Health effects of organic dusts in the farm environment. Report on agents

Extrinsic allergic alveolitis caused by misting fountains

Recently, an increasing number of patients were presented to our clinics with febrile and respiratory symptoms associated with exposure to a new type of domestic ultrasonic humidifier. We report on 11 patients who developed recurrent episodes of fever, cough and dyspnea after repeated exposure to ultrasonic misting fountains at home. A diagnosis of extrinsic allergic alveolitis (EAA) or toxic alveolitis was made on the basis of the history and the clinical, radiological, laboratory and immunological findings. Eight patients were subjected to inhalative challenge tests with their own ultrasonic misting fountains, and all of them exhibited positive reactions. Nine patients were diagnosed with an EAA (humidifier lung) and two patients with a toxic alveolitis (humidifier fever). This study demonstrates the potential for ultrasonic misting fountains to cause illness in the home. In view of the increasing popularity of these devices, humidifier lung and humidifier fever should be considered in the differential diagnosis of patients with unexplained pulmonary or flu-like illnesses with fever.

Inhaled endotoxin and organic dust particulates have synergistic proinflammatory effects in equine heaves (organic dust-induced asthma)

BACKGROUND

Equine heaves is a naturally occurring organic dust-induced asthma characterized by airway neutrophilia, mucus hypersecretion and obstructive lung dysfunction. However, the relative role of different dust components in disease severity remains unclear.

OBJECTIVE

This study investigated the relative contribution of inhaled endotoxin and organic dust particulates (mainly mould spores) in inducing heaves in heaves-susceptible horses.

METHODS

Control and heaves-susceptible horses received inhalation challenges with hay dust suspension (HDS) before and after lipopolysaccharide (LPS) depletion. Heaves-susceptible horses also received inhalation challenge with HDS particulates with and without the addition of LPS and were housed in two separate dusty environments during which mould and endotoxin exposure was measured. The airway inflammatory and functional response to each challenge was measured.

RESULTS

Depletion of endotoxin from HDS attenuated the airway neutrophilia and abrogated the airway dysfunction induced in heaves horses by inhaled HDS. The airway response was re-established by adding back LPS to the depleted HDS, confirming that the attenuation in airway response was due specifically to endotoxin depletion. Interestingly, the magnitude of alteration in airway response following endotoxin depletion and add-back was greater than that which could be attributed solely to endotoxin per se, indicating that the LPS activity was enhanced by the other dust components. Consistent with this possibility, washed particulates harvested from HDS enhanced the airway response to inhaled LPS in heaves horses. Heaves horses given two different hay/straw challenges had a significantly different severity of airway inflammation and dysfunction, despite airborne dust and endotoxin concentrations in the horses' breathing zones being similar.

CONCLUSION

Although inhaled endotoxin appears not to be the only determinant of disease severity in heaves, it does contribute significantly to the induction of airway inflammation and dysfunction. This contribution is largely via the synergistic action of inhaled endotoxin and organic dust particulates, although other soluble dust components also contribute to a lesser degree.

Sampling environments containing organic dust

Assessment of airborne organic dust in different environments is necessary to better understand the relationship between exposure and disease. Exposure assessment requires a well-defined sampling strategy which addresses the following questions: Where, how long, who, how many, and when? For assessing exposure to organic dust, the question of "what?" must be included because, in most cases, the specific toxins or appropriate surrogates for exposure have not been identified. For most environments with organic dust, these questions have not been adequately addressed. However, a large database exists for cotton dust. Cotton is used as a model of organic dust to illustrate the application of exposure assessment: 1) to develop a dose-response relationship between aerosolized dust and specific health effects; 2) to evaluate the effects of process change on gravimetric dust levels and for compliance with the cotton dust standard; and 3) to identify specific biologically active components in the dust.

Presence of endotoxins in different agricultural environments

Gram-negative bacterial endotoxins are contaminants of dusts from agricultural products. They represent a potential health hazard for farmers working in many different processes. However, the occurrence of endotoxins has not been well characterized in the various farming operations. Therefore, two farming activities with potential for generating airborne endotoxins were studied: 1) chopping of baled corn stalks or straw for bedding in New York State, and 2) oat bin unloading in Alabama. Actual airborne endotoxin levels in dusts obtained during bedding chopper operations far exceeded [90 endotoxin units (EU)/m3] the level at which acute pulmonary function decrements occur in cotton dust-exposed individuals. Endotoxin contamination of laboratory-generated dust from an oat sample likewise exceeded these levels. This study documents the presence of potentially hazardous exposures to endotoxins in two common farm processes, which expands the knowledge of airborne endotoxin exposures on the farm.

Occupational biohazards: a review

There are at least 193 important biological agents that show infectious, allergenic, toxic, or carcinogenic activities in the working population. These agents are viruses, bacteria, fungi, plant substances, invertebrate animals (mostly arthropods), and substances derived from vertebrate animals. At least 20 large occupational groups are exposed to these biohazards. The risk is greatest among health care and laboratory workers who are threatened by human pathogens and among agricultural workers who are at risk from dust-borne biological allergens and toxins and by parasitic worms in warm climates. There is growing evidence that biohazards are also important risk factors for many other professions, including woodworkers, workers of textile plants, sewage and compost workers, miners and renovators. Some suggestions for research and prevention for reducing the occupational risks from biohazards are discussed.