Occupational asthma due to turpentine in art painter--case report

Assessment of the Genotoxic and Cytotoxic Effects of Turpentine in Painters

Turpentine is a fluid used mainly as a solvent for thinning oil-based paints, obtained by distilling the resin of coniferous trees. Fine art painters use turpentine on a daily basis. The aim of this study was to investigate the genotoxic effect of turpentine and to determine the lymphocyte proliferation index in the peripheral blood of individuals occupationally exposed to turpentine. For this purpose, the cytokinesis-block micronucleus assay (CBMN) was used to determine the total number of micronuclei (MNi), nucleoplasmic bridges (NPB), and nuclear buds (NBUD), as well as the cell proliferation index (CBPI) in the peripheral blood lymphocytes of the subjects. Twenty-two subjects exposed to turpentine daily through their work participated in the study and were compared to twenty subjects in the control group. The results showed a significant increase in the number of micronuclei and other genotoxicity parameters, as well as significant cytotoxicity based on CBPI values. In addition, the genotoxic and cytotoxic effects of turpentine were found to be time-dependent, i.e., the deleterious effects of turpentine on genetic material increase with prolonged exposure. These results strongly suggest that exposure to turpentine vapors may affect genome stability and that occupational safety measures should be taken when using turpentine.

Acute eosinophilic pneumonia following inhalation of turpentine oil: A case report

Acute eosinophilic pneumonia (AEP) is an eosinophilic lung disease associated with environmental substances including smoking. Although the etiology of AEP has not been fully elucidated, it has been hypothesized that IL-33 plays a central role in the pathogenesis of AEP. Turpentine oil, from resins of pine trees, is not only used in paints, but also utilized in experimental animal models of inflammation because it leads to the production of inflammatory cytokines including IL-33. Here, we report the first case of AEP following turpentine oil inhalation. A 67-year-old woman reported using urushiol with turpentine oil to repair home goods. She had fever and persistent cough after turpentine inhalation over a very short period of time. The chest X-ray image showed consolidation in the upper right lung field. Laboratory findings indicated that there was no evidence of infection, collagen vascular diseases, and other allergic diseases that cause pneumonia, but analysis of the bronchoalveolar lavage fluid revealed 29% eosinophils with a small number of lipid-laden macrophages. With these findings, the diagnostic criteria of AEP was met. We rendered a diagnosis of AEP by inhalation of turpentine because no other cause for AEP was identified even with a structured questionnaire survey. The manifestations resolved immediately after steroid therapy. This is the first report of a case of AEP caused by the inhalation of turpentine oil.

Occupational Health and the Visual Arts: An Introduction

OBJECTIVE

Occupational hazards in the visual arts often involve hazardous materials, though hazardous equipment and hazardous work conditions can also be found. Occupational health professionals are familiar with most of these hazards and are particularly qualified to contribute clinical and preventive expertise to these issues.

METHODS

Articles illustrating visual arts health issues were sought and reviewed. Literature sources included medical databases, unindexed art-health publications, and popular press articles.

RESULTS

Few medical articles examine health issues in the visuals arts directly, but exposures to pigments, solvents, and other hazards found in the visual arts are well described. The hierarchy of controls is an appropriate model for controlling hazards and promoting safer visual art workplaces.

CONCLUSIONS

The health and safety of those working in the visual arts can benefit from the occupational health approach. Sources of further information are available.

Sputum inflammatory profile before and after specific inhalation challenge in individuals with suspected occupational asthma

BACKGROUND

The aim of this study was to establish the sputum inflammatory profile and changes in levels of leukotriene B₄ (LTB₄) and a panel of Th1/Th2 cytokines in subjects with suspected occupational asthma (OA) following specific inhalation challenge (SIC) to high-molecular-weight (HMW) and low-molecular-weight (LMW) agents.

MATERIAL AND METHODS

Fifty-one consecutive subjects undergoing SIC for suspected OA were enrolled. Sputum induction was performed the day before and 24 h after exposure to the offending agent. Total and differential cell counts were assessed. LTB₄ and a 10 Th1/Th2 cytokines were measured in sputum supernatant.

RESULTS

Thirty-four patients tested positive to SIC and were diagnosed with OA (in 10 due to HMW agents and in 24 to LMW agents). SIC was negative in 17 subjects. As compared to baseline an increase was found in the percentage of sputum eosinophils and neutrophils, and in IL-10 concentration after SIC (p = 0.0078, p = 0.0195, and p = 0.046, respectively), and a decrease was seen in LTB₄ level (p = 0.0078) in patients with OA due to HMW agents. An increase in the percentage of sputum neutrophils after SIC (p = 0.0040) was observed in subjects without OA exposed to LMW agents. IL-8 levels after SIC were higher in patients without OA compared with patients with OA (p = 0.0146).

CONCLUSION

When conducting airway inflammation studies in OA, patients should be divided according to the causal agent (HMW or LMW). In OA patients exposed to HMW agents, an increase in the number of neutrophils can be found in parallel to the increase of eosinophils, although this does not contradict an IgE-mediated mechanism. Exposure to LMW agents can result in increased neutrophilic inflammation in patients with airway diseases unrelated to OA. There is variability in the responses observed in patients with OA exposed to LMW agents.

Old and new causes of occupational asthma

International reviews suggest that the median proportion of adult cases of asthma attributable to occupational exposure is between 10% and 15%. Therefore, it is essential that clinicians have a broad knowledge of the various causes associated with occupational asthma. Occupational asthmagens are categorized as low-molecular-weight (LMW, ≤1000 kd) and high-molecular-weight (HMW, ≥1000 kd) antigens. The purpose of this article is to review the most common representative LMW and HMW causes of occupational asthma over the past 70 years, with specific emphasis on newer causes reported over the past 5 years.

New causes of occupational asthma

PURPOSE OF REVIEW

This review focuses on new causative agents of occupational asthma published in 2009 and 2010. The recent developments in the diagnostic tools employed in occupational asthma caused by new agents are summarized.

RECENT FINDINGS

Work exposures are a significant contributor to the burden of asthma and, therefore, there is great scientific interest in work-related asthma. Although the majority of cases probably represent work-aggravated asthma, in a relevant proportion of cases asthma is actually caused by one or more agents present in the workplace. The list of causative agents of immunologically mediated occupational asthma is continuously growing, and new agents and professions are described each year. New insights gained in occupational asthma include routine evaluation of airway inflammation and identification of allergenic triggers using molecular diagnosis.

SUMMARY

A variety of novel high and low-molecular-weight agents have been shown to induce occupational asthma. Apart from the identification of the allergenic sources implicated, molecular diagnosis and detailed characterization of the culprit allergens contributes to increase our knowledge into the pathogenic mechanisms of this disorder. Assessment of airway inflammation helps to confirm the diagnosis and to better understand the physiopathology of the different types of occupational asthma.