Impact of interleukin 13 (IL13) genetic polymorphism Arg130Gln on total serum immunoglobulin (IgE) levels and interferon (IFN)-γ gene expression

This cross-sectional study was designed to investigate the extent of genetic susceptibility by targeting variants in interleukin (IL)-4/IL-13 signalling pathways leading to atopic disease in early childhood. We evaluated involvement of five single nucleotide polymorphisms IL4 C-590T, IL13 C-1055T, IL13 Arg130Gln, IL4RA Ile50Val and IL4RA Gln576Arg, in the control of serum total and antigen-specific immunoglobulin (Ig)E levels. Furthermore, we analysed their association with changes in gene expression of five cytokines having key roles in inflammatory and anti-inflammatory immune response [IL-4, IL-13, interferon (IFN)-γ, IL-8 and IL-10]. Total and antigen-specific IgE levels in serum and gene expression of selected cytokines in peripheral blood were measured in 386 children aged 1-8 years. TaqMan allelic discrimination, amplification refractory mutation system-polymerase chain reaction (ARMS-PCR) and restriction fragment length polymorphisms (RFLP) methods validated by sequencing were used for genotyping. All genotypes for children with total and antigen-specific IgE levels in the normal range were in Hardy-Weinberg equilibrium. Gene expression analyses were carried out using TaqMan gene expression assays. We found elevated total IgE levels in carriers of IL13 Arg130Gln variant allele [odds ratio (OR) = 1·84; 95% confidence interval (CI) = 1·16-2·93]. This effect was more apparent for boys (OR = 2·31; 95% CI = 1·25-4·28). However, no significant association was observed for the other four variants examined. We found up-regulation of IFN-γ in children with elevated serum total IgE levels carrying the Arg130 allele (P = 0·005). No differences were found for IL4, IL8 or IL10, while IL13 gene expression was under the detection limit. IL13 Arg130Gln genotypes can play a role in genetic susceptibility to allergy via regulation of serum total IgE levels and affecting IFN-γ gene expression.

DNA repair and cyclin D1 polymorphisms and styrene-induced genotoxicity and immunotoxicity

1-SO-adenine DNA adducts, DNA single-strand breaks (SBs), chromosomal aberrations (CAs), mutant frequency (MF) at the HPRT gene, and immune parameters (hematological and of humoral immunity) were studied in styrene-exposed human subjects and controls. Results were correlated with genetic polymorphisms in DNA repair genes (XPD, exon 23, XPG, exon 15, XPC, exon 15, XRCC1, exon 10, XRCC3, exon 7) and cell cycle gene cyclin D1. Results for biomarkers of genotoxicity after stratification for the different DNA repair genetic polymorphisms showed that the polymorphism in exon 23 of the XPD gene modulates levels of chromosomal and DNA damage, HPRT MF, and moderately affects DNA adduct levels. The highest levels of biomarkers were associated with the wild-type homozygous AA genotype. The exposed individuals with the wild-type GG genotype for XRCC1 gene exhibited the lowest CA frequencies, compared to those with an A allele (P < 0.05). Cyclin D1 polymorphism seems to modulate the number of leukocytes and lymphocytes in the analyzed subjects. The number of eosinophiles was positively associated with XPD variant C allele and negatively with XRCC1 variant A allele (P < 0.05) and XPC variant C allele (P < 0.05). Immunoglobulin IgA was positively associated with an XRCC3 variant T allele (P < 0.01) and negatively with XPC variant C allele (P < 0.05). Both C3- and C4-complement components were lower in individuals with XRCC3 CT (P < 0.05) and TT genotypes (P < 0.01). Adhesion molecules sL-selectin and sICAM-1 were associated with XPC genotype (P < 0.05). Individual susceptibility may be reflected in genotoxic and immunotoxic responses to environmental and occupational exposures to xenobiotics.

Effects of occupational exposure to styrene on expression of adhesion molecule on leukocytes

Styrene is an indispensable chemical extensively used in plastic and synthetic rubber industries. Styrene is known to produce various types of hepatotoxic, neurotoxic, and genotoxic effects. Styrene may be immunotoxic by both direct and indirect mechanisms. Measurement of adhesion molecules is a new tool for the investigation of immune system modulation. The aim of this study was to evaluate the association of the expression of the adhesion molecules CD11a, CD11b, CD18, CD54, CD49d, and CD62-L in white blood cells and levels of soluble adhesion molecules ICAM-1 and L-selectin in serum with occupational exposure to styrene. Analyses by flow cytometry revealed elevated levels of most of the assessed adhesion molecules on surfaces of lymphocytes, monocytes, and granulocytes. Expression of the adhesion receptor antigens CD11a on lymphocytes, CD11b on monocytes, and CD18 on granulocytes were unaffected. Workers exposed to styrene had decreased concentrations of sICAM-1 and no changes in concentrations of sL-selectin. Styrene exposure appears to increase activation of the immune system and alter leukocyte adherence. This interaction is a critical first step in immune stimulation and leukocyte-endothelial interaction.

Allergenicity testing of supermethrin, phenoxyacetic acid and DNCB using in vivo and in vitro modifications of the local lymph node assays, maximization and epicutaneous testing

The purpose of this study was to compare two methods of testing for allergenicity: in vivo and in vitro modifications of local lymph node assays (LLNA) in mice and the maximization and epicutaneous skin tests in guinea pigs as per the Organization for Economic Cooperation and Development (1981). Two pesticides-the synthetic pyrethroid insecticide supermethrin (SM) and the herbicide phenoxyacetic acid (PAA)-were evaluated using this testing battery. 1-Chloro-2,4-dinitrobenzene (DNCB) was selected as a reference allergen for the local lymph node assay. In vitro modification of LLNA proliferative response per standard cell count in lymphocyte cultures derived from treated Balb/c mice did not differ from control mice. Results of the in vivo modification showed that treatment with 50% PAA and 50% SM resulted in a lower proliferation response of lymphocytes in lymph nodes compared with control animals. The vigour of the proliferative response varied more in in vivo modification of LLNA. Stimulation indices were <3, so PAA and SM did not indicate classification as allergens. Lymphocyte proliferation in 1% DNCB-activated lymph nodes was approximately fivefold higher than in those derived from control mice. Proliferation response in vitro calculated as stimulation index was higher in DNCB-treated mice than those observed in vivo, but differences were not dramatic. Auricular lymph node weight and cellularity in mice treated with PAA and SM were similar to controls. The DNCB stimulation index for lymph node cellularity was 5.5. Lymph node weight was three times higher in comparison with controls. In the maximization test in guinea pigs SM and PAA acid resulted in 40% and 50% of animals demonstrating sensitization, respectively. Epicutaneous administration resulted in weaker reaction. Both SM and PAA are mildly strong sensitizers by this battery.

Epidemiology of occupational injuries and illnesses in a university population: a focus on age and gender differences

BACKGROUND

Occupational injuries and illnesses are a major preventable public health problem.

METHODS

This study evaluated the incidence, nature, and cause of awarded workers' compensation claims for a large state university and teaching hospital. Rates and types of injury were compared across age and gender.

RESULTS

Rates of injury varied over twofold with age, with those 16-25 having the lowest rates of injury and those 36-45 having the highest rates. Claims rates were 1.36-fold higher for women than men. Women had higher rates for injury resulting from lifting, falling, noxious exposures, repetitive motion, and carpal tunnel syndrome. Similarly women had significantly higher rates of claims for pain, sprains, bruises, burns, concussion, and inhalation injury; with lower rates of cuts, ligament injury, and jammed joints.

CONCLUSIONS

These group differences suggest the need to examine age and gender job distributions and relevant ergonomic and environmental causative factors.

Changes in cellular immunity among workers occupationally exposed to styrene in a plastics lamination plant

BACKGROUND

Styrene is a widely used industrial chemical. Immune and hematological parameters were examined in 29 hand laminators and sprayers exposed to styrene for an average of 14 years and in 19 in-factory unexposed controls. The workers performed hand lamination procedures in a production area with an average area airborne styrene level of 139.5 mg/m(3). Mean concentration of styrene in the blood of exposed workers was 945.7 microg/L and the mean styrene in exhaled air was 38.8 microg/L.

METHODS

Parameters of internal and external exposure, immune function assays, immunoglobulins, acute phase reactants and hematology were evaluated in exposed and non-exposed populations.

RESULTS

Using multifactorial analysis of variance we found a significant decrease in proliferation of lymphocytes stimulated by Concanavalin A but not by pokeweed mitogen (PWM) in workers occupationally exposed to styrene. Proliferative response to PWM was significantly correlated with the levels of styrene in blood. Phagocytic activity of monocytes, levels of IgG, IgA, IgM, IgE and alpha-2-macroglobulin in serum were indistinguishable in the two groups. The population exposed to styrene had increased levels of C4-component of complement. Levels of C3-component of complement were positively correlated with duration of exposure. A significant elevation in the percentage and number of monocytes and a significantly decreased number of lymphocytes were seen in exposed workers. Styrene concentrations in both blood and exhaled air were associated with decreased percentage of large granular lymphocytes.

CONCLUSIONS

These results suggest immune alterations of cell-mediated immune response of T-lymphocytes and imbalance in leucocyte subsets in peripheral blood of workers exposed to styrene.

Marked elevation of urinary zinc levels and pleural-friction rub in metal fume fever

Zinc fume is a well-recognized cause of metal fume fever, characterized by acute or subacute symptoms of respiratory tract inflammation, myalgias and fever (similar to influenza) associated with a variety of metal oxide fumes. A welder of galvanized steel developed metal fume fever, a pleural friction rub and markedly elevated urinary zinc excretion despite work-site surveillance data indicating exposures close to the Occupational Safety and Health Administration, Permissible Exposure Limit. This patient suggests that exposure data may be misleading. This case had the highest urine zinc levels reported in the literature and a previously unreported coexistent pleural friction rub. The symptoms resolved with administrative and engineering controls to decrease exposure.

Factors associated with adequacy of diagnostic workup after abnormal breast cancer screening results

BACKGROUND

Women with certain characteristics, such as those residing in rural areas, are less likely screened for breast cancer. To enhance detection of early breast cancer, it is imperative that all women who have abnormal screening results receive appropriate diagnostic procedures. This study reports differences in receipt of diagnostic services following abnormal screening results.

METHODS

Screening and diagnostic data were collected as part of a breast and cervical cancer early detection program aimed at reaching women of lower socioeconomic status. Women with completed diagnostic information after having abnormal screening results were included. We based adequacy of diagnostic services on guidelines from the Society for Surgical Oncology, The Commission on Cancer of the American College of Surgeons, and the Centers for Disease Control and Prevention. Several factors were assessed for their association with adequacy of diagnostic follow-up: income, age, race, education, health insurance status, rural-urban residence, reported breast lump, family history of breast cancer, and clinical beast examination or mammogram results.

RESULTS

Overall, 14.1% of the 351 abnormal findings were considered inadequately followed up based on the algorithm used. Eighty percent involved an abnormal finding on a clinical breast examination regardless of the mammogram results. Rural women, those with abnormal clinical breast examination findings but normal or equivocal findings on mammograms, and those who self-discovered a mass were less likely to receive adequate follow-up than were their counterparts in multivariate analysis. Rural women were less likely to receive a biopsy or fine-needle aspiration, although it was indicated. One facility accounted for most of the inadequate follow-up screenings among urban women.

CONCLUSIONS

Women who have specific demographic and clinical characteristics were less likely to have received adequate diagnostic services. Breast cancers could have been missed initially as a result of inappropriate follow-up. Further investigation of the clinical scenarios using chart reviews is warranted.

Lead contamination of imported candy wrappers

Lead toxicity in a young Hispanic woman from sucking on a terra cotta candy container led to investigating lead contamination in candy packaging materials imported from Mexico. Printed cellophane candy wrappers may present a significant risk for lead exposure.

Use of the capture-recapture method to estimate severe traumatic brain injury rates

OBJECTIVE

This study assessed the applicability of using three different data sources (hospital discharge data, Traumatic Brain Injury Registry data, and death certificates) to identify high-risk groups for traumatic brain injuries (TBI). Reporting biases were also addressed.

METHODS

Linkage of the data sources and log-linear modelling in conjunction with the capture-recapture method was used to estimate the number of missing TBI. Biased reporting to each data source was assessed by using the total number of estimated TBI by age and sex.

RESULTS

An estimated 2% of TBI that occurred in Iowa were not reported to any of the data sources. Overall, women 85 years old and older were more likely to be missed by the combined data sources. Males and those of advanced age were less likely to be reported to the Registry. By using the capture-recapture method, falls among the elderly were found to be a significant public health problem in Iowa.

CONCLUSION

Despite biased reporting to the three data sources, the capture-recapture method can be used to identify high-risk groups for TBI in Iowa.

Functional status following traumatic brain injuries: population-based rural-urban differences

Many studies have described functional outcomes following traumatic brain injury (TBI), but few have attempted to contrast differences in functional status and receipt of services of persons residing in rural and urban counties. Persons hospitalized with TBI completed a self-administered survey 1-1.5 years after their injury. Survivors of TBI in rural areas were more likely to be functionally dependent and reported a lower health status than their urban counterparts. Additionally, those who did not receive any TBI-related services but perceived an additional service need were more likely to be functionally dependent than those who received services and did not perceive any additional need. Perceived service needs of those functionally dependent are described. Further investigations into this rural-urban difference are warranted to maximize functional status following TBI for all individuals.

Biomonitoring of occupational exposure to styrene in a plastics lamination plant

A comprehensive approach to biological monitoring of 44 workers occupationally exposed to styrene in a hand lamination plant was performed by using several end-points: styrene in workplace air, styrene in exhaled air, styrene in blood, DNA strand breaks (SBs) and oxidised bases in mononuclear leukocytes, chromosomal aberrations in lymphocytes, immune parameters and genotyping of polymorphic genes of some xenobiotic-metabolizing enzymes (CYP 1A1, EPHX, GSTM1 and GSTP1). We found a significantly higher number of DNA SBs, measured by a modified comet assay, in mononuclear leukocytes of the styrene-exposed workers compared with results from 19 unexposed controls (P<0.001). A fairly strong correlation was observed between SBs and years of exposure (P<0.001, r=0.545). The styrene-exposed workers also showed a significantly increased frequency of chromosomal aberrations (P<0.0001 for highly exposed group, P<0.004 for medium-exposed group, and P=0.0001 for low-exposed group). The proliferative response of T-lymphocytes stimulated with concanavalin A was significantly suppressed in people exposed to styrene (P<0.05). We recorded a significant increase of the percentage of monocytes in differential white blood cell counts in the exposed group (P<0.05). Using flow cytometry, we found an increased expression of adhesion molecules CD62L, CD18, CD11a, CD11b, CD49d and CD54 in the exposed workers as compared with the control group (P<0.05).

Urticaria due to airborne permethrin exposure

Although naturally derived pyrethrins are well recognized sensitizers, there is currently some degree of controversy regarding the sensitizing potential of synthetic pyrethroids. The literature is briefly reviewed, and an outbreak of several cases of urticaria occurring in children from 1 household and associated with airborne exposure to permethrin is reported.

Surveillance and epidemiology of occupational pesticide poisonings on banana plantations in Costa Rica

A review of one year's workers' compensation records from the Costa Rican National Insurance Institute was performed in a banana plantation region to determine rates of and risk factors for agrichemical poisonings. Review of 9,060 medical records revealed that the most commonly reported agrichemical-related injuries (n=800) were chemical burns (28%) and acute intoxications (21%). Other agrichemical-related injuries included eye injuries, chemical dermatoses, and chronic fungal infections. The incidences and types of injuries differed between male and female workers and workers of different age groups. Older female workers were more likely to report chemical dermatoses. Young male workers were more likely to experience acute intoxication. These differences seem to be attributable to divisions of labor by gender and age among plantation workers.

Association between female infertility and agricultural work history

Lifetime industrial and occupational histories of women with a medically-confirmed diagnosis of infertility (n = 281) were compared to a group of postpartum women (n = 216) for risks of infertility. Controlling for age of first pregnancy or self-report of infertility, date of outcome, cigarette use, and employment in other types of industries, women were at increased risk of infertility if they had worked in industries associated with agriculture (OR = 7.0, 95% CI 2.3-20.8; cases = 11.7%, controls = 1.9%). Among the occupations in which women worked prior to outcome, only those in agriculture were at significantly elevated risk (adj. OR = 11.3, CI 2.6-48.8; cases = 10.0%, controls = 0.9%). Among those who resided on a farm, the risk of infertility was significantly increased (adj. OR = 1.8, CI 1.2-2.7; cases = 37.4%, controls = 25.8%) although yearly duration of farm residence was not (adj. OR = 0.99, CI 0.95-1.03). Farm residence did not alter the OR seen in agricultural industries or occupations. The risk of being diagnosed with an ovulatory or tubal factor increased 4-16-fold among those who had worked in agricultural industries or occupations. These data suggest that, as has been established in men, agriculturally-related exposures may be a significant risk for infertility in women.

Occupational exposures and risk of female infertility

This study examined the association between occupational chemical and radiation exposures and risk of medically diagnosed infertility in 281 women compared with 216 fertile women. After adjustment for age and exposures that occurred before case/referent ascertainment, there was an increased risk of infertility among those women exposed to volatile organic solvents (odds ratio [OR], 1.74; 95% confidence interval [CI], 1.11 to 2.71), chemical dusts (OR, 2.66; CI, 1.17 to 6.05), pesticides (OR, 3.02; CI, 1.10 to 8.29), and video display terminals (OR, 2.21, CI, 1.22, to 4.01). Among the medically diagnosed causes of infertility, the adjusted risk associated with having an ovulatory factor increased among those women exposed to solvents (OR, 1.75; CI, 1.03 to 2.98), dusts (OR, 3.00; CI, 1.19 to 7.52), or pesticides (OR, 3.82; 1.28 to 11.42). Solvents and dusts also were associated with a higher risk of tubal-factor infertility (solvents; OR, 1.95; CI, 1.08 to 3.52; dusts: OR, 2.87; CI, 1.05 to 7.88) and endometriosis (solvents: OR, 2.13; CI, 0.96 to 4.72; dusts: OR, 3.63; CI, 0.99 to 13.28). Video display terminal exposure was more likely to be found among those women diagnosed with endometriosis (OR, 3.69; CI, 1.50 to 9.13) and cervical-factor infertility (OR, 2.65; CI, 0.99 to 7.12). Results suggest that among women with a medically confirmed diagnosis, fertility may be adversely affected by a variety of occupational chemical exposures.

Method to electronically collect emergency department data

STUDY OBJECTIVE

To describe the development and completeness of an electronic injury-surveillance system, the Rural Injury Surveillance System (RISS).

METHODS

The emergency departments of nine rural Iowa hospitals submitted information on all patients treated from May 1993 through June 1994.

RESULTS

The EDs submitted information on 23,594 patients with 32,445 different injury, disease, or follow-up visits. On the basis of comparison with the handwritten ED logbook, 90% of visits were also available in the RISS. Of the visits recorded in the RISS, 99% were also recorded in the logbook. The proportion of missing diagnostic codes decreased from a high of 22.6% in May 1993 to 8.1% in June 1994. The proportion of missing external cause codes was about 25% at the end of the study period. The proportion of missing industry and occupational codes was less than 5% at the end of the study period.

CONCLUSION

Our findings show that complete, computerized, ED-based injury surveillance in rural EDs is possible and should be developed further.

Chronic arsenicalism suspected from arsine exposure: a case report and literature review

This report describes an unusual case of long-term arsenic exposure, apparently of industrial origin. The afflicted worker suffered from a complex of medical problems of sudden onset. Chemical (atomic absorption spectrometry, AAS) and physical (electron dispersion spectrometry, EDS) examination of the work environment showed long-term deposition of high levels of arsenic in a cleaning bath. When a new acidic cleaning solution was employed, elemental arsenic was apparently volatilized as arsine gas, resulting in sudden toxicity. Periodic reoccurrences of debilitation were explained by repeated use of the acid cleaning solution; each new application released a deeper layer of the metallic arsenic previously deposited on the bath walls electrolytically. The original source of the arsenic appears to have been prior cleaning of arsenic-contaminated agricultural spray equipment.

Acute respiratory fatality associated with exposure to sheet metal and cadmium fumes

The authors report on a case of an acute fatality characterized by abdominal pain and respiratory failure occurring soon after beginning to weld and solder galvanized sheet metal. Heating of galvanized sheet metal is a recognized cause of metal fume fever, data from this patient suggests an additional and unrecognized risk for cadmium poisoning.

A sick house syndrome, possibly resulting from a landfill geologic effluvia

A novel indoor air quality investigation was associated with carbon dioxide and methane accumulation, presumably from effluvia from geologic sources. Each of 6 workers in an office building complained of respiratory symptoms, and of difficulty with memory and concentration in the workplace, a tightly-sealed structure under negative pressure. No single contaminant was identified to explain the clinical syndromes. No detectable levels of carbon monoxide, methyl ethyl ketone, formaldehyde, ozone, carbon disulfide, nitric oxide, ethylene oxide, ammonia, aldehydes, trichloroethylene or similar chlorinated compounds were found. Carbon dioxide and methane were both present at above ambient outdoor air concentrations. Carbon dioxide was documented to accumulate over a weekend with no occupants in the building, suggesting a geologic source.

Leukemia incidence and radioactivity in drinking water in 59 Iowa towns

Fifty-nine towns in Iowa with single source drinking water supplies were stratified on the basis of radium content in finished non-softened water to test the hypothesis of an association with total or acute myeloid leukemia. Fourteen towns had radium concentrations in drinking water exceeding the EPA safety limit of 5 picocuries per liter (pCi/L). A small increasing trend existed for total leukemia with increased radium content in drinking water that is in accordance with either the hypothesis of no effect or of a small effect.

An outbreak of acute histoplasmosis in a family

Acute pulmonary histoplasmosis was diagnosed in three members of a New Mexico family that had recently attended a family reunion in Iowa. The treating physicians rapidly documented an outbreak of atypical pneumonia in the family. The clinical features and epidemiology of the outbreak suggest histoplasmosis was contracted during exposure in an abandoned barn. Fever, chills and myalgia were the most common symptoms; shortness of breath occurred frequently.

Arsenic poisoning. Ongoing diagnostic and social problem

Arsenic, commonly found in insecticides, herbicides, and industrial materials, is involved in the majority of heavy metal poisonings reported in the United States. Accidental poisoning appears to be most common in the pediatric age-group, whereas intentional and covert poisonings predominate in adults. Diagnosis is often difficult. The clinical presentations of arsenic poisoning, both acute and chronic types, represent a wide spectrum, largely dependent on route of exposure, chemical form, and dose. Because the patient or others providing the history may suppress information on exposure and because toxic levels of arsenic in the system drop rapidly in the first 24 hours, swift administration of diagnostic tests is important. Physician follow-up is determined by the route of exposure to arsenic and may involve referral to a social service network or a mental health facility.

Occupational disease surveillance data sources, 1985

Health department epidemiologists in 50 states, New York City, and the District of Columbia were surveyed in 1985 about seven potential data sources for occupational disease surveillance. Reported sources of occupational disease data were: automated workers' compensation claims (63 per cent of the 52 respondents); provider reports (62 per cent); death certificates with occupation or industry (60 per cent); cancer registries with occupational histories (35 per cent); birth certificates with parent's occupation (27 per cent); non-cancer disease registries (13 per cent); and hospital or insurance records (8 per cent).