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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Mihaicuta S, Udrescu L, Militaru A, Nadasan V, Tiotiu A, Bikov A, Ursoniu S, Birza R, Popa AM, Frent S. Multivariate analysis and data mining help predict asthma exacerbations. J Asthma 2024; 61:608-618. [PMID: 38112563 DOI: 10.1080/02770903.2023.2297366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 12/16/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Work-related asthma has become a highly prevalent occupational lung disorder. OBJECTIVE Our study aims to evaluate occupational exposure as a predictor for asthma exacerbation. METHOD We performed a retrospective evaluation of 584 consecutive patients diagnosed and treated for asthma between October 2017 and December 2019 in four clinics from Western Romania. We evaluated the enrolled patients for their asthma control level by employing the Asthma Control Test (ACT < 20 represents uncontrolled asthma), the medical record of asthma exacerbations, occupational exposure, and lung function (i.e. spirometry). Then, we used statistical and data mining methods to explore the most important predictors for asthma exacerbations. RESULTS We identified essential predictors by calculating the odds ratios (OR) for the exacerbation in a logistic regression model. The average age was 45.42 ± 11.74 years (19-85 years), and 422 (72.26%) participants were females. 42.97% of participants had exacerbations in the past year, and 31.16% had a history of occupational exposure. In a multivariate model analysis adjusted for age and gender, the most important predictors for exacerbation were uncontrolled asthma (OR 4.79, p < .001), occupational exposure (OR 4.65, p < .001), and lung function impairment (FEV1 < 80%) (OR 1.15, p = .011). The ensemble machine learning experiments on combined patient features harnessed by our data mining approach reveal that the best predictor is professional exposure, followed by ACT. CONCLUSIONS Machine learning ensemble methods and statistical analysis concordantly indicate that occupational exposure and ACT < 20 are strong predictors for asthma exacerbation.
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Affiliation(s)
- Stefan Mihaicuta
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, Department of Pulmonology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Lucretia Udrescu
- Department I-Drug Analysis, Faculty of Pharmacy, "Victor Babes" University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Adrian Militaru
- Department of Computer and Information Technology, Politehnica University Timisoara, Timisoara, Romania
| | - Valentin Nadasan
- Department of Hygiene, "G.E. Palade" University of Medicine, Pharmacy, Science and Technology of Targu Mures, Targu Mures, Romania
| | - Angelica Tiotiu
- Department of Pulmonology, Nancy University Hospital, Nancy, France
| | - Andras Bikov
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Division of Infection, Immunity & Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Sorin Ursoniu
- Department of Public Health and Health Management, "Victor Babes" University of Medicine and Pharmacy Timisoara, Timisoara, Romania
- Center for Translational Research and Systems Medicine, Timisoara, Romania
| | - Romina Birza
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, Department of Pulmonology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Alina Mirela Popa
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, Department of Pulmonology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Stefan Frent
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, Department of Pulmonology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Timisoara, Romania
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Blouin C, Lemière C. Recent developments in occupational asthma. Curr Opin Pulm Med 2024; 30:281-286. [PMID: 38415698 DOI: 10.1097/mcp.0000000000001062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
PURPOSE OF REVIEW Occupational asthma (OA) is a complex condition that can be difficult to diagnose. The purpose of this review is to describe some recent findings regarding the epidemiology of OA, the occupational sensitizing agents, the prognosis of OA, and its primary prevention. RECENT FINDINGS The risk of developing OA varies according to the geographic localization of the worker, the type of industry and the type of sensitizing agents. New findings have been reported for several known sensitizing agents, such as isocyanates, seafood & cleaning agents, and their related industries, such as hairdressing salons and schools. Moreover, a few new sensitizing agents, such as cannabis, have been identified in the past few years. The prognosis of OA seems worse than that of nonwork-related asthma. It is mainly determined by the duration and the level of exposure. Primary prevention is crucial to reduce the number of new cases of OA. Complete avoidance of exposure to the causal agent remains the optimal treatment of sensitizer-induced OA. SUMMARY Improving our knowledge regarding OA and its causative agents is key to enable an early recognition of this condition and improve its prognosis. Further research is still needed to improve primary prevention.
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Affiliation(s)
- Claudia Blouin
- CIUSSS du Nord de l'île de Montréal
- Université de Montréal, Montréal, QC Canada
| | - Catherine Lemière
- CIUSSS du Nord de l'île de Montréal
- Université de Montréal, Montréal, QC Canada
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Migueres N, Vandenplas O, Walusiak-Skorupa J, Wiszniewska M, Munoz X, Romero-Mesones C, Suojalehto H, Lindström I, van Kampen V, Merget R, Mason P, Maestrelli P, Sastre J, Quirce S, Rifflart C, Godet J, de Blay F. Sputum Inflammatory Patterns Are Associated With Distinct Clinical Characteristics in Patients with Occupational Asthma Independently of the Causal Agent. J Investig Allergol Clin Immunol 2024; 34:85-96. [PMID: 36377541 DOI: 10.18176/jiaci.0868] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Background: Clinical heterogeneity in sensitizer-induced occupational asthma (OA) and its relationship to airway inflammatory profiles remain poorly elucidated. Objectives: To further characterize interactions between induced sputum inflammatory patterns, asthma-related outcomes, and the high- or low-molecular-weight category of causal agents in a large cohort of patients with OA. METHODS We conducted a multicenter, retrospective, cross-sectional study of 296 patients with OA confirmed by a positive specific inhalation challenge who completed induced sputum assessment before and 24 hours after challenge exposure. RESULTS Multivariate logistic regression analysis revealed that sputum eosinophilia ≥3% was significantly associated with a high dose of inhaled corticosteroid (OR [95%CI], 1.31 [1.11 1.55] for each 250-μg increment in daily dose), short-acting ß2-agonist use less than once a day (3.54 [1.82-7.00]), and the level of baseline nonspecific bronchial hyperresponsiveness (mild, 2.48 [1.21-5.08]; moderate/severe, 3.40 [1.44-8.29]). Sputum neutrophilia ≥76% was associated with age (1.06 [1.01-1.11]), male sex (3.34 [1.29-9.99]), absence of corticosteroid use (5.47 [2.09-15.16]), use of short-acting ß2-agonists once or more a day (4.09 [1.71-10.01]), ≥2 severe exacerbations during the previous 12 months at work (4.22 [1.14-14.99]), and isolated early reactions during the specific inhalation challenge (4.45 [1.85-11.59]). CONCLUSIONS The findings indicate that sputum inflammatory patterns in patients with OA are associated with distinct phenotypic characteristics and further highlight the differential effects of neutrophils and eosinophils on asthma-related outcomes. These associations between inflammatory patterns and clinical characteristics share broad similarities with findings reported in nonoccupational asthma and are not related to the type of causal agent.
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Affiliation(s)
- N Migueres
- Division of Pulmonology, Department of Chest Diseases, University Hospital of Strasbourg, Strasbourg University, Strasbourg, France
- UMR 7357 Laboratoire des sciences de l´ingénieur, de l´informatique et de l´imagerie ICUBE, Strasbourg, France
| | - O Vandenplas
- Service de Pneumologie, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - J Walusiak-Skorupa
- Department of Occupational Diseases and Environmental Health, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - M Wiszniewska
- Department of Occupational Diseases and Environmental Health, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - X Munoz
- Servei Pneumologia, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - C Romero-Mesones
- Servei Pneumologia, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - H Suojalehto
- Occcupational Health, Finnish Institute of Occupational Health, Helsinki, Finland
| | - I Lindström
- Occcupational Health, Finnish Institute of Occupational Health, Helsinki, Finland
| | - V van Kampen
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (IPA), Ruhr University, Bochum, Germany
| | - R Merget
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (IPA), Ruhr University, Bochum, Germany
| | - P Mason
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - P Maestrelli
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - J Sastre
- Department of Allergy, Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - S Quirce
- Department of Allergy, La Paz University Hospital, Madrid, Spain
| | - C Rifflart
- Service de Pneumologie, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - J Godet
- UMR 7357 Laboratoire des sciences de l´ingénieur, de l´informatique et de l´imagerie ICUBE, Strasbourg, France
- Groupe Méthode Recherche Clinique, Pôle de Santé Publique, Strasbourg University, Strasbourg, France
| | - F de Blay
- Division of Pulmonology, Department of Chest Diseases, University Hospital of Strasbourg, Strasbourg University, Strasbourg, France
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Mason P, Biasioli M, Liviero F. Endotypes of occupational asthma. Curr Opin Allergy Clin Immunol 2024; 24:58-63. [PMID: 38295127 PMCID: PMC10916750 DOI: 10.1097/aci.0000000000000969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
PURPOSE OF REVIEW To describe recent findings in endotyping occupational asthma by addressing the role of specific biomarkers. RECENT FINDINGS Studies on occupational asthma endotypes have focused on immune and inflammatory patterns associated with different occupational exposures to sensitizers or irritants.Sputum neutrophilia has been found in 58.5% patients with occupational asthma caused by high molecular weight (HMW) agents, and work-related dysphonia in patients with occupational asthma was described as associated with sputum neutrophilia too. Neutrophils have been associated also with irritant-induced asthma. The measurement of specific IgE has been confirmed as a valuable diagnostic tool in occupational asthma caused by HMW agents, on the contrary, for most low-molecular-weight agents, the presence of specific IgE has been proven in a small subset of affected workers. Fractional exhaled nitric oxide has been confirmed as a marker of type 2 (T2) inflammation in occupational asthma, mostly when induced by HMW agents (e.g. flour), and it has proved to be more sensitive than spirometry in measuring the efficacy of an intervention.MicroRNA-155 has been shown to contribute to airway inflammation in occupational asthma induced by toluene diisocyanate. SUMMARY Occupational asthma is heterogeneous, thus monitoring multiple biomarkers is crucial to understand, which inflammatory responses are prevalent.
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Affiliation(s)
- Paola Mason
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
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Suojalehto H, Lindström I. Long-term outcome of occupational asthma with different etiology. Curr Opin Allergy Clin Immunol 2024; 24:64-68. [PMID: 38126800 DOI: 10.1097/aci.0000000000000962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
PURPOSE OF REVIEW This review summarizes the recent literature on the long-term outcome of sensitizer-induced and irritant-induced occupational asthma. RECENT FINDINGS Recent studies of sensitizer-induced occupational asthma show that after the offending exposure has ceased, most patients report at least partial relief of symptoms. However, in the long term, the diagnosis may negatively impact their careers, incomes, and quality of life. The studies also offer new insights into diisocyanate-induced occupational asthma phenotypes and asthma remission rates. One third of these cases were in remission in long-term after reduction or cessation of exposure. The long-term prognosis of irritant-induced occupational asthma was demonstrated to be poorer than sensitizer-induced occupational asthma. Older age, low fractional exhaled nitric oxide levels and uncontrolled asthma at the time of diagnosis predicted uncontrolled asthma in the long term in patients with irritant and low-molecular-weight sensitizer induced occupational asthma. SUMMARY Recent studies provide further evidence of the long-term outcome of different occupational asthma phenotypes and the factors that affect them. These findings help us identify patients at risk of poor asthma outcomes, who need close monitoring and support. It should also be borne in mind that occupational asthma diagnosis may have wider-ranging negative impacts on patients' lives.
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Affiliation(s)
- Hille Suojalehto
- Occupational Medicine, Finnish Institute of Occupational Health, Finland
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Heederik D, van Rooy F. Update on occupational allergy, including asthma, to soluble platinum salts. Curr Opin Allergy Clin Immunol 2024; 24:69-72. [PMID: 38359103 PMCID: PMC10906205 DOI: 10.1097/aci.0000000000000963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
PURPOSE OF REVIEW This review aims to evaluate recent literature on occupational platinum salt exposure and allergy and asthma in the context of existing evidence. RECENT FINDINGS A major recent development is that large quantitative platinum salt exposure datasets have become available and are finding applications in epidemiological studies. These exposure data are expected to lead to higher quality epidemiological studies focusing on exposure response relations, modifiers of exposure and sensitization risk. The exposure data might also improve medical referral advice as part of medical surveillance studies and contribute to improved evidence on the effectiveness of exposure referral. SUMMARY Hopefully, the availability of exposure databases form a stimulus for more exposure response studies and risk assessments leading to science based primary prevention approaches. The availability of more detailed exposure data can guide job transfer decisions in occupational clinical practice.
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Affiliation(s)
- Dick Heederik
- Institute for Risk Assessment Sciences, Division of Environmental Allergy
| | - Frits van Rooy
- Arbounie, Expert Center for Chemical Risk Management, Utrecht, The Netherlands
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Chan FL, Lipszyc J, Dekoven B, Nguyen V, Ribeiro M, Tarlo SM. Occupational asthma in Ontario, Canada (2000-2022): A retrospective, clinic-based study evaluating sex differences. The Journal of Allergy and Clinical Immunology: In Practice 2024; 12:1073-1076.e2. [PMID: 38307206 DOI: 10.1016/j.jaip.2024.01.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 12/28/2023] [Accepted: 01/23/2024] [Indexed: 02/04/2024]
Affiliation(s)
- Felix L Chan
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Joshua Lipszyc
- Department of Family and Community Medicine, Faculty of Medicine, Toronto, Ontario, Canada
| | - Ben Dekoven
- Schulich School of Medicine, Western University, London, Ontario, Canada
| | - Victor Nguyen
- Human Biology Program, Faculty of Arts and Science, University of Toronto, Toronto, Ontario, Canada
| | - Marcos Ribeiro
- Section of Pulmonology, Department of Medicine, Health Science Centre, State University of Londrina, Parana, Brazil
| | - Susan M Tarlo
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Gage Occupational and Environmental Health Unit, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Respiratory Division, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; Centre for Research Expertise in Occupational Diseases, St. Michael's Hospital, Toronto, Ontario, Canada.
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Gaddour A, Chatti S, Chouchene A, Kacem I, Bouhoula M, Aloui A, Marnaoui M, Maoua M, Brahem A, Kalboussi H, El Maalel O, Mrizek N. [An epidemiological and evolutionary profile of occupational asthma of Tunisian workers]. Rev Mal Respir 2024; 41:227-236. [PMID: 38429194 DOI: 10.1016/j.rmr.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 12/16/2023] [Indexed: 03/03/2024]
Abstract
INTRODUCTION This study aims to identify the epidemiological and occupational characteristics of patients with occupational asthma (OA) and to assess their clinical evolution and occupational outcomes. METHODS We carried out a descriptive epidemiological study over a period of five years (from 2012 to 2016) about the OA cases in the private sector reported in the Tunisian region of Zaghouan. RESULTS All in all, 165 OA cases were reported during the study period, representing an annual incidence of 733.3 cases per 1,000,000 workers in the private sector. Our study population was composed predominantly (85.5%) of women, whose mean age was 41.5±6.8years. More than three quarters of the affected persons were working in the automobile industry, and most illnesses (77%) were attributable to isocyanates. The mean time to onset of the respiratory symptoms was longer for low molecular weight agents (13.6±3.1years) compared to high molecular weight agents (12.0±3.9years) (P=0.0006). The majority of OA cases (66.7%) lost their jobs. Job loss was significantly more frequent among asthmatic women and workers with OA due to isocyanates. Among the 62 cases of OA for whom risk factors were eliminated, 45 nonetheless remained symptomatic. CONCLUSION Effective prevention strategies involving the various actors need to be implemented in work environments so as to reduce the frequency and the medico-legal repercussions of a disabling condition.
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Affiliation(s)
- A Gaddour
- Département de médecine de travail, faculté de médecine de Sousse, université de Sousse, Sousse, Tunisie; Service de médecine de travail et pathologies professionnelles, hôpital universitaire Ibn El Jazzar, Kairouan, Tunisie.
| | - S Chatti
- Département de médecine de travail, faculté de médecine de Sousse, université de Sousse, Sousse, Tunisie; Service de médecine de travail et pathologies professionnelles, hôpital universitaire Farhat Hached, Sousse, Tunisie
| | - A Chouchene
- Département de médecine de travail, faculté de médecine de Sousse, université de Sousse, Sousse, Tunisie; Service de médecine de travail et pathologies professionnelles, hôpital universitaire Farhat Hached, Sousse, Tunisie
| | - I Kacem
- Département de médecine de travail, faculté de médecine de Sousse, université de Sousse, Sousse, Tunisie; Service de médecine de travail et pathologies professionnelles, hôpital universitaire Farhat Hached, Sousse, Tunisie
| | - M Bouhoula
- Département de médecine de travail, faculté de médecine de Sousse, université de Sousse, Sousse, Tunisie; Service de médecine de travail et pathologies professionnelles, hôpital universitaire Farhat Hached, Sousse, Tunisie
| | - A Aloui
- Département de médecine de travail, faculté de médecine de Sousse, université de Sousse, Sousse, Tunisie; Service de médecine de travail et pathologies professionnelles, hôpital universitaire Farhat Hached, Sousse, Tunisie
| | - M Marnaoui
- Inspection médicale de travail, Zaghouan, Tunisie
| | - M Maoua
- Département de médecine de travail, faculté de médecine de Sousse, université de Sousse, Sousse, Tunisie; Service de médecine de travail et pathologies professionnelles, hôpital universitaire Farhat Hached, Sousse, Tunisie
| | - A Brahem
- Département de médecine de travail, faculté de médecine de Sousse, université de Sousse, Sousse, Tunisie; Service de médecine de travail et pathologies professionnelles, hôpital universitaire Farhat Hached, Sousse, Tunisie
| | - H Kalboussi
- Département de médecine de travail, faculté de médecine de Sousse, université de Sousse, Sousse, Tunisie; Service de médecine de travail et pathologies professionnelles, hôpital universitaire Farhat Hached, Sousse, Tunisie
| | - O El Maalel
- Département de médecine de travail, faculté de médecine de Sousse, université de Sousse, Sousse, Tunisie; Service de médecine de travail et pathologies professionnelles, hôpital universitaire Farhat Hached, Sousse, Tunisie
| | - N Mrizek
- Département de médecine de travail, faculté de médecine de Sousse, université de Sousse, Sousse, Tunisie; Service de médecine de travail et pathologies professionnelles, hôpital universitaire Farhat Hached, Sousse, Tunisie
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Pemberton MA, Arts JH, Kimber I. Identification of true chemical respiratory allergens: Current status, limitations and recommendations. Regul Toxicol Pharmacol 2024; 147:105568. [PMID: 38228280 DOI: 10.1016/j.yrtph.2024.105568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 01/06/2024] [Accepted: 01/13/2024] [Indexed: 01/18/2024]
Abstract
Asthma in the workplace is an important occupational health issue. It comprises various subtypes: occupational asthma (OA; both allergic asthma and irritant-induced asthma) and work-exacerbated asthma (WEA). Current regulatory paradigms for the management of OA are not fit for purpose. There is therefore an important unmet need, for the purposes of both effective human health protection and appropriate and proportionate regulation, that sub-types of work-related asthma can be accurately identified and classified, and that chemical respiratory allergens that drive allergic asthma can be differentiated according to potency. In this article presently available strategies for the diagnosis and characterisation of asthma in the workplace are described and critically evaluated. These include human health studies, clinical investigations and experimental approaches (structure-activity relationships, assessments of chemical reactivity, experimental animal studies and in vitro methods). Each of these approaches has limitations with respect to providing a clear discrimination between OA and WEA, and between allergen-induced and irritant-induced asthma. Against this background the needs for improved characterisation of work-related asthma, in the context of more appropriate regulation is discussed.
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Affiliation(s)
| | | | - Ian Kimber
- Faculty of Biology, Medicine and Health, University of Manchester, UK
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Añibarro B, Feijoo L, de Las Cuevas N, Seoane FJ. Occupational asthma induced by fish exposure. Occup Med (Lond) 2023; 73:581-583. [PMID: 38016183 DOI: 10.1093/occmed/kqad127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023] Open
Abstract
Occupational asthma triggered by inhaling fish-derived aerosols is estimated to affect 2-8% of exposed individuals. This primarily affects workers in the fish processing industry. Fishmongers, rarely experience this issue, as recent research found no significant difference in asthma rates compared to a control group. We report the case of a fishmonger who presented with a 1-year history of rhinoconjunctivitis and asthma. The patient attributed these symptoms to his occupational exposure within the fish market environment, which worsened in the cold storage warehouse. Symptoms improved during holidays. Diagnosis involved skin-prick tests, sIgE (ImmunoCAP-specific IgE) measurements, and bronchial challenge tests, confirming occupational asthma from fish bioaerosol exposure. Parvalbumins, common fish proteins, share structural similarities, leading to cross-reactivity in fish allergy sufferers. In this case, sensitivity to rGad c1 (cod parvalbumin) was identified as the primary trigger for the patient's asthma, and responsible for sensitizations observed across various tested fish species.
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Affiliation(s)
- B Añibarro
- Allergy Unit, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain
| | - L Feijoo
- Allergy Unit, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain
| | - N de Las Cuevas
- Allergy Unit Hospital Universitario 12 de Octubre, Madrid, Spain
| | - F J Seoane
- Allergy Unit, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain
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Weaver VM, Hua JT, Fitzsimmons KM, Laing JR, Farah W, Hart A, Braegger TJ, Reid M, Weissman DN. Fatal Occupational Asthma in Cannabis Production - Massachusetts, 2022. MMWR Morb Mortal Wkly Rep 2023; 72:1257-1261. [PMID: 37971937 PMCID: PMC10684356 DOI: 10.15585/mmwr.mm7246a2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Multiple respiratory hazards have been identified in the cannabis cultivation and production industry, in which occupational asthma and work-related exacerbation of preexisting asthma have been reported. An employee working in a Massachusetts cannabis cultivation and processing facility experienced progressively worsening work-associated respiratory symptoms, which culminated in a fatal asthma attack in January 2022. This report represents findings of an Occupational Safety and Health Administration inspection, which included a worksite exposure assessment, coworker and next-of-kin interviews, medical record reviews, and collaboration with the Massachusetts Department of Public Health. Respiratory tract or skin symptoms were reported by four of 10 coworkers with similar job duties. Prevention is best achieved through a multifaceted approach, including controlling asthmagen exposures, such as cannabis dust, providing worker training, and conducting medical monitoring for occupational allergy. Evaluation of workers with new-onset or worsening asthma is essential, along with prompt diagnosis and medical management, which might include cessation of work and workers' compensation when relation to work exposures is identified. It is important to recognize that work in cannabis production is potentially causative.
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Romero-Mesones C, Cruz MJ, Alobid I, Barroso B, Arismendi E, Barranco P, Betancor D, Bobolea I, Cárdaba B, Curto E, Domenech G, Domínguez-Ortega J, Espejo D, González-Barcala FJ, Luna-Porta JA, Martínez-Rivera C, Méndez-Brea P, Mullol J, Olaguibel JM, Picado C, Plaza V, Del Pozo V, Quirce S, Rial MJ, Rodrigo-Muñoz JM, Sastre J, Serrano S, Soto-Retes L, Valero A, Valverde-Monge M, Munoz X. Disposition of Work-Related Asthma in a Spanish Asthma Cohort: Comparison of Asthma Severity Between Employed and Retired Workers. J Allergy Clin Immunol Pract 2023; 11:3407-3413.e1. [PMID: 37391017 DOI: 10.1016/j.jaip.2023.06.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Exposure to certain agents in the workplace can trigger occupational asthma or work-exacerbated asthma, both of which come under the heading of work-related asthma (WRA). Understanding the burden that WRA represents can help in the management of these patients. OBJECTIVE To assess the influence of occupation on asthma in real life and analyze the characteristics of patients with WRA included in an asthma cohort. METHODS This was a prospective multicenter study of a cohort of consecutive patients with asthma. A standardized clinical history was completed. Patients were classified as having WRA or non-WRA. All patients underwent respiratory function tests, FeNO test, and methacholine challenge (methacholine concentration that causes a 20% drop in FEV1) at the beginning of the study. They were classified into two groups, depending on their employment status: employed (group 1) or unemployed (group 2). RESULTS Of the 480 patients included in the cohort, 82 (17%) received the diagnosis of WRA. Fifty-seven patients (70%) were still working. Mean age (SD) was 46 (10.69) years in group 1 and 57 (9.91) years in group 2 (P < .0001). Significant differences were observed in adherence to treatment (64.9% in group 1 vs 88% in group 2; P = .0354) and in severe asthma exacerbations (35.7% in group 1 vs 0% in group 2; P = .0172). No significant differences were observed in the rest of the variables analyzed. CONCLUSIONS The burden of WRA in specialized asthma units is not negligible. The absence of differences in the severity of asthma, the treatment administered, alterations in lung function, and the number of exacerbations in those working versus not working may support the idea that advice regarding changing jobs should be customized for individual patients.
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Affiliation(s)
- Christian Romero-Mesones
- Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain; CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Maria-Jesus Cruz
- Servicio de Neumología. Hospital Universitario Vall d'Hebron, Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain; CIBER de Enfermedades Respiratorias, Madrid, Spain.
| | - Isam Alobid
- CIBER de Enfermedades Respiratorias, Madrid, Spain; Rhinology Unit and Smell Clinic, ENT Department, Hospital Clinic Barcelona, Universitat de Barcelona, Barcelona, Spain; Clinical and Experimental Respiratory Immunoallergy, Instituto de Investigaciones Biomédicas August Pi i Sunyer, Barcelona, Spain
| | - Blanca Barroso
- CIBER de Enfermedades Respiratorias, Madrid, Spain; Allergy Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Ebymar Arismendi
- CIBER de Enfermedades Respiratorias, Madrid, Spain; Allergy Unit and Severe Asthma Unit, Pneumonology and Allergy Department, Hospital Clínic, Instituto de Investigaciones Biomédicas August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Pilar Barranco
- CIBER de Enfermedades Respiratorias, Madrid, Spain; Department of Allergy, La Paz University Hospital, IdiPAZ, Madrid, Spain
| | - Diana Betancor
- CIBER de Enfermedades Respiratorias, Madrid, Spain; Allergy Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Irina Bobolea
- CIBER de Enfermedades Respiratorias, Madrid, Spain; Allergy Unit and Severe Asthma Unit, Pneumonology and Allergy Department, Hospital Clínic, Instituto de Investigaciones Biomédicas August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Blanca Cárdaba
- CIBER de Enfermedades Respiratorias, Madrid, Spain; Immunology Department, Instituto de Investigación Sanitaria Fundación Jiménez Díaz-Universidad Autónoma de Madrid, Madrid, Spain
| | - Elena Curto
- CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Gemma Domenech
- Medical Statistics Core Facility, Instituto de Investigaciones Biomédicas August Pi i Sunyer, Hospital Clinic Barcelona, Barcelona, Spain
| | - Javier Domínguez-Ortega
- CIBER de Enfermedades Respiratorias, Madrid, Spain; Department of Allergy, La Paz University Hospital, IdiPAZ, Madrid, Spain
| | - David Espejo
- Servicio de Neumología. Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | | | - Juan-Alberto Luna-Porta
- CIBER de Enfermedades Respiratorias, Madrid, Spain; Department of Allergy, La Paz University Hospital, IdiPAZ, Madrid, Spain
| | - Carlos Martínez-Rivera
- CIBER de Enfermedades Respiratorias, Madrid, Spain; Pulmonology Department, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona Badalona, Barcelona, Spain
| | - Paula Méndez-Brea
- Allergy Department, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
| | - Joaquim Mullol
- CIBER de Enfermedades Respiratorias, Madrid, Spain; Rhinology Unit and Smell Clinic, ENT Department, Clinical and Experimental Respiratory Immunoallergy (Instituto de Investigaciones Biomédicas August Pi i Sunyer), Universitat de Barcelona, Barcelona, Spain
| | | | - Cesar Picado
- Rhinology Unit and Smell Clinic, ENT Department, Hospital Clinic Barcelona, Universitat de Barcelona, Barcelona, Spain; Clinical and Experimental Respiratory Immunoallergy, Instituto de Investigaciones Biomédicas August Pi i Sunyer, Barcelona, Spain
| | - Vicente Plaza
- Servicio de Neumología y Alergia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Victoria Del Pozo
- CIBER de Enfermedades Respiratorias, Madrid, Spain; Immunology Department, Instituto de Investigación Sanitaria Fundación Jiménez Díaz-Universidad Autónoma de Madrid, Madrid, Spain
| | - Santiago Quirce
- CIBER de Enfermedades Respiratorias, Madrid, Spain; Department of Allergy, La Paz University Hospital, IdiPAZ, Madrid, Spain
| | - Manuel-Jorge Rial
- Allergy Department, Complexo Hospitalario Universitario, A Coruña, Spain
| | - José-María Rodrigo-Muñoz
- CIBER de Enfermedades Respiratorias, Madrid, Spain; Immunology Department, Instituto de Investigación Sanitaria Fundación Jiménez Díaz-Universidad Autónoma de Madrid, Madrid, Spain
| | - Joaquin Sastre
- CIBER de Enfermedades Respiratorias, Madrid, Spain; Allergy Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Sandra Serrano
- Medical Statistics Core Facility, Instituto de Investigaciones Biomédicas August Pi i Sunyer, Hospital Clinic Barcelona, Barcelona, Spain
| | - Lorena Soto-Retes
- Servicio de Neumología y Alergia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Antonio Valero
- CIBER de Enfermedades Respiratorias, Madrid, Spain; Allergy Unit and Severe Asthma Unit, Pneumonology and Allergy Department, Hospital Clínic, Instituto de Investigaciones Biomédicas August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Marcela Valverde-Monge
- CIBER de Enfermedades Respiratorias, Madrid, Spain; Allergy Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Xavier Munoz
- Servicio de Neumología. Hospital Universitario Vall d'Hebron, Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain; CIBER de Enfermedades Respiratorias, Madrid, Spain
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Doyen V, Kespohl S, Sohy C, Jadot I, Rifflart C, Thimpont J, de Lovinfosse S, Raulf M, Vandenplas O. Eosinophilic occupational asthma caused by padauk wood dust. J Allergy Clin Immunol Pract 2023; 11:3240-3241.e1. [PMID: 37352932 DOI: 10.1016/j.jaip.2023.06.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/12/2023] [Indexed: 06/25/2023]
Affiliation(s)
- Virginie Doyen
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - Sabine Kespohl
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany
| | - Carine Sohy
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - Ines Jadot
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - Catherine Rifflart
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - Joël Thimpont
- Service médical, Agence fédérale des risques professionnels-Federaal agentschap voor beroepsrisico's, Brussels, Belgium
| | | | - Monika Raulf
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany
| | - Olivier Vandenplas
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium; Service médical, Agence fédérale des risques professionnels-Federaal agentschap voor beroepsrisico's, Brussels, Belgium.
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15
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van Kampen V, Migueres N, Doyen V, Deckert A, de Blay F, Vandenplas O, Merget R. Phenotyping occupational asthma caused by platinum salts compared with other low-molecular weight agents. J Allergy Clin Immunol Pract 2023; 11:2929-2932.e2. [PMID: 37328060 DOI: 10.1016/j.jaip.2023.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/23/2023] [Accepted: 06/06/2023] [Indexed: 06/18/2023]
Affiliation(s)
- Vera van Kampen
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum, Bochum, Germany
| | - Nicolas Migueres
- Service de Pneumologie et Allergologie, Pôle de Pathologie Thoracique, University Hospital of Strasbourg, Strasbourg, France; UMR 7357 Laboratoire des Sciences de l'Ingénieur, de l'Informatique et de l'Imagerie ICUBE, Strasbourg University, Strasbourg, France
| | - Virginie Doyen
- Service de Pneumologie, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - Anja Deckert
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum, Bochum, Germany
| | - Frédéric de Blay
- Service de Pneumologie et Allergologie, Pôle de Pathologie Thoracique, University Hospital of Strasbourg, Strasbourg, France; EA 3072 Fédération de Médecine Translationnelle, Strasbourg University, Strasbourg, France
| | - Olivier Vandenplas
- Service de Pneumologie, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium.
| | - Rolf Merget
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum, Bochum, Germany
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16
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Lucas D, Vallet R, Kamga A, Obstler JB, Mialon P, Dewitte JD, Loddé B, Gourier G. Occupational asthma induced by exposure to celeriac. J Allergy Clin Immunol Pract 2022; 10:2754-2755. [PMID: 35803540 DOI: 10.1016/j.jaip.2022.06.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 06/15/2023]
Affiliation(s)
- David Lucas
- Department of Physiology, Orphy Laboratory, University of Brest, Brest, France; Department of Public Health and Research, Occupational Environmental and Maritime Diseases Center, University Hospital of Brest, France.
| | - Rachel Vallet
- Department of Occupational Health, Interprofessional Occupational Health Service Amiem, Lorient, France
| | - Audrey Kamga
- Department of Public Health and Research, Occupational Environmental and Maritime Diseases Center, University Hospital of Brest, France
| | - Jean-Baptiste Obstler
- Department of Pulmonary Diseases, Center for Pulmonary Diseases, South Quimper Clinical Hospital, Quimper, France
| | - Philippe Mialon
- Department of Pulmonary Function Testing and Exercise Physiology, University Hospital of Brest, Brest, France
| | - Jean-Dominique Dewitte
- Department of Public Health and Research, Occupational Environmental and Maritime Diseases Center, University Hospital of Brest, France
| | - Brice Loddé
- Department of Physiology, Orphy Laboratory, University of Brest, Brest, France; Department of Public Health and Research, Occupational Environmental and Maritime Diseases Center, University Hospital of Brest, France
| | - Greta Gourier
- Department of Public Health and Research, Occupational Environmental and Maritime Diseases Center, University Hospital of Brest, France
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Kongsupon N, Walters GI, Adab P, Jordan RE. Screening tools for work-related asthma and their diagnostic accuracy: a systematic review protocol. BMJ Open 2022; 12:e058054. [PMID: 36153029 PMCID: PMC9511564 DOI: 10.1136/bmjopen-2021-058054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Work-related asthma (WRA) refers to asthma caused by exposures at work (occupational asthma) and asthma made worse by work conditions (work-exacerbated asthma). WRA is common among working-age adults with asthma and impacts individual health, work-life and income but is often not detected by healthcare services. Earlier identification can lead to better health and employment outcomes. However, the optimal tool for screening and its effectiveness in practice is not well established. Screening tools may include whole questionnaires, questionnaire items, physiological measurements and/or immunological tests. Since the publication of the most contemporary WRA or occupational asthma-specific guidelines, further studies evaluating tools for identifying WRA have been performed. Our systematic review aims to summarise and compare the performance of screening tools for identifying WRA in both clinical and workplace settings. METHODS AND ANALYSIS We will conduct a systematic review of observational and experimental studies (1975-2021) using MEDLINE, EMBASE, CINAHL Plus, Web of Science, CDSR, DARE, HTA, CISDOC databases and grey literature. Two independent reviewers will screen the studies using predetermined criteria, extract data according to a schedule and assess study quality using the Quality Assessment of Diagnostic Test Accuracy 2 tool. Screening tools and test accuracy measures will be summarised. Paired forest plots and summary receiver operating characteristic curves of sensitivities and specificities will be evaluated for heterogeneity between studies, using subgroup analyses, where possible. If the studies are sufficiently homogenous, we will use a bivariate random effect model for meta-analysis. A narrative summary and interpretation will be provided if meta-analysis is not appropriate. ETHICS AND DISSEMINATION As this is a systematic review and does not involve primary data collection, formal ethical review is not required. We will disseminate our findings through open access peer-reviewed publication as well as through other academic and social media. PROSPERO REGISTRATION NUMBER CRD42021246031.
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Affiliation(s)
- Ngamjit Kongsupon
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Gareth I Walters
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Birmingham Regional NHS Occupational Lung Disease Service, Birmingham Chest Clinic, Birmingham, UK
| | - Peymané Adab
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Rachel E Jordan
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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18
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Tsui HC, Ronsmans S, Hoet PHM, Nemery B, Vanoirbeek JAJ. Occupational Asthma Caused by Low-Molecular-Weight Chemicals Associated With Contact Dermatitis: A Retrospective Study. J Allergy Clin Immunol Pract 2022; 10:2346-2354.e4. [PMID: 35643279 DOI: 10.1016/j.jaip.2022.05.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 04/12/2022] [Accepted: 05/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Occupational asthma (OA) may have different etiologies, but it is not clear whether the etiologic agents influence the clinical presentation, especially the co-occurrence of skin lesions. OBJECTIVE To determine the impact of different asthmagens on the characteristics of OA, with a focus on the occurrence of prior or concomitant skin disorders. METHODS In a retrospective analysis of patients who visited the Occupational and Environmental Disease Clinic of a tertiary referral hospital from 2009 to 2019, we classified patients into definite, probable, or possible OA according to prespecified diagnostic guidelines. In multivariate logistic regression with sensitivity analysis, we examined the relation of high- and low-molecular-weight (HMW and LMW) agents with the clinical presentation. RESULTS Of 209 cases of OA, 66 were caused by HMW agents and 143 by LMW agents. Patients with OA exposed to LMW agents had higher odds of having (had) allergic contact dermatitis (odds ratio, 5.45 [1.80-23.70]; P < .01), compared with patients exposed to HMW agents. Conversely, HMW agents were associated with higher odds of rhinitis symptoms (odds ratio of LMW/HMW, 0.33 [0.17-0.63]; P < .001) and high total IgE (odds ratio of LMW/HMW, 0.35 [0.17-0.70]; P < .01). Risk factors for having coexisting contact dermatitis included construction work, hairdressing, and exposure to metals or epoxy resins. CONCLUSIONS Among patients with OA, exposure to specific LMW agents was associated with a high frequency of contact dermatitis. Different types of asthmagens within HMW or LMW agents appear to determine the phenotype and comorbidity of OA.
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Affiliation(s)
- Hung-Chang Tsui
- Centre for Environment and Health, Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium
| | - Steven Ronsmans
- Centre for Environment and Health, Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium
| | - Peter H M Hoet
- Centre for Environment and Health, Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium
| | - Benoit Nemery
- Centre for Environment and Health, Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium.
| | - Jeroen A J Vanoirbeek
- Centre for Environment and Health, Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium.
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Ahmed OS, El-Shayeb MA, Shahin RY, Fouad SH, Yosef MM, Fahim NA, Mohamed MF. Prevalence of work-related asthma among Egyptian farmers in Great Cairo. Egypt J Immunol 2022; 29:9-18. [PMID: 35758964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Work related asthma (WRA) refers to asthma induced by exposure to sensitizing agents and/or irritants in the workplace leaving health and economic consequences. Early diagnosis can improve the prognosis of WRA permitting sometimes full recovery. This study aimed to assess the prevalence of WRA among Egyptian adult agriculture workers. A multi-center cross sectional study included 150 adult workers from 4 different farms, during the period from 2019 and 2021. All participants were subjected to full medical history, clinical examination, chest x-ray, skin prick test and CBC to detect absolute eosinophilic count. Spirometry with post bronchodilatation test (reversibility test) at the farm (in the day of insecticide aerosol and without aerosol) and after a week off the farm was also done. Age, median ± SD, was 37.67 ± 9.75 years, duration of farming occupation was 21.84 ± 10.18 years. Of the 150 participants, 11 had WRA. Of these, 6 had allergic occupational asthma, 3/11 had work exacerbated asthma and only 2/11 had irritant occupational asthma. Of the allergic subjects, 7.3% tested positive to mixed pollens, 4.7% to Alternaria, 2% to penicillium and 2% to the farm pollens. The onset of respiratory symptoms was 13.45 ± 6.93 months after start working in the farm. A statistical significance was observed between WRA and non-WRA individuals regarding age, duration of farming occupation and asthma symptoms during workday (P < 0.001). There was a statistical significance between WRA group and non-WRA group regarding FEV1, FEV1/FVC ratio carried out at work, during holidays and during spraying (P < 0.001). Absolute eosinophilic count, mean among WRA group was 0.55 ± 0.13 (×103cells/mm3) with significance between WRA and non-WRA (P= 0.001). Farming occupation may cause WRA, therefore, more attention should be given to minimize exposure and risk of inducing WRA.
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Affiliation(s)
- Omar S Ahmed
- Department of Internal Medicine, Allergy and Clinical Immunology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed A El-Shayeb
- Department of Internal Medicine, Allergy and Clinical Immunology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Rasha Y Shahin
- Department of Internal Medicine, Allergy and Clinical Immunology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Shaimaa H Fouad
- Department of Internal Medicine, Allergy and Clinical Immunology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mostafa M Yosef
- Department of Community, Environmental and Occupationa, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Noha A Fahim
- Department of Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Manar F Mohamed
- Department of Internal Medicine, Allergy and Clinical Immunology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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20
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Lantto J, Suojalehto H, Karvala K, Remes J, Soini S, Suuronen K, Lindström I. Clinical Characteristics of Irritant-Induced Occupational Asthma. J Allergy Clin Immunol Pract 2022; 10:1554-1561.e7. [PMID: 35259533 DOI: 10.1016/j.jaip.2022.02.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/25/2022] [Accepted: 02/04/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Work is a substantial contributing factor of adult-onset asthma. A subtype of occupational asthma (OA) is caused by irritant agents, but knowledge of the clinical outcomes of irritant-induced asthma (IIA) is incomplete. OBJECTIVES To evaluate whether the clinical picture of IIA differs from that of sensitizer-induced OA. METHODS This retrospective study analyzed acute and subacute IIA patients diagnosed in an occupational medicine clinic during 2004 to 2018. Sixty-nine patients fulfilled the inclusion criteria, and their characteristics were analyzed at the time of the diagnosis and 6 months later. The results were compared with those of 2 subgroups of sensitizer-induced OA: 69 high-molecular-weight (HMW) and 89 low-molecular-weight (LMW) agent-induced OA patients. RESULTS Six months after the diagnosis, 30% of the patients with IIA needed daily short-acting β-agonists (SABA), 68% were treated with Global Initiative for Asthma, 2020 report (GINA) step 4-5 medication, and 24% of the patients had asthma exacerbation after the first appointment. IIA depicted inferiority to LMW-induced OA in daily need for SABA (odds ratio [OR]: 3.80, 95% confidence interval [CI]: 1.38-10.46), treatment with GINA step 4-5 medication (OR: 2.22, 95% CI: 1.08-4.57), and exacerbation (OR: 3.85, 95% CI: 1.35-11.04). IIA showed poorer results than HMW-induced OA in the latter 2 of these features (OR: 2.49, 95% CI: 1.07-5.79 and OR: 6.29, 95% CI: 1.53-25.83, respectively). CONCLUSIONS Six months after the OA diagnosis, a significant proportion of the patients with IIA remain symptomatic and the majority of these patients use asthma medications extensively suggesting uncontrolled asthma. The short-term outcomes of IIA appear poorer than that of sensitizer-induced OA.
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Affiliation(s)
- Jussi Lantto
- Doctoral Program in Clinical Research, University of Helsinki, Helsinki, Finland; Finnish Institute of Occupational Health, Occupational Medicine, Helsinki, Finland.
| | - Hille Suojalehto
- Finnish Institute of Occupational Health, Occupational Medicine, Helsinki, Finland
| | - Kirsi Karvala
- Finnish Institute of Occupational Health, Occupational Medicine, Helsinki, Finland; Varma Mutual Pension Insurance Company, Consultant Physicians, Helsinki, Finland
| | - Jouko Remes
- Finnish Institute of Occupational Health, Occupational Medicine, Oulu, Finland
| | - Satu Soini
- Finnish Institute of Occupational Health, Occupational Medicine, Oulu, Finland
| | - Katri Suuronen
- Finnish Institute of Occupational Health, Occupational Medicine, Helsinki, Finland
| | - Irmeli Lindström
- Finnish Institute of Occupational Health, Occupational Medicine, Helsinki, Finland
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21
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Bælum J, Jacobsen IB, Sherson D. [Isocyanate-induced asthma]. Ugeskr Laeger 2022; 184:V07210584. [PMID: 35319454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Isocyanates are often found in workplaces in e.g., glue, paint, plastics and foam products. Asthma caused by isocyanates is one of the most common forms of occupational asthma, though it is difficult to diagnose, as described in this review. It is not possible to demonstrate sensitisation with available allergy tests. A certain diagnosis can only be made with the help of specific bronchial provocation, which is performed at three centres in Denmark. A correct diagnosis is important, as it helps provide optimal treatment as well as alerting the employer, that improvements are needed at the workplace.
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Affiliation(s)
- Jesper Bælum
- Arbejds- og Miljømedicinsk Klinik, Odense Universitetshospital
| | | | - David Sherson
- Arbejds- og Miljømedicinsk Klinik, Odense Universitetshospital
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Walters GI, Barber CM. Barriers to identifying occupational asthma among primary healthcare professionals: a qualitative study. BMJ Open Respir Res 2021; 8:e000938. [PMID: 34362763 PMCID: PMC8351481 DOI: 10.1136/bmjresp-2021-000938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 07/11/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Occupational asthma (OA) accounts for one in six cases of adult-onset asthma and is associated with a large societal cost. Many cases of OA are missed or delayed, leading to ongoing exposure to the causative agent and avoidable lung function loss and poor employment-related outcomes. Enquiry about work-related symptoms and the nature of work by healthcare professionals (HCPs) is limited, evident in primary and secondary care. Potential reasons cited for this are time pressure, lack of expertise and poor access to specialists. AIM To understand organisational factors and beliefs and behaviours among primary HCPs that may present barriers to identifying OA. METHODS We employed a qualitative phenomenological methodology and undertook 20-45 min interviews with primary HCPs in West Midlands, UK. We used purposive and snowball sampling to include general practitioners (GPs) and practice nurses with a range of experience, from urban and rural settings. Interviews were recorded digitally and transcribed professionally for analysis. Data were coded by hand, and thematic analysis was undertaken and determined theoretically until themes were saturated. RESULTS Eleven HCPs participated (eight GPs, three nurses). Four themes were identified that were considered to impact on identification of OA: (1) training and experience, (2) perceptions and beliefs, (3) systems constraints, and (4) variation in individual practice. OA-specific education had been inadequate at every stage of training and practice, and clinical exposure to OA had been generally limited. OA-specific beliefs varied, as did clinical behaviour with working-age individuals with asthma. There was a focus on diagnosis and treatment rather than attributing causation. Identified issues regarding organisation of asthma care were time constraints, lack of continuity, referral pressure, use of guidelines and templates, and external targets. CONCLUSION Organisation and delivery of primary asthma care, negative OA-related beliefs, lack of formal education, and exposure to OA may all currently inhibit its identification.
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Affiliation(s)
- Gareth I Walters
- Regional NHS Occupational Lung Disease Service, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Occupational and Environmental Medicine, University of Birmingham, Birmingham, UK
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Migueres N, Debaille C, Walusiak-Skorupa J, Lipińska-Ojrzanowska A, Munoz X, van Kampen V, Suojalehto H, Suuronen K, Seed M, Lee S, Rifflart C, Godet J, de Blay F, Vandenplas O. Occupational Asthma Caused by Quaternary Ammonium Compounds: A Multicenter Cohort Study. J Allergy Clin Immunol Pract 2021; 9:3387-3395. [PMID: 33940212 DOI: 10.1016/j.jaip.2021.04.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/11/2021] [Accepted: 04/16/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Quaternary ammonium compounds (QACs) are used extensively for cleaning and disinfection and have been documented in scattered reports as a cause of occupational asthma (OA) through bronchoprovocation tests (BPTs). OBJECTIVE To examine the clinical, functional, and inflammatory profile of QAC-induced OA compared with OA caused by other low-molecular weight (LMW) agents. METHODS The study was conducted in a retrospective multicenter cohort of 871 subjects with OA ascertained by a positive BPT. Subjects with QAC-induced OA (n = 22) were identified based on a positive BPT to QACs after exclusion of those challenged with cleaning products or disinfectants that contained other potential respiratory sensitizers. They were compared with 289 subjects with OA caused by other LMW agents. RESULTS Most subjects with QAC-induced OA were working in the health care sector (n = 14). A twofold or greater increase in the postchallenge level of nonspecific bronchial hyperresponsiveness was recorded in eight of 11 subjects with QAC-induced OA (72.7%) and in 49.7% of those with OA caused by other LMW agents. Although sputum assessment was available in only eight subjects with QAC-induced OA, they showed a significantly greater median (interquartile) increase in sputum eosinophils (18.1% [range, 12.1% to 21.1%]) compared with those with OA caused by other LMW agents (2.0% [range, 0% to 5.2%]; P < .001). CONCLUSIONS This study indicates that QAC-induced OA is associated with a highly eosinophilic pattern of airway response and provides further evidence supporting the sensitizing potential of QACs. The findings highlight the heterogeneous nature of the pathobiologic pathways involved in OA caused by LMW agents.
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Affiliation(s)
- Nicolas Migueres
- Groupe Méthode Recherche Clinique, Pôle de Santé Publique, Strasbourg University, Strasbourg, France; Division of Asthma and Allergy, Department of Chest Diseases, University Hospital of Strasbourg and Fédération de Médecine Translationnelle, Strasbourg University, Strasbourg, France
| | - Charlotte Debaille
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - Jolanta Walusiak-Skorupa
- Department of Occupational Diseases and Environmental Health, Nofer Institute of Occupational Medicine, Lodz, Poland
| | | | - Xavier Munoz
- Servei Pneumologia, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona and CIBER de Enfermedades Respiratorias, Barcelona, Spain
| | - Vera van Kampen
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Ruhr University, Bochum, Germany
| | - Hille Suojalehto
- Occupational Health, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Katri Suuronen
- Occupational Health, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Martin Seed
- Centre for Occupational and Environmental Health, The University of Manchester, Manchester, United Kingdom
| | - Sewon Lee
- Centre for Occupational and Environmental Health, The University of Manchester, Manchester, United Kingdom
| | - Catherine Rifflart
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - Julien Godet
- Groupe Méthode Recherche Clinique, Pôle de Santé Publique, Strasbourg University, Strasbourg, France
| | - Frédéric de Blay
- Division of Asthma and Allergy, Department of Chest Diseases, University Hospital of Strasbourg and Fédération de Médecine Translationnelle, Strasbourg University, Strasbourg, France
| | - Olivier Vandenplas
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium.
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24
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Wiszniewska M, Dellis P, van Kampen V, Suojalehto H, Munoz X, Walusiak-Skorupa J, Lindström I, Merget R, Romero-Mesones C, Sastre J, Quirce S, Mason P, Rifflart C, Godet J, de Blay F, Vandenplas O. Characterization of Occupational Eosinophilic Bronchitis in a Multicenter Cohort of Subjects with Work-Related Asthma Symptoms. J Allergy Clin Immunol Pract 2021; 9:937-944.e4. [PMID: 32920064 DOI: 10.1016/j.jaip.2020.08.056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/31/2020] [Accepted: 08/15/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Occupational eosinophilic bronchitis (OEB) has been described only as anecdotal case reports. OBJECTIVE We investigated the clinical and inflammatory characteristics of subjects with OEB identified in a cohort of subjects who completed a specific inhalation challenge (SIC) with occupational agents. METHODS In this retrospective multicenter study, OEB was defined by (1) a fall in FEV1 less than 15% during the SIC and the absence of nonspecific bronchial hyperresponsiveness both before and after the SIC and (2) a postchallenge increase of 3% or more in sputum eosinophils. The subjects who fulfilled these criteria were compared with 226 subjects with a negative SIC and 30 subjects with a positive SIC who failed to show baseline nonspecific bronchial hyperresponsiveness. RESULTS An isolated increase in postchallenge sputum eosinophils was documented in 33 of 259 subjects (13%) with a negative SIC. These subjects reported significantly more often an isolated cough at work compared with the negative and positive SIC controls. When compared with positive SIC controls, the subjects with OEB experienced less frequently work-related wheezing and reported a shorter duration of symptoms at work. The sensitivity of the post-SIC increase in fractional exhaled nitric oxide in identifying OEB among subjects with a negative SIC was low, ranging from 43% to 24% using cutoff values of 8 ppb to 17.5 ppb, whereas the specificity was high (90%-97%). CONCLUSIONS This study highlights the relevance of induced sputum analysis in the investigation of work-related asthma symptoms to identify isolated increases in sputum eosinophils that are consistent with a diagnosis of OEB.
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Affiliation(s)
- Marta Wiszniewska
- Department of Occupational Diseases and Environmental Health, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - Perrine Dellis
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - Vera van Kampen
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (IPA), Ruhr University, Bochum, Germany
| | - Hille Suojalehto
- Occcupational Health, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Xavier Munoz
- Servei Pneumologia, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona and CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Jolanta Walusiak-Skorupa
- Department of Occupational Diseases and Environmental Health, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - Irmeli Lindström
- Occcupational Health, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Rolph Merget
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (IPA), Ruhr University, Bochum, Germany
| | - Christian Romero-Mesones
- Servei Pneumologia, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona and CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Joaquin Sastre
- Department of Allergy, Fundacion Jimenez Dıaz, Universidad Autonoma de Madrid and CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Santiago Quirce
- Department of Allergy, La Paz University Hospital, IdiPAZ and CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Paola Mason
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Catherine Rifflart
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - Julien Godet
- Groupe Méthode Recherche Clinique, Pôle de Santé Publique, Strasbourg University, Strasbourg, France
| | - Frédéric de Blay
- Division of Asthma and Allergy, Department of Chest Diseases, University Hospital of Strasbourg and Fédération de Médecine translationnelle, Strasbourg University, Strasbourg, France
| | - Olivier Vandenplas
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium.
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Tiotiu AI, Novakova S, Labor M, Emelyanov A, Mihaicuta S, Novakova P, Nedeva D. Progress in Occupational Asthma. Int J Environ Res Public Health 2020; 17:E4553. [PMID: 32599814 PMCID: PMC7345155 DOI: 10.3390/ijerph17124553] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/20/2020] [Accepted: 06/22/2020] [Indexed: 01/12/2023]
Abstract
Occupational asthma (OA) represents one of the major public health problems due to its high prevalence, important social and economic burden. The aim of this review is to summarize current data about clinical phenotypes, biomarkers, diagnosis and management of OA, a subtype of work-related asthma. Most studies have identified two phenotypes of OA. One is sensitizer-induced asthma, occuring after a latency period and caused by hypersensitivity to high- or low-molecular weight agents. The other is irritant-induced asthma, which can occur after one or more exposures to high concentrations of irritants without latency period. More than 400 agents causing OA have been identified and its list is growing fast. The best diagnostic approach for OA is a combination of clinical history and objective tests. An important tool is a specific inhalation challenge. Additional tests include assessments of bronchial hyperresponsiveness to methacholine/histamine in patients without airflow limitations, monitoring peak expiratory flow at- and off-work, sputum eosinophil count, exhaled nitric oxide measurement, skin prick tests with occupational allergens and serum specific IgE. Treatment of OA implies avoidance of exposure, pharmacotherapy and education. OA is a heterogeneous disease. Mechanisms of its different phenotypes, their diagnosis, role of new biomarkers and treatment require further investigation.
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Affiliation(s)
- Angelica I. Tiotiu
- Department of Pulmonology, University Hospital of Nancy, 54000 Nancy, France
- Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control (EA 3450 DevAH), University of Lorraine, 54000 Nancy, France
| | - Silviya Novakova
- Allergy Unit, Internal Consulting Department, University Hospital “St. George”, 4000 Plovdiv, Bulgaria;
| | - Marina Labor
- Department of Pulmonology, University Hospital Centre Osijek, 31000 Osijek, Croatia;
- Medical Faculty Osijek, J.J. Strossmayer University, 31000 Osijek, Croatia
| | - Alexander Emelyanov
- Department of Respiratory Medicine, North-Western Medical University, 191015 Saint-Petersburg, Russia;
| | - Stefan Mihaicuta
- Victor Babes University of Medicine and Pharmacy, 300120 Timisoara, Romania
| | - Plamena Novakova
- Clinic of Clinical Allergy, Medical University, 1000 Sofia, Bulgaria;
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26
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Nicholson PJ. When to patch test and when to prick test. Occup Med (Lond) 2020; 69:521. [PMID: 31811306 DOI: 10.1093/occmed/kqz106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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27
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Sköld MB, Møller JJ, Holm JW. [Occupational allergic asthma in a laboratory animal keeper with COPD]. Ugeskr Laeger 2020; 182:V10190562. [PMID: 32138826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This is a case report of a 63-year-old woman, who had worked as a laboratory animal keeper for 23 years. She developed increasing symptoms of rhinitis, coughing and shortness of breath and was diagnosed and treated for COPD based on her smoking history and spirometry results. She went on sick leave due to dyspnoea, and after testing she was diagnosed with occupational allergic asthma from rodents. Her lung function was at this point significantly reduced. Occupational asthma is common, and occupational causes of respiratory symptoms should always be taken into consideration when assessing patients in the working population.
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28
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Klusáčková P, Lebedová J. Occupational asthma and rhinitis: Do we think about it as soon as possible? Cas Lek Cesk 2018; 157:406-410. [PMID: 30754977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Occupational asthma and allergic diseases of the upper airway play an important role in occupational diseases. The most frequent allergens, which causes occupational respiratory diseases in the Czech Republic, are isocyanates and wheat and rye flour. Isocyanates are the substances used in car industry during production of polyurethanes, they are in colours and glues. Occupational allergic asthma and rhinitis are diagnosed using specific challenge tests with substances from the workplace. These tests can be done in a special exposure box in a lab with substances taken by hygiene specialists from the patient´s workplace or using direct exposure at the workplace. Spirometry and anterior active rhinomanometry are used as objective methods during these tests. For prognosis the early diagnosis and withdrawal from the occupational allergen exposure are essential. Keywords: allergic asthma, allergic rhinitis, irritant-induced asthma, irritant-induced rhinitis, isocyanate, occupational disease, specific inhalation challenge.
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Lee JH, Kim SH, Choi Y, Trinh HKT, Yang EM, Ban GY, Shin YS, Ye YM, Izuhara K, Park HS. Serum Periostin Levels: A Potential Serologic Marker for Toluene Diisocyanate-Induced Occupational Asthma. Yonsei Med J 2018; 59:1214-1221. [PMID: 30450856 PMCID: PMC6240562 DOI: 10.3349/ymj.2018.59.10.1214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 10/08/2018] [Accepted: 10/16/2018] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Toluene diisocyanate (TDI) is a leading cause of occupational asthma (OA). Periostin is a matricellular protein implicated in type 2 immunity-driven asthma. Its pathogenic role in TDI-OA has not been completely elucidated. The present study was performed to investigate the role of periostin in TDI-OA. MATERIALS AND METHODS Serum periostin levels were measured in subjects with TDI-OA, asymptomatic TDI-exposure controls (AECs), non-occupational asthmatics (NAs), and unexposed normal controls (NCs). To understand the mechanism by which TDI induces periostin production, primary small airway epithelial cells (SAECs) were cultured under stimulation of TDI and neutrophils from asthmatic patients. RESULTS Fifty-three subjects with TDI-OA, 71 AECs, 67 NAs, and 83 NCs were enrolled. Serum periostin levels were significantly higher in TDI-OA subjects than in AECs (p=0.001), NAs (p<0.001), and NCs (p<0.001). In TDI-exposed subjects (TDI-OA and AEC), the PC₂₀ methacholine levels were significantly lower in subjects with a higher periostin level than in those with a lower periostin level. TDI exposure did not increase periostin production directly by SAECs; however, periostin production increased significantly after co-culture with TDI and neutrophils, which was suppressed by an antioxidant. In addition, increased release of TGF-β1 was noted from SAECs when exposed to TDI and neutrophils, which was also suppressed by an antioxidant. CONCLUSION These results suggest that an increased periostin level may contribute to the progression of airway inflammation to remodeling in TDI-exposed workers. A high serum periostin level is a potential serologic marker of the phenotype of TDI-OA.
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Affiliation(s)
- Ji Ho Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sang Ha Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Youngwoo Choi
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Hoang Kim Tu Trinh
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Eun Mi Yang
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Ga Young Ban
- Department of Pulmonary, Allergy and Critical Care Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Yoo Seob Shin
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Young Min Ye
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Kenji Izuhara
- Division of Medical Biochemistry, Department of Biomolecular Sciences, Saga Medical School, Saga, Japan
| | - Hae Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea.
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Herrero Herranz S, Pegenaute Esparza C, García López V. [Characteristics of asthma cases reported as a suspected occupational disease in Navarra. Period 2010-2015]. Rev Esp Salud Publica 2018; 92:e201809066. [PMID: 30181531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 06/13/2018] [Indexed: 06/08/2023] Open
Abstract
OBJECTIVE Although, occupational asthma (OA) causes great work disability, due to its diagnostic complexity, it is difficult to have it recognized by the official registration systems. To improve its detection, suspected systems have been developed. After years of experience in Navarre, we set out to characterize the suspected cases and compare them with those declared as an occupational disease (OD). METHODS We identified the cases of OA reported as sentinel events in the Epidemiological Surveillance Program in Occupational Health in Navarra from January 2010 to December 2015 and the cases declared as OD (asthma). The population under study was the Navarra employed population (357,200 on average). In the cases with consent, the clinical and labor characteristics were compared with those of OD. Using the SPSS Statistics® 20v computer program, mean differences were calculated by the T test for independent samples and distribution percentage differences by Chi-square test, Fisher's exact test and nonparametric tests when application conditions were not satisfied. As an indicator of notification, the accumulated incidence per 100,000 workers was calculated for each year of program monitoring. RESULTS In the period, 79 sentinel events were reported (in 22 the investigation was concluded) and 50 cases of OD (24% relapses). We did not find statistically significant differences in age (41 vs. 40 years), nor gender (40.9% women vs. 44.7%), nor proportion that caused sick leave (45% and 36.8%), nor size, activity of the company or occupation of the worker. Where differences are found was in the meantime of exposure before the recognition/notification, significantly higher in the OD than in the sentinel (94.1 vs. 22.2 months), 72 months longer. CONCLUSIONS The cases detected by both systems are similar but, due to the diagnostic complexity, the recognition is delayed as OD, which demonstrates the usefulness of a more agile system for reporting suspicions of this work pathology.
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Lindström I, Karvonen H, Suuronen K, Suojalehto H. Occupational asthma from biological pest control in greenhouses. J Allergy Clin Immunol Pract 2018; 6:692-694.e3. [PMID: 29030000 DOI: 10.1016/j.jaip.2017.08.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 08/11/2017] [Accepted: 08/17/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Irmeli Lindström
- Department of Occupational Medicine, Finnish Institute of Occupational Health, Helsinki, Finland.
| | | | - Katri Suuronen
- Department of Occupational Medicine, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Hille Suojalehto
- Department of Occupational Medicine, Finnish Institute of Occupational Health, Helsinki, Finland
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Abstract
PURPOSE OF REVIEW Numerous clinically relevant allergenic molecules enhance the performance of specific (s) IgE tests and improve the specificity of allergy diagnosis. This review aimed to summarize our current knowledge of the high-molecular-weight allergens involved in the development of occupational asthma and rhinitis and to critically analyze the contribution of component-resolved diagnosis in the management of these conditions. RECENT FINDINGS There is a lack of standardization and validation for most available extracts of occupational agents, and assessment of sIgE reactivity to occupational allergen components has been poorly investigated, with the notable exception of natural rubber latex (NRL) and wheat flour. In the case of NRL, the application of recombinant single allergens and amplification of natural extracts with stable recombinant allergens improved the test sensitivity. IgE-sensitization profile in patients with baker's asthma showed great interindividual variation, and extract-based diagnostic is still recommended. For other occupational allergens, it remains necessary to evaluate the relevance of single allergen molecules for the sensitization induced by occupational exposure. Progress has been made to characterize occupational allergens especially NRL and wheat, although there is still an unmet need to increase the knowledge of occupational allergens, to include standardized tools into routine diagnostic, and to evaluate their usefulness in clinical practice.
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Affiliation(s)
- Monika Raulf
- Institute of Prevention and Occupational Medicine of the German Social accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bochum, Germany.
| | - Santiago Quirce
- Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ) and CIBER of Respiratory diseases (CIBERES), Madrid, Spain
| | - Olivier Vandenplas
- Centre Hospitalier Universitaire UCL Namur, Department of Chest Medicine, Université Catholique de Louvain, Yvoir, Belgium
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Savi E, Montagni M, Peveri S. [New in vitro allergological diagnostic tool and its application in professional disease.]. G Ital Med Lav Ergon 2017; 39:278-284. [PMID: 29916583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 05/09/2017] [Indexed: 06/08/2023]
Abstract
Molecular diagnostic is a new therapeutic approach that - allows to valuate sensitization towards a single molecule in a allergenic source and to obtain relevant information on clinical features: sensitization towards molecules as alfa amylase of wheat or lipocalins of pets, Alt a 1 of alternaria spores and Hev b 6 of latex correlates with the risk to develop asthma - has a greater sensitivity in the serum IgE identification than the whole source.
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Affiliation(s)
- Eleonora Savi
- Unità operativa Dipartimentale di Allergologia Ospedale G. Da Saliceto Ausl Piacenza
| | - Marcello Montagni
- Unità operativa Dipartimentale di Allergologia Ospedale G. Da Saliceto Ausl Piacenza
| | - Silvia Peveri
- Unità operativa Dipartimentale di Allergologia Ospedale G. Da Saliceto Ausl Piacenza
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34
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Guarnieri G. [Diagnostic approach to occupational allergic respiratory diseases.]. G Ital Med Lav Ergon 2017; 39:178-181. [PMID: 29916584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 05/09/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVES An accurate diagnosis of occupational allergic respiratory diseases is crucial because they are related to disability, loss of work and worsening of psychosocial and economic status of workers. Early diagnosis is therefore essential to prevent the progression of allergic respiratory diseases and to implement preventive measures. The most frequent occupational allergic respiratory diseases are asthma (OA) and rhinitis (OR), less frequently hypersensitivity pneumonia (HP) and non-asthmatic eosinophilic bronchitis (NAEB). METHODS The diagnosis is based on the objective evidence of the disease, on a clear correlation with the work activity and the identification of a specific sensitizing agent in the workplace. RESULTS Reference standard methods are available, such as Specific Inhalation Challenge in the laboratory or in the workplace. CONCLUSIONS A multidisciplinary approach in highly-specialized centres is always recommended for diagnostic confirmation, as it is accompanied by greater diagnostic sensitivity and specificity.
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Affiliation(s)
- Gabriella Guarnieri
- Medicina del Lavoro, Fisiopatologia Respiratoria, Dipartimento di Scienze Cardiologiche, Toraciche e Vascolari, Azienda Ospedaliera e Università di Padova
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35
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Harber P, Redlich CA, Hines S, Filios M, Storey E. Recommendations for a Clinical Decision Support System for Work-Related Asthma in Primary Care Settings. J Occup Environ Med 2017; 59:e231-e235. [PMID: 29023337 PMCID: PMC6282164 DOI: 10.1097/jom.0000000000001182] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to describe a recommended clinical decision support (CDS) approach for work-related asthma for incorporation in electronic health records (EHRs) for primary care health care providers. METHODS Subject matter experts convened by the American Thoracic Society reviewed available guidelines and published literature to develop specific recommendations. RESULTS It is important to recognize possible work-related asthma among persons with new-onset or worsening asthma. The work group recommends incorporating three simple questions about temporal relations between asthma symptoms and work in EHR systems and identified specific clinical conditions to trigger this intervention. Patients with positive responses to the three questions should have the asthma diagnosis documented and have further evaluation, education, and possible referral. CONCLUSION An effective CDS system for improving recognition of work-related asthma may help reduce morbidity and mortality of asthma in adults.
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Affiliation(s)
- Philip Harber
- Department of Community, Environment, and Policy. Mel and Enid Zuckerman College of Public Health, University Of Arizona, Tucson, Arizona, USA
| | - Carrie A. Redlich
- Department of Medicine, Yale University School of Medicine, New Haven Connecticut USA
| | - Stella Hines
- Department of Medicine, University Of Maryland, Baltimore Maryland
| | - Margaret Filios
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention (CDC), Morgantown, WV, USA
| | - Eileen Storey
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention (CDC), Morgantown, WV, USA
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36
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Roth E, Kristiansen CB, Assing KD, Weinreich UM. [Work-related asthma in an orthopaedic surgeon]. Ugeskr Laeger 2017; 179:V01170028. [PMID: 28789768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
An orthopaedic surgeon with no history of lung disease developed cough and dyspnoea. The patient was diagnosed with asthma by spirometry and bronchial provocation test with methacholine. A clear correlation between symptoms and work was established meriting a referral to a centre for occupational health. The patient was diagnosed with work-related disease, which was recognized by the industrial injury board. The cause was methyl methacrylate, a known airway irritant, which is an important component of bone cement. Previously, no cases of work-related asthma in orthopaedic surgeons have been reported.
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Moore VC, Burge PS, Robertson AS, Walters GI. What causes occupational asthma in cleaners? Thorax 2017; 72:581-583. [PMID: 28093530 DOI: 10.1136/thoraxjnl-2016-209228] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 12/13/2016] [Accepted: 12/14/2016] [Indexed: 11/03/2022]
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Lipinska-Ojrzanowska AA, Wiszniewska M, Walusiak-Skorupa JM. Work-related asthma among professional cleaning women. Arch Environ Occup Health 2017; 72:53-60. [PMID: 26895185 DOI: 10.1080/19338244.2016.1156046] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 02/13/2016] [Indexed: 06/05/2023]
Abstract
The job of cleaning has developed dynamically as a working service, and women constitute the majority of all professional cleaning workers. Cleaners are at an increased risk of work-related asthma (WRA). This study characterizes work-related respiratory symptoms reported by female cleaners, evaluates any associated factors of WRA, and shows diagnostic management of medical certification. The study group comprised 50 professional cleaning women referred to our Occupational Diseases Department due to suspicion of occupational asthma (OA). A questionnaire, skin prick tests, serum specific IgE antibodies, and specific inhalant challenge were performed in all of the participants. Work-related asthma was recognized in 46% of symptomatic cleaners, of whom 15 were considered as having work-exacerbated asthma (WEA) and 8 as having OA. Sensitization to latex and disinfectants played an important role as a causative agent in OA of cleaners.
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Affiliation(s)
| | - Marta Wiszniewska
- a Department of Occupational Diseases and Environmental Health , Nofer Institute of Occupational Medicine , Lodz , Poland
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39
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Krüll G, Gianella P, Soccal PM, Pralong JA. [Occupational asthma]. Rev Med Suisse 2016; 12:1972-1975. [PMID: 28696639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Occupational asthma is the most common occupational respiratory disease. It mainly affects young workers with significant socio-economic consequences. Early recognition improves its prognosis. A rigorous investigative approach while the worker is still exposed at work and appropriate medical care require a multi-disciplinary collaboration. Prevention is the key element in the management of professional asthma.
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Affiliation(s)
- Grazia Krüll
- Service de pneumologie, Département des spécialités de médecine, HUG, 1211 Genève 14
| | - Pietro Gianella
- Service de pneumologie, Département des spécialités de médecine, HUG, 1211 Genève 14
| | - Paola M Soccal
- Service de pneumologie, Département des spécialités de médecine, HUG, 1211 Genève 14
| | - Jacques André Pralong
- Consultation spécialisée des maladies respiratoires professionnelles, Département des spécialités de médecine, HUG, 1211 Genève 14
- Institut universitaire romand de santé au travail, Route de la Corniche 2, 1066 Epalinges
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Hagerman LM, Law BF, Bledsoe TA, Hettick JM, Kashon ML, Lemons AR, Wisnewski AV, Siegel PD. The influence of diisocyanate antigen preparation methodology on monoclonal and serum antibody recognition. J Occup Environ Hyg 2016; 13:829-839. [PMID: 27124286 PMCID: PMC5016257 DOI: 10.1080/15459624.2016.1183013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Exposure to diisocyanates (dNCOs), such as methylene diphenyl diisocyanate (MDI) can cause occupational asthma (OA). Currently, lab tests for dNCO specific IgE are specific, but not sensitive, which limits their utility in diagnosing dNCO asthma. This may be due to variable preparation and poor characterization of the standard antigens utilized in these assays. The aim of this study was to produce and characterize a panel of antigens prepared using three different commonly employed methods and one novel method. The conjugates were examined for recognition by anti-MDI monoclonal antibodies (mAbs) in varying enzyme linked immunosorbant assay (ELISA) formats, extent of crosslinking, total amount of MDI, the sites of MDI conjugation, relative shape/charge, and reactivity with human serum with antibodies from sensitized, exposed workers. Results indicate that while there are minimal differences in the total amount of MDI conjugated, the extent of crosslinking, and the conjugation sites, there are significant differences in the recognition of differently prepared conjugates by mAbs. Native and denaturing polyacrylamide gel electrophoresis demonstrate differences in the mobility of different conjugates, indicative of structural changes that are likely important for antigenicity. While mAbs exhibited differential binding to different conjugates, polyclonal serum antibodies from MDI exposed workers exhibited equivalent binding to different conjugates by ELISA. While differences in the recognition of the different conjugates exist by mAb detection, differences in antigenicity could not be detected using human serum from MDI-sensitized individuals. Thus, although dNCO conjugate preparation can, depending on the immunoassay platform, influence binding of specific antibody clones, serologic detection of the dNCO-exposure-induced polyclonal antibody response may be less sensitive to these differences.
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Affiliation(s)
- Lauren M Hagerman
- a Allergy and Clinical Immunology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention , Morgantown West Virginia
| | - Brandon F Law
- a Allergy and Clinical Immunology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention , Morgantown West Virginia
| | - Toni A Bledsoe
- a Allergy and Clinical Immunology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention , Morgantown West Virginia
| | - Justin M Hettick
- a Allergy and Clinical Immunology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention , Morgantown West Virginia
| | - Michael L Kashon
- b Biostatistics and Epidemiology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention , Morgantown , West Virginia
| | - Angela R Lemons
- a Allergy and Clinical Immunology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention , Morgantown West Virginia
| | - Adam V Wisnewski
- c Department of Internal Medicine , Yale School of Medicine , New Haven , Connecticut
| | - Paul D Siegel
- a Allergy and Clinical Immunology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention , Morgantown West Virginia
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Tarlo SM, Altman KW, Oppenheimer J, Lim K, Vertigan A, Prezant D, Irwin RS. Occupational and Environmental Contributions to Chronic Cough in Adults: Chest Expert Panel Report. Chest 2016; 150:894-907. [PMID: 27521735 DOI: 10.1016/j.chest.2016.07.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 06/15/2016] [Accepted: 07/15/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND In response to occupational and environmental exposures, cough can be an isolated symptom reflecting exposure to an irritant with little physiological consequence, or it can be a manifestation of more significant disease. This document reviews occupational and environmental contributions to chronic cough in adults, focusing on aspects not previously covered in the 2006 ACCP Cough Guideline or our more recent systematic review, and suggests an approach to investigation of these factors when suspected. METHODS MEDLINE and TOXLINE literature searches were supplemented by articles identified by the cough panel occupational and environmental subgroup members, to identify occupational and environmental aspects of chronic cough not previously covered in the 2006 ACCP Cough Guideline. Based on the literature reviews and the Delphi methodology, the cough panel occupational and environmental subgroup developed guideline suggestions that were approved after review and voting by the full cough panel. RESULTS The literature review identified relevant articles regarding: mechanisms; allergic environmental causes; chronic cough and the recreational and involuntary inhalation of tobacco and marijuana smoke; nonallergic environmental triggers; laryngeal syndromes; and occupational diseases and exposures. Consensus-based statements were developed for the approach to diagnosis due to a lack of strong evidence from published literature. CONCLUSIONS Despite increased understanding of cough related to occupational and environmental triggers, there remains a gap between the recommended assessment of occupational and environmental causes of cough and the reported systematic assessment of these factors. There is a need for further documentation of occupational and environmental causes of cough in the future.
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Affiliation(s)
- Susan M Tarlo
- Division of Respiratory Medicine, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada.
| | - Kenneth W Altman
- Department of Otolaryngology-Head & Neck Surgery, Baylor College of Medicine, Houston, TX
| | - John Oppenheimer
- Division of Allergy and Immunology, University of Medicine and Dentistry of New Jersey-Rutgers University, Newark, NJ
| | - Kaiser Lim
- Pulmonary and Critical Care Medicine, Mayo Clinic Rochester, Mayo College of Medicine, Rochester, MN
| | | | - David Prezant
- Fire Department of the City of New York, Brooklyn, NY
| | - Richard S Irwin
- Division of Pulmonary, Allergy and Critical Care Medicine, UMass Memorial Medical Center, Worcester, MA
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42
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Sabbioni G, Dongari N, Kumar A, Baur X. Determination of albumin adducts of 4,4'-methylenediphenyl diisocyanate after specific inhalative challenge tests in workers. Toxicol Lett 2016; 260:46-51. [PMID: 27521498 DOI: 10.1016/j.toxlet.2016.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 08/08/2016] [Accepted: 08/09/2016] [Indexed: 12/31/2022]
Abstract
4,4'-Methylenediphenyl diisocyanate (MDI) is the most important isocyanate used in the industry. Lung sensitization with bronchial asthma is the main disorder in exposed workers. Albumin adducts of MDI might be involved in specific immunological reactions. MDI adducts with lysine (MDI-Lys) of albumin have been found in MDI-workers and construction workers. MDI-Lys is an isocyanate-specific adduct of MDI with albumin. In the present study, we report MDI-adducts in workers undergoing diagnostic MDI challenge tests. The workers were exposed for 2h to 5ppb of MDI. The adduct levels increase significantly after the exposure to MDI in the challenge chamber. About 0.6% of the dose was bound to albumin. So far, only urinary metabolites of MDI were measured to monitor isocyanate workers. However, such urinary metabolites are not isocyanate specific. Therefore, we propose to measure albumin adducts for monitoring MDI exposed subjects.
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Affiliation(s)
- Gabriele Sabbioni
- Institute of Environmental and Occupational Toxicology, Casella Postale 108, CH-6780 Airolo, Switzerland; Walther-Straub-Institut für Pharmakologie und Toxikologie, Ludwig-Maximilians-Universität, D-80336 München, Germany; Department of Environmental Health Sciences, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal St., Suite 2100, New Orleans, LA 70112, USA.
| | - Nagaraju Dongari
- Department of Environmental Health Sciences, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal St., Suite 2100, New Orleans, LA 70112, USA; National Laboratories Inc., 3011 W. Grand Blvd, Suite 310, Detroit, MI 48202, USA
| | - Anoop Kumar
- Department of Environmental Health Sciences, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal St., Suite 2100, New Orleans, LA 70112, USA
| | - Xaver Baur
- Institut für Arbeitsmedizin, Charité Universitätsmedizin Berlin, Thielallee 69, 14195 Berlin, Germany
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43
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Nicholson PJ, Fox DP. Smaller employers are less likely to provide occupational health support. BMJ 2016; 354:i4326. [PMID: 27495154 DOI: 10.1136/bmj.i4326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Paul J Nicholson
- Occupational Medicine Committee, British Medical Association, London WC1H 9JP, UK
| | - David P Fox
- Occupational Medicine Committee, British Medical Association, London WC1H 9JP, UK
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Affiliation(s)
- Johanna Feary
- Department of Occupational and Environmental Medicine, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6LR, UK
| | - Hilary Pinnock
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Medical School, Edinburgh, UK Whitstable Medical Practice, Whitstable, UK
| | - Paul Cullinan
- Department of Occupational and Environmental Medicine, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6LR, UK
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45
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Sherson D, Bælum J, Johnsen CR, Schlünssen V, Meyer HW, Pedersen EB, Mosebech H, Bønnelykke J, Brandt LPA, Madsen H. [Specific bronchial and nasal provocations with work-related allergens]. Ugeskr Laeger 2016; 178:V01160046. [PMID: 27094537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Specific inhalation challenge (SIC) is the golden standard for identifying specific causes of work-related asthma and rhinoconjunctivitis. Few centres offer SIC as it requires experience, resources and acute treatment facilities. Prior to SIC treatment should be carefully reduced. A control challenge is performed on a separate day. Many new asthma causes have been identified with SIC. SIC provides the basis for optimal treatment and advice.
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46
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Baldassarre A, Dragonieri S, Luisi V, Musti M, Vimercati L. Occupational asthma in a fruit and vegetables vendor. Med Lav 2016; 107:87-91. [PMID: 27015024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 02/03/2016] [Accepted: 02/29/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND This study presents a case report of a woman running a fruit and vegetables market stall, occupationally exposed to mushroom spores, who developed asthmatic symptoms. Basidiospores are allergens that can give rise to sensitization and subsequently trigger an allergic reaction, such as contact dermatitis, rhino-conjunctivitis, asthma and hypersensitivity pneumonitis. METHODS A 40-year-old atopic woman, who had worked at a market stall selling fruit and vegetables for the past 26 years in a small town market in southern Italy, came to our attention at the Occupational Medicine Unit, complaining of a 3-year history of dyspnoea, cough, and wheezing during autumn and winter. RESULTS Spirometry showed a severe mixed type respiratory deficit with a significant bronchodilator response obtained with salbutamol administration. Skin prick tests to common aeroallergens were negative. Prick-to-prick test with fresh Pleurotus ostreatus was positive. We evaluated the size of the skin wheals and compared them to the positive control according to the Skin Index. An on-the-spot inspection of her store was performed and environmental conditions were identified that did not allow a satisfactory air exchange. CONCLUSIONS The clinical history and the results of the allergologic investigations, plus an on-the-spot inspection, permitted us to ascertain that this subject had developed occupational asthma due to Pleurotus ostreatus spores. We advised her to stop handling and selling mushrooms, and she has no longer suffered asthmatic symptoms, over seven years of follow-up, and regularly continued to work without needing to take anti-asthma drugs.
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Affiliation(s)
- Antonio Baldassarre
- Medicina del Lavoro "B. Ramazzini" Dipartimento Interdisciplinare di Medicina Università degli Studi di Bari "Aldo Moro".
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47
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Kudaeva IV, Dyakovich OA, Beygel EA, Masnavieva LB, Naumova OV, Budarina LA. [Clinical, biochemical and allergological indices characterizing occupational diseases of the bronchial and pulmonary system in employees at aluminium production]. Gig Sanit 2016; 95:1142-1145. [PMID: 29446284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
There are many harmful factors that possess a damaging impact on the body of employees at aluminum production. It leads to the development of bronchial asthma (BA), chronic nonobstructive bronchitis (CNB) and chronic obstructive pulmonary disease (COPD). The pathogenesis of these disorders, as well as sensitizing effect offluorine in the aluminum production is not fully understood. The purpose of this work was to study the characteristics of laboratory indices in patients with occupational diseases of the respiratory system. In workers of aluminum production with the diagnosis of occupational diseases of respiratory system (15 patients with a diagnosis of asthma, 30 CNB cases, 20 COPD patients) we evaluated the content of total protein, total cholesterol, high density lipoprotein cholesterol (HDLC), total calcium, phosphorus, ceruloplasmin, hematological indices and performed emigration of leukocytes braking test (TTEEL). Clinical and biochemical profile ofpersons with occupational asthma was characterized by a low level of total calcium and ceruloplasmin, a high concentration of phosphorus in the blood serum and inhibition of leukocyte emigration in the test with sodium fluoride. For aluminum production CNB workers characteristic active proatherogenic process was pronounced by a decrease in the HDLC level and an increase in atherogenic index; higher hematocrit value and concentration of erythrocytes, and more than 50% of cases of sensitization to the presence of sodium fluoride. COPD cases had occupational lower average concentration of hemoglobin in the erythrocyte, total protein in serum, as well as polymorphic variant response to sodium fluoride in the form of a depression and activation of leucocytes emigration.
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Poussel M, Penven E, Richard C, Jacquenet S, Chabot F, Paris C. Occupational asthma to "the miracle tree" (Moringa oleifera): first description. J Allergy Clin Immunol Pract 2015; 3:813-4. [PMID: 26116950 DOI: 10.1016/j.jaip.2015.05.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 04/02/2015] [Accepted: 05/05/2015] [Indexed: 11/19/2022]
Affiliation(s)
- Mathias Poussel
- Department of Pulmonary Function Testing and Exercise Physiology, Centre Hospitalier Universitaire Nancy, Nancy, France; Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control, Université de Lorraine, France
| | - Emmanuelle Penven
- Occupational Diseases Department, Bâtiment Philippe Canton, Centre Hospitalier Universitaire Nancy, Vandoeuvre-lès-Nancy, France; Interactions Gènes-Risques Environnementaux et Effets sur la Santé, Université de Lorraine, France
| | | | | | - François Chabot
- Interactions Gènes-Risques Environnementaux et Effets sur la Santé, Université de Lorraine, France; Pulmonology Department, Centre Hospitalier Universitaire Nancy, Nancy, France
| | - Christophe Paris
- Occupational Diseases Department, Bâtiment Philippe Canton, Centre Hospitalier Universitaire Nancy, Vandoeuvre-lès-Nancy, France; Interactions Gènes-Risques Environnementaux et Effets sur la Santé, Université de Lorraine, France.
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Aasen TOB, Kongerud J. [T.O.B. Aasen & J. Kongerud reply]. Tidsskr Nor Laegeforen 2015; 135:11. [PMID: 25589105 DOI: 10.4045/tidsskr.14.1488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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50
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Alfonso JH, Danielsen TE, Holm JØ. [Re: The working environment continues to cause illness]. Tidsskr Nor Laegeforen 2015; 135:10-1. [PMID: 25589104 DOI: 10.4045/tidsskr.14.1489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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