefore, there is a need to search for a new therapeutic agent
with no or minimal side effects while most economical for patients. In folk
medicine, antiasthmatics herbal medicine has been used and showed potential
therapeutic antiasthmatic efficacy due to the presence of potential
bioactive compounds. Methods: Different databases were searched (ie, Embase, PubMed, CBM, AMED, and
CINAHL). We have reviewed the published data of the last 20 years. We used
MeSH terms “asthma” herbal treatment of asthma, allopathic treatment of
asthma, and treatment strategies for asthma. The traditional medicine was
compared with modern medicine and the same pharmacotherapies alone or with
placebo. The methodology was evaluated by using the GRADE summary of Finding
tables and Cochrane Risk of Bias Tool. Results: There have been some clear-cut indications toward the recognition of further
molecular and cellular mechanisms of asthma. Most of them recommend a
further target for treatment. The novel procedures, biologics, and
pharmaceuticals are evaluated. Both allopathic and herbal treatments of
asthma are effective. Due to none or lesser side effects, herbal medicines
are safer than conventional medicine. Conclusion: The preliminary documentation of the plants discussed in the review show the
presence of several secondary metabolites that are responsible for the
management of asthma and its relevant complications. Further research
studies are needed to identify the bioactive compounds from these plants
that have potential efficacy to cure asthma, and clinically based studies
are needed to search for a complete cure for this disease.
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Affiliation(s)
- Rida Zainab
- Department of Eastern Medicine, Government College University Faisalabad, Faisalabad, Pakistan
| | - Muhammad Akram
- Department of Eastern Medicine, Government College University Faisalabad, Faisalabad, Pakistan
| | - Muhammad Daniyal
- TCM and Ethnomedicine Innovation & Development International Laboratory, School of Pharmacy, Hunan University of Chinese Medicine, Changsha, China
| | - Muhammad Riaz
- Department of Allied Health Sciences, University of Sargodha, Sargodha, Pakistan
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19
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Kimber I, Agius R, Basketter DA, Corsini E, Cullinan P, Dearman RJ, Gimenez-Arnau E, Greenwell L, Hartung T, Kuper F, Maestrelli P, Roggen E, Rovida C. Chemical Respiratory Allergy: Opportunities for Hazard Identification and Characterisation. Altern Lab Anim 2019; 35:243-65. [PMID: 17559314 DOI: 10.1177/026119290703500212] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Ian Kimber
- Syngenta Central Toxicology Laboratory, Macclesfield, UK.
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20
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Fragrance inhalation and adverse health effects: The question of causation. Regul Toxicol Pharmacol 2019; 104:151-156. [PMID: 30904429 DOI: 10.1016/j.yrtph.2019.03.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 02/18/2019] [Accepted: 03/16/2019] [Indexed: 12/28/2022]
Abstract
The toxicology of fragrance materials is largely well understood. Although most are benign, a minority have the potential to cause adverse health effects, notably allergic contact dermatitis resulting from skin sensitization. As a consequence, industry guidelines have banned certain materials and strictly limited the use of others. Recently, data have been published that have been interpreted to suggest that inhalation of fragrances is associated with the occurrence of a variety of health effects, ranging from headaches to asthma attacks. In this review, the evidence basis for these assertions is examined critically and the biological basis and mechanistic plausibility for causation by fragranced products of these health effects is explored. This review concludes that respiratory effects, including irritation and allergy appear highly unlikely to occur by this route. While some sensory/psychosomatic effects are possible, this does not explain the very high rates of adverse effects reported in the recently published questionnaire studies, which this review concludes are more likely to be attributed to methodological weaknesses. Ultimately, it is concluded that adverse health effects arising from fragrance inhalation are uncommon and remain to be identified and confirmed by methodologically rigorous epidemiological investigations supported by a convincing biological and mechanistic basis.
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21
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Hawley B, Casey M, Virji MA, Cummings KJ, Johnson A, Cox-Ganser J. Respiratory Symptoms in Hospital Cleaning Staff Exposed to a Product Containing Hydrogen Peroxide, Peracetic Acid, and Acetic Acid. Ann Work Expo Health 2018; 62:28-40. [PMID: 29077798 DOI: 10.1093/annweh/wxx087] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 10/02/2017] [Indexed: 11/13/2022] Open
Abstract
Cleaning and disinfecting products consisting of a mixture of hydrogen peroxide (HP), peracetic acid (PAA), and acetic acid (AA) are widely used as sporicidal agents in health care, childcare, agricultural, food service, and food production industries. HP and PAA are strong oxidants and their mixture is a recognized asthmagen. However, few exposure assessment studies to date have measured HP, PAA, and AA in a health care setting. In 2015, we performed a health and exposure assessment at a hospital where a new sporicidal product, consisting of HP, PAA, and AA was introduced 16 months prior. We collected 49 full-shift time-weighted average (TWA) air samples and analyzed samples for HP, AA, and PAA content. Study participants were observed while they performed cleaning duties, and duration and frequency of cleaning product use was recorded. Acute upper airway, eye, and lower airway symptoms were recorded in a post-shift survey (n = 50). A subset of 35 cleaning staff also completed an extended questionnaire that assessed symptoms reported by workers as regularly occurring or as having occurred in the previous 12 months. Air samples for HP (range: 5.5 to 511.4 ppb) and AA (range: 6.7 to 530.3 ppb) were all below established US occupational exposure limits (OEL). To date, no full-shift TWA OEL for PAA has been established in the United States, however an OEL of 0.2 ppm has been suggested by several research groups. Air samples for PAA ranged from 1.1 to 48.0 ppb and were well below the suggested OEL of 0.2 ppm. Hospital cleaning staff using a sporicidal product containing HP, PAA, and AA reported work-shift eye (44%), upper airway (58%), and lower airway (34%) symptoms. Acute nasal and eye irritation were significantly positively associated with increased exposure to the mixture of the two oxidants: HP and PAA, as well as the total mixture (TM)of HP, PAA, and AA. Shortness of breath when hurrying on level ground or walking up a slight hill was significantly associated with increased exposure to the oxidant mixture (P = 0.017), as well as the TM (P = 0.026). Our results suggest that exposure to a product containing HP, PAA, and AA contributed to eye and respiratory symptoms reported by hospital cleaning staff at low levels of measured exposure.
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Affiliation(s)
- Brie Hawley
- Respiratory Health Division, National Institute for Occupational Safety and Health, CDC, USA
| | - Megan Casey
- Respiratory Health Division, National Institute for Occupational Safety and Health, CDC, USA
| | - Mohammed Abbas Virji
- Respiratory Health Division, National Institute for Occupational Safety and Health, CDC, USA
| | - Kristin J Cummings
- Respiratory Health Division, National Institute for Occupational Safety and Health, CDC, USA
| | | | - Jean Cox-Ganser
- Respiratory Health Division, National Institute for Occupational Safety and Health, CDC, USA
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22
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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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23
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Kimber I, Poole A, Basketter DA. Skin and respiratory chemical allergy: confluence and divergence in a hybrid adverse outcome pathway. Toxicol Res (Camb) 2018; 7:586-605. [PMID: 30090609 PMCID: PMC6060610 DOI: 10.1039/c7tx00272f] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 01/18/2018] [Indexed: 12/14/2022] Open
Abstract
Sensitisation of the respiratory tract to chemicals resulting in respiratory allergy and allergic asthma is an important occupational health problem, and presents toxicologists with no shortage of challenges. A major issue is that there are no validated or, even widely recognised, methods available for the identification and characterisation of chemical respiratory allergens, or for distinguishing respiratory allergens from contact allergens. The first objective here has been review what is known (and what is not known) of the mechanisms through which chemicals induce sensitisation of the respiratory tract, and to use this information to construct a hybrid Adverse Outcome Pathway (AOP) that combines consideration of both skin and respiratory sensitisation. The intention then has been to use the construction of this hybrid AOP to identify areas of commonality/confluence, and areas of departure/divergence, between skin sensitisation and sensitisation of the respiratory tract. The hybrid AOP not only provides a mechanistic understanding of how the processes of skin and respiratory sensitisation differ, buy also a means of identifying areas of uncertainty about chemical respiratory allergy that benefit from a further investment in research.
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Affiliation(s)
- Ian Kimber
- Faculty of Biology , Medicine and Health , University of Manchester , Oxford Road , Manchester M13 9PT , UK . ; Tel: +44 (0) 161 275 1587
| | - Alan Poole
- European Centre for Ecotoxicology and Toxicology of Chemicals (ECETOC) , 2 Av E Van Nieuwenhuyse , 1160 Brussels , Belgium
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Tarlo SM, Arif AA, Delclos GL, Henneberger P, Patel J. Opportunities and obstacles in translating evidence to policy in occupational asthma. Ann Epidemiol 2018; 28:392-400. [PMID: 28434545 PMCID: PMC5953844 DOI: 10.1016/j.annepidem.2017.03.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 02/27/2017] [Accepted: 03/13/2017] [Indexed: 01/14/2023]
Abstract
PURPOSE Occupational asthma (OA), a common respiratory disorder in Western countries, is caused by exposures at the workplace. It is part of a broader definition of work-related asthma (WRA) that also includes pre-existing asthma aggravated by substances present in the workplace environment, and it is potentially preventable. The purpose of this paper is to illustrate preventive measures for occupational asthma by case studies. METHODS In three case studies we discuss preventive measures that have been associated with reductions in incidence of occupational asthma from natural rubber latex and from diisocyanates as supported by published literature. We also discuss challenges in relation to asthma from cleaning products in healthcare work. RESULTS AND CONCLUSIONS Several preventive measures have been associated with reduction in incidence of occupational asthma from natural rubber latex and from diisocyanates, and may provide lessons for prevention of other causes of occupational asthma. Cleaning products remain an unresolved problem at present with respect to asthma risks but potential measures include the use of safer products and safer applications such as avoidance of spray products, use of occupational hygiene methods such as improving local ventilation, and when appropriate, the use of personal protective devices.
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Affiliation(s)
- Susan M Tarlo
- Department of Medicine, University Health Network, University of Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Ontario, Canada; Department of Public Health Sciences, University of Toronto, Ontario, Canada.
| | - Ahmed A Arif
- UNC Charlotte, Department of Public Health Sciences, Charlotte, NC
| | - George L Delclos
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas School of Public Health, Houston
| | | | - Jenil Patel
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas School of Public Health, Houston
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Prospective Impact of Psychiatric Disorders on Employment Status and Health Care Use in Patients Investigated for Occupational Asthma. J Occup Environ Med 2018; 58:1196-1201. [PMID: 27930478 DOI: 10.1097/jom.0000000000000886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We previously reported high rates (34%) of psychiatric disorders (PSY) in patients evaluated for occupational asthma (OA). We determined the impact of PSY on employment status and health care use 12 to 18 months later. METHODS One hundred ninety-six patients underwent clinical and psychiatric interviews on the day of their OA evaluation. Patients were re-contacted 12to 18 months later to assess employment status and health care use. RESULTS Results indicated that patients with a PSY at baseline were less likely to be employed (adjusted odds ratio = 2.88; 95% confidence interval = 1.29 to 6.44) irrespective of final medical diagnosis (including OA), and had higher rates of emergency visits (35% vs 19%, P = 0.04). CONCLUSION Psychiatric morbidity is common in this population and associated with lower employment rates and greater use of emergency services. Greater efforts should be made to assess and treat PSY in this population.
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Daniels RD. Occupational asthma risk from exposures to toluene diisocyanate: A review and risk assessment. Am J Ind Med 2018; 61:282-292. [PMID: 29389014 DOI: 10.1002/ajim.22815] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND Toluene Diisocyanate (TDI) is a known respiratory sensitizer linked to occupational asthma (OA). To better manage worker risks, an appropriate characterization of the TDI-OA dose-risk relationship is needed. METHODS The literature was reviewed for data suitable for dose-response modeling. Previous study data were fit to models to derive prospective occupational exposure limits (OELs), using benchmark dose (BMD) and low-dose extrapolation approaches. RESULTS Data on eight TDI-exposed populations were suitable for analysis. There were 118 OA cases in a population contributing 13 590 person-years. The BMD-based OEL was 0.4 ppb. The OEL based on low-dose extrapolation to working lifetime extra risk of 1/1000 was 0.3 ppb. CONCLUSIONS This study synthesized epidemiologic data to characterize the TDI-OA dose-risk relationship. This approach yielded prospective OEL estimates below recent recommendations by the American Conference of Governmental Industrial Hygienists, but given significant study limitations, this should be interpreted with caution. Confirmatory research is needed.
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Affiliation(s)
- Robert D. Daniels
- National Institute for Occupational Safety and Health (NIOSH); Cincinnati, Ohio
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27
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Balmes JR. AJRCCM: 100-Year Anniversary. Clearing the Air: Indoors, Outdoors, and At Work. Am J Respir Crit Care Med 2017; 195:1100-1103. [PMID: 28459315 DOI: 10.1164/rccm.201701-0152ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- John R Balmes
- 1 Division of Occupational and Environmental Medicine University of California, San Francisco San Francisco, California and.,2 Division of Environmental Health Sciences University of California, Berkeley Berkeley, California
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28
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Beyan AC, Alici NS, Cimrin A. Assessment of work-related Asthma cases: Our three-year experience. Pak J Med Sci 2017; 33:1230-1235. [PMID: 29142570 PMCID: PMC5673739 DOI: 10.12669/pjms.335.12923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective Work-related asthma (WRA) is one of the most common occupational diseases. In this study, we aimed to review diagnosing procedures and the characteristics of patients who were diagnosed with WRA. Methods Between November 2013 and June 2016; 214 patients were referred to our clinic with WRA suspicion by an occupational health specialist, personal visit, chest disease specialists [61 (28%), 51 (23%), and 102 (47%) respectively]. Occupational history, functional and radiological assessment, skin prick test, PEF monitoring were done. Results Fifty-four patients (25%) were diagnosed with OA, and 24 (11%) with WEA, total 78 workers were diagnosed with WRA. Twenty-five (32.1%) had allergic rhinitis, 13 (16.7%) had allergic dermatitis, and 8 (10%) had both diseases. Conclusion WRA can be seen in many areas. Complaints are the basic route for admission to physician, and the diagnosis can be delayed for a long time as one year. Lower rates of referral by occupational health physicians are the signs of limitations on management of cases. Non-specific BPT and skin prick test for selected cases would be sufficient besides occupational history and clinical examination for the diagnosis of WRA. PEF assessment, one of the most important tests for the diagnosis of WRA, must be performed.
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Affiliation(s)
- Ayse Coskun Beyan
- Ayse Coskun Beyan, Dokuz Eylul University Faculty of Medicine, Occupational Medicine Department, Izmir, Turkey
| | - Nur Safak Alici
- Nur Safak Alici, Dokuz Eylul University Faculty of Medicine, Occupational Medicine Department, Izmir, Turkey
| | - Arif Cimrin
- Arif Cimrin, Dokuz Eylul University Faculty of Medicine, Occupational Medicine Department, Izmir, Turkey
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29
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Abstract
PURPOSE OF REVIEW Work-related asthma encompasses both sensitizer-induced and irritant-induced occupational asthma as well as work-exacerbated asthma. This review summarizes current diagnostic and management strategies for occupational asthma. RECENT FINDINGS Occupational asthma is the most common occupational lung disease in the industrialized world. Over 400 agents have been described to cause occupational asthma. Specific inhalation challenge is often considered the reference method for diagnosis of occupational asthma but specific inhalation challenge as well as other diagnostic tests all generate false positive or false negative results. Definitive avoidance of the inciting agent is the preferred strategy for sensitizer-induced occupational asthma and reduction of exposure is the next best step. Immunotherapy is not currently well established and can cause systemic reactions. SUMMARY An accurate diagnosis made in a timely fashion can positively impact the health and socioeconomic burden associated with occupational asthma. Newer diagnostic tools are promising, but much work needs to be done to standardize and validate these testing methods. Primary, secondary, and tertiary prevention strategies are crucial for effective management of sensitizer-induced occupational asthma.
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Vincent MJ, Parker A, Maier A. Cleaning and asthma: A systematic review and approach for effective safety assessment. Regul Toxicol Pharmacol 2017; 90:231-243. [PMID: 28918194 DOI: 10.1016/j.yrtph.2017.09.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 07/06/2017] [Accepted: 09/10/2017] [Indexed: 12/14/2022]
Abstract
Research indicates a correlative relationship between asthma and use of consumer cleaning products. We conduct a systematic review of epidemiological literature on persons who use or are exposed to cleaning products, both in occupational and domestic settings, and risk of asthma or asthma-like symptoms to improve understanding of the causal relationship between exposure and asthma. A scoring method for assessing study reliability is presented. Although research indicates an association between asthma and the use of cleaning products, no study robustly investigates exposure to cleaning products or ingredients along with asthma risk. This limits determination of causal relationships between asthma and specific products or ingredients in chemical safety assessment. These limitations, and a lack of robust animal models for toxicological assessment of asthma, create the need for a weight-of-evidence (WoE) approach to examine an ingredient or product's asthmatic potential. This proposed WoE method organizes diverse lines of data (i.e., asthma, sensitization, and irritation information) through a systematic, hierarchical framework that provides qualitatively categorized conclusions using hazard bands to predict a specific product or ingredient's potential for asthma induction. This work provides a method for prioritizing chemicals as a first step for quantitative and scenario-specific safety assessments based on their potential for inducing asthmatic effects. Acetic acid is used as a case study to test this framework.
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Affiliation(s)
- Melissa J Vincent
- Department Environmental Health, University Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Ann Parker
- Department Environmental Health, University Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Andrew Maier
- Department Environmental Health, University Cincinnati College of Medicine, Cincinnati, OH, USA
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31
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Sullivan KM, Enoch SJ, Ezendam J, Sewald K, Roggen EL, Cochrane S. An Adverse Outcome Pathway for Sensitization of the Respiratory Tract by Low-Molecular-Weight Chemicals: Building Evidence to Support the Utility ofIn VitroandIn SilicoMethods in a Regulatory Context. ACTA ACUST UNITED AC 2017. [DOI: 10.1089/aivt.2017.0010] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Kristie M. Sullivan
- Physicians Committee for Responsible Medicine, Washington, District of Columbia
| | - Steven J. Enoch
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, England
| | - Janine Ezendam
- National Institute for Public Health and the Environment (RIVM), Centre for Health Protection, Bilthoven, The Netherlands
| | - Katherina Sewald
- Fraunhofer Institute for Toxicology and Experimental Medicine ITEM, Hannover, Germany
| | - Erwin L. Roggen
- 3Rs Management & Consulting ApS (3RsMC ApS), Lyngby, Denmark
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32
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Shin HM, McKone TE, Bennett DH. Model framework for integrating multiple exposure pathways to chemicals in household cleaning products. INDOOR AIR 2017; 27:829-839. [PMID: 27859724 DOI: 10.1111/ina.12356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 11/11/2016] [Indexed: 05/03/2023]
Abstract
We present a screening-level exposure-assessment method which integrates exposure from all plausible exposure pathways as a result of indoor residential use of cleaning products. The exposure pathways we considered are (i) exposure to a user during product use via inhalation and dermal, (ii) exposure to chemical residues left on clothing, (iii) exposure to all occupants from the portion released indoors during use via inhalation and dermal, and (iv) exposure to the general population due to down-the-drain disposal via inhalation and ingestion. We use consumer product volatilization models to account for the chemical fractions volatilized to air (fvolatilized ) and disposed down the drain (fdown-the-drain ) during product use. For each exposure pathway, we use a fate and exposure model to estimate intake rates (iR) in mg/kg/d. Overall, the contribution of the four exposure pathways to the total exposure varies by the type of cleaning activities and with chemical properties. By providing a more comprehensive exposure model and by capturing additional exposures from often-overlooked exposure pathways, our method allows us to compare the relative contribution of various exposure routes and could improve high-throughput exposure assessment for chemicals in cleaning products.
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Affiliation(s)
- H-M Shin
- Department of Public Health Sciences, University of California, Davis, CA, USA
- Department of Earth and Environmental Sciences, University of Texas, Arlington, TX, USA
| | - T E McKone
- Energy Analysis and Environmental Impacts Division, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
- School of Public Health, University of California, Berkeley, CA, USA
| | - D H Bennett
- Department of Public Health Sciences, University of California, Davis, CA, USA
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33
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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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Del Giacco SR, Bakirtas A, Bel E, Custovic A, Diamant Z, Hamelmann E, Heffler E, Kalayci Ö, Saglani S, Sergejeva S, Seys S, Simpson A, Bjermer L. Allergy in severe asthma. Allergy 2017; 72:207-220. [PMID: 27775836 DOI: 10.1111/all.13072] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2016] [Indexed: 12/20/2022]
Abstract
It is well recognized that atopic sensitization is an important risk factor for asthma, both in adults and in children. However, the role of allergy in severe asthma is still under debate. The term 'Severe Asthma' encompasses a highly heterogeneous group of patients who require treatment on steps 4-5 of GINA guidelines to prevent their asthma from becoming 'uncontrolled', or whose disease remains 'uncontrolled' despite this therapy. Epidemiological studies on emergency room visits and hospital admissions for asthma suggest the important role of allergy in asthma exacerbations. In addition, allergic asthma in childhood is often associated with severe asthma in adulthood. A strong association exists between asthma exacerbations and respiratory viral infections, and interaction between viruses and allergy further increases the risk of asthma exacerbations. Furthermore, fungal allergy has been shown to play an important role in severe asthma. Other contributing factors include smoking, pollution and work-related exposures. The 'Allergy and Asthma Severity' EAACI Task Force examined the current evidence and produced this position document on the role of allergy in severe asthma.
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Affiliation(s)
- S. R. Del Giacco
- Department of Medical Sciences and Public Health; University of Cagliari; Cagliari Italy
| | - A. Bakirtas
- Department of Pediatric Allergy and Asthma; School of Medicine; Gazi University; Ankara Turkey
| | - E. Bel
- Department of Respiratory Medicine; Academic Medical Centre; University of Amsterdam; Amsterdam The Netherlands
| | - A. Custovic
- Department of Paediatrics; Imperial College London; London UK
| | - Z. Diamant
- Department of General Practice and Department of Clinical Pharmacy & Pharmacology; University Medical Centre Groningen; University of Groningen; Groningen The Netherlands
- Department of Respiratory Medicine and Allergology; Lund University; Lund Sweden
| | - E. Hamelmann
- Klinik für Kinder and Jugendmedizin Kinderzentrum; Bethel Evangelisches Krankenhaus; Allergy Center; Ruhr University Bochum; Bielefeld Germany
| | - E. Heffler
- Respiratory Medicine and Allergology - Department of Experimental and Clinical Medicine; University of Catania; Catania Italy
| | - Ö. Kalayci
- School of Medicine; Hacettepe University; Ankara Turkey
| | - S. Saglani
- National Heart & Lung Institute; Imperial College London; London UK
| | - S. Sergejeva
- Institute of Technology; University of Tartu; Tartu Estonia
| | - S. Seys
- Department of Microbiology and Immunology; Laboratory of Clinical Immunology; KU Leuven Belgium
| | - A. Simpson
- Centre Lead for Respiratory Medicine and Allergy; University Hospital of South Manchester; Education and Research Centre; University of Manchester; Manchester UK
| | - L. Bjermer
- Department of Respiratory Medicine and Allergology; Lund University; Lund Sweden
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Watanabe M, Kurai J, Sano H, Kitano H, Shimizu E. Prevalence of asthma and wheezes among snow crab workers in western Japan: a cross-sectional study. THE JOURNAL OF MEDICAL INVESTIGATION 2017; 63:74-9. [PMID: 27040057 DOI: 10.2152/jmi.63.74] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES Few reports are available concerning the prevalence of asthma among snow crab workers in Japan. The object of this study was to estimate the prevalence of asthma and wheezes among Japanese snow crab workers and their associations with exhaled nitric oxide (FeNO) and YKL-40. METHODS Forty-nine snow crab workers enrolled in this study, which was cross-sectional by design and was conducted using a translated version of the European Community Respiratory Health Survey questionnaire. The levels of FeNO and serum YKL-40 were measured between September and October 2014. RESULTS The prevalences of current asthma and wheezes were 10.2% (95% CI, 3.4 to 22.2) and 12.2% (95% CI, 4.6 to 24.8), respectively. There was no association between these prevalences and the duration of snow crab employment. Six subjects' FeNO levels exceeded 50 ppb, and nine subjects' levels exceeded 25 ppb. Twelve subjects' (25.5%) serum YKL-40 levels exceeded 77.2 ng/mL, which was 2 standard deviations above the mean for healthy subjects. However, there were no significant relationships among the prevalences for asthma and wheezes, FeNO, and serum YKL-40. CONCLUSIONS This study provides information concerning the prevalences of asthma and wheezes among Japanese snow crab processing workers.
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Affiliation(s)
- Masanari Watanabe
- Department of Respiratory Medicine and Rheumatology, Tottori University Faculty of Medicine
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37
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Watanabe M, Kurai J, Sano H, Torai S, Yanase H, Funakoshi T, Fukada A, Hayakawa S, Kitano H, Shimizu E. Prevalence of allergic rhinitis based on the SACRA questionnaire among Japanese nursing professionals with asthma. THE JOURNAL OF MEDICAL INVESTIGATION 2017; 63:108-13. [PMID: 27040063 DOI: 10.2152/jmi.63.108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Although adult asthma is attributable to occupational factors and asthma and rhinitis are related, relatively few studies have investigated the prevalence of occupational rhinitis based on occupation, and knowledge of occupational rhinitis in Japan is currently limited. The objective of this cross-sectional study was to estimate the prevalence of allergic rhinitis among Japanese nursing professionals with asthma. A postal survey was conducted from October to December 2013 using translated versions of the European Community Respiratory Health Survey for the prevalence of asthma and State of the Impact of Allergic Rhinitis on Asthma Control questionnaire for the prevalence of rhinitis. Of 4,634 Japanese nursing professionals, 497 subjects had asthma, and 270 of these 497 subjects had allergic rhinitis (54.3%; 95% confidence interval [CI], 49.7-58.7). Latex allergy was significantly associated with allergic rhinitis (odds ratio, 1.77; 95% CI, 1.21-2.60). There was no relationship between employment period and prevalent allergic rhinitis. The results of this study provide fundamental information regarding occupational health among Japanese nursing professionals, including the prevalence of allergic rhinitis among Japanese nursing professionals with asthma and latex allergy as a potential risk factor for prevalent allergic rhinitis.
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Affiliation(s)
- Masanari Watanabe
- Department of Respiratory Medicine and Rheumatology, Tottori University Faculty of Medicine
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Reza Masjedi M, Saeedfar K, Masjedi J. Occupational Allergies: A Brief Review. EUROPEAN MEDICAL JOURNAL 2016. [DOI: 10.33590/emj/10313903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Occupational allergies are groups of work-related disorders that are accompanied by immunologic reaction to workplace allergens and include occupational asthma, rhinitis, hypersensitivity pneumonitis, dermatitis, and anaphylaxis. This mini review presents a brief analysis of the more important aspects of occupational allergic disorders.
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Affiliation(s)
- Mohammad Reza Masjedi
- Pulmonary Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Tobacco Control Research Center, Iranian Anti-Tobacco Association, Tehran, Iran
| | - Kayvan Saeedfar
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Javid Masjedi
- Tobacco Control Research Center, Iranian Anti-Tobacco Association, Tehran, Iran
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Dik S, Rorije E, Schwillens P, van Loveren H, Ezendam J. Can the Direct Peptide Reactivity Assay Be Used for the Identification of Respiratory Sensitization Potential of Chemicals? Toxicol Sci 2016; 153:361-71. [PMID: 27473337 DOI: 10.1093/toxsci/kfw130] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Prospective identification of low molecular weight respiratory sensitizers is difficult due to the current lack of adequate test methods. The direct peptide reactivity assay (DPRA) seems to be a promising method to determine the sensitization potential of chemicals because it determines the intrinsic characteristic of sensitizers to bind to proteins. It is already applied in the field of skin sensitization, and adaptation to respiratory sensitization has started recently. This article further evaluates the ability of the DPRA to predict the respiratory sensitization potential of chemicals. In addition, the added value of applying High Performance Liquid Chromatography (HPLC)-MS and measurements after 20 minutes and 24 hours of incubation was evaluated. Eighteen respiratory sensitizers (10 haptens, 3 prehaptens, and 5 prohaptens) and 14 nonsensitizers were tested with 2-model peptides. Based on peptide depletion, a prediction model was proposed for the identification of (respiratory) sensitizers. Application of mass spectrometry and measurements at 2 time-points increased prediction accuracy of the assay by resolving discordant results. The prediction model correctly identified all haptens and prehaptens as sensitizers. The 5 prohaptens were not identified as sensitizers, most likely due to lack of metabolic activity in the DPRA. All but 1 nonsensitizer was correctly predicted. The model, therefore, shows an accuracy of 78% for the tested dataset. Unfortunately, this assay cannot be used to distinguish respiratory from skin sensitizers. To make this distinction, the DPRA needs to be combined with other test methods that are able to identify respiratory sensitizers.
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Affiliation(s)
- Sander Dik
- *Centre for Health Protection Department of Toxicogenomics, Maastricht University, Maastricht 6200 MD, The Netherlands
| | - Emiel Rorije
- Centre for Safety of Substances and Products, National Institute for Public Health and the Environment, Bilthoven 3720 BA, The Netherlands
| | | | - Henk van Loveren
- *Centre for Health Protection Department of Toxicogenomics, Maastricht University, Maastricht 6200 MD, The Netherlands
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Bertelsen RJ, Svanes Ø, Madsen AM, Hollund BE, Kirkeleit J, Sigsgaard T, Uhrbrand K, Do TV, Aasen TB, Svanes C. Pulmonary illness as a consequence of occupational exposure to shrimp shell powder. ENVIRONMENTAL RESEARCH 2016; 148:491-499. [PMID: 27148672 DOI: 10.1016/j.envres.2016.04.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 04/14/2016] [Accepted: 04/25/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVES An employee with no prior history of allergy or asthma, experienced respiratory and flu-like symptoms during production of shrimp shell powder in a seafood savory factory in Norway. We aimed to clarify the diagnosis and to identify the cause of the symptoms by specific inhalation challenge (SIC) and by characterizing the powder's biocontaminants, particle size fractions and inflammatory potential. METHODS Respiratory and immunological responses were measured the day before and after each of four challenges with 20-150g shrimp shell powder during three consecutive days. The powder was analyzed for endotoxin, microorganisms and particle size fractions by standardized laboratory methods. Total inflammatory potential was quantified by reactive oxygen species (ROS) production in a granulocyte assay. RESULTS The patient had elevated IgG, but not IgE, towards shrimp shell powder. 20min challenge with 150g shrimp shell powder induced 15% decrease in FVC, 23% decrease in FEV1 and increased unspecific bronchial reactivity by methacholine. Neutrophils and monocytes increased 84% and 59%, respectively, and the patient experienced temperature increase and flu-like symptoms. The shrimp shell powder contained 1118 endotoxin units/g and bacteria including Bacillus cereus, and 57% respirable size fraction when aerosolized. The ROS production was higher for shrimp shell powder than for endotoxin alone. CONCLUSIONS Endotoxin and other bacterial components combined with a high fraction of respirable dust might be the cause of the symptoms. The patient's characteristics and response to SIC were best compatible with occupational asthma and organic dust toxic syndrome, while hypersensitivity pneumonitis could not be excluded.
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Affiliation(s)
- Randi Jacobsen Bertelsen
- Department of Occupational Medicine, Haukeland University Hospital, P.O. Box 1400, N-5021 Bergen, Norway; Department of Clinical Science, University of Bergen, P.O. Box 7804, N-5020 Bergen, Norway.
| | - Øistein Svanes
- Department of Occupational Medicine, Haukeland University Hospital, P.O. Box 1400, N-5021 Bergen, Norway; Department of Clinical Science, University of Bergen, P.O. Box 7804, N-5020 Bergen, Norway; Department of Thoracic Medicine, Haukeland University Hospital, N-5021 Bergen, Norway
| | - Anne Mette Madsen
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Bjørg Eli Hollund
- Department of Occupational Medicine, Haukeland University Hospital, P.O. Box 1400, N-5021 Bergen, Norway; Department of Clinical Science, University of Bergen, P.O. Box 7804, N-5020 Bergen, Norway
| | - Jorunn Kirkeleit
- Department of Occupational Medicine, Haukeland University Hospital, P.O. Box 1400, N-5021 Bergen, Norway; Department of Clinical Science, University of Bergen, P.O. Box 7804, N-5020 Bergen, Norway
| | - Torben Sigsgaard
- Department of Public Health, Institute of Environmental and Occupational Medicine, Aarhus University, Aarhus, Denmark
| | - Katrine Uhrbrand
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Thien Van Do
- Laboratory of Clinical Biochemistry, Haukeland University Hospital, N-5021 Bergen, Norway
| | - Tor B Aasen
- Department of Occupational Medicine, Haukeland University Hospital, P.O. Box 1400, N-5021 Bergen, Norway
| | - Cecilie Svanes
- Department of Occupational Medicine, Haukeland University Hospital, P.O. Box 1400, N-5021 Bergen, Norway; Centre for International Health, University of Bergen, N-5020 Bergen, Norway
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Meca O, Cruz MJ, Sánchez-Ortiz M, González-Barcala FJ, Ojanguren I, Munoz X. Do Low Molecular Weight Agents Cause More Severe Asthma than High Molecular Weight Agents? PLoS One 2016; 11:e0156141. [PMID: 27280473 PMCID: PMC4900572 DOI: 10.1371/journal.pone.0156141] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 05/09/2016] [Indexed: 11/26/2022] Open
Abstract
Introduction The aim of this study was to analyse whether patients with occupational asthma (OA) caused by low molecular weight (LMW) agents differed from patients with OA caused by high molecular weight (HMW) with regard to risk factors, asthma presentation and severity, and response to various diagnostic tests. Methods Seventy-eight patients with OA diagnosed by positive specific inhalation challenge (SIC) were included. Anthropometric characteristics, atopic status, occupation, latency periods, asthma severity according to the Global Initiative for Asthma (GINA) control classification, lung function tests and SIC results were analysed. Results OA was induced by an HMW agent in 23 patients (29%) and by an LMW agent in 55 (71%). A logistic regression analysis confirmed that patients with OA caused by LMW agents had a significantly higher risk of severity according to the GINA classification after adjusting for potential confounders (OR = 3.579, 95% CI 1.136–11.280; p = 0.029). During the SIC, most patients with OA caused by HMW agents presented an early reaction (82%), while in patients with OA caused by LMW agents the response was mainly late (73%) (p = 0.0001). Similarly, patients with OA caused by LMW agents experienced a greater degree of bronchial hyperresponsiveness, measured as the difference in the methacholine dose-response ratio (DRR) before and after SIC (1.77, range 0–16), compared with patients with OA caused by HMW agents (0.87, range 0–72), (p = 0.024). Conclusions OA caused by LMW agents may be more severe than that caused by HMW agents. The severity of the condition may be determined by the different mechanisms of action of these agents.
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Affiliation(s)
- Olga Meca
- Servicio de Neumología, Hospital General Universitario Morales Messeguer, Murcia, Spain
| | - María-Jesús Cruz
- Servicio de Neumología, Hospital Universitario Vall d’Hebron, Barcelona, Catalonia, Spain
- Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
- * E-mail:
| | - Mónica Sánchez-Ortiz
- Servicio de Neumología, Hospital Universitario Vall d’Hebron, Barcelona, Catalonia, Spain
- Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | | | - Iñigo Ojanguren
- Servicio de Neumología, Hospital Universitario Vall d’Hebron, Barcelona, Catalonia, Spain
- Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Xavier Munoz
- Servicio de Neumología, Hospital Universitario Vall d’Hebron, Barcelona, Catalonia, Spain
- Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
- Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Catalonia, Spain
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Respiratory hazards: clinical and functional assessment in aluminum industry workers. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2016. [DOI: 10.1016/j.ejcdt.2016.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Ari A, Fink JB. Differential Medical Aerosol Device and Interface Selection in Patients during Spontaneous, Conventional Mechanical and Noninvasive Ventilation. J Aerosol Med Pulm Drug Deliv 2016; 29:95-106. [DOI: 10.1089/jamp.2015.1266] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Arzu Ari
- Division of Respiratory Therapy, Georgia State University, Atlanta, Georgia
| | - James B. Fink
- Division of Respiratory Therapy, Georgia State University, Atlanta, Georgia
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44
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Maher M, Olfa EM, Wided B, Souhail C, Ezzeddine G, Houda K, Houda K, Jabrane M, Ammar A, Aicha B, Mouna L, Habib HS, Khaled BK, Tasnim M, Mohamed B, Faten D, Néjib M. Epidemiology of Occupational Asthma in Tunisia: Results of a First National Study. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/odem.2016.42004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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45
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Kurai J, Watanabe M, Sano H, Torai S, Yanase H, Funakoshi T, Fukada A, Hayakawa S, Shimizu E, Kitano H. Asthma and Wheeze Prevalence among Nursing Professionals in Western Japan: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:15459-69. [PMID: 26690187 PMCID: PMC4690933 DOI: 10.3390/ijerph121214997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 11/21/2015] [Accepted: 12/03/2015] [Indexed: 11/16/2022]
Abstract
Although adult asthma is attributable to occupational factors, few reports are available on asthma prevalence among health care workers in Japan. The objective of this study was to estimate the prevalence of asthma and wheeze among Japanese nursing professionals. A cross-sectional study was conducted by postal survey using a translated version of the European Community Respiratory Health Survey questionnaire from April to June 2013. The analysis included 4634 nursing professionals (257 men and 4377 women) and the overall response rate was 84.8%. The prevalence of current asthma and wheeze were 10.7% (95% confidence interval (CI), 9.9%-11.7%) and 15.6% (95% CI, 14.5%-16.6%), respectively. More than one year of work experience as a nursing professional and more than one year of experience with bed-making tasks were associated with odds ratios (ORs) of 1.95 (95% CI, 1.12-3.39) and 1.64 (95% CI, 1.15-2.23) for wheeze, respectively. Current smoking was significantly associated with the presence of wheeze, with ORs of 2.27 for men (95% CI, 1.11-4.64) and 2.01 for women (95% CI, 1.54-2.64). Among female nurses, latex allergy was associated with wheeze (OR, 1.87; 95% CI, 1.56-2.23), as was body mass index ≥30 (OR, 2.76; 95% CI, 1.65-4.62). This study has provided the prevalence of asthma and wheeze among Japanese nursing professionals. Employment period, bed-making tasks, latex allergy, obesity, and smoking may be risk factors for prevalent wheeze among nursing professionals.
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Affiliation(s)
- Jun Kurai
- Department of Respiratory Medicine and Rheumatology, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago 683-8504, Japan.
| | - Masanari Watanabe
- Department of Respiratory Medicine and Rheumatology, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago 683-8504, Japan.
| | - Hiroyuki Sano
- Department of Respiratory Medicine and Allergology, Faculty of Medicine, Kinki University, 377-2 Ohnohigashi, Osakasayama 589-0014, Japan.
| | - Saeko Torai
- Tottori Nursing Association, 318-1 Gotsu, Tottori 680-0901, Japan.
| | - Hirokazu Yanase
- Division of Nursing, Tottori University Hospital, 36-1 Nishi-cho, Yonago 683-8504, Japan.
| | - Tomoaki Funakoshi
- Division of Nursing, Tottori University Hospital, 36-1 Nishi-cho, Yonago 683-8504, Japan.
| | - Atsuko Fukada
- Division of Nursing, Tottori University Hospital, 36-1 Nishi-cho, Yonago 683-8504, Japan.
| | - Sachiko Hayakawa
- Department of Public Relations, Tottori University Hospital, 36-1 Nishi-cho, Yonago 683-8504, Japan.
| | - Eiji Shimizu
- Department of Respiratory Medicine and Rheumatology, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago 683-8504, Japan.
| | - Hiroya Kitano
- The Board of Directors, Tottori University, 4-101 Koyamachou-Minami, Tottori 68-8550, Japan.
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Rabell-Santacana V, Panadès-Valls R, Vila-Rigat R, Hernandez-Huet E, Sivecas-Maristany J, Blanché-Prat X, Prieto G, Muñoz L, Torán P. Prevalence of Work-Related Asthma in Primary Health Care: Study Rationale and Design. Open Respir Med J 2015; 9:127-39. [PMID: 26865884 PMCID: PMC4740970 DOI: 10.2174/1874306401509010127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 10/01/2015] [Accepted: 10/01/2015] [Indexed: 11/22/2022] Open
Abstract
Background : Occupational Asthma (OA) is the most frequent origin of occupational respiratory diseases in industrialized countries and accounts for between 5% and 25% of asthmatic patients. The correct and early diagnosis of OA is of great preventive and socio-economic importance. However, few studies exist on OA’s prevalence in Catalonia and in Spain and those affected are mainly treated by the public health services and not by the occupational health services, which are private. Objective : To determine the prevalence of OA in patients diagnosed with asthma in the Primary Healthcare system and to evaluate the socio-economic impact of OA in the Primary Healthcare system. Methods/Design : We will carry out an observational, transversal and multi-center study in the Primary Healthcare Service in the Barcelona region (Catalonia, Spain), with 385 asthmatic workers aged between 16 and 64 who are currently working or have been working in the past. We will confirm the asthma diagnosis in each patient, and those meeting the inclusion criteria will be asked to answer a questionnaire that aims to link asthma to the patient’s past employment history. The resulting diagnosis will be of either occupational asthma, work-aggravated asthma or common asthma. We will also collect socio-demographic information about the patients, about their smoking status, their exposure outside of the workplace, their work situation at the onset of the symptoms, their employment history, their symptoms of asthma, their present and past medical asthma treatment, and, in order to estimate the economic impact in the Primary Healthcare system, where they have been attended to and treated. Prevalence will link OA or work-aggravated asthma to the total of patients participating in the study with a asthma diagnosis. Discussion : The results will show the prevalence of OA and work-aggravated asthma, and shall provide valuable information to set out and apply the necessary personal and technical measures, either in the public or in the occupational health services. No studies evaluating the costs generated by the OA in the Primary Healthcare system have been carried out.
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Affiliation(s)
- Ventura Rabell-Santacana
- Primary Healthcare Centre Vallès Oriental, Catalan Health Institute, Carrer del Museu, 19, 08401 Granollers, Spain
| | - Rafael Panadès-Valls
- Health and Safety Occupational Centre, Department of Business and Occupation, Plaça Eusebi Güell 4-5, 08034 Barcelona, Spain
| | - Rosa Vila-Rigat
- Primary Healthcare Centre La Garriga, Catalan Health Institute, Carrer Torrent de la Sínia 7, 08530 La Garriga, Spain
| | - Enric Hernandez-Huet
- Primary Healthcare Centre Les Franqueses del Vallès, Catalan Health Institute, Carrer de Girona 290, 08520 Les Franqueses del Vallès, Spain
| | - Joan Sivecas-Maristany
- Primary Healthcare Centre Can Borràs, Catalan Health Institute Carrer, Balmes 51, 08440 Cardedeu, Spain
| | - Xavier Blanché-Prat
- Primary Healthcare Centre Llinars del Vallès, Catalan Health Institute Carrer, Frederic Marès, s/n. 08450 Llinars del Vallès
| | - Gemma Prieto
- Primary Care Management of Health of Ávila, Castilla y León (SACYL), Avenida de Portugal 47, 05001 Ávila, Spain
| | - Laura Muñoz
- Primary Healthcare Research Support Unit Metropolitana Nord.IDIAP Jordi Gol, Carrer Major 49-53, 08921 Santa Coloma de Gramenet, Spain
| | - Pere Torán
- Primary Healthcare Research Support Unit Metropolitana Nord.IDIAP Jordi Gol, Carrer Major 49-53, 08921 Santa Coloma de Gramenet, Spain
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Dik S, Pennings JLA, van Loveren H, Ezendam J. Development of an in vitro test to identify respiratory sensitizers in bronchial epithelial cells using gene expression profiling. Toxicol In Vitro 2015; 30:274-80. [PMID: 26518187 DOI: 10.1016/j.tiv.2015.10.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 10/21/2015] [Accepted: 10/24/2015] [Indexed: 11/29/2022]
Abstract
Chemicals that induce asthma at the workplace are substances of concern. At present, there are no widely accepted methods to identify respiratory sensitizers, and classification of these substances is based on human occupational data. Several studies have contributed to understanding the mechanisms involved in respiratory sensitization, although uncertainties remain. One point of interest for respiratory sensitization is the reaction of the epithelial lung barrier to respiratory sensitizers. To elucidate potential molecular effects of exposure of the epithelial lung barrier, a gene expression profile was created based on a DNA microarray experiment using the bronchial epithelial cell line 16 HBE14o(-). The cells were exposed to 12 respiratory sensitizers and 10 non-sensitizers. For statistical analysis, we used a class prediction approach that combined three machine learning algorithms, leave-one-compound-out cross validation, and majority voting per tested compound. This approach allowed for a prediction accuracy of 95%. Identified predictive genes were mainly associated with the cytoskeleton and barrier function of the epithelial cell. Several of these genes were reported to be associated with asthma as well. Taken together, this indicates that pulmonary barrier function is an important target for respiratory sensitizers and associated genes can be used to predict the respiratory sensitization potential of chemicals.
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Affiliation(s)
- Sander Dik
- Centre for Health Protection, National Institute for Public Health and the Environment, 3720 BA Bilthoven, The Netherlands; Department of Toxicogenomics, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Jeroen L A Pennings
- Centre for Health Protection, National Institute for Public Health and the Environment, 3720 BA Bilthoven, The Netherlands
| | - Henk van Loveren
- Centre for Health Protection, National Institute for Public Health and the Environment, 3720 BA Bilthoven, The Netherlands; Department of Toxicogenomics, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Janine Ezendam
- Centre for Health Protection, National Institute for Public Health and the Environment, 3720 BA Bilthoven, The Netherlands.
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48
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Sundaresan AS, Hirsch AG, Storm M, Tan BK, Kennedy TL, Greene JS, Kern RC, Schwartz BS. Occupational and environmental risk factors for chronic rhinosinusitis: a systematic review. Int Forum Allergy Rhinol 2015; 5:996-1003. [PMID: 26077513 DOI: 10.1002/alr.21573] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 05/07/2015] [Accepted: 05/14/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is a prevalent and disabling paranasal sinus disease, with a likely multifactorial etiology potentially including hazardous occupational and environmental exposures. We completed a systematic review of the occupational and environmental literature to evaluate the quality of evidence of the role that hazardous exposures might play in CRS. METHODS We searched PubMed for studies of CRS and following exposure categories: occupation, employment, work, industry, air pollution, agriculture, farming, environment, chemicals, roadways, disaster, and traffic. We abstracted information from the final set of articles across 6 primary domains: study design; population; exposures evaluated; exposure assessment; CRS definition; and results. RESULTS We identified 41 articles from 1080 manuscripts: 37 occupational risk papers, 1 environmental risk paper, and 3 papers studying both categories of exposures. None of the 41 studies used a CRS definition consistent with current diagnostic guidelines. Exposure assessment was generally dependent on self-report or binary measurements of exposure based on industry of employment. Only grain, dairy, and swine operations among farmers were evaluated by more than 1 study using a common approach to defining CRS, but employment in these settings was not consistently associated with CRS. The multiple other exposures did not meet quality standards for reporting associations or were not evaluated by more than 1 study. CONCLUSION The current state of the literature allows us to make very few conclusions about the role of hazardous occupational or environmental exposures in CRS, leaving a critical knowledge gap regarding potentially modifiable risk factors for disease onset and progression.
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Affiliation(s)
| | | | - Margaret Storm
- Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD
| | - Bruce K Tan
- Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Thomas L Kennedy
- Department of Otolaryngology-Head and Neck Surgery, Geisinger Health System, Danville, PA
| | - J Scott Greene
- Department of Otolaryngology-Head and Neck Surgery, Geisinger Health System, Danville, PA
| | - Robert C Kern
- Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Brian S Schwartz
- Center for Health Research, Geisinger Health System, Danville, PA.,Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
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49
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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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50
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Mbatchou Ngahane BH, Nde F, Ngomo E, Afane Ze E. Sensitization to workplace respiratory allergens among bakery workers in Douala, Cameroon: a cross-sectional study. Allergy Asthma Clin Immunol 2015; 11:13. [PMID: 25873977 PMCID: PMC4396722 DOI: 10.1186/s13223-015-0080-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 04/03/2015] [Indexed: 01/12/2023] Open
Abstract
Background Sensitization to flour or fungal alpha-amylase is a prerequisite for the development of respiratory allergy in bakers. The knowledge of occupational allergen sensitization among bakery workers will facilitate the implementation of preventive measures for respiratory allergies in bakeries. The objective of this study was to determine the prevalence and factors associated with sensitization to wheat flour and α-amylase in bakers in Douala. Methods A cross-sectional study was conducted in 42 of the 151 bakeries that are present in the city of Douala. Demographics, clinical data, as well as results of skin prick tests to wheat flour, α-amylase and common aeroallergens were collected from all participants. A logistic regression model of the SPSS.20 software was used to identify factors associated with sensitization to wheat flour and α-amylase. Results Of the 229 participants included in the study, 222 (96.9%) were male. The mean age was 36.3 ± 8.9 years. The prevalence of sensitization to flour and α-amylase were 16.6% and 8.3% respectively. After multivariate analysis, factors associated with sensitization to flour were work seniority and sensitization to storage mites while an age of 30 years and above was the only factor associated with sensitization to α-amylase. Conclusion Bakers in Douala are at risk of sensitization to occupational allergens. The environmental hygiene in bakeries, health surveillance and the use of personal protective equipment could reduce the risk of respiratory allergies among bakers.
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Affiliation(s)
- Bertrand Hugo Mbatchou Ngahane
- Internal Medicine, Douala General Hospital, PO Box 4856, Douala, Cameroon ; Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon ; Douala Research Network, Douala, Cameroon
| | - Francis Nde
- Ecole de Santé Publique, Université Libre de Bruxelles, Bruxelles, Belgium
| | | | - Emmanuel Afane Ze
- Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
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