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Song X, Ding X, Niu P, Chen T, Yan T. The Associations between Exposure to Multiple Heavy Metals and Total Immunoglobulin E in U.S. Adults. TOXICS 2024; 12:116. [PMID: 38393211 PMCID: PMC10891582 DOI: 10.3390/toxics12020116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/25/2024] [Accepted: 01/27/2024] [Indexed: 02/25/2024]
Abstract
Immunoglobulin E (IgE) is a type of immunoglobulin, and elevated serum total IgE is often present in allergic diseases. Exposure to environmental heavy metals has been markedly linked to allergic diseases, leading to elevated total IgE levels. However, studies concerning the effects of multiple metal exposures on total IgE levels are limited. Therefore, the current study seeks to explore the correlation between heavy-metal co-exposure and total IgE levels based on the National Health and Nutrition Examination Survey (NHANES, 2005-2006). Participants possessed complete data on total IgE levels, 11 urinary metal concentrations and other covariates. The correlations between 11 metals and total IgE levels were analyzed using multiple linear regression, and total IgE levels were a continuous variable. Total IgE levels exceeding 150 kU/L were considered sensitized. Binary logistic regression analyses were employed to assess the correlation between metal exposure and the occurrence of an allergic state. Then, the association between co-exposure to the 11 metals and total IgE levels or the occurrence of sensitization status was further analyzed by Bayesian kernel machine regression (BKMR), a multi-contaminant model. There were 1429 adults with complete data included. Based on the median concentration, molybdenum (Mo) had the highest concentration (46.60 μg/L), followed by cesium (Cs), barium (Ba), lead (Pb), and mercury (Hg). And the median (interquartile range) for total IgE levels was 43.7 (17.3, 126.0) kU/L. Multiple linear regression results showed that Pb was significantly and positively associated with total IgE levels (β = 0.165; 95% CI: 0.046, 0.284). Binary logistic regression showed a significant positive correlation between urinary Pb (OR: 1.258; 95% CI: 1.052, 1.510) and tungsten (W) (OR: 1.251; 95% CI: 1.082, 1.447). Importantly, the BKMR model found a positive correlation between combined-metal exposure and total IgE levels and the occurrence of sensitization status. The mixed heavy-metal exposure was associated with increased total IgE levels, and this association may be driven primarily by the exposure of Pb and W. This study provides new insights into the relationship between heavy-metal exposure and allergic diseases. More research is needed to confirm these findings.
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Affiliation(s)
- Xin Song
- Department of Occupational Health and Environmental Health, School of Public Health, Capital Medical University, Beijing 100069, China; (X.S.)
- Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing 100069, China
| | - Xiaowen Ding
- Beijing Institute of Occupational Disease Prevention and Treatment, Beijing 100093, China
| | - Piye Niu
- Department of Occupational Health and Environmental Health, School of Public Health, Capital Medical University, Beijing 100069, China; (X.S.)
- Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing 100069, China
| | - Tian Chen
- Department of Occupational Health and Environmental Health, School of Public Health, Capital Medical University, Beijing 100069, China; (X.S.)
- Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing 100069, China
| | - Tenglong Yan
- Beijing Institute of Occupational Disease Prevention and Treatment, Beijing 100093, China
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Temkin AM, Geller SL, Swanson SA, Leiba NS, Naidenko OV, Andrews DQ. Volatile organic compounds emitted by conventional and "green" cleaning products in the U.S. market. CHEMOSPHERE 2023; 341:139570. [PMID: 37709066 DOI: 10.1016/j.chemosphere.2023.139570] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 09/16/2023]
Abstract
Exposure to cleaning products has been associated with harm to the respiratory system, neurotoxicity, harm to the reproductive system, and elevated risk of cancer, with greatest adverse impacts for workers exposed in an occupational setting. Social and consumer interest in cleaning products that are safer for health created a market category of "green" products defined here as products advertised as healthier, non-toxic, or free from harmful chemicals as well as products with a third-party certification for safety or environmental features. In the present study we examined the air quality impacts of cleaning products and air fresheners, measuring the number, concentrations, and emission factors of volatile organic compounds (VOCs) in an air chamber following product application. Across seven common product categories, 30 products were tested overall including 14 conventional, 9 identified as "green" with fragrance, and 7 identified as "green" and fragrance-free. A total of 530 unique VOCs were quantified with 205 additional VOCs detected below the limits of quantification. Of the quantifiable VOCs, 193 were considered hazardous according to either the California's Department of Toxic Substances Control Candidate Chemicals List or the European Chemical Agency's Classification and Labeling Inventory. The total concentration of VOCs and total emission factors across all products with detections ranged from below limits of detection to 18,708 μg/m3, 38,035 μg/g product and 3803 μg/application. Greater total concentration, total emission factors, and numbers of VOCs were generally observed in conventional cleaning products compared to products identified as "green", particularly compared to fragrance-free products. A hazard index approach was utilized to assess relative risk from measured VOC emissions. The five products with the highest hazard indices were conventional products with emissions of 2-butoxyethanol, isopropanol, toluene and chloroform. Overall, this analysis suggests that the use of "green" cleaning products, especially fragrance-free products, may reduce exposure to VOC emissions.
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Affiliation(s)
- Alexis M Temkin
- Environmental Working Group, 1250 I St NW Suite 1000, Washington DC, 20005, USA.
| | - Samara L Geller
- Environmental Working Group, 1250 I St NW Suite 1000, Washington DC, 20005, USA
| | - Sydney A Swanson
- Environmental Working Group, 1250 I St NW Suite 1000, Washington DC, 20005, USA
| | | | - Olga V Naidenko
- Environmental Working Group, 1250 I St NW Suite 1000, Washington DC, 20005, USA
| | - David Q Andrews
- Environmental Working Group, 1250 I St NW Suite 1000, Washington DC, 20005, USA
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Gandhi SA, Heinzerling A, Flattery J, Cummings KJ. Occupational Contributions to Respiratory Health Disparities. Clin Chest Med 2023; 44:635-649. [PMID: 37517841 PMCID: PMC10861114 DOI: 10.1016/j.ccm.2023.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
Occupation is an important contributor to disparities in respiratory disease, affecting financial status, health-care access, and exposure to hazardous substances. Although occupation and associated exposures are included in the socioecological models, work exposures remain persistently absent from research on health inequities and their contribution to health. This article focuses on the occupational contribution to disparities in asthma, chronic obstructive pulmonary disease, silicosis, coronavirus disease 2019, and lung cancer. Because occupational exposures are largely preventable through proper workplace controls, the recognition of occupational causes of disease can provide an opportunity for interventions to bring about health equity.
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Affiliation(s)
- Sheiphali A Gandhi
- Division of Occupational and Environmental Medicine, Department of Medicine, University of California San Francisco, 2330 Post St Ste 460, San Francisco, CA 94115, USA
| | - Amy Heinzerling
- Occupational Health Branch, California Department of Public Health, 850 Marina Bay Parkway P-3, Richmond, CA 94804, USA
| | - Jennifer Flattery
- Occupational Health Branch, California Department of Public Health, 850 Marina Bay Parkway P-3, Richmond, CA 94804, USA
| | - Kristin J Cummings
- Occupational Health Branch, California Department of Public Health, 850 Marina Bay Parkway P-3, Richmond, CA 94804, USA.
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Erfani B, Vilela LA, Julander A, Schenk L. Safety data sheets as an information pathway on hazards of occupationally used cleaning agents. Regul Toxicol Pharmacol 2023:105447. [PMID: 37414128 DOI: 10.1016/j.yrtph.2023.105447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/09/2023] [Accepted: 07/03/2023] [Indexed: 07/08/2023]
Abstract
To investigate consistency and accessibility of asthma and skin allergy hazard information in safety data sheets (SDSs) for cleaning agents on the Swedish market, we compiled a database of 504 SDSs and 351 therein declared ingredients. Labelling of products was compared to that of ingredients according to harmonised classification. For each ingredient, also notified classification and three additional sources on sensitising properties were compared. Product labelling most frequently indicated corrosion and irritation hazards. Only 3% of products were labelled as skin sensitisers and none as asthmagens. According to harmonised classification, 9% of products contained skin sensitisers, using other information sources increased the number to 46%. While 2% of products contained respiratory sensitisers according to harmonised classification, the number increased to 17% when using other information sources. Furthermore, sensitisers were declared across several sections of the SDSs, hampering easy access of such information. In conclusion, there are inconsistencies in hazard identification of cleaning agents and their ingredients. Hence, SDSs may not altogether fulfil its hazard information role. Improved criteria for identifying sensitisers and respiratory irritants are warranted. Additionally, we argue that all ingredients should be listed in section 3 regardless of concentration, to facilitate access of information about sensitising properties.
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Affiliation(s)
- Behnaz Erfani
- Institute of Environmental Medicine, Karolinska Institutet, Sweden
| | - Libe A Vilela
- Institute of Environmental Medicine, Karolinska Institutet, Sweden
| | - Anneli Julander
- Institute of Environmental Medicine, Karolinska Institutet, Sweden; IVL Swedish Environmental Research Institute, Sweden
| | - Linda Schenk
- Institute of Environmental Medicine, Karolinska Institutet, Sweden.
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5
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Dalbøge A, Albert Kolstad H, Ulrik CS, Sherson DL, Meyer HW, Ebbehøj N, Sigsgaard T, Zock JP, Baur X, Schlünssen V. The Relationship Between Potential Occupational Sensitizing Exposures and Asthma: An Overview of Systematic Reviews. Ann Work Expo Health 2023; 67:163-181. [PMID: 36472234 DOI: 10.1093/annweh/wxac074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 10/05/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES The aim was to identify, appraise, and synthesize the scientific evidence of the relationship between potential occupational sensitizing exposures and the development of asthma based on systematic reviews. METHODS The study was conducted as an overview of systematic reviews. A systematic literature search was conducted for systematic reviews published up to 9 February 2020. Eligibility study criteria included persons in or above the working age, potential occupational sensitizing exposures, and outcomes defined as asthma. Potential occupational sensitizing exposures were divided into 23 main groups comprising both subgroups and specific exposures. Two reviewers independently selected studies, extracted study data, assessed study quality, and evaluated confidence in study results and level of evidence of the relationship between potential occupational sensitizing exposures and asthma. RESULTS Twenty-seven systematic reviews were included covering 1242 studies and 486 potential occupational sensitizing exposures. Overall confidence in study results was rated high in three systematic reviews, moderate in seven reviews, and low in 17 reviews. Strong evidence for the main group of wood dusts and moderate evidence for main groups of mites and fish was found. For subgroups/specific exposures, strong evidence was found for toluene diisocyanates, Aspergillus, Cladosporium, Penicillium, and work tasks involving exposure to laboratory animals, whereas moderate evidence was found for 52 subgroups/specific exposures. CONCLUSIONS This overview identified hundreds of potential occupational sensitizing exposures suspected to cause asthma and evaluated the level of evidence for each exposure. Strong evidence was found for wood dust in general and for toluene diisocyanates, Aspergillus, Cladosporium, Penicillium, and work tasks involving exposure to laboratory animals.
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Affiliation(s)
- Annett Dalbøge
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, 8200 Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark
| | - Henrik Albert Kolstad
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Hvidovre University Hospital, 2650 Hvidovre, Denmark
| | - David Lee Sherson
- Department of Occupational and Environmental Medicine, Odense University Hospital, 5000 Odense, Denmark.,Department of Pulmonary Medicine, Odense University Hospital, 5000 Odense, Denmark
| | - Harald William Meyer
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, 2400 Copenhagen, Denmark
| | - Niels Ebbehøj
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, 2400 Copenhagen, Denmark
| | - Torben Sigsgaard
- Department of Public Health, Environment, Occupation, and Health, Danish Ramazzini Centre, Aarhus University, 8000 Aarhus, Denmark
| | - Jan-Paul Zock
- National Institute for Public Health and the Environment (RIVM), Bilthoven, 3721 MA, The Netherlands
| | - Xaver Baur
- Institut für Arbeitsmedizin, Charité Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Vivi Schlünssen
- National Research Centre for the Working Environment, 2100 Copenhagen, Denmark.,Department of Public Health, Environment, Occupation, and Health, Danish Ramazzini Centre, Aarhus University, 8000 Aarhus, Denmark
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Dodd KE, Blackley DJ, Mazurek JM. Cardiovascular Disease Among Adults With Work-Related Asthma, 2012-2017. Am J Prev Med 2023; 64:194-203. [PMID: 36371324 DOI: 10.1016/j.amepre.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/23/2022] [Accepted: 09/12/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Asthma is associated with an increased risk for cardiovascular disease, and adults with persistent, severe asthma have a significantly higher risk of cardiovascular disease than adults with intermittent or no asthma. METHODS The objective of this cross-sectional study was to assess the association between work-related asthma status and cardiovascular disease among ever-employed adults (aged 18-64 years) with current asthma using data from the 2012-2017 Behavioral Risk Factor Surveillance System Asthma Call-Back Survey from 37 states and the District of Columbia. Weighted prevalence ratios and 95% CIs, adjusted for age, sex, race/ethnicity, education, household income, smoking status, chronic obstructive pulmonary disease, diabetes, and BMI, were calculated. In addition, the associations of cardiovascular disease with adverse asthma outcomes and asthma control among adults with work-related asthma were examined. Analyses were conducted in 2021. RESULTS Among an estimated annualized 14.8 million ever-employed adults aged 18-64 years with current asthma, adults with work-related asthma (prevalence ratio=1.5; 95% CI=1.2, 1.8) and possible work-related asthma (prevalence ratio=1.2; 95% CI=1.0, 1.5) were significantly more likely to have cardiovascular disease than adults with non-work-related asthma. Among adults with work-related asthma, those with very poorly controlled asthma (prevalence ratio=1.8; 95% CI=1.3, 2.5) and an asthma-related emergency room visit (prevalence ratio=1.5; 95% CI=1.1, 2.0) were significantly more likely to have cardiovascular disease. CONCLUSIONS Adults with work-related asthma were more likely to have cardiovascular disease than those with non-work-related asthma. Primary prevention, early diagnosis, and implementation of optimal work-related asthma management are essential for workers' health. Cardiovascular disease should be considered where appropriate when diagnosing and recommending treatment and interventions for adults with work-related asthma.
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Affiliation(s)
- Katelynn E Dodd
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention (CDC), Morgantown, West Virginia.
| | - David J Blackley
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention (CDC), Morgantown, West Virginia
| | - Jacek M Mazurek
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention (CDC), Morgantown, West Virginia
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Lemiere C, Lavoie G, Doyen V, Vandenplas O. Irritant-Induced Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:2799-2806. [PMID: 35820617 DOI: 10.1016/j.jaip.2022.06.045] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/30/2022] [Accepted: 06/30/2022] [Indexed: 06/15/2023]
Abstract
Irritant-induced asthma (IIA) is a phenotype of asthma caused by the inhalation of irritant agents. Definite, probable, or possible IIA have been described, depending on the concentration of the inhaled irritants and the onset of respiratory symptoms respective to the time of exposure. Definite IIA represents approximately 4% to 14% of all cases of new-onset work-related asthma. Agents responsible for IIA can be encountered as fumes, gases, aerosols, or dusts. The most frequent are chlorine, nitrogen oxides, sulfur dioxide, ammonia, acetic acid, solvents, and cleaning materials. Although the diagnosis of definite IIA is based on a suggestive clinical history along with evidence of reversible airflow limitation and/or nonspecific bronchial hyperresponsiveness, possible IIA cannot be diagnosed with certainty because the relationship between exposure and the onset of symptoms is difficult to establish. This article reviews the epidemiology, pathophysiology, diagnostic approach, and management of IIA.
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Affiliation(s)
- Catherine Lemiere
- Department of Chest Medicine, CIUSSS du Nord de l' Île de Montréal, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada.
| | - Gabriel Lavoie
- Department of Chest Medicine, CIUSSS du Nord de l' Île de Montréal, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada
| | - Virginie Doyen
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - Olivier Vandenplas
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
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8
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Kirkland KH, Rosenman KD. Association of occupational and environmental clinics exposure code system and criteria for substances that cause work-related asthma. Occup Environ Med 2022; 79:287-288. [PMID: 35177429 DOI: 10.1136/oemed-2021-108174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 01/27/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Katherine H Kirkland
- Association of Occupational and Environmental Clinics, Washington, District of Columbia, USA
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9
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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. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 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] [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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Lee S, Povey AC, Seed MJ, van Tongeren M. Insufficient respiratory hazard identification in the safety data sheets for cleaning and disinfection products used in healthcare organisations across England and Wales. Occup Environ Med 2021; 78:293-295. [PMID: 33563606 DOI: 10.1136/oemed-2020-106881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/17/2020] [Accepted: 11/25/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Exposure to cleaning and disinfection products has been associated with respiratory disorders such as asthma in cleaning and healthcare workers. Safety data sheets (SDSs) provide information on hazardous chemicals that are present in products to help users with risk assessment and implement appropriate control measures. However, they have potential limitations in identifying respiratory hazards due to a lack of regulatory test methods for respiratory sensitisation and irritation of chemicals. METHODS SDSs were first used to identify chemicals on the database as respiratory sensitisers and irritants. A quantitative structure-activity relationship (QSAR) model and an asthmagen list established by the Association of Occupational and Environmental Clinics (AOEC) were used to identify potential respiratory sensitisers and irritants (by the AOEC list only) in the cleaning and disinfection products. RESULTS From a total of 459 cleaning and disinfection products used in healthcare organisations across England and Wales, 35 respiratory sensitisers not labelled as such on the SDS were identified by QSAR or AOEC. Only 2% of cleaning and disinfection products contained at least one respiratory sensitiser as identified by their SDSs; this was increased to 37.7% of products when the QSAR or the AOEC list was used. CONCLUSIONS A significantly higher proportion of cleaning products contain respiratory hazardous chemicals, particularly respiratory sensitisers than would be expected from the information provided by SDSs alone. Cleaners and healthcare workers may, therefore, be insufficiently protected.
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Affiliation(s)
- Sewon Lee
- Centre for Occupational and Environmental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Andrew C Povey
- Centre for Occupational and Environmental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Martin J Seed
- Centre for Occupational and Environmental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Martie van Tongeren
- Centre for Occupational and Environmental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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11
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Rosenman KD, Reilly MJ, Wang L. Calls to a State Poison Center Concerning Cleaners and Disinfectants From the Onset of the COVID-19 Pandemic Through April 2020. Public Health Rep 2020; 136:27-31. [PMID: 33059533 PMCID: PMC7856373 DOI: 10.1177/0033354920962437] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
An increased use of disinfectants during the coronavirus disease 2019 (COVID-19) pandemic may increase the number of adverse health effects among people who apply them or among those who are in the area being disinfected. For the 3-month period from January 1 to March 30, 2020, the number of calls about exposure to cleaners and disinfectants made to US poison centers in all states increased 20.4%, and the number of calls about exposure to disinfectants increased 16.4%. We examined calls about cleaners and disinfectants to the Michigan Poison Center (MiPC) since the onset of the COVID-19 pandemic. We compared all calls related to exposure to cleaners or disinfectants, calls with symptoms, and calls in which a health care provider was seen during the first quarters of 2019 and 2020 and in relationship to key COVID-19 dates. From 2019 to 2020, the number of all disinfectant calls increased by 42.8%, the number of calls with symptoms increased by 57.3%, the average number of calls per day doubled after the first Michigan COVID-19 case, from 4.8 to 9.0, and the proportion of calls about disinfectants among all exposure calls to the MiPC increased from 3.5% to 5.0% (P < .001). Calls for exposure to cleaners did not increase significantly. Exposure occurred at home for 94.8%97.1% of calls, and ingestion was the exposure route for 59.7% of calls. Information about the adverse health effects of disinfectants and ways to minimize exposure should be included in COVID-19 pandemic educational materials.
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Affiliation(s)
- Kenneth D. Rosenman
- Division of Occupational and Environmental Medicine, Department of Medicine, College of Human Medicine, Michigan State University, East Lansing, MI, USA,Kenneth D. Rosenman, MD, Michigan State University, Division of Occupational and Environmental Medicine, 909 Wilson Rd, Room 117 West Fee, East Lansing, MI 48824, USA;
| | - Mary Jo Reilly
- Division of Occupational and Environmental Medicine, Department of Medicine, College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Ling Wang
- Division of Occupational and Environmental Medicine, Department of Medicine, College of Human Medicine, Michigan State University, East Lansing, MI, USA
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12
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Kurt OK, Basaran N. Occupational Exposure to Metals and Solvents: Allergy and Airway Diseases. Curr Allergy Asthma Rep 2020; 20:38. [PMID: 32506296 DOI: 10.1007/s11882-020-00931-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Occupational allergic diseases (OAD) such as occupational contact dermatitis (OCD), occupational asthma (OA), and occupational rhinitis (OR) are the most prevalent occupational diseases in industrialized countries. The purpose of this review is to provide an update about the main occupational metal and solvent exposures related to allergy and airway diseases and to discuss newly defined causative agents and industries in this field. RECENT FINDINGS Currently for over 400 causative agents for OA and OCD, several hundreds of agents for OR have been identified. Although many studies have reported an overall decline in OAD related to known agents after implementation of efficient and effective workplace preventive measures, the constant development of new products continuously introduces to the market potential unknown respiratory hazards. Workplace allergens are often high molecular weight (HMW) agents that are > 10 kDa molecular weight and capable of eliciting IgE sensitization. Sensitizing low molecular weight (LMW) agents are often reactive chemicals. Metals and solvents are two large causative agent groups related to OADs that mainly behave as LMW (< 10 kDa) sensitizers and/or irritants. Avoidance of causative exposures through control strategies is the primary prevention approach for OADs. These strategies must be applied and covered for all known and newly defined causative agents. This review aims to summarize current status of known occupational metal and solvent exposures related to allergy and airway diseases and to discuss newly defined causative agents and industries in this field.
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Affiliation(s)
- Ozlem Kar Kurt
- Department of Pulmonology and Occupational Medicine, Zonguldak Atatürk State Hospital, Zonguldak, Turkey. .,Department of Pharmaceutical Toxicology, Hacettepe University, Faculty of Pharmacy, Ankara, Turkey.
| | - Nursen Basaran
- Department of Pharmaceutical Toxicology, Hacettepe University, Faculty of Pharmacy, Ankara, Turkey
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Use of population data for assessing trends in work-related asthma mortality. Curr Opin Allergy Clin Immunol 2020; 19:98-104. [PMID: 30601151 DOI: 10.1097/aci.0000000000000508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW Work-related asthma has been associated with poorer asthma control and frequent unscheduled healthcare visits, and can be fatal. Case reports of work-related asthma deaths are rare, but can initiate efforts to prevent additional cases. We reviewed relevant literature and data sources to evaluate whether analyzing mortality data at the population level can help identify potential sources of exposures that contribute to work-related asthma. RECENT FINDINGS A limited number of population-based studies have addressed work-related asthma mortality. Data on asthma mortality are derived from death certificates using the International Classification of Diseases (ICD) as a standard for coding cause. However, no discrete code for work-related asthma is available. Analysis of asthma mortality relative to industries and occupations appears to identify high-risk jobs that were not identified by analyzing asthma morbidity data. SUMMARY Beyond recognized work-related asthma deaths, it is possible that occupational exposures have contributed to other asthma deaths that have gone unnoticed and could potentially be identified by the analysis of mortality data at the population level. Such analyses in the United States appear to assist in recognizing high-risk occupations and industries. Additional analyses would be possible if a work-related asthma ICD code were available.
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Abstract
Rationale: Exposure to a variety of substances in the workplace can cause new-onset asthma or aggravate preexisting asthma, both of which are considered work-related asthma (WRA). Understanding trends in the nature and causes of WRA can assist in the diagnosis and management of adult patients with asthma.Objective: To describe trends over 31 years of WRA surveillance in Michigan.Methods: Michigan law requires reporting of all known or suspected cases of occupational disease. WRA was confirmed by review of a standardized telephone interview and patient medical records. Enforcement inspections at the workplaces of the WRA cases included air monitoring and evaluation for asthma and asthma symptoms among coworkers.Results: The Michigan surveillance program identified 3,634 WRA cases from 1988 to 2018, including nine deaths. The cumulative incidence rate of WRA decreased from 3.5 to 2.0 cases per 100,000 workers. Cases most frequently worked in manufacturing (56%), health care (12%), and education (4%). The cumulative incidence rate of WRA decreased in each of those three industries, while increasing in retail trade and accommodations and food services. The most common exposures to known asthma inducers were to cleaning agents and isocyanates; the percentage exposed to cleaning agents increased from 5% to 20%, and the percentage exposed to isocyanates decreased from 20% to 7%. Fifty-one percent had not applied for workers' compensation benefits. Only 5% of the 571 workplaces where air sampling was performed were above the allowable exposure limit. Fifteen percent (1,622 of 10,493) of coworkers of the index cases reported onset of asthma since beginning to work at the facility or being bothered at work by daily or weekly chest tightness, shortness of breath, or wheezing.Conclusions: The industries and exposures where Michigan adults develop WRA have changed during the past 31 years. The identification of WRA cases, including WRA deaths, underscores the need for continued vigilance to monitor changes in where and how workers are exposed to asthma-causing agents, physician consideration of workplace exposures in new-onset or worsening adult asthma, and adoption of workplace standards that reduce exposure and require workplace medical monitoring to prevent and reduce the morbidity and mortality of WRA.
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Rosenman K, Reilly MJ, Pechter E, Fitzsimmons K, Flattery J, Weinberg J, Cummings K, Borjan M, Lumia M, Harrison R, Dodd K, Schleiff P. Cleaning Products and Work-Related Asthma, 10 Year Update. J Occup Environ Med 2020; 62:130-137. [PMID: 31895737 PMCID: PMC7839059 DOI: 10.1097/jom.0000000000001771] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe the frequency of work-related asthma (WRA) and characteristics of individuals with exposure to cleaning products 1998 to 2012, compared with 1993 to 1997. METHODS Cases of WRA from products used for cleaning or disinfecting surfaces were identified from California, Massachusetts, Michigan (1998 to 2012), New Jersey (1998 to 2011), and New York (2009 to 2012). RESULTS There were 1199 (12.4%) cleaning product cases among all 9667 WRA cases; 77.8% women, 62.1% white non-Hispanic, and average age of 43 years. The highest percentages worked in healthcare (41.1%), and were building cleaners (20.3%), or registered nurses (14.1%). CONCLUSIONS The percentage of WRA cases from exposure to cleaning products from 1998 to 2012 was unchanged from 1993 to 1997 indicating that continued and additional prevention efforts are needed to reduce unnecessary use, identify safer products, and implement safer work processes.
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Affiliation(s)
- Kenneth Rosenman
- Michigan State University, Michigan (Dr Rosenman, Ms Reilly); Massachusetts Department of Public Health, Massachusetts (Ms Pechter, Ms Fitzsimmons); California Department of Public Health (Ms Flattery, Dr Harrison); Public Health Institute, Contractor to California Department of Public Health (Ms Weinberg), California; New York State Department of Health (Ms Cummings), New York; New Jersey Department of Health (Dr Borjan, Dr Lumia), New Jersey; and National Institute for Occupational Safety and Health, Cincinnati, Ohio (Ms Dodd, Ms Schleiff)
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Henneberger PK, Patel JR, de Groene GJ, Beach J, Tarlo SM, Pal TM, Curti S. Workplace interventions for treatment of occupational asthma. Cochrane Database Syst Rev 2019; 10:CD006308. [PMID: 31593318 PMCID: PMC6781842 DOI: 10.1002/14651858.cd006308.pub4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The impact of workplace interventions on the outcome of occupational asthma is not well understood. OBJECTIVES To evaluate the effectiveness of workplace interventions on occupational asthma. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE (PubMed); EMBASE(Ovid); NIOSHTIC-2; and CISILO (CCOHS) up to July 31, 2019. SELECTION CRITERIA We included all eligible randomized controlled trials, controlled before and after studies and interrupted time-series of workplace interventions for occupational asthma. DATA COLLECTION AND ANALYSIS Two authors independently assessed study eligibility and risk of bias, and extracted data. MAIN RESULTS We included 26 non-randomized controlled before and after studies with 1,695 participants that reported on three comparisons: complete removal from exposure and reduced exposure compared to continued exposure, and complete removal from exposure compared to reduced exposure. Reduction of exposure was achieved by limiting use of the agent, improving ventilation, or using protective equipment in the same job; by changing to another job with intermittent exposure; or by implementing education programs. For continued exposure, 56 per 1000 workers reported absence of symptoms at follow-up, the decrease in forced expiratory volume in one second as a percentage of a reference value (FEV1 %) was 5.4% during follow-up, and the standardized change in non-specific bronchial hyperreactivity (NSBH) was -0.18.In 18 studies, authors compared removal from exposure to continued exposure. Removal may increase the likelihood of reporting absence of asthma symptoms, with risk ratio (RR) 4.80 (95% confidence interval (CI) 1.67 to 13.86), and it may improve asthma symptoms, with RR 2.47 (95% CI 1.26 to 4.84), compared to continued exposure. Change in FEV1 % may be better with removal from exposure, with a mean difference (MD) of 4.23 % (95% CI 1.14 to 7.31) compared to continued exposure. NSBH may improve with removal from exposure, with standardized mean difference (SMD) 0.43 (95% CI 0.03 to 0.82).In seven studies, authors compared reduction of exposure to continued exposure. Reduction of exposure may increase the likelihood of reporting absence of symptoms, with RR 2.65 (95% CI 1.24 to 5.68). There may be no considerable difference in FEV1 % between reduction and continued exposure, with MD 2.76 % (95% CI -1.53 to 7.04) . No studies reported or enabled calculation of change in NSBH.In ten studies, authors compared removal from exposure to reduction of exposure. Following removal from exposure there may be no increase in the likelihood of reporting absence of symptoms, with RR 6.05 (95% CI 0.86 to 42.34), and improvement in symptoms, with RR 1.11 (95% CI 0.84 to 1.47), as well as no considerable change in FEV1 %, with MD 2.58 % (95% CI -3.02 to 8.17). However, with all three outcomes, there may be improved results for removal from exposure in the subset of patients exposed to low molecular weight agents. No studies reported or enabled calculation of change in NSBH.In two studies, authors reported that the risk of unemployment after removal from exposure may increase compared with reduction of exposure, with RR 14.28 (95% CI 2.06 to 99.16). Four studies reported a decrease in income of 20% to 50% after removal from exposure.The quality of the evidence is very low for all outcomes. AUTHORS' CONCLUSIONS Both removal from exposure and reduction of exposure may improve asthma symptoms compared with continued exposure. Removal from exposure, but not reduction of exposure, may improve lung function compared to continued exposure. When we compared removal from exposure directly to reduction of exposure, the former may improve symptoms and lung function more among patients exposed to low molecular weight agents. Removal from exposure may also increase the risk of unemployment. Care providers should balance the potential clinical benefits of removal from exposure or reduction of exposure with potential detrimental effects of unemployment. Additional high-quality studies are needed to evaluate the effectiveness of workplace interventions for occupational asthma.
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Affiliation(s)
- Paul K Henneberger
- National Institute for Occupational Safety and HealthRespiratory Health Division1095 Willowdale RoadMorgantownWest VirginiaUSA26505
| | - Jenil R Patel
- University of Texas School of Public HealthDepartment of Epidemiology, Human Genetics and Environmental Sciences1200 Pressler ST#W1004aHoustonTexasUSATX 77030
- University of Arkansas for Medical SciencesDepartment of Epidemiology4301 W Markham St, Slot#820Little RockArkansasUSA72205
| | - Gerda J de Groene
- Coronel Institute of Occupational Health, Academic Medical CenterNetherlands Center of Occupational DiseasesPO Box 22660AmsterdamNetherlands1100 DD
| | - Jeremy Beach
- University of AlbertaDepartment of MedicineEdmontonABCanada
| | - Susan M Tarlo
- University of TorontoDepartment of Medicine, and Dalla Lana School of Public HealthToronto Western Hospital EW7‐449399 Bathurst StTorontoONCanadaM5T 2S8
| | - Teake M Pal
- Coronel Institute of Occupational Health, Academic Medical CenterNetherlands Center of Occupational DiseasesPO Box 22660AmsterdamNetherlands1100 DD
| | - Stefania Curti
- University of BolognaDepartment of Medical and Surgical SciencesUO Medicina del Lavoro ‐ Policlinico Sant'Orsola‐MalpighiVia Palagi 9BolognaItaly40138
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Pearlman O. Reviewing the Use of Glutaraldehyde for High-level Disinfection by Sonographers. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2018. [DOI: 10.1177/8756479318813361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A review of recent literature has demonstrated that ultrasound transducers may harbor bacteria and viruses that could cause cross-contamination for patients. Reducing the risk of cross-contamination is achieved by high-level disinfection of ultrasound transducers. One of the main types of high-level disinfectants (HLD) used in performing sonography is glutaraldehyde (GA). While GA-based HLDs are cleared in abundance by the FDA and compatible with most transducers, GA has been reported to cause extensive adverse effects and has limited efficacy as a disinfectant. This literature review provides a current set of studies that discuss high-level disinfection of ultrasound transducers, GA use, exposure, and alternatives. This information could be used by practitioners to carefully consider how to effectively clean ultrasound transducers and supporting equipment. Additional guidance is provided on how to potentially minimize GA exposure and suggestions for protecting patients during their imaging examination.
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Tarlo SM, Arif AA, Delclos GL, Henneberger P, Patel J. Opportunities and obstacles in translating evidence to policy in occupational asthma. Ann Epidemiol 2018; 28:392-400. [PMID: 28434545 PMCID: PMC5953844 DOI: 10.1016/j.annepidem.2017.03.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 02/27/2017] [Accepted: 03/13/2017] [Indexed: 01/14/2023]
Abstract
PURPOSE Occupational asthma (OA), a common respiratory disorder in Western countries, is caused by exposures at the workplace. It is part of a broader definition of work-related asthma (WRA) that also includes pre-existing asthma aggravated by substances present in the workplace environment, and it is potentially preventable. The purpose of this paper is to illustrate preventive measures for occupational asthma by case studies. METHODS In three case studies we discuss preventive measures that have been associated with reductions in incidence of occupational asthma from natural rubber latex and from diisocyanates as supported by published literature. We also discuss challenges in relation to asthma from cleaning products in healthcare work. RESULTS AND CONCLUSIONS Several preventive measures have been associated with reduction in incidence of occupational asthma from natural rubber latex and from diisocyanates, and may provide lessons for prevention of other causes of occupational asthma. Cleaning products remain an unresolved problem at present with respect to asthma risks but potential measures include the use of safer products and safer applications such as avoidance of spray products, use of occupational hygiene methods such as improving local ventilation, and when appropriate, the use of personal protective devices.
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Affiliation(s)
- Susan M Tarlo
- Department of Medicine, University Health Network, University of Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Ontario, Canada; Department of Public Health Sciences, University of Toronto, Ontario, Canada.
| | - Ahmed A Arif
- UNC Charlotte, Department of Public Health Sciences, Charlotte, NC
| | - George L Delclos
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas School of Public Health, Houston
| | | | - Jenil Patel
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas School of Public Health, Houston
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Konya’da Hayvan Yemi Fabrikası İşçilerinde Mesleksel Astım Prevalansı. JOURNAL OF CONTEMPORARY MEDICINE 2018. [DOI: 10.16899/gopctd.401228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Moscato G. Occupational Allergic Airway Disease. CURRENT OTORHINOLARYNGOLOGY REPORTS 2017. [DOI: 10.1007/s40136-017-0170-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Pérez-Calderón R, Gonzalo-Garijo MÁ, Rodríguez-Velasco FJ, Sánchez-Vega S, Bartolomé-Zavala B. Occupational respiratory allergy in peach crop workers. Allergy 2017; 72:1556-1564. [PMID: 28317175 DOI: 10.1111/all.13163] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Occupational respiratory diseases in workers of peach tree crops have been reported punctually and have been associated with sensitization to proteins present in both pollen and leaf tree. We report the study of 37 workers with respiratory symptoms related to occupational exposure to peach trees. METHODS Prick tests and specific IgE determinations were performed with extracts from leaves and branches of peach tree. Immunodetection in leaf extract was realized by sodium dodecyl sulfate-polyacrylamide gel electrophoresis SDS-PAGE-immunoblotting with patient sera and rabbit serum anti-Pru p 3. Immunodetection inhibition was performed with rPru p 3 and pollen profilins. The clinical relevance of sensitization was demonstrated by specific bronchial challenge test (SBCT) with peach leaf extract. RESULTS Most patients suffered symptoms when peach trees had leaves, specifically during thinning and harvesting fruit (rhinoconjunctivitis: 100% and asthma: 67.5%). Sensitization to leaf extract was demonstrated in 86% of patients. IgE-immunoblotting with peach leaf extract revealed in six patient sera a pair of bands of 10 and 16 kDa, and in nine a 16-kDa band. Those bands could be two isoforms of peach leaf lipid transfer proteins( LTP), so the recognition frequency of some LTP isoform by our patient sera was 42%. 33% of the sera recognized a doubled band of about 14.5 kDa and this recognition was inhibited by nPho d 2. The SBCT with peach leaf extract was positive in the asthmatic sensitized patients tested. CONCLUSIONS Sensitization to peach leaves was the cause of occupational respiratory symptoms in our patients. Some patient sera revealed IgE-binding proteins matching LTP and/or profilin.
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Affiliation(s)
- R. Pérez-Calderón
- Allergology Department; Infanta Cristina University Hospital; Badajoz Spain
| | | | | | - S. Sánchez-Vega
- Allergology Department; Infanta Cristina University Hospital; Badajoz Spain
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Abstract
Healthcare workers (HCWs) are exposed to a range of high and low molecular weight agents that are allergic sensitizers or irritants including cleaners and disinfectants, natural rubber latex, and various medications. Studies have shown that exposed HCWs are at risk for work-related rhinitis and asthma (WRA). Work-related rhinitis may precede development of WRA and should be considered as an early marker of WRA. Avoidance of causative exposures through control strategies such as elimination, substitution, engineering controls, and process modification is the preferred primary prevention strategy for preventing development of work-related allergic diseases. There is limited evidence for the effectiveness of respirators in preventing occupational asthma. If sensitizer-induced WRA is diagnosed, it is important to avoid further exposure to the causative agent, preferably by more rigorous application of exposure control strategies to the workplace. This review focuses on allergic occupational respiratory diseases in HCWs.
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Weinberg JL, Flattery J, Harrison R. Fragrances and work-related asthma-California surveillance data, 1993-2012. J Asthma 2017; 54:1041-1050. [PMID: 28332885 DOI: 10.1080/02770903.2017.1299755] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Fragrance chemicals are used in a large array of products. Workers may be exposed to these chemicals in the workplace directly when used as air fresheners, or indirectly in personal care products used by coworkers or others. This study characterizes work-related asthma (WRA) cases associated with fragrance exposures in California workplaces from 1993 through 2012. METHODS We used the California Work-Related Asthma Prevention Program's surveillance database to identify individuals with physician-diagnosed WRA associated with the use of air fresheners and scented personal care products (perfumes, colognes, etc.). Cases were classified using previously published, standardized surveillance methods. RESULTS Perfume was the ninth most common exposure identified from 1993 through 2012. A total of 270 WRA cases associated with fragrance exposure were reported during this period, representing 3.8% of all confirmed cases. These 270 cases included 242 associated with perfume or cologne, 32 associated with air freshener, and 4 associated with both. Similar to non-fragrance cases, nearly a quarter of fragrance-associated cases were classified as new-onset asthma. Fragrance-associated cases were significantly more likely to be in office, health, and education jobs than non-fragrance-associated cases. When compared to non-fragrance cases, fragrance cases were significantly more likely to be female (94% vs 62%) and be classified as having work-aggravated asthma (38% vs 20%), yet had similar outcomes compared with cases associated with other exposures. CONCLUSIONS Our surveillance data show that fragrance use in the workplace is associated with WRA. Prevention methods include employee education, enforced fragrance-free policies, well-designed ventilation systems, and good building maintenance.
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Affiliation(s)
- Justine Lew Weinberg
- a Public Health Institute , Contractors to the California Department of Public Health , Richmond , CA , USA
| | | | - Robert Harrison
- b California Department of Public Health , Richmond , CA , USA
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Abstract
PURPOSE OF REVIEW The present review summarizes the recent literature on the relation between chronic workplace irritant exposures and asthma, focusing on exposures of low to moderate levels. We discuss results from epidemiological surveys, potential biological mechanisms, and needs for further research. These aspects are largely illustrated by studies on exposure to cleaning products. RECENT FINDINGS Recent results from nine population-based and workplace-based epidemiological studies, mostly cross-sectional, found an increased risk of both new-onset and work-exacerbated asthma among participants exposed to moderate level of irritants and/or cleaning products. SUMMARY Evidence of a causal effect of chronic workplace irritant exposure in new-onset asthma remains limited, mainly because of a lack of longitudinal studies and the difficulty to evaluate irritant exposures. However, recent epidemiological studies strengthen the evidence of an effect of chronic exposure to irritants in work-related asthma. The underlying mechanism remains unknown but may be related to oxidative stress, neurogenic inflammation and dual irritant and adjuvant effects. However, disentangling chronic irritant effects from either acute irritant-induced asthma or immunological low molecular weight agent-induced asthma is difficult for some agents. Further research is needed to improve assessment of irritant exposures and identify biomarkers.
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Quirce S, Campo P, Domínguez-Ortega J, Fernández-Nieto M, Gómez-Torrijos E, Martínez-Arcediano A, Mur P, Delgado J. New developments in work-related asthma. Expert Rev Clin Immunol 2016; 13:271-281. [PMID: 27653257 DOI: 10.1080/1744666x.2017.1239529] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Work-related asthma includes two subtypes: occupational asthma or asthma caused by specific agents (sensitizers or irritants) in the workplace, and work-exacerbated asthma or pre-existing asthma worsened by workplace exposures. Areas covered: This review provides an update on the definitions and the clinical features of the different work-related asthma subtypes as well as new insights into their etiology and the pathophysiological mechanisms involved. The diagnosis of work-related asthma should be made on objective basis using a constellation of clinical, physiologic and allergologic tests. Specific inhalation challenge with the suspected occupational agent(s) remains as the reference standard for diagnosis. A literature search was performed using the following terms: work-related asthma, occupational asthma, work-exacerbated asthma, irritant-induced asthma and etiological agents. Expert commentary: Studies focusing on the biological effects and mechanisms of environmental exposures in the development of sensitizer-induced or irritant-induced asthma in various workplace settings are of greatest interest. An integrative approach that combines clinical parameters with component-resolved diagnosis as well as inflammatory biomarkers appears to be very promising. Occupational allergy provides a good opportunity to understand the complex relationships between exposure to allergens in the workplace, interaction with genes and the co-exposures to other factors in the working environment.
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Affiliation(s)
- Santiago Quirce
- a Department of Allergy , Hospital La Paz Institute for Health Research and CIBER of Respiratory Diseases, CIBERES , Madrid , Spain
| | - Paloma Campo
- b Unidad de Gestión Clínica Allergy-IBIMA , Hospital Regional Universitario , Malaga , Spain
| | - Javier Domínguez-Ortega
- a Department of Allergy , Hospital La Paz Institute for Health Research and CIBER of Respiratory Diseases, CIBERES , Madrid , Spain
| | | | | | | | - Pilar Mur
- f Allergy Unit , Hospital Santa Barbara , Puertollano , Spain
| | - Julio Delgado
- g Unidad de Gestión Clínica Alergología , Hospital Virgen Macarena , Sevilla , Spain
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