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Mwanga HH, Baatjies R, Singh T, Jeebhay MF. Asthma Phenotypes and Host Risk Factors Associated With Various Asthma-Related Outcomes in Health Workers. FRONTIERS IN ALLERGY 2021; 2:747566. [PMID: 35386991 PMCID: PMC8974710 DOI: 10.3389/falgy.2021.747566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/21/2021] [Indexed: 12/11/2022] Open
Abstract
Background: Work-related asthma phenotypes in health workers (HWs) exposed to cleaning agents have not been investigated extensively as other occupational exposures. This study aimed to describe asthma phenotypes and to identify important host risk factors associated with various asthma-related outcomes. Methods: A cross-sectional study of 699 HWs was conducted in two large tertiary hospitals. A total of 697 HWs completed questionnaire interviews. Sera collected from 682 HWs were analyzed for atopy (Phadiatop) and IgE to occupational allergens (NRL—Hev b5, Hev b6.02; chlorhexidine and ortho-phthalaldehyde—OPA). Methacholine (MCT), bronchodilator challenge (BDR) and fractional exhaled nitric oxide (FeNO) were performed. An asthma symptom score (ASS) used five asthma-related symptoms reported in the past 12 months. Current asthma was based on use of asthma medication or an asthma attack or being woken up by an attack of shortness of breath in the past 12 months. Nonspecific bronchial hyperresponsiveness (NSBH) was defined as having either a positive MCT or a significant bronchodilator response. Two continuous indices of NSBH [continuous index of responsiveness (CIR) and dose-response slope (DRS)] were calculated. Results: The prevalence of current asthma was 10%, atopic asthma (6%) and non-atopic asthma (4%). Overall, 2% of subjects had work-related asthma. There was a weak positive association between NSBH and FeNO [CIR: Beta coefficient (β) = 0.12; CI: 0.03–0.22 and DRS: β = 0.07; CI: 0.03–0.12]. Combining FeNO ≥ 50 ppb with a BDR [mean ratio (MR) = 5.89; CI: 1.02–34.14] or with NSBH (MR = 4.62; CI: 1.16–18.46) correlated better with ASS than FeNO alone (MR = 2.23; CI: 1.30–3.85). HWs with current asthma were twice as likely to be atopic. FeNO was positively associated with atopy (OR = 3.19; CI: 1.59–6.39) but negatively associated with smoking status (GMR = 0.76; CI: 0.62–0.94). Most HWs sensitized to occupational allergens were atopic. Conclusion: Atopic asthma was more prevalent than non-atopic asthma in HWs. Most asthma-related outcomes were positively associated with allergic predictors suggesting a dominant role for IgE mechanisms for work-related symptoms and asthma associated with sensitization to OPA or chlorhexidine.
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Affiliation(s)
- Hussein H. Mwanga
- Division of Occupational Medicine and Center for Environmental & Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Department of Environmental and Occupational Health, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Roslynn Baatjies
- Division of Occupational Medicine and Center for Environmental & Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Department of Environmental and Occupational Studies, Faculty of Applied Sciences, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Tanusha Singh
- National Institute for Occupational Health, National Health Laboratory Services, Johannesburg, South Africa
- Department of Clinical Microbiology and Infectious Diseases, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
- Department of Environmental Health, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Mohamed F. Jeebhay
- Division of Occupational Medicine and Center for Environmental & Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- *Correspondence: Mohamed F. Jeebhay
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Occupational rhinitis and asthma in bakers: a cross-sectional study in the former Katanga province of DR Congo. Int Arch Occup Environ Health 2021; 95:293-301. [PMID: 33904971 DOI: 10.1007/s00420-021-01698-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/13/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Bakers are at high risk of rhinitis and asthma, but the prevalence of these occupational diseases is not well known in Sub-Saharan Africa. We investigated the prevalence of occupational rhinitis and asthma among industrial bakers in the former province of Katanga. METHODS In a cross-sectional study conducted in eight towns from October 2018 to September 2019, we included 276 male workers from 18 industrial bakeries and 113 male controls (35 butchers and 78 bread sellers), all nonsmokers. Participants replied to a validated questionnaire (European Community of Respiratory Health Survey II), administered face to face, and performed spirometry at the work place. In 15 bakers with symptoms of work-related asthma, records of self-measured peak expiratory flow (PEF) 4 times per day during 4 weeks were analyzed by the OASYS (Occupational Asthma System) protocol. RESULTS The bakers and controls did not differ by age (32.2 ± 7.3 y vs 32.8 ± 10.3 y). According to the questionnaire, work-related rhinitis and asthma were significantly more prevalent among bakers (31% and 5%, respectively) than among controls (2% and 0%, respectively). However, the groups did not differ significantly with regard to spirometric parameters. Based on PEF records, 10 out of 15 were positive for occupational asthma (OASYS score > 2.5), so the rate of occupational asthma was 3.6% in this study. CONCLUSION This first study in DR Congo demonstrates the existence of occupational rhinitis and asthma among industrial bakers in Katanga. Further epidemiological studies are needed to clarify the extent and risk factors of baker's asthma in the area. In the meantime, advocacy and implementation of appropriate occupational hygiene measures are warranted to protect bakery workers in DR Congo.
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Shao Z, Bernstein JA. Occupational Rhinitis: Classification, Diagnosis, and Therapeutics. Curr Allergy Asthma Rep 2019; 19:54. [PMID: 31776689 DOI: 10.1007/s11882-019-0892-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE OF REVIEW Occupational rhinitis (OR), an inflammatory disease of the nose, refers to any nasal symptoms reported to be work-related. The purpose of this review is to provide a current overview of the classification, diagnosis, and treatment of OR. RECENT FINDINGS Occupational rhinitis (OR) can further be classified into allergic or non-allergic depending on the causative agent(s) and pathogenesis. Presenting symptoms are similar to non-OR including nasal congestion, anterior and posterior rhinorrhea, sneezing, and nasal itching. Despite its high prevalence in a spectrum of workplaces, OR is under reported as it is often considered a nuisance rather than a potential precursor to occupational asthma (OA). The diagnosis of OR is obfuscated as it is difficult to determine if this condition was caused by environmental determinants in or outside the workplace. Furthermore, workers may have a pre-existing history of allergic or non-allergic rhinitis leading the clinician and worker to overlook inciting agents in the workplace. In this case, a diagnosis of OR is still possible depending on the exposures but must be differentiated from work-exacerbated rhinitis. Further complicating the diagnosis of OR is the lack of evidence-based research focused on this condition as it is often trivialized due to the perception that it has an insignificant impact on the worker's health. The reality is that OR can have a significant impact on the worker's quality of life and is associated with a number of comorbidities including occupational asthma, recurrent sinusitis, headaches, eustachian tube dysfunction, and sleep disorders similar to non-occupational rhinitis. However, one significant difference between these disorders is that workers diagnosed with OR are eligible for worker's compensation. Treatment of OR involves avoidance of the inciting agent(s) and medications similar to those used to treat non-OR conditions. This review summarizes recent progresses on the etiology, risk factors, diagnosis, and therapy of OR. In addition, suggested areas of further research with potential targets for modifications in the workplace environment as well as therapeutic interventions will be discussed.
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Affiliation(s)
- Zhisheng Shao
- School of Podiatric Medicine, Temple University, Philadelphia, PA, 19107, USA
| | - Jonathan A Bernstein
- Bernstein Allergy Group, 8444 Winton Road, Cincinnati, OH, 45231, USA.
- Division of Immunology, Allergy and Rheumatology, Department of Internal Medicine, University of Cincinnati, 231 Albert Sabin Way, ML0563, Cincinnati, OH, 45267, USA.
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Larsen AI, Cederkvist L, Lykke AM, Wagner P, Johnsen CR, Poulsen LK. Allergy Development in Adulthood: An Occupational Cohort Study of the Manufacturing of Industrial Enzymes. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 8:210-218.e5. [PMID: 31233941 DOI: 10.1016/j.jaip.2019.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 05/16/2019] [Accepted: 06/03/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Occupational allergy may serve as a model of allergy development in adults. OBJECTIVE We aimed at describing respiratory allergy and IgE sensitization across different exposure strata defined by time, technology, and exposure control. METHODS In a retrospective (1970-2017) cohort of industrial enzyme production employees, monitored by an occupational medical center, 5024 individuals were surveyed. Five exposure groups and risk levels for sensitization and allergic disease were analyzed on the basis of demographic characteristics, hiring decade, and smoking status. RESULTS Of all persons entering the company 47 years from 1970, 149 developed occupational allergy (incidence rate, 2.72/1000 person-years). In a multivariate cause-specific Cox proportional hazards model, the hazard of allergy was significantly related to decade of recruitment. Compared with the 1970s, the hazard ratio (HR) uniformly decreased from 0.85 (95% CI, 0.57-1.27) in the 1980s to 0.16 (95% CI, 0.05-0.52) in the 2010s. Compared with expected highest exposed group, the HRs were 0.48 (95% CI, 0.31-76) and 0.13 (95% CI, 0.06-0.30) in less exposed production areas and 0.92 (95% CI, 0.48-1.73) and 0.23 (95% CI, 0.10-0.53) in different laboratory areas. The HR of smoking was 2.03 (95% CI, 1.41-2.93). The pattern of sensitizations also showed clear associations to recruitment decade, exposure, and smoking. Among individuals sensitized but not yet allergic, a high IgE level was the only risk factor (HR, 3.03; 95% CI, 1.82-5.04) for subsequent allergy development. CONCLUSIONS The impact of exposure is dose-related and linked to the sensitization step, which may subsequently lead to allergy development. For primary prevention of enzyme allergy, exposure control is mandatory and achievable despite increasing production volumes.
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Affiliation(s)
| | | | - Anne Mette Lykke
- Global Occupational Health and Safety Department, Novozymes A/S, Copenhagen, Denmark
| | - Poul Wagner
- Global Medical Centre, Novozymes A/S, Copenhagen, Denmark
| | - Claus R Johnsen
- Allergy Clinic, Copenhagen University Hospital at Gentofte, Copenhagen, Denmark
| | - Lars K Poulsen
- Allergy Clinic, Copenhagen University Hospital at Gentofte, Copenhagen, Denmark.
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Abstract
PURPOSE OF REVIEW Asthma due to cleaning products has been known for 20 years, and the interest in this topic is still large because of the number of cleaning workers with respiratory problems. In this review, we sought to highlight the most recent findings on the relationship between exposure to cleaning products and asthma and to summarize the specific literature published between 2013 and 2016. RECENT FINDINGS Women are confirmed as most of workers exposed to cleaning products and have a higher frequency than men of work-related respiratory symptoms and diseases. Many cases of asthma due to cleaning products occur in healthcare occupations. The increased risk of asthma has been shown to be related to the number of years in the job and to early life disadvantage. Recent evidence suggests that predisposition to adult-onset asthma may be related to interaction between genes and occupational exposure to low-molecular weight agents/irritants. There is some evidence that an irritant mechanism is more common, although several case reports showed animmunologic mechanism (e.g. disinfectants, amine compounds, aldehydes and fragrances). SUMMARY The review updated recent findings on epidemiology, cleaning agents and their mechanism, and prevention of asthma due to cleaning agents. This article provides new information on the level of exposure, which is still high in professional cleaners and even more in domestic cleaners, and on the frequency of asthma in professional and domestic cleaners. An irritant mechanism is more common, although an immunological mechanism is possible, especially in healthcare workers exposed to disinfectants.
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An approach to allergy risk assessments for e-liquid ingredients. Regul Toxicol Pharmacol 2017; 87:1-8. [DOI: 10.1016/j.yrtph.2017.04.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 03/31/2017] [Accepted: 04/02/2017] [Indexed: 11/20/2022]
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Risk factors for nonwork-related adult-onset asthma and occupational asthma: a comparative review. Curr Opin Allergy Clin Immunol 2014; 14:84-94. [PMID: 24535141 DOI: 10.1097/aci.0000000000000042] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW To identify the similarities and differences between nonwork-related adult-onset and occupational asthma from various literature sources published between 2010 and 2013, with respect to the epidemiology, phenotypic manifestations, and risk factors for the disease. RECENT FINDINGS The incidence of adult-onset asthma from pooled population studies is estimated to be 3.6 per 1000 person-years in men and 4.6 cases per 1000 person-years in women. In adults with new-onset asthma, occupational asthma is a common asthma phenotype. Work-related factors are estimated to account for up to 25% of adult cases of asthma and occupational asthma comprising about 16% of adult-onset asthma cases. The review finds that nonwork-related adult-onset asthma is a heterogenous entity and that environmental exposure factors (aside from occupational exposures) appear to have a lesser role than host factors when compared with occupational asthma. SUMMARY Large-scale general population studies are needed to identify the similarities and differences between nonwork-related adult-onset and occupational asthma, which may enable a better understanding of these entities and promote efforts towards holistic management approaches for these asthma phenotypes.
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Newson RB, van Ree R, Forsberg B, Janson C, Lötvall J, Dahlén SE, Toskala EM, Baelum J, Brożek GM, Kasper L, Kowalski ML, Howarth PH, Fokkens WJ, Bachert C, Keil T, Krämer U, Bislimovska J, Gjomarkaj M, Loureiro C, Burney PGJ, Jarvis D. Geographical variation in the prevalence of sensitization to common aeroallergens in adults: the GA(2) LEN survey. Allergy 2014; 69:643-51. [PMID: 24654915 DOI: 10.1111/all.12397] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Geographical variation in the prevalence of sensitization to aeroallergens may reflect differences in exposure to risk factors such as having older siblings, being raised on a farm or other unidentified exposures. OBJECTIVE We wanted to measure geographical variation in skin prick test positivity and assess whether it was explained by differences in family size and/or farm exposure. We also compared prevalence in younger and older subjects. METHODS Within the Global Allergy and Asthma European Network (GA(2) LEN) survey, we measured the prevalence of skin prick positivity to a panel of allergens, and geometric mean serum total immunoglobulin E (IgE), in 3451 participants aged 18-75 years in 13 areas of Europe. Estimated prevalence was standardized to account for study design. We compared prevalence estimates in younger and older subjects and further adjusted for age, gender, smoking history, farm exposure, number of older siblings and body mass index (BMI). RESULTS Skin prick test positivity to any one of the measured allergens varied within Europe from 31.4% to 52.9%. Prevalence of sensitization to single allergens also varied. Variation in serum total IgE was less marked. Younger participants had higher skin prick sensitivity prevalence, but not total IgE, than older participants. Geographical variation remained even after adjustment for confounders. CONCLUSION Geographical variation in the prevalence of skin prick test positivity in Europe is unlikely to be explained by geographical variation in gender, age, smoking history, farm exposure, family size and BMI. Higher prevalence in younger, compared to older, adults may reflect cohort-associated increases in sensitization or the influence of ageing on immune or tissue responses.
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Affiliation(s)
- R. B. Newson
- Respiratory Epidemiology and Public Health Group; National Heart and Lung Institute; Imperial College London; London UK
| | - R. van Ree
- Department of Experimental Immunology; Academic Medical Center; University of Amsterdam; Amsterdam the Netherlands
- Department of Otorhinolaryngology; Academic Medical Center; University of Amsterdam; Amsterdam the Netherlands
| | - B. Forsberg
- Occupational and Environmental Medicine; Umeå University; Umeå Sweden
| | - C. Janson
- Department of Medical Sciences: Respiratory Medicine and Allergology; University of Uppsala; Uppsala Sweden
| | - J. Lötvall
- Krefting Research Centre; Institute of Medicine; University of Gothenburg; Gothenburg Sweden
| | - S.-E. Dahlén
- CfA - The Centre for Allergy Research; Karolinska Institutet; Stockholm Sweden
| | - E. M. Toskala
- Skin and Allergy Hospital; Helsinki University; Helsinki Finland
- Department of ORL-HNS; Temple University; Philadelphia PA USA
| | - J. Baelum
- Department of Occupational and Environmental Medicine; Odense Patient Extended Network; Odense University Hospital; Odense University; Odense Denmark
| | - G. M. Brożek
- Department of Epidemiology; Medical University of Silesia in Katowice; Katowice Poland
| | - L. Kasper
- Department of Medicine; Jagiellonian University Medical College; Krakow Poland
| | - M. L. Kowalski
- Department of Immunology, Rheumatology and Allergy; Medical University of Lodz; Lodz Poland
| | - P. H. Howarth
- Clinical and Experimental Sciences; Faculty of Medicine; University of Southampton; Southampton UK
| | | | - C. Bachert
- Upper Airways Research Laboratory; University of Ghent; Ghent Belgium
- Division of Ear, Nose, and Throat Diseases, Clintec; Karolinska Institutet; Stockholm Sweden
| | - T. Keil
- Institute of Social Medicine, Epidemiology and Health Economics; Charité - Universitätsmedizin Berlin; Berlin Germany
- Institute of Clinical Epidemiology and Biometry; University of Würzburg; Würzburg Germany
| | - U. Krämer
- IUF - Leibniz Research Institute for Environmental Medicine; Düsseldorf Germany
- Department of Dermatology and Allergy am Biederstein; Technical University Munich; Munich Germany
| | - J. Bislimovska
- Institute for Occupational Health of Republic of Macedonia; Skopje Macedonia
| | - M. Gjomarkaj
- Institute of Biomedicine and Molecular Immunology; National Research Council; Palermo Italy
| | - C. Loureiro
- Faculty of Medicine; University of Coimbra; Coimbra Portugal
| | - P. G. J. Burney
- Respiratory Epidemiology and Public Health Group; National Heart and Lung Institute; Imperial College London; London UK
- MRC-PHE Centre for Environment and Health; Imperial College; London UK
| | - D. Jarvis
- Respiratory Epidemiology and Public Health Group; National Heart and Lung Institute; Imperial College London; London UK
- MRC-PHE Centre for Environment and Health; Imperial College; London UK
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Folletti I, Zock JP, Moscato G, Siracusa A. Asthma and rhinitis in cleaning workers: a systematic review of epidemiological studies. J Asthma 2013; 51:18-28. [PMID: 23931651 DOI: 10.3109/02770903.2013.833217] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This article presents a systematic review of epidemiological studies linking cleaning work and risk of asthma and rhinitis. METHODS Published reports were identified from PubMed covering the years from 1976 through June 30, 2012. In total, we identified 24 papers for inclusion in the review. The quality of studies was evaluated using the Strengthening of the Reporting of Observational Studies in Epidemiology (STROBE) statement checklist of 22 items for cross-sectional, cohort and case-control studies. RESULTS Increased risk of asthma or rhinitis has been shown in 79% of included epidemiological studies. In four studies the increased risk of asthma in cleaning workers was confirmed by objective tests, such as bronchial hyper-reactivity or airflow obstruction. Level of exposure to cleaning products, cleaning sprays, bleach, ammonia, mixing products and specific job tasks has been identified as specific causes of asthma and rhinitis. CONCLUSIONS Possible preventive measures encompass the substitution of cleaning sprays, bleach and ammonia, avoidance of mixing products, the use of respiratory protective devices, worker education and medical surveillance.
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Affiliation(s)
- Ilenia Folletti
- Occupational Allergology Unit, Department of Clinical and Experimental Medicine, University of Perugia , Perugia , Italy
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Shaikh S, Nafees AA, Khetpal V, Jamali AA, Arain AM, Yousuf A. Respiratory symptoms and illnesses among brick kiln workers: a cross sectional study from rural districts of Pakistan. BMC Public Health 2012; 12:999. [PMID: 23164428 PMCID: PMC3507845 DOI: 10.1186/1471-2458-12-999] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2012] [Accepted: 11/17/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Occupational risk factors are one of the major causes of respiratory illnesses and symptoms, and account for 13% of chronic obstructive pulmonary disease and 11% of asthma worldwide. Majority of brick kilns in Pakistan use wood and coal for baking the bricks which makes the brick kiln workers susceptible to high exposure of air pollution. This study was designed to describe frequency of chronic respiratory symptoms and illnesses and study the association between these symptoms and different types of work. METHODS This was a questionnaire based cross sectional survey conducted among the brick kiln workers in Larkana and Dadu districts, Sindh, Pakistan. A total of 340 adult men were assessed using translated version of the American Thoracic Society Division of Lung Disease (ATS-DLD) questionnaire. Logistic regression analysis was done to determine the relationship between various socio-demographic and occupational factors (age, education, type of work, number of years at work, smoking status), and the respiratory symptoms and illnesses (chronic cough, chronic phlegm, wheeze, Chronic Bronchitis and asthma). RESULTS Results of the study show that 22.4% workers had chronic cough while 21.2% reported chronic phlegm. 13.8% had two or more attacks of shortness of breath with wheezing. 17.1% workers were suffering from Chronic Bronchitis while 8.2% reported physician diagnosed asthma. Amongst the non-smoking workers 8.9% had Chronic Bronchitis. Multivariate analysis found that workers involved in brick baking were more likely to have Chronic Bronchitis (OR= 3.7, 95% CI 1.1-11.6, p=<0.05) and asthma (OR= 3.9, 95% CI 1.01-15.5, p=<0.05) compared to those involved in carriage and placement work. CONCLUSION A high frequency of respiratory symptoms and illnesses was observed among brick kiln workers. Age, nature of work and smoking were strong predictors of developing these symptoms and illnesses.
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Affiliation(s)
- Shiraz Shaikh
- Department of Community Health Sciences, Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan
| | - Asaad Ahmed Nafees
- Department of Community Health Sciences, Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan
| | - Vikash Khetpal
- Shaheed Mohtarma Benazir Bhutto University, Larkana, Pakistan
| | - Abid Ali Jamali
- Shaheed Mohtarma Benazir Bhutto University, Larkana, Pakistan
| | | | - Akram Yousuf
- Shaheed Mohtarma Benazir Bhutto University, Larkana, Pakistan
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Abstract
Work-related rhinitis, which includes work-exacerbated rhinitis and occupational rhinoconjunctivitis (OR), is two to three times more common than occupational asthma. High molecular weight proteins and low molecular weight chemicals have been implicated as causes of OR. The diagnosis of work-related rhinitis is established based on occupational history and documentation of immunoglobulin E (IgE) mediated sensitization to the causative agent if possible. Management of work-related rhinitis is similar to that of other causes of rhinitis and includes elimination or reduction of exposure to causative agents combined with pharmacotherapy. If allergens are commercially available, allergen immunotherapy can be considered.
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Affiliation(s)
- J Wesley Sublett
- Division of Immunology, Allergy and Rheumatology, University of Cincinnati College of Medicine, 3255 Eden Avenue, Cincinnati, OH 45267-0563, USA
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Vandenplas O. Occupational asthma: etiologies and risk factors. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2011; 3:157-67. [PMID: 21738881 PMCID: PMC3121057 DOI: 10.4168/aair.2011.3.3.157] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Accepted: 04/19/2011] [Indexed: 01/10/2023]
Abstract
The purpose of this article is to critically review the available evidence pertaining to occupational, environmental, and individual factors that can affect the development of occupational asthma (OA). Increasing evidence suggests that exploration of the intrinsic characteristics of OA-causing agents and associated structure-activity relationships offers promising avenues for quantifying the sensitizing potential of agents that are introduced in the workplace. The intensity of exposure to sensitizing agents has been identified as the most important environmental risk factor for OA and should remain the cornerstone for primary prevention strategies. The role of other environmental co-factors (e.g., non-respiratory routes of exposure and concomitant exposure to cigarette smoke and other pollutants) remains to be further delineated. There is convincing evidence that atopy is an important individual risk factor for OA induced by high-molecular-weight agents. There is some evidence that genetic factors, such as leukocyte antigen class II alleles, are associated with an increased risk of OA; however, the role of genetic susceptibility factors is likely to be obscured by complex gene-environment interactions. OA, as well as asthma in general, is a complex disease that results from multiple interactions between environmental factors and host susceptibilities. Determining these interactions is a crucial step towards implementing optimal prevention policies.
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Affiliation(s)
- Olivier Vandenplas
- Department of Chest Medicine, Mont-Godinne Hospital, Université Catholique de Louvain, Yvoir, Belgium
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Adisesh A, Gruszka L, Robinson E, Evans G. Smoking status and immunoglobulin E seropositivity to workplace allergens. Occup Med (Lond) 2010; 61:62-4. [PMID: 21098081 DOI: 10.1093/occmed/kqq171] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Detection of serum-specific immunoglobulin E (IgE) can be helpful in the diagnosis of work-related allergic conditions. There have been conflicting reports regarding any association between smoking and specific IgE levels. AIMS To establish whether a relationship exists between smoking status and the outcome of specific IgE tests to workplace allergens. METHODS The Health and Safety Laboratory provides test services for workplace allergens and the request form used collects data on smoking status. Laboratory results of 695 subjects who had undergone specific IgE tests were examined by information on smoking. RESULTS Smokers were more likely than non-smokers to have positive specific IgE tests (P < 0.05). Smoking was the only independent predictor of a positive specific IgE test in logistic regression, with odds ratio of 2.39 (95% confidence interval 1.01-5.65, P < 0.05) for IgE seropositivity. Allergen subgroups also showed a positive association with smoking and in particular for high molecular weight allergens. CONCLUSIONS Being a current smoker is a risk factor for sensitization to workplace allergens especially for those of high molecular weight. Workplace well-being activities may make use of such information for smoking cessation programmes and emphasizing the importance of allergen exposure control. Collaboration between testing laboratories may provide useful datasets for further analysis.
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Affiliation(s)
- A Adisesh
- Centre for Workplace Health, Health and Safety Laboratory, Buxton SK17 9JN, UK
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Patiwael JA, Jong NW, Burdorf A, Groot H, Gerth van Wijk R. Occupational allergy to bell pepper pollen in greenhouses in the Netherlands, an 8-year follow-up study. Allergy 2010; 65:1423-9. [PMID: 20584006 DOI: 10.1111/j.1398-9995.2010.02411.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pollen from bell pepper plants cultivated in greenhouses are known to cause occupational allergic disease. A cross-sectional study among 472 bell pepper employees in 1999 estimated prevalences for sensitization to bell pepper pollen of 28% and for work-related allergic symptoms of 54%. There is scarce information on the incidence of work-related allergy and its risk factors. Aims of the present study were to estimate the cumulative incidence of work-related symptoms and sensitization to bell pepper pollen, and to determine risk factors for the onset of these symptoms and sensitization. METHODS Bell pepper employees who participated in a cross-sectional survey in 1999 were asked to take part in a follow-up study in 2007. Information on demographic characteristics, job characteristics and allergic symptoms was gathered by means of a questionnaire. Furthermore, skin tests were performed with a.o. bell pepper pollen. RESULTS In total, 280 of 472 employees were available for questionnaires and in 250 employees allergy tests were performed. During the 8-year follow-up, the cumulative incidence of sensitization to bell pepper pollen was 9% and of work-related rhinitis 19%. Atopy [odds ratio (OR) 5.60] and smoking (OR 3.53) were significantly associated with development of rhinitis. The cumulative incidence of work-related asthma symptoms was 8%. Again atopy (OR 5.03) and smoking (OR 11.85) were significant risk factors. CONCLUSION Cumulative incidences for sensitization to bell pepper pollen, work-related rhinitis and asthma symptoms were 9%, 19% and 8%, respectively. Atopy and smoking are risk factors for developing work-related symptoms among workers in bell pepper horticulture.
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Affiliation(s)
- J A Patiwael
- Department of Internal Medicine, Section of Allergology, Erasmus MC, Rotterdam, the Netherlands.
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15
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Abstract
Work-related rhinitis, which includes work-exacerbated rhinitis and occupational rhinitis, may be two to three times more common than occupational asthma. Both high molecular weight proteins and low molecular weight chemicals have been implicated as causes of occupational rhinitis. A diagnosis is established based on occupational history and, if appropriate, documentation of IgE-mediated sensitization to the causative agent. Management of work-related rhinitis is similar to that of non-work-related rhinitis and includes elimination or reduction of exposure to offending agents combined with pharmacotherapy. If treatment allergens are commercially available, allergen immunotherapy may also be considered if appropriate.
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16
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Quirce S, Sastre J. Recent advances in the management of occupational asthma. Expert Rev Clin Immunol 2010; 4:757-65. [PMID: 20477125 DOI: 10.1586/1744666x.4.6.757] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Occupational asthma (OA) is the most common occupational lung disease in industrialized countries. This respiratory disorder remains poorly diagnosed and managed, and inadequately compensated for worldwide. The most appropriate treatment for OA remains early removal from exposure to ensure that the worker has no further exposure to the causal agent with preservation of income. However, various studies demonstrate that many workers with OA continue to remain exposed to the causative agent or suffer prolonged work disruption and discrimination, and may face unemployment. Despite removal from exposure, OA frequently turns into a chronic condition and requires intensive medical management, including appropriate pharmacotherapy and patient education and counseling. There are very few studies on allergen immunotherapy in OA. Subcutaneous immunotherapy with latex extract in healthcare workers and with wheat-flour extract in subjects with baker's asthma, at adequate doses, appears to be a useful treatment in reducing cutaneous and respiratory symptoms, but should be considered as a high-risk treatment due to the appearance of systemic reactions.
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Affiliation(s)
- Santiago Quirce
- Hospital La Paz, Allergy Department, Paseo Castellana 261, 28046 Madrid, Spain.
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17
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Zacharisen MC. Occupational asthma: what can be done to prevent it? Expert Rev Clin Immunol 2010; 3:47-55. [PMID: 20476951 DOI: 10.1586/1744666x.3.1.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Occupational asthma (OA) accounts for at least 10% of cases of adult asthma and presents as intermittent asthma occurring at the workplace and remitting on weekends and holidays, or persistent asthma, especially if the diagnosis and early intervention is delayed. OA is under-recognized, challenging and time-consuming to diagnose, difficult to confirm with currently available tests and complex in terms of legal implications of disability and impairment. Over 400 agents have been identified as causing OA with allergic triggers accounting for 80-90% of cases. Managing the worker with OA is demanding as it requires the most thorough evaluation with attention to detail to provide an accurate diagnosis and develop a thoughtful treatment recommendation. This frequently has to occur in the context of various competing entities including management, unions, insurance carriers and attorneys. The primary goal is excellent employee health through interventions that may allow the worker to continue in their occupation safely. Primary, secondary and tertiary prevention measures have been adopted for various types of OA with success. Novel approaches may become available and be beneficial to identify and treat OA early before severe, chronic, unremitting and irreversible changes occur.
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Affiliation(s)
- Michael C Zacharisen
- Medical College of Wisconsin, 9000 West Wisconsin Avenue, Suite 411, Milwaukee, WI 53226, USA.
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18
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Stenton SC. Occupational and environmental lung disease: occupational asthma. Chron Respir Dis 2009; 7:35-46. [PMID: 19819911 DOI: 10.1177/1479972309346757] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Occupational exposures cause 10-15% of new-onset asthma in adults, and that represents a considerable health and economic burden. Exposure to many causative agents is now well controlled but workplace practices are constantly evolving and new hazards being introduced. Overall, there is no good evidence that the incidence of occupational asthma is decreasing. Evidence-based guidelines such as those published by the British Occupational Health research Foundation and Standards of Care documents should help raise awareness of the problem and improve management. Key targets include the control of occupational exposures, a high index of suspicion in any adult with new onset asthma, and early detailed investigation.
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Affiliation(s)
- S C Stenton
- Department of Respiratory Medicine, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
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19
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Dykewicz MS. Occupational asthma: current concepts in pathogenesis, diagnosis, and management. J Allergy Clin Immunol 2009; 123:519-28; quiz 529-30. [PMID: 19281900 DOI: 10.1016/j.jaci.2009.01.061] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Revised: 01/27/2009] [Accepted: 01/28/2009] [Indexed: 11/17/2022]
Abstract
Occupational asthma (OA) may account for 25% or more of de novo adult asthma. The nomenclature has now better defined categories of OA caused by sensitizing agents and irritants, the latter best typified by the reactive airways dysfunction syndrome. Selecting the most appropriate diagnostic testing and management is driven by assessing whether a sensitizer is involved, and if so, identifying whether the sensitizing agent is a high-molecular-weight agent such as a protein or a low-molecular-weight reactive chemical such as an isocyanate. Increased understanding of the pathogenesis of OA from reactive chemical sensitizers is leading to development of better diagnostic testing and also an understanding of why testing for sensitization to such agents can be problematic. Risk factors for OA including possible genetic factors are being delineated better. Recently published guidelines for the diagnosis and management of occupational asthma are summarized; these reflect an increasingly robust evidence basis for recommendations. The utility of diagnostic tests for OA is being better defined by evidence, including sputum analysis performed in relation to work exposure with suspected sensitizers. Preventive and management approaches are reviewed. Longitudinal studies of patients with OA continue to show that timely removal from exposure leads to the best prognosis.
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Affiliation(s)
- Mark S Dykewicz
- Allergy and Immunology Service, Section of Pulmonary, Critical Care, Allergy and Immunologic Diseases, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
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20
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21
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Moscato G, Vandenplas O, Van Wijk RG, Malo JL, Perfetti L, Quirce S, Walusiak J, Castano R, Pala G, Gautrin D, De Groot H, Folletti I, Yacoub MR, Siracusa A. EAACI position paper on occupational rhinitis. Respir Res 2009; 10:16. [PMID: 19257881 PMCID: PMC2654869 DOI: 10.1186/1465-9921-10-16] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Accepted: 03/03/2009] [Indexed: 01/15/2023] Open
Abstract
The present document is the result of a consensus reached by a panel of experts from European and non-European countries on Occupational Rhinitis (OR), a disease of emerging relevance which has received little attention in comparison to occupational asthma. The document covers the main items of OR including epidemiology, diagnosis, management, socio-economic impact, preventive strategies and medicolegal issues. An operational definition and classification of OR tailored on that of occupational asthma, as well as a diagnostic algorithm based on steps allowing for different levels of diagnostic evidence are proposed. The needs for future research are pointed out. Key messages are issued for each item.
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Affiliation(s)
- Gianna Moscato
- Allergy and Immunology Unit, Fondazione 'Salvatore Maugeri', Institute of Care and Research, Scientific Institute of Pavia, Pavia, Italy
| | - Olivier Vandenplas
- Service de Pneumologie, Cliniques de Mont-Godinne, Université Catholique de Louvain, Yvoir, Belgium
| | | | - Jean-Luc Malo
- Center for Asthma in the Workplace, Hôpital du Sacré-Coeur de Montréal, Centre de Recherche-Pneumologie, Montreal, Quebec, Canada
| | - Luca Perfetti
- Allergy and Immunology Unit, Fondazione 'Salvatore Maugeri', Institute of Care and Research, Scientific Institute of Pavia, Pavia, Italy
| | | | - Jolanta Walusiak
- Department of Occupational Diseases, Institute of Occupational Medicine, Lodz, Poland
| | - Roberto Castano
- Center for Asthma in the Workplace, Hôpital du Sacré-Coeur de Montréal, Centre de Recherche-Pneumologie, Montreal, Quebec, Canada
| | - Gianni Pala
- Allergy and Immunology Unit, Fondazione 'Salvatore Maugeri', Institute of Care and Research, Scientific Institute of Pavia, Pavia, Italy
| | - Denyse Gautrin
- Center for Asthma in the Workplace, Hôpital du Sacré-Coeur de Montréal, Centre de Recherche-Pneumologie, Montreal, Quebec, Canada
| | - Hans De Groot
- Department of Allergology, Erasmus MC, Rotterdam, The Netherlands
| | - Ilenia Folletti
- Occupational Medicine, Terni Hospital, University of Perugia, Perugia, Italy
| | - Mona Rita Yacoub
- Allergy and Immunology Unit, Fondazione 'Salvatore Maugeri', Institute of Care and Research, Scientific Institute of Pavia, Pavia, Italy
| | - Andrea Siracusa
- Occupational Medicine, Terni Hospital, University of Perugia, Perugia, Italy
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22
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Gangl K, Reininger R, Bernhard D, Campana R, Pree I, Reisinger J, Kneidinger M, Kundi M, Dolznig H, Thurnher D, Valent P, Chen KW, Vrtala S, Spitzauer S, Valenta R, Niederberger V. Cigarette smoke facilitates allergen penetration across respiratory epithelium. Allergy 2009; 64:398-405. [PMID: 19120070 DOI: 10.1111/j.1398-9995.2008.01861.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The association between cigarette smoke exposure and allergic airway disease is a matter for debate. We sought to investigate in an in vitro system whether active smoking reduces the integrity and barrier function of the respiratory epithelium and thus facilitates allergen penetration. METHODS We cultured the human bronchial epithelial cell line 16HBE14o- in a transwell culture system as a surrogate for the intact respiratory epithelium. The cell monolayer was exposed to standardized cigarette smoke extract (CSE). The extent and effects of trans-epithelial allergen penetration were measured using 125I-labelled purified major respiratory allergens (rBet v 1, rPhl p 5 and rDer p 2) and histamine release experiments. RESULTS Exposure of cells to concentrations of CSE similar to those found in smokers induced the development of para-cellular gaps and a decrease in trans-epithelial resistance. CSE exposure induced a more than threefold increase in allergen penetration. Increased subepithelial allergen concentrations provoked a substantial augmentation of histamine release from sensitized basophils. CONCLUSIONS Our results indicate that cigarette smoke is a potent factor capable of reducing the barrier function of the respiratory epithelium for allergens and may contribute to increased allergic inflammation, exacerbation of allergic disease and boosting of IgE memory.
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Affiliation(s)
- K Gangl
- Department of Otorhinolaryngology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
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23
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Parks CG, Cooper GS, Dooley MA, Park MM, Treadwell EL, Gilkeson GS. Childhood agricultural and adult occupational exposures to organic dusts in a population-based case-control study of systemic lupus erythematosus. Lupus 2008; 17:711-9. [PMID: 18625648 DOI: 10.1177/0961203308089436] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Organic dust exposure can influence the development and symptoms of immune-related diseases such as atopy and asthma, but has rarely been examined in relation to systemic autoimmunity. The present analyses explore the association of lifetime farm and occupational organic dust exposures with systemic lupus erythematosus (SLE) in recently diagnosed patients (n = 265) compared with controls (n = 355) frequency matched by age, sex and state. Questionnaire data included childhood farm residence, childhood and adult experience with specific crops, and adult work in textiles, hog or poultry processing and paper or furniture manufacture. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were estimated by logistic regression models including age, sex, state, race, education and silica exposure. Overall childhood or adult farm contact and childhood farm residence were not associated with SLE. Farm contact with livestock was inversely associated with SLE (OR = 0.55, 95% CI 0.35, 0.88). This effect was most pronounced among those with childhood farm residence and both childhood and adult livestock exposure (OR = 0.19; 95% CI 0.06, 0.63), but was difficult to separate from adult exposure to grains or corn. Other adult occupational exposures were not associated with SLE risk overall, regardless of childhood farm residence or livestock exposure, although an inverse association was seen among non-smokers (OR = 0.59; 95% CI 0.33, 1.1), particularly for textile work (OR = 0.34; 95% CI 0.19, 0.64). These exploratory findings support the development of studies to specifically investigate the effects of organic dust exposure on SLE risk, with particular attention to exposure assessment and characterization of demographics, smoking and other occupational exposures.
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Affiliation(s)
- C G Parks
- Biostatistics and Epidemiology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA.
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Demir A, Joseph L, Becklake MR. Work-related asthma in Montreal, Quebec: population attributable risk in a community-based study. Can Respir J 2008; 15:406-12. [PMID: 19107239 PMCID: PMC2682161 DOI: 10.1155/2008/391269] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Occupational exposures are an important cause of adult-onset asthma but the population attributable risk percentage (PAR%) has been less frequently studied. OBJECTIVES To examine the distribution and determinants of adult asthma in six centres across Canada using data gathered in a community-based study. METHODS Data were gathered in a community survey of 2959 adults using the European Community Respiratory Health Survey Protocol. A subsample of 498 subjects completed detailed health and occupational questionnaires, methacholine challenge tests and allergy skin tests. Asthma was defined in three ways: current wheeze, asthma symptoms and/or medication, and airway hyperresponsiveness. Occupational exposures were classified as sensitizers or irritants. Associations between asthma and occupational exposures were examined using logistic regression analysis. Model selection was based on the findings for current wheeze, and the same model was applied to the other definitions of asthma. RESULTS Fifty-six per cent of subjects reported ever having had occupational exposure to sensitizers, and 9.8% to irritants. Current wheeze was associated with exposure to irritants (PAR% 4.54%), and airway hyperresponsiveness was associated with exposure to sensitizers (PAR% 30.7%). Neither a history of childhood asthma, atopy, nor confining the analysis to adult-onset asthma affected these associations. Analysis of effect modification suggested two types of work-related asthma: one due to exposure to occupational sensitizers, and the other due to exposure to irritants. CONCLUSIONS Detailed assessment of past and current exposures is essential in the investigation of work-related asthma. Childhood asthma reactivated or aggravated by work exposures is not easy to distinguish from asthma induced by work, a misclassification that could lead to an underestimation of work-induced asthma. This should be taken into account in jurisdictions in which persons with work-aggravated asthma are not eligible for workers' compensation.
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Affiliation(s)
- Ahmet Demir
- Hacettepe University, Sihhiye Ankara, Turkey.
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25
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Moscato G, Vandenplas O, Gerth Van Wijk R, Malo JL, Quirce S, Walusiak J, Castano R, De Groot H, Folletti I, Gautrin D, Yacoub MR, Perfetti L, Siracusa A. Occupational rhinitis. Allergy 2008; 63:969-80. [PMID: 18691299 DOI: 10.1111/j.1398-9995.2008.01801.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The present document is the result of a consensus reached by a panel of experts from European and nonEuropean countries on Occupational Rhinitis (OR), a disease of emerging relevance, which has received little attention in comparison to occupational asthma. The document covers the main items of OR including epidemiology, diagnosis, management, socio-economic impact, preventive strategies and medicolegal issues. An operational definition and classification of OR tailored to that of occupational asthma, as well as a diagnostic algorithm based on steps allowing different levels of diagnostic evidence, are proposed. The needs for future research are pointed out. Key messages are issued for each item.
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26
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Folletti I, Forcina A, Marabini A, Bussetti A, Siracusa A. Have the prevalence and incidence of occupational asthma and rhinitis because of laboratory animals declined in the last 25 years? Allergy 2008; 63:834-41. [PMID: 18588548 DOI: 10.1111/j.1398-9995.2008.01786.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Data for time trends in the prevalence of occupational asthma (OA) and rhinitis (OR) are not known. OBJECTIVE To investigate the prevalence and incidence of OA and OR over time. METHODS We chose to review studies on the prevalence and incidence of OA and OR due to laboratory animals (LA) as a marker of changing OA and OR patterns over time and analysed 15 cross-sectional and 4 longitudinal studies published from 1980 to 2006. RESULTS The estimated prevalence of OA, defined as work-related chest symptoms (WRCS), declined from 8.2% in 1976 to 4.2% in 2001 (P < 0.005). When defined by WRCS and positive skin prick test (SPT) to LA, the estimated prevalence of OA was 6.7% in 1977 and 2.9% in 1999 (P < 0.02). The prevalence of OR, defined by WRNS or WRNS and SPT to LA, was not related to study date but was inversely associated with mean exposure duration. In four longitudinal studies no clear trend emerged over time. CONCLUSIONS This review suggests a trend toward a progressive decline in the prevalence of occupational asthma due to laboratory animals, which may be due to the reduction of exposure since the early 1980s. A further reduction of exposure is needed to prevent the onset of occupational rhinitis.
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Affiliation(s)
- I Folletti
- Occupational Allergology, Department of Clinical and Experimental Medicine, University of Perugia, Perugia, Italy
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27
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Occupational and environmental allergic disorders. Clin Immunol 2008. [DOI: 10.1016/b978-0-323-04404-2.10049-1] [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]
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28
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Storaas T, Irgens A, Florvaag E, Steinsvåg SK, Ardal L, Do TV, Greiff L, Aasen TB. Bronchial responsiveness in bakery workers: relation to airway symptoms, IgE sensitization, nasal indices of inflammation, flour dust exposure and smoking. Clin Physiol Funct Imaging 2007; 27:327-34. [PMID: 17697030 DOI: 10.1111/j.1475-097x.2007.00755.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Bronchial hyperresponsiveness (BHR) is common in bakery workers. The relation between bronchial responsiveness measured with a tidal breathing method and smoking, airway symptoms, IgE-sensitization, nasal indices of inflammation and flour dust exposure have been studied with bronchial responsiveness expressed as a continuous outcome. MATERIAL AND METHODS Bakery workers (n = 197) were subjected to interviews, questionnaires, allergy tests, workplace dust measurements and bronchial metacholine provocation. Eosinophil cationic protein (ECP) and alpha(2)-macroglobulin were measured in nasal lavage. Bronchial responsiveness was expressed as slope(conc), a measurement based on regressing the per cent reduction in FEV(1) at each provocation step. RESULTS BHR expressed as slope(conc) was associated with smoking (P = 0.009), asthma symptoms at work (P = 0.001), and occupational IgE sensitization (P = 0.048). After adjusting for baseline lung function the association between BHR and IgE sensitization was no longer present. We demonstrated an association between nasal ECP and BHR (slope(conc) < 3: P = 0.012), but not to alpha(2)-macroglobulin in nasal lavage. No association was seen between BHR and current exposure level of flour dust, number of working years in a bakery or a history of dough-making. CONCLUSION BHR is related to baseline lung function, work-related asthma symptoms, smoking and nasal eosinophil activity, but not to occupational IgE sensitization and current flour dust exposure when measured with metacholine provocation. The slope(conc) expression seems to be a useful continuous outcome in bronchial responsiveness testing.
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Affiliation(s)
- Torgeir Storaas
- Department of Otolaryngology, Head & Neck Surgery, Haukeland University Hospital, N-5021 Bergen, Norway.
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