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Koschel D, Behr J, Berger M, Bonella F, Hamer O, Joest M, Jonigk D, Kreuter M, Leuschner G, Nowak D, Raulf M, Rehbock B, Schreiber J, Sitter H, Theegarten D, Costabel U. [Diagnosis and Treatment of Hypersensitivity Pneumonitis - S2k Guideline of the German Respiratory Society and the German Society for Allergology and Clinical Immunology]. Pneumologie 2024. [PMID: 39227017 DOI: 10.1055/a-2369-8458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
Hypersensitivity pneumonitis (HP) is an immune-mediated interstitial lung disease (ILD) in sensitized individuals caused by a large variety of inhaled antigens. The clinical form of acute HP is often misdiagnosed, while the chronic form, especially the chronic fibrotic HP, is difficult to differentiate from other fibrotic ILDs. The present guideline for the diagnosis and treatment of HP replaces the former German recommendations for the diagnosis of HP from 2007 and is amended explicitly by the issue of the chronic fibrotic form, as well as by treatment recommendations for the first time. The evidence was discussed by a multidisciplinary committee of experts. Then, recommendations were formulated for twelve questions on important issues of diagnosis and treatment strategies. Recently published national and international guidelines for ILDs and HP were considered. Detailed background information on HP is useful for a deeper insight into HP and the handling of the guideline.
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Affiliation(s)
- Dirk Koschel
- Abteilung Innere Medizin und Pneumologie, Fachkrankenhaus Coswig, Lungenzentrum, Coswig, Deutschland
- Bereich Pneumologie, Medizinische Klinik 1, Universitätsklinikum Carl Gustav Carus, TU Dresden, Dresden, Deutschland
- Ostdeutsches Lungenzentrum (ODLZ), Coswig/Dresden, Deutschland
| | - Jürgen Behr
- Medizinische Klinik und Poliklinik V, LMU Klinikum der Universität München, München, Deutschland
- Deutsches Zentrum für Lungenforschung, Gießen, Deutschland
| | - Melanie Berger
- Lungenklinik, Kliniken der Stadt Köln gGmbH, Köln
- Lehrstuhl für Pneumologie, Universität Witten/Herdecke, Fakultät für Gesundheit, Köln, Deutschland
| | - Francesco Bonella
- Zentrum für interstitielle und seltene Lungenerkrankungen, Ruhrlandklinik, Universitätsmedizin Essen, Essen, Deutschland
| | - Okka Hamer
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, Regensburg, Deutschland
- Abteilung für Radiologie, Lungenfachklinik Donaustauf, Donaustauf, Deutschland
| | - Marcus Joest
- Praxis für Pneumologie und Allergologie, Bonn, Deutschland
| | - Danny Jonigk
- Deutsches Zentrum für Lungenforschung, Gießen, Deutschland
- Institut für Pathologie, RWTH Aachen, Universität Aachen, Aachen, Deutschland
| | - Michael Kreuter
- Lungenzentrum Mainz, Klinik für Pneumologie, Beatmungs- und Schlafmedizin, Marienhaus Klinikum Mainz und Klinik für Pneumologie, ZfT, Universitätsmedizin Mainz, Mainz, Deutschland
| | - Gabriela Leuschner
- Medizinische Klinik und Poliklinik V, LMU Klinikum der Universität München, München, Deutschland
- Deutsches Zentrum für Lungenforschung, Gießen, Deutschland
| | - Dennis Nowak
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, LMU München, München, Deutschland
| | - Monika Raulf
- Abteilung Kompetenz-Zentrum Allergologie/Immunologie, Institut für Prävention und Arbeitsmedizin der DGUV, Institut der Ruhr-Universität Bochum (IPA), Bochum, Deutschland
| | - Beate Rehbock
- Privatpraxis für Diagnostische Radiologie und Begutachtung, Berlin, Deutschland
| | - Jens Schreiber
- Universitätsklinik für Pneumologie, Universitätsklinikum Magdeburg, Magdeburg, Deutschland
| | - Helmut Sitter
- Institut für Theoretische Chirurgie, Philipps-Universität Marburg, Marburg, Deutschland
| | - Dirk Theegarten
- Institut für Pathologie, Universitätsklinikum Essen, Essen, Deutschland
| | - Ulrich Costabel
- Zentrum für interstitielle und seltene Lungenerkrankungen, Ruhrlandklinik, Universitätsmedizin Essen, Essen, Deutschland
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Doyen V, Gautrin D, Vandenplas O, Malo JL. Comparison of high- and low-molecular-weight sensitizing agents causing occupational asthma: an evidence-based insight. Expert Rev Clin Immunol 2024; 20:635-653. [PMID: 38235552 DOI: 10.1080/1744666x.2024.2306885] [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] [Accepted: 01/15/2024] [Indexed: 01/19/2024]
Abstract
INTRODUCTION The many substances used at the workplace that can cause sensitizer-induced occupational asthma are conventionally categorized into high-molecular-weight (HMW) agents and low-molecular-weight (LMW) agents, implying implicitly that these two categories of agents are associated with distinct phenotypic profiles and pathophysiological mechanisms. AREAS COVERED The authors conducted an evidence-based review of available data in order to identify the similarities and differences between HMW and LMW sensitizing agents. EXPERT OPINION Compared with LMW agents, HMW agents are associated with a few distinct clinical features (i.e. concomitant work-related rhinitis, incidence of immediate asthmatic reactions and increase in fractional exhaled nitric oxide upon exposure) and risk factors (i.e. atopy and smoking). However, some LMW agents may exhibit 'HMW-like' phenotypic characteristics, indicating that LMW agents are a heterogeneous group of agents and that pooling them into a single group may be misleading. Regardless of the presence of detectable specific IgE antibodies, both HMW and LMW agents are associated with a mixed Th1/Th2 immune response and a predominantly eosinophilic pattern of airway inflammation. Large-scale multicenter studies are needed that use objective diagnostic criteria and assessment of airway inflammatory biomarkers to identify the pathobiological pathways involved in OA caused by the various non-protein agents.
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Affiliation(s)
- Virginie Doyen
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - Denyse Gautrin
- Université de Montréal and Hôpital du Sacré-Cœur de Montréal, Montréal, Canada
| | - Olivier Vandenplas
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - Jean-Luc Malo
- Université de Montréal and Hôpital du Sacré-Cœur de Montréal, Montréal, Canada
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Gibb M, Liu JY, Sayes CM. The transcriptomic signature of respiratory sensitizers using an alveolar model. Cell Biol Toxicol 2024; 40:21. [PMID: 38584208 PMCID: PMC10999393 DOI: 10.1007/s10565-024-09860-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 03/25/2024] [Indexed: 04/09/2024]
Abstract
Environmental contaminants are ubiquitous in the air we breathe and can potentially cause adverse immunological outcomes such as respiratory sensitization, a type of immune-driven allergic response in the lungs. Wood dust, latex, pet dander, oils, fragrances, paints, and glues have all been implicated as possible respiratory sensitizers. With the increased incidence of exposure to chemical mixtures and the rapid production of novel materials, it is paramount that testing regimes accounting for sensitization are incorporated into development cycles. However, no validated assay exists that is universally accepted to measure a substance's respiratory sensitizing potential. The lungs comprise various cell types and regions where sensitization can occur, with the gas-exchange interface being especially important due to implications for overall lung function. As such, an assay that can mimic the alveolar compartment and assess sensitization would be an important advance for inhalation toxicology. Some such models are under development, but in-depth transcriptomic analyses have yet to be reported. Understanding the transcriptome after sensitizer exposure would greatly advance hazard assessment and sustainability. We tested two known sensitizers (i.e., isophorone diisocyanate and ethylenediamine) and two known non-sensitizers (i.e., chlorobenzene and dimethylformamide). RNA sequencing was performed in our in vitro alveolar model, consisting of a 3D co-culture of epithelial, macrophage, and dendritic cells. Sensitizers were readily distinguishable from non-sensitizers by principal component analysis. However, few differentially regulated genes were common across all pair-wise comparisons (i.e., upregulation of genes SOX9, UACA, CCDC88A, FOSL1, KIF20B). While the model utilized in this study can differentiate the sensitizers from the non-sensitizers tested, further studies will be required to robustly identify critical pathways inducing respiratory sensitization.
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Affiliation(s)
- Matthew Gibb
- Institute of Biomedical Studies (BMS), Baylor University, Waco, TX, 76798-7266, USA
| | - James Y Liu
- Department of Environmental Science (ENV), Baylor University, One Bear Place #97266, Waco, TX, 76798-7266, USA
| | - Christie M Sayes
- Institute of Biomedical Studies (BMS), Baylor University, Waco, TX, 76798-7266, USA.
- Department of Environmental Science (ENV), Baylor University, One Bear Place #97266, Waco, TX, 76798-7266, USA.
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Sabbioni G, Pugh SA. New Method to Biomonitor Workers Exposed to 1,6-Hexamethylene Diisocyanate. Chem Res Toxicol 2022; 35:2285-2295. [PMID: 36413493 DOI: 10.1021/acs.chemrestox.2c00266] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Isocyanates such as 1,6-hexamethylene diisocyanate (HDI), 4,4'-methylenediphenyl diisocyanate, and toluene diisocyanate are highly reactive compounds that have a variety of commercial applications, including manufacturing polyurethane foam, elastomers, paints, adhesives, coatings, insecticides, and many other products. Their primary route of occupational exposure is through inhalation. Due to their high chemical reactivity, they are toxic and have adverse effects at the cellular and subcellular levels, leading to irritative and immunological reactions associated with lung disease. High concentrations of isocyanates are strong respiratory irritants. Bronchial sensitization and asthma are among the major adverse clinical reactions associated with low-level chronic exposure to isocyanates. Albumin adducts have been linked to the mechanism of occupational asthma caused by isocyanates. Isocyanates react in vivo with albumin, which is recognized by the immune system. Albumin adducts of isocyanates trigger immune responses and are probably the antigenic basis for isocyanate asthma. Sensitization to isocyanates is the main pathway for adverse health effects. Therefore, markers for the biologically effective dose such as albumin adducts of HDI are needed. A new isocyanate adduct of HDI with lysine─Nε-[(6-amino-hexyl-amino)carbonyl]-lysine (HDI-Lys)─was synthesized and characterized by 1H-NMR, 13C-NMR, and mass spectrometry (MS). Appropriate internal standards─HDI-Lys-4,4'-5,5'-d4 (HDI-d4-Lys) and Nε-[(7-amino-heptyl-amino)carbonyl]-lysine (Hep-Lys)─were synthesized to establish a LC-MS/MS method for the analysis of HDI adducts in in vitro modified albumin and in workers. The presence of HDI-Lys was found after pronase digestion of albumin and confirmed by two independent chromatographic approaches: with a C8 reversed-phase column and with a hydrophilic interaction liquid chromatography column. Quantification was performed with positive electrospray ionization (ESI)-MS. The adduct peak found in vivo was confirmed with the less sensitive negative ESI-MS. In summary, these are new compounds and methods to determine isocyanate-specific adducts with albumin in workers exposed to HDI.
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Affiliation(s)
- Gabriele Sabbioni
- Institute of Environmental and Occupational Toxicology, CH-6780 Airolo, Switzerland.,Walther-Straub-Institut für Pharmakologie und Toxikologie, Ludwig-Maximilians-Universität München, Nussbaumstrasse 26, D-80336 München, Germany
| | - Shirley A Pugh
- Institute of Environmental and Occupational Toxicology, CH-6780 Airolo, Switzerland
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Sennekamp J, Lehmann E, Joest M. Optimierte IgG-Antikörper-Diagnostik der exogen-allergischen Alveolitis und pulmonaler Mykosen mittels neu evaluierter Spannweiten und Häufigkeiten der IgG-Antikörper im ImmunoCAPTM. ALLERGO JOURNAL 2022. [DOI: 10.1007/s15007-022-5085-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Environmental Substances Associated with Chronic Obstructive Pulmonary Disease-A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073945. [PMID: 35409627 PMCID: PMC8997594 DOI: 10.3390/ijerph19073945] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/16/2022] [Accepted: 03/23/2022] [Indexed: 12/13/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a slowly developing non-communicable disease (NCD), causing non-reversible obstruction and leading to marked morbidity and mortality. Besides traditional risk factors such as smoking, some environmental substances can augment the risk of COPD. The European Human Biomonitoring Initiative (HBM4EU) is a program evaluating citizens’ exposure to various environmental substances and their possible health impacts. Within the HBM4EU, eighteen priority substances or substance groups were chosen. In this scoping review, seven of these substances or substance groups are reported to have an association or a possible association with COPD. Main exposure routes, vulnerable and high-exposure risk groups, and matrices where these substances are measured are described. Pesticides in general and especially organophosphate and carbamate insecticides, and some herbicides, lead (Pb), and polycyclic aromatic hydrocarbons (PAHs) showed an association, and cadmium (Cd), chromium (Cr and CrVI), arsenic (As), and diisocyanates, a possible association with COPD and/or decreased lung function. Due to long latency in COPD’s disease process, the role of chemical exposure as a risk factor for COPD is probably underestimated. More research is needed to support evidence-based conclusions. Generally, chemical exposure is a growing issue of concern, and prompt action is needed to safeguard public health.
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Viability of cultured human skin cells treated with 1,6-hexamethylene diisocyanate monomer and its oligomer isocyanurate in different culture media. Sci Rep 2021; 11:23804. [PMID: 34893638 PMCID: PMC8664849 DOI: 10.1038/s41598-021-02811-0] [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: 04/01/2021] [Accepted: 11/23/2021] [Indexed: 11/17/2022] Open
Abstract
The isocyanate monomer 1,6-hexamethylene diisocyanate (HDI) and one of its trimers, HDI isocyanurate, are airway and skin sensitizers contained in polyurethane paint. The toxic response of cultured skin cells to these compounds was measured by evaluating the isocyanate concentrations at which 50% of the cells die (i.e., lethal concentration 50%, LC50) because the relative toxicity of each form of HDI should be considered when exposure limits of HDI-based paints are set. By using a luminescent ATP-viability assay, we compared the cytotoxic effects of HDI monomer and HDI isocyanurate on cultured human skin cells (keratinocytes, fibroblasts, and melanocytes) after 4-h isocyanate exposures using culture media with varying levels of nutrients in order to also determine the effects of media composition on isocyanate toxicity. Before analysis, experimental wells were normalized to controls containing cells that were cultured with the same vehicle and media. The measured mean LC50 values ranged from 5 to 200 µM across the experimental conditions, in which HDI isocyanurate in protein-devoid media was the most toxic to cells, producing the lowest LC50 values. For HDI monomer, keratinocytes were the most resistant to its toxicity and melanocytes were the most susceptible. However, when exposed to HDI isocyanurate, the opposite was observed, with melanocytes being the most resilient and the keratinocytes and fibroblasts were more susceptible. Depending on the type of skin cells, dose–response data indicated that HDI isocyanurate was 2–6 times more toxic than HDI monomer when using protein-devoid media whereas HDI isocyanurate was 4–13 times more toxic than HDI monomer when protein-rich media was used. Therefore, if the protein-devoid saline medium alone were used for these experiments, then a significant under-estimation of their relative toxicities in protein-rich environments would have resulted. This difference is because HDI monomer toxicity was more attenuated by the presence of protein in the culture media than HDI isocyanurate toxicity. Thus, conclusions based on comparative toxicity studies and consequent inference applied to potential human toxicity can be affected by in vitro culture media conditions. The physiochemical difference in reactivity of the two forms of HDI to biological molecules most likely explains the observed toxicity differences and may have implications for skin penetration, adverse effects like skin sensitization, and systemic responses like asthma. Future studies are warranted to investigate differences in the biological availability, cellular toxicity, and immunologic sensitization mechanisms for HDI monomer and HDI isocyanurate.
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Occupational Respiratory Allergy: Risk Factors, Diagnosis, and Management. Handb Exp Pharmacol 2021; 268:213-225. [PMID: 34031758 DOI: 10.1007/164_2021_472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Occupational allergies are among the most common recorded occupational diseases. The skin and the upper and lower respiratory tract are the classical manifestation organs. More than 400 occupational agents are currently documented as being potential "respiratory sensitizers" and new reported causative agents are reported each year. These agents may induce occupational rhinitis (OR) or occupational asthma (OA) and can be divided into high-molecular weight (HMW) and low-molecular weight (LMW) agents. The most common occupational HMW agents are (glycol)proteins found in flour and grains, enzymes, laboratory animals, fish and seafood, molds, and Hevea brasiliensis latex. Typical LMW substances are isocyanates, metals, quaternary ammonium persulfate, acid anhydrides, and cleaning products/disinfectants. Diagnosis of occupational respiratory allergy is made by a combination of medical history, physical examination, positive methacholine challenge result or bronchodilator responsiveness, determination of IgE-mediated sensitization, and specific inhalation challenge tests as the gold standard. Accurate diagnosis of asthma is the first step to managing OA as shown above. Removal from the causative agent is of central importance for the management of OA. The best strategy to avoid OA is primary prevention, ideally by avoiding the use of and exposure to the sensitizer or substituting safer substances for these agents.
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Classification of chemicals as respiratory allergens based on human data: Requirements and practical considerations. Regul Toxicol Pharmacol 2021; 123:104925. [PMID: 33831493 DOI: 10.1016/j.yrtph.2021.104925] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/23/2021] [Accepted: 04/01/2021] [Indexed: 02/01/2023]
Abstract
Occupational asthma is an important health problem that can include exacerbation of existing asthma, or induce new asthma either through allergic sensitisation, or non-immunological mechanisms. While allergic sensitisation of the respiratory tract can be acquired to proteins, or to low molecular weight chemicals (chemical respiratory allergens) this article is on the latter exclusively. Chemical respiratory allergy resulting in occupational asthma is associated with high levels of morbidity and there is a need, therefore, that chemicals which can cause sensitisation of the respiratory tract are identified accurately. However, there are available no validated, or even widely accepted, predictive test methods (in vivo, in vitro or in silico) that have achieved regulatory acceptance for identifying respiratory sensitising hazards. For this reason there is an important reliance on human data for the identification of chemical respiratory allergens, and for distinguishing these from chemicals that cause occupational asthma through non-immunological mechanisms. In this article the reasons why it is important that care is taken in designating chemicals as respiratory allergens are reviewed. The value and limitations of human data that can aid the accurate identification of chemical respiratory allergens are explored, including exposure conditions, response characteristics in specific inhalation challenge tests, and immunological investigations.
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Wendels S, Avérous L. Biobased polyurethanes for biomedical applications. Bioact Mater 2021; 6:1083-1106. [PMID: 33102948 PMCID: PMC7569269 DOI: 10.1016/j.bioactmat.2020.10.002] [Citation(s) in RCA: 125] [Impact Index Per Article: 41.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/01/2020] [Accepted: 10/01/2020] [Indexed: 12/15/2022] Open
Abstract
Polyurethanes (PUs) are a major family of polymers displaying a wide spectrum of physico-chemical, mechanical and structural properties for a large range of fields. They have shown suitable for biomedical applications and are used in this domain since decades. The current variety of biomass available has extended the diversity of starting materials for the elaboration of new biobased macromolecular architectures, allowing the development of biobased PUs with advanced properties such as controlled biotic and abiotic degradation. In this frame, new tunable biomedical devices have been successfully designed. PU structures with precise tissue biomimicking can be obtained and are adequate for adhesion, proliferation and differentiation of many cell's types. Moreover, new smart shape-memory PUs with adjustable shape-recovery properties have demonstrated promising results for biomedical applications such as wound healing. The fossil-based starting materials substitution for biomedical implants is slowly improving, nonetheless better renewable contents need to be achieved for most PUs to obtain biobased certifications. After a presentation of some PU generalities and an understanding of a biomaterial structure-biocompatibility relationship, recent developments of biobased PUs for non-implantable devices as well as short- and long-term implants are described in detail in this review and compared to more conventional PU structures.
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Affiliation(s)
- Sophie Wendels
- BioTeam/ICPEES-ECPM, UMR CNRS 7515, Université de Strasbourg, 25 Rue Becquerel, 67087, Strasbourg Cedex 2, France
| | - Luc Avérous
- BioTeam/ICPEES-ECPM, UMR CNRS 7515, Université de Strasbourg, 25 Rue Becquerel, 67087, Strasbourg Cedex 2, France
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Ojo TO, Onayade AA, Afolabi OT, Ijadunola MY, Esan OT, Akinyemi PA, Awe OO. Work Practices and Health Problems of Spray Painters Exposed to Organic Solvents in Ile-Ife, Nigeria. J Health Pollut 2020; 10:201208. [PMID: 33324505 PMCID: PMC7731485 DOI: 10.5696/2156-9614-10.28.201208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 09/16/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Automobile spray painters in Nigeria are exposed to organic solvents due to the hazardous nature of their work. Inadequate use of personal protective equipment (PPE) may intensify exposure to high levels of chemical hazards with resultant health problems. OBJECTIVES The present study assessed PPE use and work practices and compared work-related health problems of spray painters and controls in Ile-Ife, Nigeria. METHODS A cross-sectional study was conducted among 120 spray painters and 120 controls (electronic technicians). Data on socio-demographics, work practices, knowledge about organic solvent-related hazards and self-reported health symptoms were obtained using a semi-structured questionnaire. Clinical examinations were performed for all respondents and the composition of organic solvents in paints and paint products were derived from material safety data sheets. RESULTS All respondents were male, and the mean age was 32.7±13.8 years for painters and 33.9±15.5 years for controls. Few (7.5%) painters perceived their use of PPE to be adequate. All spray painters worked in enclosed workshops and N-butyl acetate was the most commonly used organic solvent. Spray painters reported excessive tear production, recurrent cough, and short-term memory loss more frequently than controls (P<0.05). In addition, 89% of painters noticed paint-stained sputum immediately after spray painting. The prevalence ratio of respiratory symptoms was higher in spray painters than controls (prevalence ratio=21.0, CI=2.9-153.6). On clinical examination, more spray painters had corneal opacity and dry skin when compared with controls (P<0.05). CONCLUSIONS Spray painters in the study area worked amidst chemical hazards and had poor use of PPE. Exposure to organic solvents may be responsible for the higher prevalence of self-reported health problems among spray painters. Interventions to enforce the use of PPE and improve the knowledge of organic solvent-related hazards among spray painters are essential. PARTICIPANT CONSENT Obtained. ETHICS APPROVAL Ethical approval to conduct the study was obtained from the Health Research and Ethics Committee of the Institute of Public Health, Obafemi Awolowo University, Ile-Ife Nigeria (HREC No: IPHOAU/12/463). COMPETING INTERESTS The authors declare no competing financial interests.
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Affiliation(s)
- Temitope Olumuyiwa Ojo
- Department of Community Health, Faculty of Clinical Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | | | - Olusegun Temitope Afolabi
- Department of Community Health, Faculty of Clinical Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | | | - Oluwaseun Taiwo Esan
- Department of Community Health, Faculty of Clinical Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Patrick Ayodeji Akinyemi
- Department of Community Health, Faculty of Clinical Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Oluwaseun Olaniyi Awe
- Department of Community Health, Faculty of Clinical Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
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Plehiers PM, Chappelle AH, Spence MW. Practical learnings from an epidemiology study on TDI-related occupational asthma: Part II-Exposure without respiratory protection to TWA-8 values indicative of peak events is a good indicator of risk. Toxicol Ind Health 2020; 36:885-891. [PMID: 32945732 PMCID: PMC7750671 DOI: 10.1177/0748233720947203] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The anonymized data of an epidemiology study on the incidence of toluene
diisocyanate (TDI)-related occupational asthma in three US-based TDI production
facilities have been reanalyzed to identify where to best focus exposure
reduction efforts in industrial practice in order to reduce the risk of
sensitization to TDI. In Part I, it was demonstrated that cumulative exposure is
not a good indicator of the risk of developing TDI-related occupational asthma.
In this Part II, an alternative model was developed based on net exposure
parameters (i.e. samples taken when no respiratory protection was used). A
statistically significant relationship was determined between asthma incidence
and the frequency of exposure to TDI levels indicative of peak events that are
expressed as time-weighted average-8 (TWA-8) values greater than 3 ppb during
which no respiratory protection was used. This relationship suggests a threshold
to induction of TDI-related asthma. The findings also highlight the importance
of a comprehensive program for controlling workplace atmosphere in the plant by
technical measures (e.g. selection of equipment, cleaning procedures) and
controlling exposure by organizational measures and situational awareness (e.g.
training, use of in-the-field direct reading indicators) during high potential
exposure scenarios (e.g. line breaking, spills) to encourage or enforce the
appropriate use of respiratory protection.
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Affiliation(s)
| | - Anne H Chappelle
- 550512International Isocyanate Institute, Inc. (III), Boonton, NJ, USA
| | - Mark W Spence
- 550512International Isocyanate Institute, Inc. (III), Boonton, NJ, USA
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Wisnewski AV, Liu J. Molecular Characterization and Experimental Utility of Monoclonal Antibodies with Specificity for Aliphatic Di- and Polyisocyanates. Monoclon Antib Immunodiagn Immunother 2020; 39:66-73. [PMID: 32302507 PMCID: PMC7310211 DOI: 10.1089/mab.2020.0006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/16/2020] [Indexed: 11/12/2022] Open
Abstract
Aliphatic di- and polyisocyanates are crucial chemical ingredients in many industrial processes and are a well-recognized cause of occupational asthma. Serologic detection of "chemical epitopes" in biological samples could serve as an exposure surveillance approach toward disease prevention, and thus we sought to generate aliphatic isocyanate-specific monoclonal antibodies (mAbs). Three hybridomas were generated from Balb/c mice immunized with a commercial product containing a combination of uretdione, homopolymer, and monomeric forms of hexamethylene diisocyanate (HDI). Three stable hybridomas were subcloned by limiting dilution, two secreting IgG1κ and one secreting IgMκ mAb that bind aliphatic di- and polyisocyanates (conjugated to albumin), but not aromatic toluene or methylene diphenyl diisocyanate (TDI or MDI). Each mAb demonstrates slight differences in epitope specificity, for example, recognition of hydrogenated MDI (HMDI) or different carrier proteins (transferrin, actin) reacted with vapor phase HDI, and is encoded by unique recombination of different germline antibody genes, with distinct complementary determining regions. By western blot, all three mAbs detect a molecule with characteristics of an albumin adduct uniquely in urine from mice skin exposed to a mixture of aliphatic di- and polyisocyanate. Together, the data define molecular determinants of humoral immune recognition of aliphatic di- and polyisocyanates through new mAbs, which will serve as useful research reagents and may be applicable to future exposure surveillance efforts.
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Affiliation(s)
- Adam V. Wisnewski
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jian Liu
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
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Exposures and urinary biomonitoring of aliphatic isocyanates in construction metal structure coating. Int J Hyg Environ Health 2020; 226:113495. [PMID: 32120250 DOI: 10.1016/j.ijheh.2020.113495] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/17/2020] [Accepted: 02/18/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Isocyanates are highly reactive chemicals used widely in metal structure coating applications in construction. Isocyanates are potent respiratory and skin sensitizers and a leading cause of occupational asthma. At present, there is no cure for isocyanate asthma and no biomarkers of early disease. Exposure reduction is considered the most effective preventive strategy. To date, limited data are available on isocyanate exposures and work practices in construction trades using isocyanates, including metal structure coatings. OBJECTIVES The primary objectives of this work were: i) to characterize isocyanate inhalation and dermal exposures among painters during metal structure coating tasks in construction; and ii) to assess the adequacy of existing work practices and exposure controls via urinary biomonitoring pre- and post-shift. METHODS Exposures to aliphatic isocyanates based on 1,6-hexamethylene diisocyanate (1,6-HDI) and its higher oligomers (biuret, isocyanurate and uretdione) were measured among 30 workers performing painting of bridges and other metal structures in several construction sites in the Northeastern USA. Exposure assessment included simultaneous measurement of personal inhalation exposures (n = 20), dermal exposures (n = 22) and body burden via urinary biomonitoring pre- and post-shift (n = 53). Contextual information was collected about tasks, processes, materials, work practices, personal protective equipment (PPEs) and exposure controls, work histories, and environmental conditions. RESULTS Breathing zone concentrations were the highest for biuret (median, 18.4 μg/m3), followed by 1,6-HDI monomer (median, 3.5 μg/m3), isocyanurate (median, 3.4 μg/m3) and uretdione (median, 1.7 μg/m3). The highest exposures, measured during painting inside an enclosed bridge on a hot summer day, were: 10,288 μg/m3 uretdione; 8,240 μg/m3 biuret; and 947 μg/m3 1,6-HDI. Twenty percent of samples were above the NIOSH ceiling exposure limit for 1,6- HDI (140 μg/m3) and 35% of samples were above the UK-HSE ceiling for total isocyanate group (70 μg NCO/m3). Isocyanate loading on the gloves was generally high, with a median of 129 μg biuret/pair and maximum of 60.8 mg biuret/pair. The most frequently used PPEs in the workplace were half-face organic vapor cartridge (OVC) respirators, disposable palmar dip-coated polymer gloves, and cotton coveralls. However, 32% of workers didn't wear any respirator, 47% wore standard clothing with short-sleeve shirts and 14% didn't wear any gloves while performing tasks involving isocyanates. Based on biomonitoring results, 58.4% of urine samples exceeded the biological monitoring guidance value (BMGV) of 1 μmol hexamethylene diamine (HDA)/mol creatinine. Post-shift geometric mean HDA normalized to specific gravity increased by 2.5-fold compared to pre-shift (GM, 4.7 vs. 1.9 ng/mL; p value, < 0.001), and only 1.4-fold when normalized to creatinine. CONCLUSIONS Exposure and biomonitoring results, coupled with field observations, support the overall conclusions that (i) substantial inhalation and dermal exposures to aliphatic isocyanates occur during industrial coating applications in construction trades; that (ii) the current work practices and exposure controls are not adequately protective. High urinary creatinine values in the majority of workers, coupled with significant cross-shift increases and filed observations, point to the need for further investigations on possible combined effects of heat stress, dehydration, and nutritional deficiencies on kidney toxicity. Implementation of comprehensive exposure control programs and increased awareness are warranted in order to reduce isocyanate exposures and associated health risks among this cohort of construction workers.
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Keer S, Taptiklis P, Glass B, McLean D, McGlothlin JD, Douwes J. Determinants of Airborne Solvent Exposure in the Collision Repair Industry. Ann Work Expo Health 2019; 62:871-883. [PMID: 29912331 DOI: 10.1093/annweh/wxy047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 06/05/2018] [Indexed: 11/13/2022] Open
Abstract
Objectives To assess the determinants of airborne solvent exposures in contemporary vehicle collision repair workplaces. Methods Personal, full-shift airborne solvent exposures (n = 97) were assessed in 85 vehicle collision repair workers from 18 workshops. Peak exposures were assessed using a small number of video exposure monitoring measurements. Results Solvent exposures were highest in spray painters (geometric mean = 2.7 ppm) followed by panel beaters (0.5 ppm), but were well below workplace exposure standards. The lowest exposure levels were observed for mixing room extraction located away from the mixing bench [exposure ratio (ER) = 0.51, 95% confidence interval (CI) = 0.30-0.87]. Time spent mixing paint was associated with higher exposures (ER for every 10-min increase = 1.14, 95% CI = 1.05-1.24), as was time spent cleaning equipment with solvents (ER = 1.11, 95% CI = 0.88-1.39), spraying primer (ER = 1.10, 95% CI = 0.96-1.27), and spraying clear coat paint (ER = 1.07, 95% CI = 1.00-1.15). Overall, the combined non-spray painting tasks (mixing paint, degreasing, and cleaning equipment) were more strongly associated with exposure (ER = 1.10, 95% CI = 1.03-1.18) than the combined spray painting tasks (ER = 1.03, 95% CI = 1.00-1.05). Peak exposures ranged from 10 to 1100 ppm with the strongest and most frequent peaks occurring during paint mixing, decanting of solvents, cleaning of equipment, and painting in a cross-draft spray booth. Conclusions Airborne solvent exposures in the collision repair industry were associated with job title, the design and location of exhaust ventilation and emission sources, and time spent on specific tasks, with the highest average and peak exposures shown for non-spray painting tasks. These findings provide a contemporary basis for intervention programmes to reduce airborne solvent exposures in this industry.
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Affiliation(s)
- Samuel Keer
- Centre for Public Health Research, Massey University, Wellington, New Zealand
| | - Phoebe Taptiklis
- Centre for Public Health Research, Massey University, Wellington, New Zealand
| | - Bill Glass
- Centre for Public Health Research, Massey University, Wellington, New Zealand
| | - Dave McLean
- Centre for Public Health Research, Massey University, Wellington, New Zealand
| | | | - Jeroen Douwes
- Centre for Public Health Research, Massey University, Wellington, New Zealand
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Saraei M, Pouryaghoub G, Eftekhari S. Effects of Car Painting Vapors on Spirometric Parameters in Automobile Painting Workers. TANAFFOS 2019; 18:346-350. [PMID: 32607116 PMCID: PMC7309884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Automobile spray painting is considered a high-risk occupation for respiratory diseases. The present survey aimed to assess the effects of automobile paint vapors on spirometric parameters among workers of a painting workshop in a large automobile manufacturing plant in Iran. MATERIALS AND METHODS This cross-sectional study was conducted on 820 workers of an automobile manufacturing plant, including 431 spray painters (case group) and 389 assembly line workers (control group). Spirometry was conducted for all participants under standard conditions, according to the American Thoracic Society (ATS) Clinical Practice Guidelines. The forced expiratory volume in one second (FEV1), forced vital capacity (FVC), FEV1/FVC, and forced expiratory flow at 25% and 75% of the pulmonary volume (FEF25-75) were reported. RESULTS Painters with more than ten years of work experience had significantly lower predicted values of FEV1/FVC (P= 0.005), FEV1 (P=0.008), and FEF25-75 (P=0.003), compared to the control group. Also, painters who were exposed to solvent-based paints were not significantly different from those exposed to water-based paints in terms of spirometric parameters (P>0.05). CONCLUSION The results indicated the impact of automobile spray painting on the spirometric parameters. A slight decrease in the mean values of these parameters calls for attention to occupational safety, regular medical examinations, and effective measures.
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Affiliation(s)
| | | | - Sahar Eftekhari
- Correspondence to: Eftekhari S, Address: Center for Research on Occupational Diseases (CROD), Tehran University of Medical Sciences (TUMS), Tehran, Iran., Email address:
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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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Wisnewski AV, Kanyo J, Asher J, Goodrich JA, Barnett G, Patrylak L, Liu J, Redlich CA, Nassar AF. Reaction products of hexamethylene diisocyanate vapors with "self" molecules in the airways of rabbits exposed via tracheostomy. Xenobiotica 2018; 48:488-497. [PMID: 28489470 PMCID: PMC5863241 DOI: 10.1080/00498254.2017.1329569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 05/08/2017] [Accepted: 05/09/2017] [Indexed: 10/19/2022]
Abstract
1. Hexamethylenediisocyanate (HDI) is a widely used aliphatic diisocyanate and a well-recognized cause of occupational asthma. 2. "Self" molecules (peptides/proteins) in the lower airways, susceptible to chemical reactivity with HDI, have been hypothesized to play a role in asthma pathogenesis and/or chemical metabolism, but remain poorly characterized. 3. This study employed unique approaches to identify and characterize "self" targets of HDI reactivity in the lower airways. Anesthetized rabbits free breathed through a tracheostomy tube connected to chambers containing either, O2, or O2 plus ∼200 ppb HDI vapors. Following 60 minutes of exposure, the airways were lavaged and the fluid was analyzed by LC-MS and LC-MS/MS. 4. The low-molecular weight (<3 kDa) fraction of HDI exposed, but not control rabbit bronchoalveolar lavage (BAL) fluid identified 783.26 and 476.18 m/z [M+H]+ ions with high energy collision-induced dissociation (HCD) fragmentation patterns consistent with bis glutathione (GSH)-HDI and mono(GSH)-HDI. Proteomic analyses of the high molecular weight (>3 kDa) fraction of exposed rabbit BAL fluid identified HDI modification of specific lysines in uteroglobin (aka clara cell protein) and albumin. 5. In summary, this study utilized a unique approach to chemical vapor exposure in rabbits, to identify HDI reaction products with "self" molecules in the lower airways.
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Affiliation(s)
- Adam V Wisnewski
- a Department of Internal Medicine , Yale University School of Medicine , New Haven , CT , USA
| | - Jean Kanyo
- b W.M. Keck Foundation Biotechnology Resource Laboratory, Yale University School of Medicine , New Haven , CT , USA , and
| | - Jennifer Asher
- c Section of Comparative Medicine, Yale University School of Medicine , New Haven , CT , USA
| | - James A Goodrich
- c Section of Comparative Medicine, Yale University School of Medicine , New Haven , CT , USA
| | - Grace Barnett
- c Section of Comparative Medicine, Yale University School of Medicine , New Haven , CT , USA
| | - Lyn Patrylak
- c Section of Comparative Medicine, Yale University School of Medicine , New Haven , CT , USA
| | - Jian Liu
- a Department of Internal Medicine , Yale University School of Medicine , New Haven , CT , USA
| | - Carrie A Redlich
- a Department of Internal Medicine , Yale University School of Medicine , New Haven , CT , USA
| | - Ala F Nassar
- a Department of Internal Medicine , Yale University School of Medicine , New Haven , CT , USA
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Kobayashi K, Suzuki M, Yamamoto S, Ueno K, Miyawaki E, Takazawa I, Shiozawa A, Sato T, Hojo M, Sugiyama H. Early-onset, Severe Chronic Obstructive Pulmonary Disease with Pulmonary Hypertension that was Likely Induced by Toluene Exposure. Intern Med 2017; 56:2329-2334. [PMID: 28794356 PMCID: PMC5635309 DOI: 10.2169/internalmedicine.8077-16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Early-onset pulmonary emphysema is uncommon and its pathogenesis is poorly defined. A 30-year-old man was admitted to our intensive care unit with severe respiratory failure. Besides smoking heavily since the 14 years of age, he had habitually inhaled organic solvents, such as toluene, in his adolescence. High-resolution computed tomography showed evident pulmonary emphysema throughout the lung fields. Based on the findings of right heart catheterization, he was diagnosed with an acute exacerbation of chronic obstructive pulmonary disease complicated with pulmonary hypertension. Heavy smoking from a young age and exposure to toluene were the suspected causes of the patient's severe pulmonary emphysema.
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Affiliation(s)
- Konomi Kobayashi
- Division of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Manabu Suzuki
- Division of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Shota Yamamoto
- Division of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Keisuke Ueno
- Division of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Eriko Miyawaki
- Division of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Ikuo Takazawa
- Division of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Ayako Shiozawa
- Division of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Teruhiko Sato
- Division of Pulmonary Medicine, Kohnodai Hospital, National Center for Global Health and Medicine, Japan
| | - Masayuki Hojo
- Division of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Haruhito Sugiyama
- Division of Respiratory Medicine, National Center for Global Health and Medicine, Japan
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20
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Vila J, Bowman JD, Figuerola J, Moriña D, Kincl L, Richardson L, Cardis E. Development of a source-exposure matrix for occupational exposure assessment of electromagnetic fields in the INTEROCC study. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2017; 27:398-408. [PMID: 27827378 PMCID: PMC5573206 DOI: 10.1038/jes.2016.60] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 08/18/2016] [Indexed: 05/07/2023]
Abstract
To estimate occupational exposures to electromagnetic fields (EMF) for the INTEROCC study, a database of source-based measurements extracted from published and unpublished literature resources had been previously constructed. The aim of the current work was to summarize these measurements into a source-exposure matrix (SEM), accounting for their quality and relevance. A novel methodology for combining available measurements was developed, based on order statistics and log-normal distribution characteristics. Arithmetic and geometric means, and estimates of variability and maximum exposure were calculated by EMF source, frequency band and dosimetry type. The mean estimates were weighted by our confidence in the pooled measurements. The SEM contains confidence-weighted mean and maximum estimates for 312 EMF exposure sources (from 0 Hz to 300 GHz). Operator position geometric mean electric field levels for radiofrequency (RF) sources ranged between 0.8 V/m (plasma etcher) and 320 V/m (RF sealer), while magnetic fields ranged from 0.02 A/m (speed radar) to 0.6 A/m (microwave heating). For extremely low frequency sources, electric fields ranged between 0.2 V/m (electric forklift) and 11,700 V/m (high-voltage transmission line-hotsticks), whereas magnetic fields ranged between 0.14 μT (visual display terminals) and 17 μT (tungsten inert gas welding). The methodology developed allowed the construction of the first EMF-SEM and may be used to summarize similar exposure data for other physical or chemical agents.
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Affiliation(s)
- Javier Vila
- ISGlobal, Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Joseph D Bowman
- National Institute for Occupational Safety and Health (NIOSH), Ohio, USA
| | - Jordi Figuerola
- ISGlobal, Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
| | - David Moriña
- ISGlobal, Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
| | - Laurel Kincl
- Oregon State University (OSU), Corvallis, Oregon, USA
| | - Lesley Richardson
- University of Montreal Hospital Research Centre (CRCHUM), Montreal, Canada
| | - Elisabeth Cardis
- ISGlobal, Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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21
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Hu C, Cruz MJ, Ojanguren I, de Homdedeu M, Gonzalez-Barcala FJ, Munoz X. Specific inhalation challenge: the relationship between response, clinical variables and lung function. Occup Environ Med 2017; 74:586-591. [PMID: 28270447 DOI: 10.1136/oemed-2016-103806] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 01/30/2017] [Accepted: 02/10/2017] [Indexed: 11/03/2022]
Abstract
INTRODUCTION The specific inhalation challenge (SIC) is considered the gold standard for the diagnosis of occupational asthma (OA). However, its use is not standardised, and the intensity of exposure is regulated empirically. The aim of this study was to identify clinical variables and/or pulmonary function variables able to predict the scale of patients' response to SIC. MATERIAL AND METHODS All patients who underwent SIC at our centre between 2005 and 2013 were studied. Anthropometric characteristics, atopic status, type of causal agent, latency times, pulmonary function tests and SIC results were analysed. RESULTS Two hundred and one patients (51% men) were assessed, of whom 86 (43%) had positive SIC. In the patients with positive results, 29 (34%) were exposed to high molecular weight (HMW) agents and 57 (64%) to low molecular weight (LMW) agents. Patients with a positive SIC exposed to HMW agents had a higher fall in FEV1 after SIC compared with those exposed to LMW agents (p=0.036). The type of asthmatic reaction after SIC also differed between the groups (p=0.020). The logistic regression analysis showed that patients with a higher PC20 before SIC were less likely to have severe decreases in FEV1 after SIC after adjusting for potential confounders (OR=0.771, 95% CI 0.618 to 0.961, p=0.021). CONCLUSIONS The scale of the response to SIC is influenced mainly by the degree of bronchial hyper-responsiveness, regardless of whether the causative agent is HMW or LMW, or whether the response is early or late.
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Affiliation(s)
- Chunshao Hu
- Pulmonology, Hospital General Universitario Morales Meseguer, Murcia, Spain
| | - Maria-Jesus Cruz
- Servei de Pneumologia, Hospital Universitari Vall dHebron, Institut de Recerca (VHIR), Universitat Autnoma de Barcelona, Barcelona, Spain.,Respiratory, CIBER Enfermedades Respiratorias (Ciberes), Barcelona, Spain
| | - Iñigo Ojanguren
- Servei de Pneumologia, Hospital Universitari Vall dHebron, Institut de Recerca (VHIR), Universitat Autnoma de Barcelona, Barcelona, Spain.,Respiratory, CIBER Enfermedades Respiratorias (Ciberes), Barcelona, Spain
| | - Miquel de Homdedeu
- Servei de Pneumologia, Hospital Universitari Vall dHebron, Institut de Recerca (VHIR), Universitat Autnoma de Barcelona, Barcelona, Spain
| | | | - Xavier Munoz
- Servei de Pneumologia, Hospital Universitari Vall dHebron, Institut de Recerca (VHIR), Universitat Autnoma de Barcelona, Barcelona, Spain.,Respiratory, CIBER Enfermedades Respiratorias (Ciberes), Barcelona, Spain
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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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Quirce S, Vandenplas O, Campo P, Cruz MJ, de Blay F, Koschel D, Moscato G, Pala G, Raulf M, Sastre J, Siracusa A, Tarlo SM, Walusiak-Skorupa J, Cormier Y. Occupational hypersensitivity pneumonitis: an EAACI position paper. Allergy 2016; 71:765-79. [PMID: 26913451 DOI: 10.1111/all.12866] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2016] [Indexed: 12/14/2022]
Abstract
The aim of this document was to provide a critical review of the current knowledge on hypersensitivity pneumonitis caused by the occupational environment and to propose practical guidance for the diagnosis and management of this condition. Occupational hypersensitivity pneumonitis (OHP) is an immunologic lung disease resulting from lymphocytic and frequently granulomatous inflammation of the peripheral airways, alveoli, and surrounding interstitial tissue which develops as the result of a non-IgE-mediated allergic reaction to a variety of organic materials or low molecular weight agents that are present in the workplace. The offending agents can be classified into six broad categories that include bacteria, fungi, animal proteins, plant proteins, low molecular weight chemicals, and metals. The diagnosis of OHP requires a multidisciplinary approach and relies on a combination of diagnostic tests to ascertain the work relatedness of the disease. Both the clinical and the occupational history are keys to the diagnosis and often will lead to the initial suspicion. Diagnostic criteria adapted to OHP are proposed. The cornerstone of treatment is early removal from exposure to the eliciting antigen, although the disease may show an adverse outcome even after avoidance of exposure to the causal agent.
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Affiliation(s)
- S. Quirce
- Department of Allergy; Hospital La Paz Institute for Health Research (IdiPAZ) and CIBER de Enfermedades Respiratorias (CIBERES); Madrid Spain
| | - O. Vandenplas
- Department of Chest Medicine; Centre Hospitalier Universitaire de Mont-Godinne; Université Catholique de Louvain; Yvoir Belgium
| | - P. Campo
- Unidad de Gestión Clínica Allergy-IBIMA; Hospital Regional Universitario; Málaga Spain
| | - M. J. Cruz
- Pulmonology Service; Hospital Universitari Vall d'Hebron; Universitat Autonoma de Barcelona; Barcelona Spain
- CIBER de Enfermedades Respiratorias (CIBERES); Barcelona Spain
| | - F. de Blay
- Division of Asthma and Allergy; Department of Chest Diseases; University Hospital; Fédération de Médecine Translationnelle de Strasbourg; Strasbourg University; Strasbourg France
| | - D. Koschel
- Fachkrankenhaus Coswig GmbH Zentrum für Pneumologie, Allergologie, Beatmungsmedizin, Thorax- und Gefäßchirurgie; Coswig Germany
| | - G. Moscato
- Department of Public Health, Experimental and Forensic Medicine; University of Pavia; Pavia Italy
| | - G. Pala
- Occupational Physician's Division; Local Health Authority of Sassari; Sassari Italy
| | - M. Raulf
- IPA Institute for Prevention and Occupational Medicine of the German Social Accident Insurance; Institute of the Ruhr-Universität Bochum; Bochum Germany
| | - J. Sastre
- Department of Allergy; Fundación Jiménez Díaz, and CIBER de Enfermedades Respiratorias (CIBERES); Madrid Spain
| | - A. Siracusa
- Formerly Department of Clinical and Experimental Medicine; University of Perugia; Perugia Italy
| | - S. M. Tarlo
- Department of Medicine and Dalla Lana School of Public Health; University of Toronto; Toronto ON Canada
- Respiratory Division Toronto Western Hospital; Gage Occupational and Environmental Health Unit; St Michael's Hospital; Toronto ON Canada
| | - J. Walusiak-Skorupa
- Department of Occupational Diseases and Toxicology; Nofer Institute of Occupational Medicine; Lodz Poland
| | - Y. Cormier
- Centre de Pneumologie; Institut Universitaire de Cardiologie et de Pneumologie de Québec; Université Laval; Québec City QC Canada
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Singleton H, Popple A, Gellatly N, Maxwell G, Williams J, Friedmann PS, Kimber I, Dearman RJ. Anti-hapten antibodies in response to skin sensitization. Contact Dermatitis 2015; 74:197-204. [PMID: 26560413 DOI: 10.1111/cod.12486] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 09/07/2015] [Accepted: 09/21/2015] [Indexed: 02/04/2023]
Abstract
Whereas T lymphocyte (T cell) activation is the key event in the acquisition of skin sensitization and subsequent elicitation of allergic contact dermatitis, the humoral component of immune responses to organic contact allergens has received little consideration. There is evidence that, in experimental animals, topical exposure to potent contact allergens is associated with B cell activation and proliferation, and hapten-specific antibody production. However, there is very limited evidence available for anti-hapten antibody responses being induced following topical exposure of humans to contact allergens. Nevertheless, it is important to appreciate that there are almost no negative studies in which evidence for antibody production as the result of skin sensitization has been sought and not found. That is, there is absence of evidence rather than evidence of absence. Furthermore, exposure to chemical respiratory allergens, in which the skin has been implicated as a potential route of sensitization, results in anti-hapten antibody responses. It is proposed that skin sensitization to contact allergens will normally be accompanied by antibody production. The phenomenon is worthy of investigation, as anti-hapten antibodies could potentially influence and/or regulate the induction of skin sensitization. Moreover, such antibodies may provide an informative correlate of the extent to which sensitization has been acquired.
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Affiliation(s)
- Helen Singleton
- Department of Toxicology, Faculty of Life Sciences, University of Manchester, Manchester, M13 9PT, UK
| | - Amy Popple
- Department of Toxicology, Faculty of Life Sciences, University of Manchester, Manchester, M13 9PT, UK
| | - Nichola Gellatly
- Unilever Safety and Environmental Assurance Centre, Colworth Science Park, Bedford, MK44 1LQ, UK
| | - Gavin Maxwell
- Unilever Safety and Environmental Assurance Centre, Colworth Science Park, Bedford, MK44 1LQ, UK
| | | | - Peter S Friedmann
- Division of Infection, Inflammation & Immunity, University of Southampton, Southampton, SO17 1BJ, UK
| | - Ian Kimber
- Department of Toxicology, Faculty of Life Sciences, University of Manchester, Manchester, M13 9PT, UK
| | - Rebecca J Dearman
- Department of Toxicology, Faculty of Life Sciences, University of Manchester, Manchester, M13 9PT, UK
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Dement J, Welch L, Ringen K, Quinn P, Chen A, Haas S. A case-control study of airways obstruction among construction workers. Am J Ind Med 2015; 58:1083-97. [PMID: 26123003 PMCID: PMC5034836 DOI: 10.1002/ajim.22495] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2015] [Indexed: 01/10/2023]
Abstract
BACKGROUND While smoking is the major cause of chronic obstructive pulmonary disease (COPD), occupational exposures to vapors, gases, dusts, and fumes (VGDF) increase COPD risk. This case-control study estimated the risk of COPD attributable to occupational exposures among construction workers. METHODS The study population included 834 cases and 1243 controls participating in a national medical screening program for older construction workers between 1997 and 2013. Qualitative exposure indices were developed based on lifetime work and exposure histories. RESULTS Approximately 18% (95% CI = 2-24%) of COPD risk can be attributed to construction-related exposures, which are additive to the risk contributed by smoking. A measure of all VGDF exposures combined was a strong predictor of COPD risk. CONCLUSIONS Construction workers are at increased risk of COPD as a result of broad and complex effects of many exposures acting independently or interactively. Control methods should be implemented to prevent worker exposures, and smoking cessation should be promoted.
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Affiliation(s)
- John Dement
- Division of Occupational and Environmental Medicine, Duke University Medical Center, Durham, North Carolina
| | - Laura Welch
- The Center for Construction Research and Training, Silver Spring, Maryland
| | - Knut Ringen
- The Center for Construction Research and Training, Silver Spring, Maryland
- Stoneturn Consultants, Seattle, Washington
| | - Patricia Quinn
- The Center for Construction Research and Training, Silver Spring, Maryland
| | - Anna Chen
- Zenith American Solutions, Seattle, Washington
| | - Scott Haas
- Zenith American Solutions, Seattle, Washington
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Kawamoto T, Tsuji M, Isse T. Comparison of IgG against plastic resin in workers with and without chemical dermatitis. BMC Public Health 2015; 15:930. [PMID: 26390923 PMCID: PMC4576395 DOI: 10.1186/s12889-015-2302-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 09/18/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are many chemical sensitizers which cause allergy in the surrounding environment. However, the identification of substances causing allergy is difficult. We developed a new method to detect IgG which reacts against many kinds of chemical-human serum albumin (HSA) adducts at the same time. In this study, the diagnostic significance of the IgG was studied among workers of a company where a mass outbreak of chemical dermatitis had occurred after changing a plastic resin to a new one. METHODS Eleven workers who handled the new plastic resin and suffered from dermatitis (case) and 9 workers who also handled the same resin in the same company but were free from dermatitis (control) were the subjects. Immunological dot blotting was carried out to detect serum IgG using originally prepared diagnostic antigens, comprising a mixture of HSA and the plastic resin or its components under various conditions. RESULTS IgG against the plastic resin in use was detected in all workers who suffered from dermatitis. The prevalence of the IgG against the plastic resin was significantly higher in workers with than in those without dermatitis. On the other hand, IgG against its components (bisphenol A diglycidyl ether, m-xylylenediamine and butyl 2,3-epoxypropyl ether) was detected in a few workers with dermatitis. DISCUSSION This suggests that IgG against chemical-HSA adduct reflects not only exposure but also causative chemicals of dermatitis. Our method to use a material itself as a hapten is practical and useful in the occupational field. CONCLUSION It is suggested that IgG against chemicals is a useful marker of chemicals inducing dermatitis.
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Affiliation(s)
- Toshihiro Kawamoto
- Department of Environmental Health, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan.
| | - Mayumi Tsuji
- Department of Environmental Health, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan.
| | - Toyohi Isse
- Department of Environmental Health, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan.
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Pauluhn J. Analysis of the interrelationship of the pulmonary irritation and elicitation thresholds in rats sensitized with 1,6-hexamethylene diisocyanate (HDI). Inhal Toxicol 2015; 27:191-206. [PMID: 25924102 PMCID: PMC4496806 DOI: 10.3109/08958378.2015.1026619] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
This paper summarizes a range of experimental data central for developing a science-based approach for hazard identification of monomeric and polymeric aliphatic 1,6-hexamethylene diisocyanate (HDI). The dose–response curve of HDI-induced pulmonary responses in naïve or dermally sensitized rats after one or several inhalation priming exposures was examined in the Brown Norway (BN) rat asthma model. Emphasis was directed to demonstrate the need and the difficulty in selecting an appropriate pulmonary dose when much of the inhaled chemically reactive vapor may concentration dependently be retained in the upper airways of obligate nose-breathing rats. The course taken acknowledges the experimental challenges in identifying an elicitation threshold for HDI-monomer near or above the saturated vapor concentration or in the presence of a HDI-polymer aerosol. The inhalation threshold dose on elicitation was determined based on a fixed concentration (C) × variable exposure duration (t) protocol for improving inhalation dosimetry of the lower airways. Neutrophilic granulocytes (PMN) in bronchoalveolar lavage (BAL) fluid in equally inhalation primed naïve and dermally sensitized rats were used to define the inhalation elicitation threshold C × t. Sensitized rats elaborated markedly increased PMN challenged sensitized rats relative to equally challenged naïve rats at 5625 mg HDI/m3 × min (75 mg/m3 for 75 min). PMN were essentially indistinguishable at 900 mg HDI/m3 × min. By applying adjustment factors accounting for both inter-species differences in inhalation dosimetry and intra-species susceptibility, the workplace human-equivalent threshold C × t was estimated to be in the range of the current ACGIH TLV® of HDI. Thus, this rat “asthma” model was suitable to demonstrate elicitation thresholds for HDI-vapor after one or several inhalation priming exposures and seems to be suitable to derive occupational exposure values (OELs) for diisocyanates in general.
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Affiliation(s)
- Jürgen Pauluhn
- Bayer Pharma AG, Experimental Toxicology , Wuppertal , Germany (retired) and
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Is the analysis of histamine and/or interleukin-4 release after isocyanate challenge useful in the identification of patients with IgE-mediated isocyanate asthma? J Immunol Methods 2015; 422:35-50. [PMID: 25865264 DOI: 10.1016/j.jim.2015.03.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 02/21/2015] [Accepted: 03/25/2015] [Indexed: 11/20/2022]
Abstract
Isocyanates are a well-known and frequent cause of occupational asthma. The implementation of specific inhalation challenges (SICs) is the gold standard in asthma diagnosis supporting occupational case history, lung function testing, specific skin prick tests and the detection of specific IgE. However, the diagnosis is not always definitive. An interesting new approach, analyses of individual genetic susceptibilities, requires discrimination between a positive SIC reaction arising from IgE-mediated immune responses and one from other pathophysiological mechanisms. Hence, additional refinement tools would be helpful in defining sub-classes of occupational asthma and diagnosis. We used total IgE levels, specific IgE and SIC results for sub-classification of 27 symptomatic isocyanate workers studied. Some mutations in glutathione S-transferases (GSTs) are suspected either to enhance or to decrease the individual risk in the development of isocyanate asthma. Our patient groups were assessed for the point mutations GSTP1*I105V and GSTP1*A114V as well as deletions (null mutations) of GSTM1 and GSTT1. There seems to be a higher risk in developing IgE-mediated reactions when GSTM1 is deleted, while GSTT1 deletions were found more frequently in the SIC positive group. Blood samples taken before SIC, 30-60 min and 24h after SIC, were analyzed for histamine and IL-4, classical markers for the IgE-mediated antigen-specific activation of basophils or mast cells. We suggest that the utility of histamine measurements might provide an additional useful marker reflecting isocyanate-induced cellular reactions (although the sampling times require optimization). The promising measurement of IL-4 is not feasible at present due to the lack of a reliable, validated assay.
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Mølgaard B, Viitanen AK, Kangas A, Huhtiniemi M, Larsen ST, Vanhala E, Hussein T, Boor BE, Hämeri K, Koivisto AJ. Exposure to airborne particles and volatile organic compounds from polyurethane molding, spray painting, lacquering, and gluing in a workshop. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:3756-73. [PMID: 25849539 PMCID: PMC4410214 DOI: 10.3390/ijerph120403756] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 03/16/2015] [Accepted: 03/24/2015] [Indexed: 12/07/2022]
Abstract
Due to the health risk related to occupational air pollution exposure, we assessed concentrations and identified sources of particles and volatile organic compounds (VOCs) in a handcraft workshop producing fishing lures. The work processes in the site included polyurethane molding, spray painting, lacquering, and gluing. We measured total VOC (TVOC) concentrations and particle size distributions at three locations representing the various phases of the manufacturing and assembly process. The mean working-hour TVOC concentrations in three locations studied were 41, 37, and 24 ppm according to photo-ionization detector measurements. The mean working-hour particle number concentration varied between locations from 3000 to 36,000 cm−3. Analysis of temporal and spatial variations of TVOC concentrations revealed that there were at least four substantial VOC sources: spray gluing, mold-release agent spraying, continuous evaporation from various lacquer and paint containers, and either spray painting or lacquering (probably both). The mold-release agent spray was indirectly also a major source of ultrafine particles. The workers’ exposure can be reduced by improving the local exhaust ventilation at the known sources and by increasing the ventilation rate in the area with the continuous source.
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Affiliation(s)
- Bjarke Mølgaard
- Department of Physics, University of Helsinki, P.O. Box 48, FI-00014 Helsinki, Finland.
| | - Anna-Kaisa Viitanen
- Nanosafety Research Centre, Finnish Institute of Occupational Health, Topeliuksenkatu 41 a A, FI-00250 Helsinki, Finland.
| | - Anneli Kangas
- Nanosafety Research Centre, Finnish Institute of Occupational Health, Topeliuksenkatu 41 a A, FI-00250 Helsinki, Finland.
| | - Marika Huhtiniemi
- Nanosafety Research Centre, Finnish Institute of Occupational Health, Topeliuksenkatu 41 a A, FI-00250 Helsinki, Finland.
| | - Søren Thor Larsen
- National Research Centre for the Working Environment, Lersø Parkallé 105, Copenhagen DK-2100, Denmark.
| | - Esa Vanhala
- Nanosafety Research Centre, Finnish Institute of Occupational Health, Topeliuksenkatu 41 a A, FI-00250 Helsinki, Finland.
| | - Tareq Hussein
- Department of Physics, University of Helsinki, P.O. Box 48, FI-00014 Helsinki, Finland.
- Department of Physics, Faculty of Science, The University of Jordan, Amman, JO-11942, Jordan.
| | - Brandon E Boor
- Department of Physics, University of Helsinki, P.O. Box 48, FI-00014 Helsinki, Finland.
- Department of Civil, Architectural, and Environmental Engineering, The University of Texas at Austin, Austin, TX 78712, USA.
| | - Kaarle Hämeri
- Department of Physics, University of Helsinki, P.O. Box 48, FI-00014 Helsinki, Finland.
| | - Antti Joonas Koivisto
- Nanosafety Research Centre, Finnish Institute of Occupational Health, Topeliuksenkatu 41 a A, FI-00250 Helsinki, Finland.
- National Research Centre for the Working Environment, Lersø Parkallé 105, Copenhagen DK-2100, Denmark.
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Dotson GS, Maier A, Siegel PD, Anderson SE, Green BJ, Stefaniak AB, Codispoti CD, Kimber I. Setting Occupational Exposure Limits for Chemical Allergens--Understanding the Challenges. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2015; 12 Suppl 1:S82-98. [PMID: 26583909 PMCID: PMC4685595 DOI: 10.1080/15459624.2015.1072277] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Chemical allergens represent a significant health burden in the workplace. Exposures to such chemicals can cause the onset of a diverse group of adverse health effects triggered by immune-mediated responses. Common responses associated with workplace exposures to low molecular weight (LMW) chemical allergens range from allergic contact dermatitis to life-threatening cases of asthma. Establishing occupational exposure limits (OELs) for chemical allergens presents numerous difficulties for occupational hygiene professionals. Few OELs have been developed for LMW allergens because of the unique biological mechanisms that govern the immune-mediated responses. The purpose of this article is to explore the primary challenges confronting the establishment of OELs for LMW allergens. Specific topics include: (1) understanding the biology of LMW chemical allergies as it applies to setting OELs; (2) selecting the appropriate immune-mediated response (i.e., sensitization versus elicitation); (3) characterizing the dose (concentration)-response relationship of immune-mediated responses; (4) determining the impact of temporal exposure patterns (i.e., cumulative versus acute exposures); and (5) understanding the role of individual susceptibility and exposure route. Additional information is presented on the importance of using alternative exposure recommendations and risk management practices, including medical surveillance, to aid in protecting workers from exposures to LMW allergens when OELs cannot be established.
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Affiliation(s)
- G. S. Dotson
- Education and Information Division, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Cincinnati, Ohio
- Address correspondence to G.S. Dotson, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Education and Information Division, 1090 Tusculum Avenue, MS C-32, CincinnatiOhio45226. E-mail:
| | - A. Maier
- Education and Information Division, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Cincinnati, Ohio
- College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - P. D. Siegel
- Health Effects Laboratory Division, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Morgantown, West Virginia
| | - S. E. Anderson
- Health Effects Laboratory Division, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Morgantown, West Virginia
| | - B. J. Green
- Health Effects Laboratory Division, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Morgantown, West Virginia
| | - A. B. Stefaniak
- Respiratory Health Division, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Morgantown, West Virginia
| | - C. D. Codispoti
- Department of Immunology and Microbiology, Rush University Medical Center, Chicago, Illinois
| | - I. Kimber
- Faculty of Life Sciences, University of Manchester, Manchester, United Kingdom
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Gui W, Wisnewski AV, Neamtiu I, Gurzau E, Sparer JA, Stowe MH, Liu J, Slade MD, Rusu OA, Redlich CA. Inception cohort study of workers exposed to toluene diisocyanate at a polyurethane foam factory: initial one-year follow-up. Am J Ind Med 2014; 57:1207-15. [PMID: 25266741 DOI: 10.1002/ajim.22385] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2014] [Indexed: 11/12/2022]
Abstract
BACKGROUND Isocyanates are one of the most commonly reported causes of occupational asthma; however, the risks of developing isocyanate asthma in modern production facilities remain poorly defined. We evaluated TDI exposure and respiratory health among an inception cohort of workers during their first year of employment at a new polyurethane foam production factory. METHODS Forty-nine newly hired workers were evaluated pre-employment, 6-months, and 12-months post-employment through questionnaire, spirometry, and TDI-specific serology. Airborne TDI levels were monitored by fixed-point air sampling and limited personal sampling. Qualitative surface SWYPE™ tests were performed to evaluate potential sources of skin exposure. RESULTS Airborne TDI levels overall were low; over 90% of fixed-point air measurements were below the limit of detection (0.1 ppb). Over the first year of employment, 12 of the 49 original workers (24.5%) were lost to follow-up, no additional workers were enrolled, and seven of the 49 original workers (14.2%) developed either new asthma symptoms (N = 3), TDI-specific IgG (N = 1), new airflow obstruction (N = 1) and/or a decline in FEV1 ≥ 15% (N = 3), findings that could indicate TDI-related health effects. The prevalence of current asthma symptoms was significantly higher in the workers lost to follow-up compared to those who completed the 12-month follow-up (25% vs. 2.7%; P = 0.04). CONCLUSIONS The findings suggest possible early TDI-related health effects in a modern polyurethane production plant. These findings also highlight the need for further longitudinal evaluation of these workers and the challenges of studying workers at risk for isocyanate asthma.
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Affiliation(s)
- Wei Gui
- Department of Internal Medicine; Yale University School of Medicine; New Haven Connecticut
| | - Adam V. Wisnewski
- Department of Internal Medicine; Yale University School of Medicine; New Haven Connecticut
| | - Iulia Neamtiu
- The Environmental Health Center; Cluj-Napoca Romania
| | - Eugen Gurzau
- The Environmental Health Center; Cluj-Napoca Romania
| | - Judith A. Sparer
- Department of Internal Medicine; Yale University School of Medicine; New Haven Connecticut
| | - Meredith H. Stowe
- Department of Internal Medicine; Yale University School of Medicine; New Haven Connecticut
| | - Jian Liu
- Department of Internal Medicine; Yale University School of Medicine; New Haven Connecticut
| | - Martin D. Slade
- Department of Internal Medicine; Yale University School of Medicine; New Haven Connecticut
| | | | - Carrie A. Redlich
- Department of Internal Medicine; Yale University School of Medicine; New Haven Connecticut
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Abstract
PURPOSE OF REVIEW This review aims to update the knowledge on the burden of disease due to exposure to isocyanates. Health effects of isocyanates and their major products, polyurethanes, are mainly determined by sensitization to isocyanates. Recent studies on the genetic factors to explain individual susceptibility to sensitization are reviewed. RECENT FINDINGS Production of isocyanates has rapidly increased in the past and is predicted to increase at an annual rate of around 5%. Consumer products and the construction area are the main drivers of growth. This leads to increased nonoccupational exposure. The use of sprayed polyurethane foams for insulation in existing homes is one such example of nonoccupational exposure. The percentage of people exposed who show health effects is not known. Occupational exposure increases are mainly caused by the increase in the workforce. The percentage of workers exhibiting health effects remained fairly stable at 5-15% in the last decade. To explain why not all people exposed to isocyanates develop adverse health effects, recent findings on sensitization to isocyanate are reviewed. The skin is the most important route for sensitization. SUMMARY Increased production of isocyanates and rising use of these substances in consumer products is leading to an increased burden of disease, with an increase in nonoccupational exposure as well. Sensitization to isocyanates is the main route for adverse health effects. The skin is the major route for sensitization. Recently, several genetic factors have been identified that play a role in the individual susceptibility for sensitization.
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Postapprenticeship isocyanate exposure and risk of work-related respiratory symptoms using an asthma-specific job exposure matrix, self-reported and expert-rated exposure estimates. J Occup Environ Med 2014; 56:125-7. [PMID: 24504247 DOI: 10.1097/jom.0000000000000075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kimber I, Dearman RJ, Basketter DA. Diisocyanates, occupational asthma and IgE antibody: implications for hazard characterization. J Appl Toxicol 2014; 34:1073-7. [PMID: 25059672 DOI: 10.1002/jat.3041] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 06/02/2014] [Accepted: 06/02/2014] [Indexed: 11/12/2022]
Abstract
Sensitization of the respiratory tract by chemicals resulting in rhinitis and asthma is an important occupational health issue. Occupational asthma is associated with significant morbidity and can be fatal. Tests for the identification and characterization of chemicals with the potential to cause sensitization of the respiratory tract are lacking. In spite of sustained interest there are no validated or widely accepted methods available, and this presents toxicologists with a considerable challenge. One important constraint on the development of appropriate testing strategies has been uncertainty and controversy about the immunological mechanisms through which chemicals may induce sensitization of the respiratory tract. By analogy with protein respiratory allergy it is legitimate to consider that IgE antibody-dependent mechanisms may play a pivotal role. However, although many aspects of chemical respiratory allergy are consistent with reactions caused by IgE antibody, uncertainty remains because among patients with occupational asthma caused by chemical respiratory allergens there are commonly a proportion, and sometimes a significant proportion, of subjects that lack detectable IgE antibody. Here we consider the relevance of IgE antibody responses for the development of a chemical respiratory allergy to diisocyanates. A case is made that IgE antibody responses are, either directly or indirectly, closely associated with occupational asthma to the diisocyanates (and to other chemical respiratory allergens). As such the argument is advanced here that IgE antibody represents an appropriate readout for the characterization of chemical respiratory allergens, and that uncertainty about mode of action should no longer represent a hurdle in the development of suitable test methods.
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Affiliation(s)
- Ian Kimber
- Faculty of Life Sciences, University of Manchester, Michael Smith Building, Oxford Road, Manchester, M13 9PT, UK
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Jonaid BS, Pronk A, Doekes G, Heederik D. Exhaled nitric oxide in spray painters exposed to isocyanates: effect modification by atopy and smoking. Occup Environ Med 2014; 71:415-22. [PMID: 24683011 DOI: 10.1136/oemed-2013-101672] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Isocyanate asthma is one of the most frequently identified forms of occupational asthma in industrialised countries. The underlying mechanisms have not been clarified. There is only limited information about the relationship between exhaled nitric oxide (eNO) and occupational exposure to isocyanates and asthma. OBJECTIVES To investigate the association between isocyanate exposure and eNO levels in isocyanate-exposed workers and to elucidate whether eNO acts as a marker of airway inflammation controlling for smoking and atopy in an industry-wide survey. METHODS Information on estimated personal isocyanate exposure, measured eNO levels, health effects and sensitisation were analysed in 229 workers from a cross-sectional study. Univariate and multiple regression analyses were used to explore the exposure-response relationships between isocyanate exposure and eNO, stratified by smoking and atopy. RESULTS A marginally significant exposure-response relationship was found between isocyanate exposure and eNO in atopic, non-smokers (p=0.054). eNO was significantly associated with atopy and smoking, bronchial hyper-responsiveness (BHR), work-related conjunctivitis and rhinitis after adjustment for age, gender, atopy and smoking (p<0.05). A borderline significant association was found between eNO and asthma-like symptoms after adjustment for age, gender, atopy and current smoking (p=0.055). In a small group of isocyanate-exposed workers with positive serum-specific immunoglobulin E (IgE) antibodies to hexamethylene diisocyanate (HDI), elevated eNO levels were clearly exposure related. eNO was associated with the positive specific IgG antibodies to HDI in non-atopic, non-smokers (p=0.03). CONCLUSIONS Increased eNO levels may indicate increased airway inflammation in atopic, non-smokers exposed to isocyanates especially at higher levels of isocyanate exposure.
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Affiliation(s)
- Badri Sadat Jonaid
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, The Netherlands
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ter Burg W, Bouma K, Schakel DJ, Wijnhoven SWP, van Engelen J, van Loveren H, Ezendam J. Assessment of the risk of respiratory sensitization from fragrance allergens released by air fresheners. Inhal Toxicol 2014; 26:310-8. [DOI: 10.3109/08958378.2014.888110] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Raulf-Heimsoth M, Liebig R, Marczynski B, Borowitzki G, Bernard S, Freundt S, Heinze E, Brüning T, Merget R. Implementation of non-invasive methods in the diagnosis of diisocyanate-induced asthma. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2014; 788:293-300. [PMID: 23835990 DOI: 10.1007/978-94-007-6627-3_40] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Diisocyanate-induced asthma is difficult to diagnose since the immunopathological mechanisms and exposure determinants at the workplace are not well defined. The aim of this study was to evaluate the non-invasive methods of nasal lavage fluid (NALF) and induced sputum (IS) to enhance the diagnostic efficiency. Sixty-three diisocyanate-exposed workers with work-related shortness of breath underwent a standardized 4-steps-1-day-whole body exposure test with diisocyanates used at work up to 30 ppb. NALF and IS were collected before, 0.5, and 19 h after the end of exposure. Cellular composition and soluble inflammatory biomarkers were studied in the samples. In addition, ten controls with bronchial hyperresponsiveness, but without prior occupational diisocyanate exposure, were also examined. Twelve out of the 63 subjects (19 %) showed a significant asthmatic reaction (pulmonary responders) after challenge (FEV1 decrease >20 %). NALF samples did not demonstrate significant effects either on cellular composition or on mediator concentrations in the responders, non-responders, or controls at any time point. In contrast, in the IS samples of the pulmonary responders collected 19 h after challenge, the percentage of eosinophils was higher (p = 0.001) compared with baseline before challenge. Eosinophils were also increased 30 min and 19 h after challenge in IS samples of the responders compared with the non-responders or controls. In addition, 19 h after challenge the eosinophilic cationic protein (ECP) concentration was significantly higher in the responders than non-responders (p < 0.04) or controls (p < 0.002). In conclusion, positive asthmatic reactions to diisocyanates are accompanied by an influx of eosinophils into lower airways. Analysis of induced sputum should be implemented in the diagnostic procedure of diisocyanate-related airway diseases.
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Affiliation(s)
- M Raulf-Heimsoth
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (IPA), Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany,
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Cells and mediators in diisocyanate-induced occupational asthma. Curr Opin Allergy Clin Immunol 2013; 13:125-31. [PMID: 23324746 DOI: 10.1097/aci.0b013e32835e0322] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Diisocyanates are the most common cause of occupational asthma in many industrialized countries, and various pathogenic mechanisms have been suggested to be involved. Occupational asthma causes airway remodeling unless diagnosed and treated within a proper time frame. However, treatment modalities are limited because of an insufficient understanding regarding underlying pathogenic mechanisms. RECENT FINDINGS Several immunological and nonimmunological mechanisms have been suggested, indicating that the pathogenesis of occupational asthma may be more complex than other types of asthma. Airway epithelial cells are the first to encounter diisocyanates and orchestrate various responses, such as cytokine release, oxidative stress generation, and autoantibody formation. Some evidence supports the involvement of adaptive immune responses. Additional evidence suggests that other mechanisms are involved in diisocyanate-induced occupational asthma. One such candidate mechanism is oxidative stress. Oxidative stress has been shown to trigger and aid in the development of diisocyanate-induced occupational asthma in human samples and genetic studies, and some therapeutic trials were performed based on this finding. SUMMARY Diisocyanate-induced occupational asthma may be caused by a complex interaction of innate and adaptive immune responses. The knowledge presented in this review may help lead to the development of new treatment modalities through an increased understanding of occupational asthma pathogenesis.
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Challenge Exposure to Isocyanates Induces Changes in Nasal Patency in Patients Reporting Work-Related Respiratory Symptoms. J Occup Environ Med 2013; 55:954-9. [DOI: 10.1097/jom.0b013e318293aef9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Baur X, Barbinova L. Occupational airborne exposure, specific sensitization and the atopic status: evidence of a complex interrelationship. J Occup Med Toxicol 2013; 8:2. [PMID: 23406275 PMCID: PMC3598540 DOI: 10.1186/1745-6673-8-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Accepted: 01/30/2013] [Indexed: 11/21/2022] Open
Abstract
Background We have investigated the relationship between atopic status and long-term occupational exposure to latex proteins or methyl diethyl diisocyanate (MDI) as high and low molecular weight asthma-inducing agents, respectively. Methods This study is based on retrospective analyses of two groups of symptomatic outpatients: 184 healthcare workers with latex exposure and 156 workers with isocyanate (MDI) exposure. We analysed atopic and non-atopic subgroups according to exposure duration and the frequencies of specific sensitization. Results 45% of the healthcare subgroup specifically sensitized to latex were atopic, whereas in the non-sensitized healthcare subgroup only 26% were atopic. On the other hand, subjects specifically sensitized to MDI were rarely atopic (only 15%), whereas in the subgroup non-sensitized to MDI atopy was present in 38%. After prolonged durations of exposure, the proportion of atopics was further elevated in most healthcare subgroups but it decreased in the MDI-exposed subjects. Conclusions We hypothesize that latex proteins as sensitizing agents might promote the development of atopy, whereas exposure to the low molecular weight MDI might inhibit the atopic status.
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Affiliation(s)
- Xaver Baur
- Institute for Occupational Medicine, Charité Universitätsmedizin Berlin, Thielallee 69, Berlin D-14195, Germany.
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Schaeffer JW, Sargent LM, Sandfort DR, Brazile WJ. A comparison of two sampling methods for the detection of airborne methylene bisphenyl diisocyanate. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2013; 10:213-221. [PMID: 23442121 DOI: 10.1080/15459624.2013.766546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The purpose of this study was to determine if there was a significant difference between two readily available sampling methodologies for airborne methylene bisphenyl diisocyanate (MDI), which is an essential precursor in the spray-on truck bed lining industry. Seventy-two personal airborne samples of MDI were collected and analyzed from nine spray-on truck bed liner businesses in northern Colorado. Wide ranges of exposure concentrations were encountered during the spray-on application, including concentrations that exceeded the OSHA permissible exposure limit. The highest airborne MDI concentration measured was 690 ppb. A statistically significant difference between field-desorbed and laboratory-desorbed methods was determined. The field-desorbed sampling methodology yielded consistently higher MDI concentrations than the laboratory-desorbed sampling methodology, which suggests that immediate desorption minimizes isocyanate loss and potential underestimations. Results from the analysis of variance also indicated that different facility factors and environmental conditions within each company, such as the use of ventilation or humidity level, affected the MDI concentrations, indicating the potential for better mitigation of exposures using the hierarchy of controls.
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Affiliation(s)
- Joshua W Schaeffer
- Department of Environmental and Radiological Health Sciences, Colorado State University, Ft. Collins, Colorado 80523, USA.
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Pignatti P, Frossi B, Pala G, Negri S, Oman H, Perfetti L, Pucillo C, Imbriani M, Moscato G. Oxidative activity of ammonium persulfate salt on mast cells and basophils: implication in hairdressers' asthma. Int Arch Allergy Immunol 2012. [PMID: 23183487 DOI: 10.1159/000343020] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Persulfate salts are components of bleaching powders widely used by hairdressers during hair-bleaching procedures. Hairdressers are at high risk for occupational asthma and rhinitis, and ammonium persulfate is the main etiologic agent. OBJECTIVE To explore the effects of ammonium persulfate on human albumin, mast cells, and basophils in order to evaluate a possible effect of ammonium persulfate oxidizing activity in the mechanism of ammonium persulfate-induced occupational asthma. METHODS High-performance liquid chromatography/mass spectrometry was performed on ammonium persulfate-incubated human albumin. The activation of LAD2 human mast cell and KU812 human basophil cell lines incubated with ammonium persulfate was evaluated. CD63 expression on persulfate-in-vitro-incubated blood basophils from nonexposed healthy controls (n = 31) and hairdressers with work-related respiratory symptoms (n = 29) was assessed by flow cytometry. RESULTS No persulfate-albumin conjugate was found. An oxidative process on tryptophan and methionine was detected. Ammonium persulfate induced reactive oxygen species (ROS) generation and the degranulation of LAD2 and KU812 cells. Human basophils from healthy controls, incubated in vitro with ammonium persulfate, showed increased CD63 expression and ROS production. In hairdressers with ammonium persulfate-caused occupational asthma (positive persulfate challenge), basophil-CD63 expression was higher than in those with a negative challenge and in healthy controls. CONCLUSIONS Ammonium persulfate incubated with human albumin did not generate any adduct but oxidized some amino acids. This oxidizing activity induced human mast cell and basophil activation which might be crucial in the mechanism of persulfate-induced occupational asthma and rhinitis.
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Affiliation(s)
- Patrizia Pignatti
- Allergy and Immunology Unit, Fondazione Salvatore Maugeri, Institute of Research and Care, Scientific Institute of Pavia, Pavia, Italy.
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El-Gharabawy RM, El-Maddah EI, Oreby MM, Salem HSA, Ramadan MO. Immunotoxicity and pulmonary toxicity induced by paints in Egyptian painters. J Immunotoxicol 2012; 10:270-8. [PMID: 23046204 DOI: 10.3109/1547691x.2012.714005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Associations between painting, sensitization, and respiratory disease have received little attention, despite the extensive use of paint and paint removal products. The objectives of this study were to investigate the possible immunotoxicity and pulmonary toxicity induced by paints in Egyptian painter workers. This study was carried out on 60 adult males. Subjects were designated as controls (n = 30 healthy persons) or paint-exposed workers (n = 30). The controls and workers were then divided into four equal groups (15 individuals/group): Group I, Control group-never smoked; Group II, Smoker controls; Groups III, paint-exposed non-smoking workers; and Group IV, paint-exposed smoker workers. A complete physical examination, chest radiograph, and pulmonary function test (PFT) were performed with each subject. Serum levels of immunoglobulin (Ig) E and interleukin (IL)-4, -6, and -10, WBC sub-set counts, total numbers of WBC, and leukocyte differentials were also assessed. The pulmonary toxicity due to the paint exposures appeared in the form of allergic manifestations in the respiratory tract, significant reductions in FVC, FEV1, FEV1/FVC ratio and PEF parameters, and a reticular pattern in both lung fields. Immunotoxicity was evidenced by increases in total leukocyte levels, total lymphocytes, CD8(+) T-lymphocytes, B (CD19(+))-lymphocytes, NK (CD3(+)CD16(+)CD56(+)) cells, and eosinophils, as well as a significant decrease in CD4+ T-lymphocyte; there were also significant elevations in serum IgE, IL-4, and IL-6, and a significant reduction in IL-10, levels in these hosts. Based on these results, we assert that repeated paint exposure is associated with pulmonary and immune system toxicities that may lead to an augmentation of allergic diseases.
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Affiliation(s)
- Rehab M El-Gharabawy
- Department of Pharmacology, Faculty of Pharmacy, Tanta University, Tanta, Egypt.
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Wisnewski AV, Stowe MH, Nerlinger A, Opare-Addo P, Decamp D, Kleinsmith CR, Redlich CA. Biomonitoring Hexamethylene diisocyanate (HDI) exposure based on serum levels of HDI-specific IgG. ACTA ACUST UNITED AC 2012; 56:901-10. [PMID: 22449630 DOI: 10.1093/annhyg/mes024] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Isocyanate chemicals essential for polyurethane production are widely used industrially, and are increasingly found in consumer products. Asthma and other adverse health effects of isocyanates are well-documented and exposure surveillance is crucial to disease prevention. Hexamethylene diisocyanate (HDI)-specific serum immunoglobulin G (IgG) was evaluated as an exposure biomarker among workers at a US Air Force Air Logistics Center, which includes a large aircraft maintenance facility. METHODS HDI-specific IgG (HDI-IgG) titers in serum samples (n = 74) were measured using an enzyme-linked immunosorbent assay based upon the biuret form of HDI conjugated to human albumin. Information on personal protective equipment (PPE), work location/tasks, smoking, asthma history, basic demographics, and HDI skin exposure was obtained through questionnaire. RESULTS HDI-specific serum IgG levels were elevated in n = 17 (23%) of the workers studied. The prevalence and/or end-titer of the HDI-IgG was significantly (P < 0.05) associated with specific job titles, self-reported skin exposure, night-shift work, and respirator use, but not atopy, asthma, or other demographic information. The highest titers were localized to specific worksites (C-130 painting), while other worksites (generator painting) had no or few workers with detectable HDI-IgG. CONCLUSIONS HDI-specific immune responses (IgG) provide a practical biomarker to aid in exposure surveillance and ongoing industrial hygiene efforts. The strategy may supplement current air sampling approaches, which do not assess exposures via skin, or variability in PPE use or effectiveness. The approach may also be applicable to evaluating isocyanate exposures in other settings, and may extend to other chemical allergens.
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Affiliation(s)
- Adam V Wisnewski
- Department of Internal Medicine, Yale Occupational and Environmental Medicine Program, Yale University School of Medicine, New Haven, CT 06520-8057, USA.
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Arrandale V, Meijster T, Pronk A, Doekes G, Redlich CA, Holness DL, Heederik D. Skin symptoms in bakery and auto body shop workers: associations with exposure and respiratory symptoms. Int Arch Occup Environ Health 2012; 86:167-75. [PMID: 22411214 PMCID: PMC3555349 DOI: 10.1007/s00420-012-0760-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Accepted: 03/01/2012] [Indexed: 11/25/2022]
Abstract
Purpose Despite the importance of skin exposure, studies of skin symptoms in relation to exposure and respiratory symptoms are rare. The goals of this study were to describe exposure–response relationships for skin symptoms, and to investigate associations between skin and respiratory symptoms in bakery and auto body shop workers. Methods Data from previous studies of bakery and auto body shop workers were analyzed. Average exposure estimates for wheat allergen and isocyanates were used. Generalized linear models were constructed to describe the relationships between exposure and skin symptoms, as well as between skin and respiratory symptoms. Results Data from 723 bakery and 473 auto body shop workers were analyzed. In total, 5.3 % of bakery and 6.1 % of auto body shop workers were female; subjects’ mean age was 39 and 38 years, respectively. Exposure–response relationships were observed in auto body shop workers for itchy or dry skin (PR 1.55, 95 % CI 1.2–2.0) and work-related itchy skin (PR 1.97, 95 % CI 1.2–3.3). A possible exposure–response relationship for work-related itchy skin in bakery workers did not reach statistical significance. In both groups, reporting skin symptoms was strongly and significantly associated with reporting respiratory symptoms, both work-related and non-work-related. Conclusions Exposure–response relationships were observed for skin symptoms in auto body shop workers. The lack of significant exposure–response associations in bakery workers should be interpreted cautiously. Workers who reported skin symptoms were up to four times more likely to report respiratory symptoms. Improved awareness of both skin and respiratory outcomes in exposed workers is needed. Electronic supplementary material The online version of this article (doi:10.1007/s00420-012-0760-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Victoria Arrandale
- Centre for Research Expertise in Occupational Disease, University of Toronto, 223 College St, Toronto, ON M5T 1R4, Canada.
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Reeb-Whitaker C, Whittaker SG, Ceballos DM, Weiland EC, Flack SL, Fent KW, Thomasen JM, Trelles Gaines LG, Nylander-French LA. Airborne isocyanate exposures in the collision repair industry and a comparison to occupational exposure limits. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2012; 9:329-39. [PMID: 22500941 PMCID: PMC4075771 DOI: 10.1080/15459624.2012.672871] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Isocyanate exposure was evaluated in 33 spray painters from 25 Washington State autobody shops. Personal breathing zone samples (n = 228) were analyzed for isophorone diisocyanate (IPDI) monomer, 1,6-hexamethylene diisocyanate (HDI) monomer, IPDI polyisocyanate, and three polyisocyanate forms of HDI. The objective was to describe exposures to isocyanates while spray painting, compare them with short-term exposure limits (STELs), and describe the isocyanate composition in the samples. The composition of polyisocyanates (IPDI and HDI) in the samples varied greatly, with maximum amounts ranging from up to 58% for HDI biuret to 96% for HDI isocyanurate. There was a significant inverse relationship between the percentage composition of HDI isocyanurate to IPDI and to HDI uretdione. Two 15-min STELs were compared: (1) Oregon's Occupational Safety and Health Administration (OR-OSHA) STEL of 1000 μg/m(3) for HDI polyisocyanate, and (2) the United Kingdom's Health and Safety Executive (UK-HSE) STEL of 70 μg NCO/m(3) for all isocyanates. Eighty percent of samples containing HDI polyisocyanate exceeded the OR-OSHA STEL while 98% of samples exceeded the UK-HSE STEL. The majority of painters (67%) wore half-face air-purifying respirators while spray painting. Using the OR-OSHA and the UK-HSE STELs as benchmarks, 21% and 67% of painters, respectively, had at least one exposure that exceeded the respirator's OSHA-assigned protection factor. A critical review of the STELs revealed the following limitations: (1) the OR-OSHA STEL does not include all polyisocyanates, and (2) the UK-HSE STEL is derived from monomeric isocyanates, whereas the species present in typical spray coatings are polyisocyanates. In conclusion, the variable mixtures of isocyanates used by autobody painters suggest that an occupational exposure limit is required that includes all polyisocyanates. Despite the limitations of the STELs, we determined that a respirator with an assigned protection factor of 25 or greater is required to protect against isocyanate exposures during spray painting. Consequently, half-face air-purifying respirators, which are most commonly used and have an assigned protection factor of 10, do not afford adequate respiratory protection.
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Affiliation(s)
- Carolyn Reeb-Whitaker
- Safety & Health Assessment & Research for Prevention Program, Washington State Department of Labor & Industries, Tumwater, Washington, USA.
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De Vries TT, Bello D, Stowe MH, Harari H, Slade MD, Redlich CA. Transferability of aliphatic isocyanates from recently applied paints to the skin of auto body shop workers. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2012; 9:699-711. [PMID: 23067057 DOI: 10.1080/15459624.2012.728893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Isocyanates, the essential cross-linking chemicals used to make polyurethane, are potent sensitizers and a common cause of occupational asthma. In addition, isocyanate (NCO) skin contact may contribute to the development of isocyanate asthma. Prior work has shown that unbound NCO can persist on recently spray coated auto body parts after appearing dry. The purpose of this study was to assess whether isocyanate skin exposure can result from handling such surfaces. Quantitative surface and skin wipe sampling for total NCO was performed on test panels sprayed with aliphatic isocyanate coatings, and on paired skin samples obtained from participants who had rubbed the recently dried surfaces. Surface and skin samples, obtained from 18 workers in five auto body shops, were prepared following NIOSH method 5525 (modified for skin samples), and isocyanate species derived from hexamethylene diisocyanate and isophorone diisocyanate were analyzed using high-performance liquid chromatography with ultraviolet and fluorescence detectors. Quantifiable unbound NCO species were detected on 84.2% of all sprayed surfaces sampled after initially considered dry. Only 7 out of a total of 104 (6.7%) non-compounded skin samples obtained after contact with the recently dried coatings had detectable quantities of free NCO. The 7 positive samples, all obtained at the initial sampling time (t(0)), had a geometric mean of 0.016 μg NCO cm(-2) (range: 0.002-0.88 μg NCO cm(-2)). Only 1 of 12 (8.3%) of skin samples obtained after compounding contained detectable free NCO. The risk of substantial human isocyanate skin exposure from contact with the dry appearing (yet not fully cured) isocyanate coatings evaluated in this study appears to be low, although other isocyanate coatings and tasks may pose a greater risk of NCO skin exposure.
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Affiliation(s)
- Thomas T De Vries
- Yale Occupational and Environmental Medicine Program, Yale University School of Medicine, New Haven, Connecticut, USA.
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Crameri R. Immunoglobulin E-binding autoantigens: biochemical characterization and clinical relevance. Clin Exp Allergy 2011; 42:343-51. [PMID: 22092496 DOI: 10.1111/j.1365-2222.2011.03878.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Revised: 07/20/2011] [Accepted: 09/02/2011] [Indexed: 01/14/2023]
Abstract
Although immediate-Type I skin reactions to human dander have been described six decades ago, only the recent application of molecular biology to allergology research allowed fast and detailed characterization of IgE-binding autoantigens. These can be functionally subdivided into three classes: (1) self-antigens with sequence homology to environmental allergens belonging to the class of phylogenetically conserved proteins, (2) self-antigens without sequence homology to known environmental allergens, and (3) chemically modified self-antigens deriving from workplace exposure. As environmental allergens, also IgE-binding autoantigens belong to different protein families without common structural features that would explain their IgE-binding capability. Many of the self-antigens showing sequence homology to environmental allergens, are phylogenetically conserved proteins like manganese dependent superoxide dismutase, thioredoxin or cyclopilin. Their IgE-binding capability can be explained by molecular mimicry resulting from shared B-cell epitopes. A common factor of IgE-binding self-antigens without sequence homology to known environmental allergens is that they elicit IgE responses only in individuals suffering from long-lasting atopic diseases. In contrast, IgE-mediated reactions to modified self-antigens might be explained with the generation of novel B-cell epitopes. Chemically modified self-antigens are likely to be recognized as non-self by the immune system. The clinical relevance of IgE responses to self-antigens remains largely unclear. Well documented is their ability to induce immediate Type I skin reactions in vivo, and to induce mediator release from effector cells of sensitized individuals in vitro. Based on these observations it is reasonable to assume that IgE-mediated cross-linking of FcRIε receptors on effector cells can elicit the same symptoms as those induced by environmental allergens, and this could explain exacerbations of chronic allergic diseases in the absence of external exposure. However, because most of the described IgE-binding self-antigens are intracellular proteins normally not accessible for antigen-antibody interactions, local release of the antigens is required to explain the induction of symptoms.
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Affiliation(s)
- R Crameri
- Department Molecular Allergology, Swiss Institute of Allergy and Asthma Research, Obere Strasse 22, CH-7270 Davos, Switzerland.
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Noss I, Wouters IM, Smit LAM, Meijer E, Pronk A, Heederik DJJ, Doekes G. IgG to various beta-glucans in a human adult population. Int Arch Allergy Immunol 2011; 157:98-108. [PMID: 21912179 DOI: 10.1159/000324674] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Accepted: 01/26/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Fungal β-(1,3)-glucans are pro-inflammatory agents, and exposures to β-(1,3)-glucans are associated with respiratory tract symptoms. IgG anti-(1,3)-glucan titers are measured in diagnosis of fungal infections. Although other β-glucan structures exist, like β-(1,6)-glucans, little is known about their antigenic or pro-inflammatory properties. We aimed to investigate IgG titers and specificities in human sera against different β-glucans with varying structures. METHODS IgG anti-β-glucan was measured by enzyme immunoassay in a random sample of 40 sera from healthy adults, with a panel of 8 differently structured glucans. In a subsequent larger series, IgG anti-β-(1,6)-glucan was measured in a random sample of 667 sera from three occupational populations with different organic dust exposures. Possible determinants of IgG anti-β-(1,6)-glucan titers were explored with linear-regression analysis. RESULTS We found wide variation in anti-β-glucan IgG levels. The highest titers were found for pure β-(1,6)-glucan pustulan. Moderate to strong reactions with other β-(1,6)-containing structures appeared to be due to cross-reacting anti-β-(1,6)-glucan antibodies. Surprisingly, the mean IgG anti-β-(1,6)-glucan titer was significantly lower in agricultural workers - with highest organic dust exposure - than in spray painters and bakery workers. Smoking status was associated with lower IgG anti-β-(1,6)-glucan titers in all populations. CONCLUSIONS IgG to β-(1,3)- and β-(1,6)-glucans can be found in normal human sera. β-(1,6)-glucans appear to be much more potent antigens. The health impact of high anti-β-(1,6)-glucan antibody levels remains unclear and further investigations are needed.
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Affiliation(s)
- Ilka Noss
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
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Flack SL, Fent KW, Gaines LGT, Thomasen JM, Whittaker SG, Ball LM, Nylander-French LA. Hemoglobin adducts in workers exposed to 1,6-hexamethylene diisocyanate. Biomarkers 2011; 16:261-70. [PMID: 21506697 DOI: 10.3109/1354750x.2010.549242] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We investigated the utility of 1,6-hexamethylene diamine (HDA) hemoglobin adducts as biomarkers of exposure to 1,6-hexamethylene diisocyanate (HDI) monomer. Blood samples from 15 spray painters applying HDI-containing paint were analyzed for hemoglobin HDA (HDA-Hb) and N-acetyl-1,6-hexamethylene diamine (monoacetyl-HDA-Hb) by GC-MS. HDA-Hb was detected in the majority of workers (≤1.2-37 ng/g Hb), whereas monoacetyl-HDA-Hb was detected in one worker (0.06 ng/g Hb). The stronger, positive association between HDA-Hb and cumulative HDI exposure (r(2) = 0.3, p < 0.06) than same day exposure (p ≥ 0.13) indicates long-term elimination kinetics for HDA-Hb adducts. This association demonstrates the suitability of HDA-Hb adducts for further validation as a biomarker of HDI exposure.
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Affiliation(s)
- Sheila L Flack
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, NC 27599, USA
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