Occupational asthma in female factory worker resulting from exposure to savinase in dishwashing tablets-a case study

New causes of immunologic occupational asthma, 2012-2014

PURPOSE OF REVIEW

The objective of this study was to review all new causes of well documented immunologic occupational asthma (IOA) published in the English and French medical literature between January 2012 and mid-2014.

RECENT FINDINGS

Ten case reports of new causes of IOA were reported during that period. The diagnosis was either confirmed by specific inhalation challenges (n = 5) or a combination of peak expiratory flow monitoring at and off work, confirmation of specific sensitisation, and asthma (n = 3). These involved both high (mites contaminating cured ham, various enzymes used as detergents and food additives, aquarium fish food, and orange allergens) and low-molecular-weight agents (spruce wood dust, a biocide, and an halogenated platinum compound used in cytotoxic drugs). Furthermore, eight studies reported cases of IOA with agents already known as airway sensitizers but in working environments that were unusual and reported for the first time.

SUMMARY

There are more than 400 known causes of IOA and the list grows continuously with the development of new technologies and better recognition of the diagnosis by physicians. IgE-mediated sensitization was confirmed in all new cases involving high-molecular-weight agents and in two of the three new cases involving low-molecular-weight agents. Symptoms of rhinitis were often associated with both types of agents. Physicians should stay alert and suspect occupational asthma in any adult with new-onset asthma or with newly uncontrolled asthma.

Occupational asthma: an overview

Occupational asthma is a form of asthma that is often under-diagnosed and under-reported. Unrecognized occupational asthma can lead to progression of disease and increased morbidity. The medical history is a critical element for establishing a diagnosis of OA. The history should include a detailed assessment of the workplace environment, the work process, changes in symptoms in and away from the workplace, and a review of relevant material safety data sheets that may provide clues regarding exposure(s) and the potential cause(s). Objective testing including spirometry pre- and post-bronchodilators, peak expiratory flow rate monitoring in and out of the workplace, provocation testing (i.e., methacholine challenge) to assess for airway hyperresponsiveness, and, if feasible, specific provocation by experienced personnel in a controlled setting to a suspected inciting agent are necessary for confirming a diagnosis. Skin or serologic testing for specific IgE to aeroallergens to assess the worker's atopic status is useful especially when considering certain forms of OA where atopy is a risk factor. Specialized laboratory testing may be useful for specific OA causes. It is important to correctly make the diagnosis of OA as the impact on the worker's future employment and earning power can be significantly affected.