Aerosolized snow-crab allergens in a processing facility

Rhino Conjunctivitis and Asthma Among Seafood Processing Workers in Greenland. A Cross-Sectional Study

Introduction: The fishing- and the seafood processing industries are the largest industrial sectors in Greenland. Despite this, only a few cases of occupational diseases in this industry have been reported to the Danish Labor Market Insurance. Occupational asthma and allergy are well-known occupational diseases in the seafood processing industry worldwide and underreporting of occupational diseases in Greenland is suspected.

Objective: The aim of the current study was to examine the associations between job exposures and occupational asthma and rhino conjunctivitis in workers in the Greenlandic seafood processing industry and to compare the prevalence of sensitization by type and degree of exposure to snow crab, shrimp, fish, and the fish parasite, Anisakis simplex.

Methods: Data from 382 Greenlandic seafood processing workers were collected during 2016–2018. Data included questionnaire answers, lung function measurements, skin prick tests, and blood samples with ImmunoCAP. For all analyses, p < 0.05 was considered the level of significance.

Results: 5.5% of the workers had occupational asthma and 4.6% had occupational rhino conjunctivitis. A large proportion of the workers were sensitized to allergens specific to the workplace; 18.1% to snow crab, 13.6% to shrimp, 1.4% to fish, and 32.6% to the fish parasite, A. simplex. We found a dose-response relationship between the risk of being sensitized to snow crab and A. simplex and years of exposure to the allergens in the seafood processing industry.

Conclusion: This study showed that a considerable proportion of workers in the Greenlandic seafood processing industry had occupational asthma and rhino conjunctivitis. Additionally, the study showed high sensitization levels toward snow crab, shrimp, and the fish parasite, A. simplex. This supports the hypothesis of a considerable degree of underreporting of occupational allergic airway disease in the Greenlandic seafood processing industry. Prospectively, it is important to inform workers, leaders, and health care professionals of the health problems and the law on worker's compensation, and to initiate preventive actions at factory and trawler level.

Exposure to Bioaerosols During Fish Processing on Board Norwegian Fishing Trawlers

OBJECTIVES

The main objective was to gain more knowledge on exposure to bioaerosols in the processing area on board fishing trawlers.

METHODS

Exposure sampling was carried out during the work shifts when processing fish in the processing area on board five deep-sea fishing trawlers (trawlers 1-5). Exposure samples were collected from 64 fishermen breathing zone and from stationary sampling stations on board five deep-sea fishing trawlers (1-5). Trawlers 2, 3, and 4 were old ships, not originally built for on board processing of the catch. Trawlers 1 and 5 were relatively new and built to accommodate processing machineries. On trawlers 1-4 round fish was produced; the head and entrails were removed before the fishes were frozen in blocks. Trawler 5 had the most extensive processing, producing fish fillets. Samples were analysed for total protein, trypsin activity, parvalbumin, and endotoxin. One side analysis of variance and Kruskal-Wallis H test were used to compare levels of exposure on the different trawlers.

RESULTS

Personal exposure to total protein were higher on the three oldest trawlers (2, 3, and 4) compared with the two new trawlers (1 and 5). Highest activity of trypsin was detected on the four trawlers producing round fish (1-4). Parvalbumin was detected in 58% of samples from the fillet-trawler (5) compared with 13% of samples from the four trawlers producing round fish. The highest level of endotoxin was detected when using high-pressure water during cleaning machines and floors in the processing area.

CONCLUSIONS

Fishermen in the processing area on board Norwegian trawlers are exposed to airborne bioaerosols as proteins, trypsin, fish allergen parvalbumin, and endotoxin. Levels varied between trawlers and type of production.

Lung function and prevalence of respiratory symptoms in Norwegian crab processing workers

Background: Seafood processing workers have an increased risk of developing occupational asthma. This has not been studied among Norwegian crab processing workers, nor has the respiratory health of exposed workers been compared to a control group.

Objectives: Assessing the impact of working in the crab processing industry on workers’ respiratory health.

Design: A cross-sectional study of the respiratory health in two types of crab processing workers compared to a control group.

Methods: The study included 148 king crab (Paralithodes camtschaticus) workers, 70 edible crab (Cancer pagurus) workers and 215 controls. Workers answered a questionnaire and performed spirometry measurements. χ² and Fishers exact tests were performed on self-reported respiratory symptoms. Regression analyses and t-tests were used to assess lung function values.

Results: Self-reported respiratory symptoms were higher among crab processing workers compared to controls, and higher among king crab workers compared to edible crab workers. There was no significant difference between crab processing workers and controls in lung function measurements. Self-reported doctor-diagnosed asthma prevalence was highest in the control group.

Conclusions: Increased respiratory symptoms reported by crab processing workers were not reflected in impaired lung function values or asthma diagnose. We suggest a healthy worker effect among crab processing workers in Norway.

Prevalence of asthma and wheezes among snow crab workers in western Japan: a cross-sectional study

OBJECTIVES

Few reports are available concerning the prevalence of asthma among snow crab workers in Japan. The object of this study was to estimate the prevalence of asthma and wheezes among Japanese snow crab workers and their associations with exhaled nitric oxide (FeNO) and YKL-40.

METHODS

Forty-nine snow crab workers enrolled in this study, which was cross-sectional by design and was conducted using a translated version of the European Community Respiratory Health Survey questionnaire. The levels of FeNO and serum YKL-40 were measured between September and October 2014.

RESULTS

The prevalences of current asthma and wheezes were 10.2% (95% CI, 3.4 to 22.2) and 12.2% (95% CI, 4.6 to 24.8), respectively. There was no association between these prevalences and the duration of snow crab employment. Six subjects' FeNO levels exceeded 50 ppb, and nine subjects' levels exceeded 25 ppb. Twelve subjects' (25.5%) serum YKL-40 levels exceeded 77.2 ng/mL, which was 2 standard deviations above the mean for healthy subjects. However, there were no significant relationships among the prevalences for asthma and wheezes, FeNO, and serum YKL-40.

CONCLUSIONS

This study provides information concerning the prevalences of asthma and wheezes among Japanese snow crab processing workers.

Seafood-Associated Shellfish Allergy: A Comprehensive Review

Shellfish are diverse, serve as main constituents of seafood, and are extensively consumed globally because of their nutritional values. Consequently, increase in reports of IgE-mediated seafood allergy is particularly food associated to shellfish. Seafood-associated shellfish consists of crustaceans (decapods, stomatopods, barnacles, and euphausiids) and molluskans (gastropods, bivalves, and cephalopods) and its products can start from mild local symptoms and lead to severe systemic anaphylactic reactions through ingestion, inhalation, or contact like most other food allergens. Globally, the most commonly causative shellfish are shrimps, crabs, lobsters, clams, oysters, and mussels. The prevalence of shellfish allergy is estimated to be 0.5-2.5% of the general population but higher in coastal Asian countries where shellfish constitute a large proportion of the diet. Diversity in allergens such as tropomyosin, arginine kinase, myosin light chain, and sarcoplasmic binding protein are from crustaceans whereas tropomyosin, paramyosin, troponin, actine, amylase, and hemoyanin are reported from molluskans shellfish. Tropomyosin is the major allergen and is responsible for cross-reactivity between shellfish and other invertebrates, within crustaceans, within molluskans, between crustaceans vs. molluskans as well as between shellfish and fish. Allergenicity diagnosis requires clinical history, in vivo skin prick testing, in vitro quantification of IgE, immunoCAP, and confirmation by oral challenge testing unless the reactions borne by it are life-threatening. This comprehensive review provides the update and new findings in the area of shellfish allergy including demographic, diversity of allergens, allergenicity, their cross-reactivity, and innovative molecular genetics approaches in diagnosing and managing this life-threatening as well as life-long disease.

Respiratory symptoms, lung functions, and exhaled nitric oxide (FENO) in two types of fish processing workers: Russian trawler fishermen and Norwegian salmon industry workers

OBJECTIVE

Respiratory outcomes and work-related factors were studied in two seafood worker populations representing different occupational environments.

METHODS

Levels of fractional exhaled nitric oxide (FENO), spirometric values, prevalence of respiratory symptoms, and self-evaluated exposures were compared between 139 Norwegian salmon workers and 127 Russian trawler workers.

RESULTS

Increased odds ratios (ORs) of shortness of breath with wheezing and prolonged cough as general respiratory symptoms were found in salmon workers, while increased ORs of work-related dry cough and running nose were found in trawler fishermen. Both worker groups ranked "cold work environment," "use of disinfectants," and "contaminated indoor air" as the first, second, and third most important causes of work-related respiratory symptoms, respectively. Fractional exhaled nitric oxide levels were higher in asthmatic trawler workers compared to asthmatic salmon workers.

CONCLUSIONS

Respiratory symptoms commonly associated with obstructive airway diseases were more prevalent in salmon workers, while symptoms commonly associated with asthma and short-term effects of cold air exposure were more prevalent in trawler workers.

Simultaneous determination of two major snow crab aeroallergens in processing plants by use of isotopic dilution tandem mass spectrometry

Snow crab is a major fishery in the North Atlantic region. During crab processing the proteins are aerosolized and some are responsible for development of occupational asthma. Tropomyosin and arginine kinase have recently been reported as major snow crab allergens. A liquid chromatographic tandem mass spectrometric method has been developed for simultaneous analysis of these two proteins in air samples collected from processing plants. These proteins were initially isolated then characterized by use of mass spectrometry to determine their primary structure and signature peptides. The signature peptides were chemically synthesized in light and heavy forms and used as standards for developing the multiple-reaction monitoring transitions to monitor allergen levels. A validation study was performed; precision and accuracy were 1.8-8% and 91-104%, respectively. Replicate air samples were collected on air filters from two crab-processing plants in Newfoundland and Labrador (NL) and four located in Quebec. In NL, measured levels of both tropomyosin and arginine kinase were between 1 and 20 ng m(-3). In Quebec plants, however, levels were found to be much higher at 2-2400 ng m(-3). Significant differences were also observed among the plants and individual processing workstations. For the first time arginine kinase has been detected in its aerosolized form in processing plants. In general, levels of the allergens were highest in the butchering and cooking areas; plant design can, however, have a significant effect on levels of the allergens.

Not all shellfish "allergy" is allergy!

The popularity of shellfish has been increasing worldwide, with a consequent increase in adverse reactions that can be allergic or toxic. The approximate prevalence of shellfish allergy is estimated at 0.5-2.5% of the general population, depending on degree of consumption by age and geographic regions. The manifestations of shellfish allergy vary widely, but it tends to be more severe than most other food allergens.

Tropomyosin is the major allergen and is responsible for cross-reactivity between members of the shellfish family, particularly among the crustacea. Newly described allergens and subtle differences in the structures of tropomyosin between different species of shellfish could account for the discrepancy between in vitro cross-antigenicity and clinical cross-allergenicity. The diagnosis requires a thorough medical history supported by skin testing or measurement of specific IgE level, and confirmed by appropriate oral challenge testing unless the reaction was life-threatening.

Management of shellfish allergy is basically strict elimination, which in highly allergic subjects may include avoidance of touching or smelling and the availability of self-administered epinephrine. Specific immunotherapy is not currently available and requires the development of safe and effective protocols.

Identification of crab proteins that elicit IgE reactivity in snow crab-processing workers

BACKGROUND

The expanding snow crab-processing industry has resulted in increased numbers of workers at risk of occupational allergy.

OBJECTIVE

Our study is to identify relevant allergenic proteins in cooked snow crab meat (CM) and crab water (CW) used for cooking for improved remediation, diagnosis, and treatment.

METHODS

Extracts were prepared from CM extracts, CW extracts, and an air-filter collection near the crab cooker. Of the 207 workers, 24 with the highest IgE antibody reactivity to CM and CW extracts, as determined by using RASTs, were tested for reactivity to nitrocellulose membranes containing CM and CW proteins separated with SDS-PAGE. A 3-serum pool was similarly incubated against nitrocellulose-bound proteins from air samples collected near the crab cooker.

RESULTS

Of the 207 sera tested, 27 and 39 sera exhibited positive IgE antibody reactivity (>or=2%) to CM and CW extracts, respectively. Twenty-two of 24 sera with the highest RAST activity (>or=3.5% binding) demonstrated IgE binding to multiple proteins (13.6-50 kd). A majority of the sera reacted to 4 proteins: 79% and 71% to a 34.0-kd protein, 79% and 42% to a 25-kd protein, 67% and 71% to an 18.5-kd protein, and 75% to a 14.4-kd protein in both CM and CW extracts, respectively. The pool of IgE-positive sera blotted against the air-filter extract reacted to 14.4-, 18.5-, 34.0-, 43.2-, and 50-kd proteins present in both crab extracts.

CONCLUSION

Four major IgE-reactive proteins were identified in CM extracts, CW extracts, and air-filter eluate. Analysis of any potential association of protein reactivity with disease suggested crab proteins at 34.0 and 14.4 kd might be more relevant.

Food hypersensitivity by inhalation

Though not widely recognized, food hypersensitivity by inhalation can cause major morbidity in affected individuals. The exposure is usually more obvious and often substantial in occupational environments but frequently occurs in non-occupational settings, such as homes, schools, restaurants, grocery stores, and commercial flights. The exposure can be trivial, as in mere smelling or being in the vicinity of the food. The clinical manifestations can vary from a benign respiratory or cutaneous reaction to a systemic one that can be life-threatening. In addition to strict avoidance, such highly-sensitive subjects should carry self-injectable epinephrine and wear MedicAlert^® identification. Asthma is a strong predisposing factor and should be well-controlled. It is of great significance that food inhalation can cause de novo sensitization.

Gender and snow crab occupational asthma in Newfoundland and Labrador, Canada

Fish and shellfish processing employs many thousands of people globally, with shellfish processing becoming more important in recent years. Shellfish processing is associated with multiple occupational health and safety (OHS) risks. Snow crab occupational asthma (OA) is work-related asthma associated with processing snow crab. We present a gender analysis of findings from a 3-year multifaceted study of snow crab OA in Newfoundland and Labrador, Canada. The study was carried out in four snow crab processing communities between 2001 and 2004. An anonymous survey questionnaire on knowledge, beliefs, and concerns related to processing snow crab administered to 158 workers attending community meetings at the start of the research found that women were significantly more likely than men to associate certain health problems, especially chest tightness, difficulty breathing, and cough, with crab processing (P<0.001). Worker health assessments carried out with 215 processing workers (187 current/28 former; 120 female/95 male) found that female participants were more likely to be diagnosed as almost certain/highly probable snow crab OA and allergy (P=0.001) and to be sensitized to snow crab (P=0.01) than male participants. Work histories from the health assessments were used to classify processing jobs as male or female. Allergen sampling (211 allergen samples: 115 area, 96 personal breathing zone) indicated that the plant areas where these male jobs were concentrated were associated with lower levels of aerosolized crab allergens (the agents responsible for OA to snow crab) than areas associated with female jobs. This difference was statistically significant in the two plants with poor ventilation (p<0.001 and P=0.017 for these plants). A gender analysis of work history data showed that female health assessment participants were likely to have worked longer processing snow crab than males (5 years versus 3.5 years, respectively). Cross-referencing of work history results with allergen sampling data for male and female job areas showed a gender difference in median cumulative exposures (duration of exposure x level of exposures) for health assessment participants. Health assessment participants with estimated higher median cumulative exposures were more likely to receive a diagnosis of almost certain/highly probable OA and allergy. Semistructured interviews with 27 health assessment participants (24 female/ 3 male) with a diagnosis of almost certain/highly probable or possible snow crab OA indicated that these workers can experience substantial quality of life impacts while working and that they seek to reduce the economic impact of their illness by remaining at their jobs as long as possible. Indications of selection bias and other study limitations point to the need for more research exploring the relationship between the gender division of labor and knowledge, beliefs, and concerns about snow crab processing, as well as gender differences in prevalence, quality of life, and socioeconomic impact.

Detection of fish antigens aerosolized during fish processing using newly developed immunoassays

BACKGROUND

Aerosolization of fish proteins during seafood processing has been identified as a potential route for allergic sensitization and occupational asthma among workers involved in high-risk activities. The aim of this study was to develop immunological assays for the quantification of aerosolized fish antigens in a fish-processing factory.

METHODS

Polyclonal antibodies to the main fish species processed in the factory (anchovy and pilchard) were generated in rabbits and compared by ELISA inhibition assay and immunoblotting. These antisera were utilized to develop ELISA assays for the detection of fish antigens. The ELISA inhibition assays were evaluated by analyzing environmental air samples collected from three areas in a fish-processing factory: pilchard canning, fish meal production and lobster processing.

RESULTS

By immunoblotting, the rabbit polyclonal antibodies demonstrated IgG antibody binding patterns comparable with IgE antibodies of fish-sensitized patients, particularly in regard to the major fish allergens parvalbumins. The sensitivity of the fish-specific ELISA assays developed was 0.5 microg/ml. The ELISA inhibition assays were able to differentiate between the two different fish species of interest but did not recognize a crustacean species. Notable differences in exposure levels to canned pilchard and anchovy antigens were demonstrated in the three different working areas of the factory, with assays having a detection limit as low as 105 ng/m(3).

CONCLUSION

These ELISA-based assays are sensitive and specific to quantify differential exposure levels to fish antigens produced during fish processing, making it possible to investigate exposure-disease response relationships among workers in this industry.

Fish and shellfish allergy

Fish and shellfish are important in the American diet and economy. Nearly $27 billion are spent each year in the United States on seafood products. Fish and shellfish are also important causes of food hypersensitivity. In fact, shellfish constitute the number one cause of food allergy in the American adult. During the past decade, much has been learned about allergens in fish and shellfish. The major allergens responsible for cross-reactivity among distinct species of fish and amphibians are parvalbumins. The major shellfish allergen has been identified as tropomyosin. Many new and important potential cross-reacting allergens have been identified within the fish family and between shellfish, arachnids, and insects. Extensive research is currently underway for the development of safer and more effective methods for the diagnosis and management of fish and shellfish hypersensitivity.

Clinical effectiveness of a silk fabric in the treatment of atopic dermatitis

BACKGROUND

In children with atopic dermatitis (AD), eczema is easily aggravated by contact with irritant factors (e.g. aggressive detergents, synthetic and woollen clothes, climatic factors).

OBJECTIVES

To evaluate the effectiveness of a special silk fabric (MICROAIR DermaSilk) in the treatment of young children affected by AD with acute lesions at the time of examination.

METHODS

Forty-six children (mean age 2 years) affected by AD in an acute phase were recruited: 31 received special silk clothes (group A) which they were instructed to wear for a week; the other 15 served as a control group (group B) and wore cotton clothing. Topical moisturizing creams or emulsions were the only topical treatment prescribed in both groups. The overall severity of the disease was evaluated using the SCORAD index. In addition, the local score of an area covered by the silk clothes was compared with the local score of an uncovered area in the same child. All patients were evaluated at baseline and 7 days after the initial examination.

RESULTS

At the end of the study a significant decrease in AD severity was observed in the children of group A (mean SCORAD decrease from 43 to 30; P = 0.003). At the same time, the improvement in the mean local score of the covered area (from 32 to 18.6; P = 0.001) was significantly greater than that of the uncovered area (from 31 to 26; P = 0.112).

CONCLUSIONS

The use of special silk clothes may be useful in the management of AD in children.

Occupational seafood allergy: a review

BACKGROUND

Recent years have seen increased levels of production and consumption of seafood, leading to more frequent reporting of allergic reactions in occupational and domestic settings. This review focuses on occupational allergy in the fishing and seafood processing industry.

REVIEW

Workers involved in either manual or automated processing of crabs, prawns, mussels, fish, and fishmeal production are commonly exposed to various constituents of seafood. Aerosolisation of seafood and cooking fluid during processing are potential occupational situations that could result in sensitisation through inhalation. There is great variability of aerosol exposure within and among various jobs with reported allergen concentrations ranging from 0.001 to 5.061(microg/m(3)). Occupational dermal exposure occurs as a result of unprotected handling of seafood and its byproducts. Occupational allergies have been reported in workers exposed to arthropods (crustaceans), molluscs, pisces (bony fish) and other agents derived from seafood. The prevalence of occupational asthma ranges from 7% to 36%, and for occupational protein contact dermatitis, from 3% to 11%. These health outcomes are mainly due to high molecular weight proteins in seafood causing an IgE mediated response. Cross reactivity between various species within a major seafood grouping also occurs. Limited evidence from dose-response relations indicate that development of symptoms is related to duration or intensity of exposure. The evidence for atopy as a risk factor for occupational sensitisation and asthma is supportive, whereas evidence for cigarette smoking is limited. Disruption of the intact skin barrier seems to be an important added risk factor for occupational protein contact dermatitis.

CONCLUSION

The range of allergic disease associated with occupational exposure to crab is well characterised, whereas for other seafood agents the evidence is somewhat limited. There is a need for further epidemiological studies to better characterise this risk. More detailed characterisation of specific protein antigens in aerosols and associated establishment of dose-response relations for acute and chronic exposure to seafood; the respective roles of skin contact and inhalational exposure in allergic sensitisation and cross reactivity; and the contribution of host associated factors in the development of occupational seafood allergies are important areas for future research.

Respiratory symptoms among crab processing workers in Alaska: epidemiological and environmental assessment

BACKGROUND

Crab processing workers may develop respiratory symptoms and specific IgE responses, but the risk factors have not been fully described.

METHODS

In 1998, 107 workers at a crab processing facility completed a survey both at the beginning and end of the processing season. The surveys included standardized symptom questionnaires, spirometry, and serological testing, as well as measurement of workplace airborne crab allergens and microscopic analysis of aerosolized materials.

RESULTS

Over the crab processing season, asthma-like symptoms developed in 26% of study participants and bronchitic symptoms in 19%. Only 9% of those with new asthma-like symptoms were IgE-sensitized to crab at the end of the season. Among the crab processing jobs, butchering and degilling workers had the highest incidence of respiratory symptoms.

CONCLUSIONS

Both personal and process-related factors appear to affect the development of respiratory symptoms in crab processing workers. In this study, crab specific IgE was not detected in most of the workers with new symptoms. Published 2001 Wiley-Liss, Inc.