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Romero-Mesones C, Cruz MJ, Alobid I, Barroso B, Arismendi E, Barranco P, Betancor D, Bobolea I, Cárdaba B, Curto E, Domenech G, Domínguez-Ortega J, Espejo D, González-Barcala FJ, Luna-Porta JA, Martínez-Rivera C, Méndez-Brea P, Mullol J, Olaguibel JM, Picado C, Plaza V, Del Pozo V, Quirce S, Rial MJ, Rodrigo-Muñoz JM, Sastre J, Serrano S, Soto-Retes L, Valero A, Valverde-Monge M, Munoz X. Disposition of Work-Related Asthma in a Spanish Asthma Cohort: Comparison of Asthma Severity Between Employed and Retired Workers. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:3407-3413.e1. [PMID: 37391017 DOI: 10.1016/j.jaip.2023.06.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Exposure to certain agents in the workplace can trigger occupational asthma or work-exacerbated asthma, both of which come under the heading of work-related asthma (WRA). Understanding the burden that WRA represents can help in the management of these patients. OBJECTIVE To assess the influence of occupation on asthma in real life and analyze the characteristics of patients with WRA included in an asthma cohort. METHODS This was a prospective multicenter study of a cohort of consecutive patients with asthma. A standardized clinical history was completed. Patients were classified as having WRA or non-WRA. All patients underwent respiratory function tests, FeNO test, and methacholine challenge (methacholine concentration that causes a 20% drop in FEV1) at the beginning of the study. They were classified into two groups, depending on their employment status: employed (group 1) or unemployed (group 2). RESULTS Of the 480 patients included in the cohort, 82 (17%) received the diagnosis of WRA. Fifty-seven patients (70%) were still working. Mean age (SD) was 46 (10.69) years in group 1 and 57 (9.91) years in group 2 (P < .0001). Significant differences were observed in adherence to treatment (64.9% in group 1 vs 88% in group 2; P = .0354) and in severe asthma exacerbations (35.7% in group 1 vs 0% in group 2; P = .0172). No significant differences were observed in the rest of the variables analyzed. CONCLUSIONS The burden of WRA in specialized asthma units is not negligible. The absence of differences in the severity of asthma, the treatment administered, alterations in lung function, and the number of exacerbations in those working versus not working may support the idea that advice regarding changing jobs should be customized for individual patients.
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Affiliation(s)
- Christian Romero-Mesones
- Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain; CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Maria-Jesus Cruz
- Servicio de Neumología. Hospital Universitario Vall d'Hebron, Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain; CIBER de Enfermedades Respiratorias, Madrid, Spain.
| | - Isam Alobid
- CIBER de Enfermedades Respiratorias, Madrid, Spain; Rhinology Unit and Smell Clinic, ENT Department, Hospital Clinic Barcelona, Universitat de Barcelona, Barcelona, Spain; Clinical and Experimental Respiratory Immunoallergy, Instituto de Investigaciones Biomédicas August Pi i Sunyer, Barcelona, Spain
| | - Blanca Barroso
- CIBER de Enfermedades Respiratorias, Madrid, Spain; Allergy Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Ebymar Arismendi
- CIBER de Enfermedades Respiratorias, Madrid, Spain; Allergy Unit and Severe Asthma Unit, Pneumonology and Allergy Department, Hospital Clínic, Instituto de Investigaciones Biomédicas August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Pilar Barranco
- CIBER de Enfermedades Respiratorias, Madrid, Spain; Department of Allergy, La Paz University Hospital, IdiPAZ, Madrid, Spain
| | - Diana Betancor
- CIBER de Enfermedades Respiratorias, Madrid, Spain; Allergy Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Irina Bobolea
- CIBER de Enfermedades Respiratorias, Madrid, Spain; Allergy Unit and Severe Asthma Unit, Pneumonology and Allergy Department, Hospital Clínic, Instituto de Investigaciones Biomédicas August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Blanca Cárdaba
- CIBER de Enfermedades Respiratorias, Madrid, Spain; Immunology Department, Instituto de Investigación Sanitaria Fundación Jiménez Díaz-Universidad Autónoma de Madrid, Madrid, Spain
| | - Elena Curto
- CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Gemma Domenech
- Medical Statistics Core Facility, Instituto de Investigaciones Biomédicas August Pi i Sunyer, Hospital Clinic Barcelona, Barcelona, Spain
| | - Javier Domínguez-Ortega
- CIBER de Enfermedades Respiratorias, Madrid, Spain; Department of Allergy, La Paz University Hospital, IdiPAZ, Madrid, Spain
| | - David Espejo
- Servicio de Neumología. Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | | | - Juan-Alberto Luna-Porta
- CIBER de Enfermedades Respiratorias, Madrid, Spain; Department of Allergy, La Paz University Hospital, IdiPAZ, Madrid, Spain
| | - Carlos Martínez-Rivera
- CIBER de Enfermedades Respiratorias, Madrid, Spain; Pulmonology Department, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona Badalona, Barcelona, Spain
| | - Paula Méndez-Brea
- Allergy Department, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
| | - Joaquim Mullol
- CIBER de Enfermedades Respiratorias, Madrid, Spain; Rhinology Unit and Smell Clinic, ENT Department, Clinical and Experimental Respiratory Immunoallergy (Instituto de Investigaciones Biomédicas August Pi i Sunyer), Universitat de Barcelona, Barcelona, Spain
| | | | - Cesar Picado
- Rhinology Unit and Smell Clinic, ENT Department, Hospital Clinic Barcelona, Universitat de Barcelona, Barcelona, Spain; Clinical and Experimental Respiratory Immunoallergy, Instituto de Investigaciones Biomédicas August Pi i Sunyer, Barcelona, Spain
| | - Vicente Plaza
- Servicio de Neumología y Alergia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Victoria Del Pozo
- CIBER de Enfermedades Respiratorias, Madrid, Spain; Immunology Department, Instituto de Investigación Sanitaria Fundación Jiménez Díaz-Universidad Autónoma de Madrid, Madrid, Spain
| | - Santiago Quirce
- CIBER de Enfermedades Respiratorias, Madrid, Spain; Department of Allergy, La Paz University Hospital, IdiPAZ, Madrid, Spain
| | - Manuel-Jorge Rial
- Allergy Department, Complexo Hospitalario Universitario, A Coruña, Spain
| | - José-María Rodrigo-Muñoz
- CIBER de Enfermedades Respiratorias, Madrid, Spain; Immunology Department, Instituto de Investigación Sanitaria Fundación Jiménez Díaz-Universidad Autónoma de Madrid, Madrid, Spain
| | - Joaquin Sastre
- CIBER de Enfermedades Respiratorias, Madrid, Spain; Allergy Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Sandra Serrano
- Medical Statistics Core Facility, Instituto de Investigaciones Biomédicas August Pi i Sunyer, Hospital Clinic Barcelona, Barcelona, Spain
| | - Lorena Soto-Retes
- Servicio de Neumología y Alergia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Antonio Valero
- CIBER de Enfermedades Respiratorias, Madrid, Spain; Allergy Unit and Severe Asthma Unit, Pneumonology and Allergy Department, Hospital Clínic, Instituto de Investigaciones Biomédicas August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Marcela Valverde-Monge
- CIBER de Enfermedades Respiratorias, Madrid, Spain; Allergy Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Xavier Munoz
- Servicio de Neumología. Hospital Universitario Vall d'Hebron, Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain; CIBER de Enfermedades Respiratorias, Madrid, Spain
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Lommatzsch M, Criée CP, de Jong CCM, Gappa M, Geßner C, Gerstlauer M, Hämäläinen N, Haidl P, Hamelmann E, Horak F, Idzko M, Ignatov A, Koczulla AR, Korn S, Köhler M, Lex C, Meister J, Milger-Kneidinger K, Nowak D, Nothacker M, Pfaar O, Pohl W, Preisser AM, Rabe KF, Riedler J, Schmidt O, Schreiber J, Schuster A, Schuhmann M, Spindler T, Taube C, Christian Virchow J, Vogelberg C, Vogelmeier CF, Wantke F, Windisch W, Worth H, Zacharasiewicz A, Buhl R. [Diagnosis and treatment of asthma: a guideline for respiratory specialists 2023 - published by the German Respiratory Society (DGP) e. V.]. Pneumologie 2023; 77:461-543. [PMID: 37406667 DOI: 10.1055/a-2070-2135] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
The management of asthma has fundamentally changed during the past decades. The present guideline for the diagnosis and treatment of asthma was developed for respiratory specialists who need detailed and evidence-based information on the new diagnostic and therapeutic options in asthma. The guideline shows the new role of biomarkers, especially blood eosinophils and fractional exhaled NO (FeNO), in diagnostic algorithms of asthma. Of note, this guideline is the first worldwide to announce symptom prevention and asthma remission as the ultimate goals of asthma treatment, which can be achieved by using individually tailored, disease-modifying anti-asthmatic drugs such as inhaled steroids, allergen immunotherapy or biologics. In addition, the central role of the treatment of comorbidities is emphasized. Finally, the document addresses several challenges in asthma management, including asthma treatment during pregnancy, treatment of severe asthma or the diagnosis and treatment of work-related asthma.
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Affiliation(s)
- Marek Lommatzsch
- Zentrum für Innere Medizin, Abt. für Pneumologie, Universitätsmedizin Rostock
| | | | - Carmen C M de Jong
- Abteilung für pädiatrische Pneumologie, Abteilung für Pädiatrie, Inselspital, Universitätsspital Bern
| | - Monika Gappa
- Klinik für Kinder und Jugendliche, Evangelisches Krankenhaus Düsseldorf
| | | | | | | | - Peter Haidl
- Abteilung für Pneumologie II, Fachkrankenhaus Kloster Grafschaft GmbH, Schmallenberg
| | - Eckard Hamelmann
- Kinder- und Jugendmedizin, Evangelisches Klinikum Bethel, Bielefeld
| | | | - Marco Idzko
- Abteilung für Pulmologie, Universitätsklinik für Innere Medizin II, Medizinische Universität Wien
| | - Atanas Ignatov
- Universitätsklinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum Magdeburg
| | - Andreas Rembert Koczulla
- Schön-Klinik Berchtesgadener Land, Berchtesgaden
- Klinik für Innere Medizin Schwerpunkt Pneumologie, Universitätsklinikum Marburg
| | - Stephanie Korn
- Pneumologie und Beatmungsmedizin, Thoraxklinik, Universitätsklinikum Heidelberg
| | - Michael Köhler
- Deutsche Patientenliga Atemwegserkrankungen, Gau-Bickelheim
| | - Christiane Lex
- Klinik für Kinder- und Jugendmedizin, Universitätsmedizin Göttingen
| | - Jochen Meister
- Klinik für Kinder- und Jugendmedizin, Helios Klinikum Aue
| | | | - Dennis Nowak
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, LMU München
| | - Monika Nothacker
- Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V
| | - Oliver Pfaar
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Hals-Chirurgie, Sektion für Rhinologie und Allergie, Universitätsklinikum Marburg, Philipps-Universität Marburg, Marburg
| | - Wolfgang Pohl
- Gesundheitszentrum Althietzing, Karl Landsteiner Institut für klinische und experimentelle Pneumologie, Wien
| | - Alexandra M Preisser
- Zentralinstitut für Arbeitsmedizin und Maritime Medizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Klaus F Rabe
- Pneumologie, LungenClinic Großhansdorf, UKSH Kiel
| | - Josef Riedler
- Abteilung für Kinder- und Jugendmedizin, Kardinal Schwarzenberg Klinikum Schwarzach
| | | | - Jens Schreiber
- Universitätsklinik für Pneumologie, Universitätsklinikum Magdeburg
| | - Antje Schuster
- Klinik für Allgemeine Pädiatrie, Neonatologie und Kinderkardiologie, Universitätsklinikum Düsseldorf
| | | | | | - Christian Taube
- Klinik für Pneumologie, Universitätsmedizin Essen-Ruhrlandklinik
| | | | - Christian Vogelberg
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus, Dresden
| | | | | | - Wolfram Windisch
- Lungenklinik Köln-Merheim, Lehrstuhl für Pneumologie, Universität Witten/Herdecke
| | - Heinrich Worth
- Pneumologische & Kardiologische Gemeinschaftspraxis, Fürth
| | | | - Roland Buhl
- Klinik für Pneumologie, Zentrum für Thoraxerkrankungen, Universitätsmedizin Mainz
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Mason P, Liviero F, Paccagnella ER, Biasioli M, Maestrelli P, Frigo AC. Impact of occupational asthma on health and employment status: a long-term follow-up study. Occup Environ Med 2023; 80:70-76. [PMID: 36581454 DOI: 10.1136/oemed-2022-108504] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 12/03/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The aim of this study was to assess the predictors of a favourable prognosis of occupational asthma (OA) and the employment status of patients with OA at least 2 years after diagnosis. METHODS We collected data from 204 patients who had a diagnosis of OA confirmed by a positive specific inhalation challenge. We defined OA remission as meeting the following three criteria: no asthma symptoms, no antiasthma therapy for the last year and having normal lung function at the end of follow-up. A logistic regression analysis was performed to estimate the effects of the covariates. RESULTS At 10.6±7.8-year follow-up, 60 of 204 possible patients participated in the study, and among them 17 showed OA remission. When compared with the 43 patients with persistent OA, these patients exhibited at diagnosis younger age (p=0.0039), shorter duration of symptomatic exposure (p=0.0512), better lung function expressed by higher forced vital capacity (FVC%) predicted (p=0.0164), forced expiratory volume in 1 s (FEV1) % predicted (p=0.0066) and FEV1/FVC% (p=0.0132), and less bronchial hyper-responsiveness (p=0.0118). Nevertheless, in the multivariable model, no variables were significantly associated with OA remission. At follow-up, three individuals have retired; among the remaining 57 workers, 91.2% were still employed and 43.8% of them had continued working in the same factory after ceasing exposure to the causative agent. CONCLUSIONS This monocentric study did not identify a strong predictor of OA remission, but documented a high employment rate and a good job preservation over a long timeframe after diagnosis of OA mainly induced by low molecular weight agents.
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Affiliation(s)
- Paola Mason
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Università degli Studi di Padova, Padova, Italy
| | - Filippo Liviero
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Università degli Studi di Padova, Padova, Italy
| | - Eleonora Rachele Paccagnella
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Università degli Studi di Padova, Padova, Italy
| | - Marco Biasioli
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Università degli Studi di Padova, Padova, Italy
| | - Piero Maestrelli
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Università degli Studi di Padova, Padova, Italy
| | - Anna Chiara Frigo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Università degli Studi di Padova, Padova, Italy
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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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Walters GI, Barber CM. Barriers to identifying occupational asthma among primary healthcare professionals: a qualitative study. BMJ Open Respir Res 2021; 8:e000938. [PMID: 34362763 PMCID: PMC8351481 DOI: 10.1136/bmjresp-2021-000938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 07/11/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Occupational asthma (OA) accounts for one in six cases of adult-onset asthma and is associated with a large societal cost. Many cases of OA are missed or delayed, leading to ongoing exposure to the causative agent and avoidable lung function loss and poor employment-related outcomes. Enquiry about work-related symptoms and the nature of work by healthcare professionals (HCPs) is limited, evident in primary and secondary care. Potential reasons cited for this are time pressure, lack of expertise and poor access to specialists. AIM To understand organisational factors and beliefs and behaviours among primary HCPs that may present barriers to identifying OA. METHODS We employed a qualitative phenomenological methodology and undertook 20-45 min interviews with primary HCPs in West Midlands, UK. We used purposive and snowball sampling to include general practitioners (GPs) and practice nurses with a range of experience, from urban and rural settings. Interviews were recorded digitally and transcribed professionally for analysis. Data were coded by hand, and thematic analysis was undertaken and determined theoretically until themes were saturated. RESULTS Eleven HCPs participated (eight GPs, three nurses). Four themes were identified that were considered to impact on identification of OA: (1) training and experience, (2) perceptions and beliefs, (3) systems constraints, and (4) variation in individual practice. OA-specific education had been inadequate at every stage of training and practice, and clinical exposure to OA had been generally limited. OA-specific beliefs varied, as did clinical behaviour with working-age individuals with asthma. There was a focus on diagnosis and treatment rather than attributing causation. Identified issues regarding organisation of asthma care were time constraints, lack of continuity, referral pressure, use of guidelines and templates, and external targets. CONCLUSION Organisation and delivery of primary asthma care, negative OA-related beliefs, lack of formal education, and exposure to OA may all currently inhibit its identification.
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Affiliation(s)
- Gareth I Walters
- Regional NHS Occupational Lung Disease Service, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Occupational and Environmental Medicine, University of Birmingham, Birmingham, UK
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van Kampen V, Mertens H, Brüning T, Merget R. Serial measurements of fractional exhaled nitric oxide at home and at work: A useful tool for monitoring workers with platinum salt allergy after exposure reduction. Health Sci Rep 2021; 4:e299. [PMID: 34136658 PMCID: PMC8190558 DOI: 10.1002/hsr2.299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 04/12/2021] [Accepted: 04/25/2021] [Indexed: 11/08/2022] Open
Affiliation(s)
- Vera van Kampen
- Institute for Prevention and Occupational Medicine of the German Social Accident InsuranceInstitute of the Ruhr University Bochum (IPA)BochumGermany
| | | | - Thomas Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accident InsuranceInstitute of the Ruhr University Bochum (IPA)BochumGermany
| | - Rolf Merget
- Institute for Prevention and Occupational Medicine of the German Social Accident InsuranceInstitute of the Ruhr University Bochum (IPA)BochumGermany
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Cullinan P, Vandenplas O, Bernstein D. Assessment and Management of Occupational Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 8:3264-3275. [PMID: 33161958 DOI: 10.1016/j.jaip.2020.06.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/27/2020] [Accepted: 06/02/2020] [Indexed: 12/01/2022]
Abstract
Exposures at work can give rise to different phenotypes of "work-related asthma." The focus of this review is on the diagnosis and management of sensitizer-induced occupational asthma (OA) caused by either a high- or low-molecular-weight agent encountered in the workplace. The diagnosis of OA remains a challenge for the clinician because there is no simple test with a sufficiently high level of accuracy. Instead, the diagnostic process combines different procedures in a stepwise manner. These procedures include a detailed clinical history, immunologic testing, measurement of lung function parameters and airway inflammatory markers, as well as various methods that relate changes in these functional and inflammatory indices to workplace exposure. Their diagnostic performances, alone and in combination, are critically reviewed and summarized into evidence-based key messages. A working diagnostic algorithm is proposed that can be adapted to the suspected agent, purpose of diagnosis, and available resources. Current information on the management options of OA is summarized to provide pragmatic guidance to clinicians who have to advise their patients with OA.
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Affiliation(s)
- Paul Cullinan
- Department of Occupational and Environmental Medicine, Royal Brompton Hospital and Imperial College (NHLI), London, United Kingdom
| | - Olivier Vandenplas
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium.
| | - David Bernstein
- Division of Immunology, Allergy and Rheumatology, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Mason P, Liviero F, Maestrelli P, Frigo AC. Long-Term Follow-Up of Cluster-Based Diisocyanate Asthma Phenotypes. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:3380-3386. [PMID: 33940214 DOI: 10.1016/j.jaip.2021.04.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Data on the outcome of occupational asthma (OA) are heterogeneous. OBJECTIVE To assess the impact of being part of a specific cluster at diagnosis on the long-term outcome of diisocyanate-induced OA. METHODS We collected data from 56 patients who had a diagnosis of OA confirmed by a positive specific inhalation challenge. Patients sensitized to toluene diisocyanate were allocated to cluster 1 or 2 based on a tree analysis, using the 3 variables relevant for cluster segregation identified in a previous study: age, body mass index, and forced expiratory volume in 1 second/forced vital capacity at diagnosis. Patients sensitized to methylene diisocyanate were allocated to cluster 3, as in previous study. We defined OA remission when a patient had met a total of 3 criteria: no asthma symptoms and no antiasthma therapy for the last year, as well as having normal lung function. RESULTS At follow-up, 16 patients showed OA remission. They exhibited better lung function, less bronchial hyperreactivity, as well as younger age at diagnosis. Twenty-eight patients were allocated to cluster 1, 10 to cluster 2, and 18 to cluster 3. The percentage of patients with OA remission was higher in cluster 2 (50% vs 25% in cluster 1 and 22.5% in cluster 3), although the difference was not statistically significant (P = .2789). CONCLUSIONS Age at diagnosis was a strong predictor of OA remission. The outcome of diisocyanate OA tended to be more favorable for patients with toluene diisocyanate OA allocated in cluster 2, but this finding needs to be validated by further data.
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Affiliation(s)
- Paola Mason
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Filippo Liviero
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Piero Maestrelli
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy.
| | - Anna Chiara Frigo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
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Vested A, Kolstad HA, Basinas I, Burdorf A, Elholm G, Heederik D, Jacobsen GH, Kromhout H, Omland Ø, Schaumburg I, Sigsgaard T, Vestergaard JM, Wouters IM, Schlünssen V. Dust exposure and the impact on hospital readmission of farming and wood industry workers for asthma and chronic obstructive pulmonary disease (COPD). Scand J Work Environ Health 2020; 47:163-168. [PMID: 33073852 PMCID: PMC8114568 DOI: 10.5271/sjweh.3926] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objectives: It is still not well established how occupational air pollutants affect the prognosis of asthma or chronic obstructive pulmonary disease (COPD). This study uses nationwide Danish registers and quantitative dust industry exposure matrices (IEM) for the farming and wood industries to estimate whether previous year dust exposure level impacts hospital readmissions for workers diagnosed with asthma or COPD. Methods: We identified all individuals with a first diagnosis of either asthma (769 individuals) or COPD (342 individuals) between 1997 and 2007 and followed them until the next hospital admission for asthma or COPD, emigration, death or 31 December 2007. We included only individuals who worked in either the wood or farming industries at least one year during follow-up. We used logistic regression analysis to investigate associations between dust exposure level in the previous year and hospital readmission, adjusting for sex, age, time since first diagnosis, socioeconomic status, and labor force participation. Results: Asthma readmissions for individuals with low and high dust exposure were increased [adjusted rate ratio (RRadj) 2.52, 95% confidence interval (CI) 1.45–4.40] and RRadj 2.64 (95% CI 1.52–4.60), respectively. For COPD readmission, the risk estimates were RRadj 1.36 (95% CI 0.57–3.23) for low and RRadj 1.20 (95% CI 0.49–2.95) for high exposure level in the previous year. For asthma readmission, stratified analyses by type of dust exposure during follow-up showed increased risks for both wood dust [RRadj 2.67 (95% CI 1.35–5.26) high exposure level] and farming dust [RRadj 3.59 (95% CI 1.11–11.59) high exposure level]. No clear associations were seen for COPD readmissions. Conclusions: This study indicates that exposure to wood or farm dust in the previous year increases the risk of hospital readmission for individuals with asthma but not for those with COPD.
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Affiliation(s)
- Anne Vested
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark.
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10
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Hoy R, Burdon J, Chen L, Miles S, Perret JL, Prasad S, Radhakrishna N, Rimmer J, Sim MR, Yates D, Zosky G. Work-related asthma: A position paper from the Thoracic Society of Australia and New Zealand and the National Asthma Council Australia. Respirology 2020; 25:1183-1192. [PMID: 33020986 PMCID: PMC7702173 DOI: 10.1111/resp.13951] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/24/2020] [Accepted: 08/31/2020] [Indexed: 01/10/2023]
Abstract
Work-related asthma (WRA) is one of the most common occupational respiratory conditions, and includes asthma specifically caused by occupational exposures (OA) and asthma that is worsened by conditions at work (WEA). WRA should be considered in all adults with asthma, but especially those with new-onset or difficult to control asthma. Improvement in asthma symptoms when away from work is suggestive of WRA. Clinical history alone is insufficient to diagnose WRA; therefore, objective investigations are required to confirm the presence of asthma and the association of asthma with work activities. Management of WRA requires pharmacotherapy similar to that of non-WRA, however, also needs to take into account control of the causative workplace exposure. Ongoing exposure will likely lead to decline in lung function and worsening asthma control. WRA is a preventable condition but this does rely on increased awareness of WRA and thorough identification and control of all potential occupational respiratory hazards.
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Affiliation(s)
- Ryan Hoy
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Allergy, Asthma and Clinical Immunology, The Alfred Hospital, Melbourne, VIC, Australia
| | | | - Ling Chen
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia
| | - Susan Miles
- Department of Medicine, Calvary Mater Newcastle, Newcastle, NSW, Australia
| | - Jennifer L Perret
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, VIC, Australia
| | - Shivonne Prasad
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Naghmeh Radhakrishna
- Allergy, Asthma and Clinical Immunology, The Alfred Hospital, Melbourne, VIC, Australia
| | - Janet Rimmer
- Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Malcolm R Sim
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Deborah Yates
- Department of Thoracic Medicine, St Vincent's Hospital, Sydney, NSW, Australia
| | - Graeme Zosky
- Menzies Institute for Medical Research, Tasmanian School of Medicine, University of Tasmania, Hobart, TAS, Australia
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Vandenplas O, Hox V, Bernstein D. Occupational Rhinitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:3311-3321. [PMID: 32653647 DOI: 10.1016/j.jaip.2020.06.047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/25/2020] [Indexed: 11/28/2022]
Abstract
There is convincing evidence that tight relationships between the upper and lower airways also apply to the workplace context. Most patients with occupational asthma (OA) also suffer from occupational rhinitis (OR), although OR is 2 to 3 times more common than OA. OR most often precedes the development of OA, especially when high-molecular-weight protein agents are involved, and longitudinal cohort studies have confirmed that OR is associated with an increased risk for the development of OA. The level of exposure to sensitizing agents at the workplace is the most important determinant for the development of IgE-mediated sensitization and OR. Atopy is a risk factor for the development of IgE-mediated sensitization only to high-molecular-weight agents. In workers with work-related rhinitis symptoms, documentation of IgE-mediated sensitization to a workplace agent via skin prick testing or serum specific IgE confirms a diagnosis of probable OR, whereas specific nasal provocation testing in the laboratory remains the reference method to establish a definite diagnosis of OR. Complete avoidance of exposure to the causal agent is the most effective therapeutic option for controlling work-related nasal symptoms and preventing the development of OA. If complete elimination of exposure is expected to induce meaningful adverse socioeconomic consequences, reduction of exposure can be considered as an alternative approach, but it is important to consider the individual risk factors for the development of OA to implement a more personalized management of OR.
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Affiliation(s)
- Olivier Vandenplas
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium.
| | - Valérie Hox
- Department of Otorhinolaryngology, Cliniques Universitaires Saint-Luc and Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, Université Catholique de Louvain, Brussels, Belgium
| | - David Bernstein
- Division of Immunology, Allergy and Rheumatology, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Tiotiu AI, Novakova S, Labor M, Emelyanov A, Mihaicuta S, Novakova P, Nedeva D. Progress in Occupational Asthma. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4553. [PMID: 32599814 PMCID: PMC7345155 DOI: 10.3390/ijerph17124553] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/20/2020] [Accepted: 06/22/2020] [Indexed: 01/12/2023]
Abstract
Occupational asthma (OA) represents one of the major public health problems due to its high prevalence, important social and economic burden. The aim of this review is to summarize current data about clinical phenotypes, biomarkers, diagnosis and management of OA, a subtype of work-related asthma. Most studies have identified two phenotypes of OA. One is sensitizer-induced asthma, occuring after a latency period and caused by hypersensitivity to high- or low-molecular weight agents. The other is irritant-induced asthma, which can occur after one or more exposures to high concentrations of irritants without latency period. More than 400 agents causing OA have been identified and its list is growing fast. The best diagnostic approach for OA is a combination of clinical history and objective tests. An important tool is a specific inhalation challenge. Additional tests include assessments of bronchial hyperresponsiveness to methacholine/histamine in patients without airflow limitations, monitoring peak expiratory flow at- and off-work, sputum eosinophil count, exhaled nitric oxide measurement, skin prick tests with occupational allergens and serum specific IgE. Treatment of OA implies avoidance of exposure, pharmacotherapy and education. OA is a heterogeneous disease. Mechanisms of its different phenotypes, their diagnosis, role of new biomarkers and treatment require further investigation.
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Affiliation(s)
- Angelica I. Tiotiu
- Department of Pulmonology, University Hospital of Nancy, 54000 Nancy, France
- Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control (EA 3450 DevAH), University of Lorraine, 54000 Nancy, France
| | - Silviya Novakova
- Allergy Unit, Internal Consulting Department, University Hospital “St. George”, 4000 Plovdiv, Bulgaria;
| | - Marina Labor
- Department of Pulmonology, University Hospital Centre Osijek, 31000 Osijek, Croatia;
- Medical Faculty Osijek, J.J. Strossmayer University, 31000 Osijek, Croatia
| | - Alexander Emelyanov
- Department of Respiratory Medicine, North-Western Medical University, 191015 Saint-Petersburg, Russia;
| | - Stefan Mihaicuta
- Victor Babes University of Medicine and Pharmacy, 300120 Timisoara, Romania
| | - Plamena Novakova
- Clinic of Clinical Allergy, Medical University, 1000 Sofia, Bulgaria;
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14
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Exposures and urinary biomonitoring of aliphatic isocyanates in construction metal structure coating. Int J Hyg Environ Health 2020; 226:113495. [PMID: 32120250 DOI: 10.1016/j.ijheh.2020.113495] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/17/2020] [Accepted: 02/18/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Isocyanates are highly reactive chemicals used widely in metal structure coating applications in construction. Isocyanates are potent respiratory and skin sensitizers and a leading cause of occupational asthma. At present, there is no cure for isocyanate asthma and no biomarkers of early disease. Exposure reduction is considered the most effective preventive strategy. To date, limited data are available on isocyanate exposures and work practices in construction trades using isocyanates, including metal structure coatings. OBJECTIVES The primary objectives of this work were: i) to characterize isocyanate inhalation and dermal exposures among painters during metal structure coating tasks in construction; and ii) to assess the adequacy of existing work practices and exposure controls via urinary biomonitoring pre- and post-shift. METHODS Exposures to aliphatic isocyanates based on 1,6-hexamethylene diisocyanate (1,6-HDI) and its higher oligomers (biuret, isocyanurate and uretdione) were measured among 30 workers performing painting of bridges and other metal structures in several construction sites in the Northeastern USA. Exposure assessment included simultaneous measurement of personal inhalation exposures (n = 20), dermal exposures (n = 22) and body burden via urinary biomonitoring pre- and post-shift (n = 53). Contextual information was collected about tasks, processes, materials, work practices, personal protective equipment (PPEs) and exposure controls, work histories, and environmental conditions. RESULTS Breathing zone concentrations were the highest for biuret (median, 18.4 μg/m3), followed by 1,6-HDI monomer (median, 3.5 μg/m3), isocyanurate (median, 3.4 μg/m3) and uretdione (median, 1.7 μg/m3). The highest exposures, measured during painting inside an enclosed bridge on a hot summer day, were: 10,288 μg/m3 uretdione; 8,240 μg/m3 biuret; and 947 μg/m3 1,6-HDI. Twenty percent of samples were above the NIOSH ceiling exposure limit for 1,6- HDI (140 μg/m3) and 35% of samples were above the UK-HSE ceiling for total isocyanate group (70 μg NCO/m3). Isocyanate loading on the gloves was generally high, with a median of 129 μg biuret/pair and maximum of 60.8 mg biuret/pair. The most frequently used PPEs in the workplace were half-face organic vapor cartridge (OVC) respirators, disposable palmar dip-coated polymer gloves, and cotton coveralls. However, 32% of workers didn't wear any respirator, 47% wore standard clothing with short-sleeve shirts and 14% didn't wear any gloves while performing tasks involving isocyanates. Based on biomonitoring results, 58.4% of urine samples exceeded the biological monitoring guidance value (BMGV) of 1 μmol hexamethylene diamine (HDA)/mol creatinine. Post-shift geometric mean HDA normalized to specific gravity increased by 2.5-fold compared to pre-shift (GM, 4.7 vs. 1.9 ng/mL; p value, < 0.001), and only 1.4-fold when normalized to creatinine. CONCLUSIONS Exposure and biomonitoring results, coupled with field observations, support the overall conclusions that (i) substantial inhalation and dermal exposures to aliphatic isocyanates occur during industrial coating applications in construction trades; that (ii) the current work practices and exposure controls are not adequately protective. High urinary creatinine values in the majority of workers, coupled with significant cross-shift increases and filed observations, point to the need for further investigations on possible combined effects of heat stress, dehydration, and nutritional deficiencies on kidney toxicity. Implementation of comprehensive exposure control programs and increased awareness are warranted in order to reduce isocyanate exposures and associated health risks among this cohort of construction workers.
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Al Badri FM, Baatjies R, Jeebhay MF. Assessing the health impact of interventions for baker's allergy and asthma in supermarket bakeries: a group randomised trial. Int Arch Occup Environ Health 2020; 93:589-599. [PMID: 31927662 DOI: 10.1007/s00420-019-01511-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 12/24/2019] [Indexed: 01/19/2023]
Abstract
PURPOSE To assess the impact of an intervention for baker's allergy and asthma in supermarket bakeries. METHODS A group randomised trial conducted in 31 bakeries (n = 337 bakers) that were randomly assigned to one of two intervention groups (n = 244 bakers) and a control group (n = 93 bakers). Health data collected prior to and 1-year after the intervention included information obtained from an ECRHS questionnaire; tests for atopy and serum-specific IgE to cereal flours; fractional exhaled nitric oxide (FeNO). Data from the two intervention groups were combined to form one intervention group for purposes of the statistical analysis. RESULTS At 1 year of follow-up, the incidence and level of decline of work-related ocular-nasal and chest symptoms, sensitisation status and elevated FeNO (FeNO > 25 ppb) was similar in both intervention and control groups. The mean FeNO difference was also similar across both groups (2.2 ppb vs 1.7 ppb, p = 0.86). In those with FeNO > 25 ppb at baseline, the decline was greater in the intervention compared to control group (16.9 ppb vs 7.7 ppb, p = 0.24). Multivariate logistic regression models (adjusting for smoking, baseline sensitisation to cereal flour, baseline FeNO > 25 ppb) did not demonstrate an appreciable FeNO decline (≥ 10%) in the intervention compared to control group. However, stratification by the presence of work-related ocular-nasal symptoms in bakers at baseline demonstrated a significant FeNO decline (≥ 10%) in the intervention compared to the control group (OR 3.73, CI 1.22-11.42). CONCLUSION This study demonstrates some evidence of an intervention effect on FeNO 1 year after an intervention, particularly in bakers with work-related ocular-nasal symptoms.
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Affiliation(s)
- F M Al Badri
- Occupational Medicine Division and Centre for Environmental & Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Room 4. 45, Fourth Level, Falmouth Building, Anzio Road, Observatory, Cape Town, 7925, South Africa.,Occupational Medicine Department, Armed Forces Medical Services, Muscat, Oman
| | - R Baatjies
- Occupational Medicine Division and Centre for Environmental & Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Room 4. 45, Fourth Level, Falmouth Building, Anzio Road, Observatory, Cape Town, 7925, South Africa.,Department of Environmental and Occupational Studies, Cape Peninsula University of Technology (CPUT), Cape Town, South Africa
| | - Mohamed F Jeebhay
- Occupational Medicine Division and Centre for Environmental & Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Room 4. 45, Fourth Level, Falmouth Building, Anzio Road, Observatory, Cape Town, 7925, South Africa.
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16
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Vandenplas O, Godet J, Hurdubaea L, Rifflart C, Suojalehto H, Walusiak-Skorupa J, Munoz X, Sastre J, Klusackova P, Moore V, Merget R, Talini D, Kirkeleit J, Mason P, Folletti I, Cullinan P, Moscato G, Quirce S, Hoyle J, Sherson D, Kauppi P, Preisser A, Meyer N, de Blay F. Severe Occupational Asthma: Insights From a Multicenter European Cohort. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:2309-2318.e4. [PMID: 30914232 DOI: 10.1016/j.jaip.2019.03.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/13/2019] [Accepted: 03/08/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Although sensitizer-induced occupational asthma (OA) accounts for an appreciable fraction of adult asthma, the severity of OA has received little attention. OBJECTIVE The aim of this study was to characterize the burden and determinants of severe OA in a large multicenter cohort of subjects with OA. METHODS This retrospective study included 997 subjects with OA ascertained by a positive specific inhalation challenge completed in 20 tertiary centers in 11 European countries during the period 2006 to 2015. Severe asthma was defined by a high level of treatment and any 1 of the following criteria: (1) daily need for a reliever medication, (2) 2 or more severe exacerbations in the previous year, or (3) airflow obstruction. RESULTS Overall, 162 (16.2%; 95% CI, 14.0%-18.7%) subjects were classified as having severe OA. Multivariable logistic regression analysis revealed that severe OA was associated with persistent (vs reduced) exposure to the causal agent at work (odds ratio [OR], 2.78; 95% CI, 1.50-5.60); a longer duration of the disease (OR, 1.04; 95% CI, 1.00-1.07); a low level of education (OR, 2.69; 95% CI, 1.73-4.18); childhood asthma (OR, 2.92; 95% CI, 1.13-7.36); and sputum production (OR, 2.86; 95% CI, 1.87-4.38). In subjects removed from exposure, severe OA was associated only with sputum production (OR, 3.68; 95% CI, 1.87-7.40); a low education level (OR, 3.41; 95% CI, 1.72-6.80); and obesity (OR, 1.98; 95% CI, 0.97-3.97). CONCLUSIONS This study indicates that a substantial proportion of subjects with OA experience severe asthma and identifies potentially modifiable risk factors for severe OA that should be targeted to reduce the adverse impacts of the disease.
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Affiliation(s)
- Olivier Vandenplas
- 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
| | - Laura Hurdubaea
- Division of Asthma and Allergy, Department of Chest Diseases, University Hospital of Strasbourg and Fédération de Médecine translationnelle, Strasbourg University, Strasbourg, France
| | - Catherine Rifflart
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - Hille Suojalehto
- Occcupational Medicine, Finnish Institute of Occupational Health, Helsinki, Finland
| | - 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 (CIBERES), Barcelona, Spain
| | - Joaquin Sastre
- Department of Allergy, Fundacion Jimenez Dıaz and CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Pavlina Klusackova
- Department of Occupational Medicine, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Vicky Moore
- Occupational Lung Disease Unit, Birmingham Heartlands Hospital, Birmingham, United Kingdom
| | - Rolf Merget
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (IPA), Ruhr University, Bochum, Germany
| | - Donatella Talini
- Cardio-Thoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Jorunn Kirkeleit
- Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | - Paola Mason
- Unit of Occupational Medicine and Public Health, University of Padova, Padova, Italy
| | - Ilenia Folletti
- Department of Medicine, Section of Occupational Medicine, Respiratory Diseases and Occupational and Environmental Toxicology, University of Perugia, Perugia, Italy
| | - Paul Cullinan
- Department of Occupational and Environmental Medicine, Royal Brompton Hospital and Imperial College (NHLI), Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Gianna Moscato
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, and Allergy and Immunology Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Pavia, Italy
| | - Santiago Quirce
- Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ) and CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Jennifer Hoyle
- Department of Respiratory Medicine, North Manchester General Hospital, Manchester, United Kingdom
| | - David Sherson
- Department of Pulmonary Medicine and Occupational Medicine, Odense University Hospital, Odense, Denmark
| | - Paula Kauppi
- Department of Allergy, Skin and Allergy Hospital, Helsinki University Central Hospital, Helsinki, Finland
| | - Alexandra Preisser
- Institute for Occupational and Maritime Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nicolas Meyer
- 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
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Rodríguez-Molina D, Barth S, Herrera R, Rossmann C, Radon K, Karnowski V. An educational intervention to improve knowledge about prevention against occupational asthma and allergies using targeted maximum likelihood estimation. Int Arch Occup Environ Health 2019; 92:629-638. [PMID: 30643958 DOI: 10.1007/s00420-018-1397-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 12/13/2018] [Indexed: 12/29/2022]
Abstract
PURPOSE Occupational asthma and allergies are potentially preventable diseases affecting 5-15% of the working population. However, the use of preventive measures is often insufficient. The aim of this study was to estimate the average treatment effect of an educational intervention designed to improve the knowledge of preventive measures against asthma and allergies in farm apprentices from Bavaria (Southern Germany). METHODS Farm apprentices at Bavarian farm schools were asked to complete a questionnaire evaluating their knowledge about preventive measures against occupational asthma and allergies (use of personal protective equipment, personal and workplace hygiene measures). Eligible apprentices were randomized by school site to either a control or an intervention group. The intervention consisted of a short educational video about use of preventive measures. Six months after the intervention, subjects were asked to complete a post-intervention questionnaire. Of the 116 apprentices (70 intervention group, 46 control group) who answered the baseline questionnaire, only 47 subjects (41%; 17 intervention group, 30 control group) also completed the follow-up questionnaire. We, therefore, estimated the causal effect of the intervention using targeted maximum likelihood estimation. Models were controlled for potential confounders. RESULTS Based on the targeted maximum likelihood estimation, the intervention would have increased the proportion of correct answers on all six preventive measures by 18.4% (95% confidence interval 7.3-29.6%) had all participants received the intervention vs. had they all been in the control group. CONCLUSIONS These findings indicate the improvement of knowledge by the educational intervention.
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Affiliation(s)
- Daloha Rodríguez-Molina
- Occupational and Environmental Epidemiology and NetTeaching Unit, Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital of Munich (LMU), Ziemssenstr. 1, 80336, Munich, Germany.
- Department of Medical Informatics, Biometry and Epidemiology (IBE), Ludwig-Maximilians University Munich (LMU), Marchioninistr. 15, 81377, Munich, Germany.
| | - Swaantje Barth
- Occupational and Environmental Epidemiology and NetTeaching Unit, Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital of Munich (LMU), Ziemssenstr. 1, 80336, Munich, Germany
| | - Ronald Herrera
- Occupational and Environmental Epidemiology and NetTeaching Unit, Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital of Munich (LMU), Ziemssenstr. 1, 80336, Munich, Germany
| | - Constanze Rossmann
- Department of Media and Communication Sciences, University of Erfurt, Nordhäuser Str. 63, 99089, Erfurt, Germany
| | - Katja Radon
- Occupational and Environmental Epidemiology and NetTeaching Unit, Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital of Munich (LMU), Ziemssenstr. 1, 80336, Munich, Germany
| | - Veronika Karnowski
- Department of Communication Studies and Media Research (IfKW), Ludwig-Maximilians University Munich (LMU), Oettingenstr. 67, 80538, Munich, Germany
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Coman I, Barranco P, Quirce S. Occupational asthma caused by high- and low-molecular weight agents in an auto body worker. Ann Allergy Asthma Immunol 2018; 120:669-670. [PMID: 29409962 DOI: 10.1016/j.anai.2018.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 01/21/2018] [Accepted: 01/30/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Isabel Coman
- Department of Allergy, Hospital La Paz, Institute for Health Research (IdiPAZ), Madrid, Spain.
| | - Pilar Barranco
- Department of Allergy, Hospital La Paz, Institute for Health Research (IdiPAZ), Madrid, Spain; CIBER de Enfermedades Respiratorias, CIBERES, Madrid, Spain
| | - Santiago Quirce
- Department of Allergy, Hospital La Paz, Institute for Health Research (IdiPAZ), Madrid, Spain; CIBER de Enfermedades Respiratorias, CIBERES, Madrid, Spain
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19
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Occupational Asthma, Not a Trivial Disorder and a Source of Fatal and Near-Fatal Events. CURRENT TREATMENT OPTIONS IN ALLERGY 2018. [DOI: 10.1007/s40521-018-0161-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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20
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De Matteis S, Heederik D, Burdorf A, Colosio C, Cullinan P, Henneberger PK, Olsson A, Raynal A, Rooijackers J, Santonen T, Sastre J, Schlünssen V, van Tongeren M, Sigsgaard T. Current and new challenges in occupational lung diseases. Eur Respir Rev 2017; 26:170080. [PMID: 29141963 PMCID: PMC6033059 DOI: 10.1183/16000617.0080-2017] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 09/02/2017] [Indexed: 01/13/2023] Open
Abstract
Occupational lung diseases are an important public health issue and are avoidable through preventive interventions in the workplace. Up-to-date knowledge about changes in exposure to occupational hazards as a result of technological and industrial developments is essential to the design and implementation of efficient and effective workplace preventive measures. New occupational agents with unknown respiratory health effects are constantly introduced to the market and require periodic health surveillance among exposed workers to detect early signs of adverse respiratory effects. In addition, the ageing workforce, many of whom have pre-existing respiratory conditions, poses new challenges in terms of the diagnosis and management of occupational lung diseases. Primary preventive interventions aimed to reduce exposure levels in the workplace remain pivotal for elimination of the occupational lung disease burden. To achieve this goal there is still a clear need for setting standard occupational exposure limits based on transparent evidence-based methodology, in particular for carcinogens and sensitising agents that expose large working populations to risk. The present overview, focused on the occupational lung disease burden in Europe, proposes directions for all parties involved in the prevention of occupational lung disease, from researchers and occupational and respiratory health professionals to workers and employers.
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Affiliation(s)
- Sara De Matteis
- Respiratory Epidemiology, Occupational Medicine and Public Health, Imperial College London, London, UK
| | - Dick Heederik
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Alex Burdorf
- Dept of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Claudio Colosio
- Dept of Health Sciences of the University of Milan and International Centre for Rural Health of the S. Paolo Hospital, Milan, Italy
| | - Paul Cullinan
- Respiratory Epidemiology, Occupational Medicine and Public Health, Imperial College London, London, UK
| | - Paul K Henneberger
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Ann Olsson
- International Agency for Research on Cancer, Lyon, France
| | - Anne Raynal
- Occupational Medicine Division, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Jos Rooijackers
- Netherlands Expertise Center for Occupational Respiratory Disorders, Utrecht, The Netherlands
| | - Tiina Santonen
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Joaquin Sastre
- Allergy Service, Fundacion Jimenez Diaz, Faculty of Medicine Universidad Autonoma de Madrid, CIBER of Respiratory Diseases, Ministry of Economy, Madrid, Spain
| | - Vivi Schlünssen
- Dept of Public Health, Section of Environment, Occupation and Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark
- National Research Center for the Working Environment, Copenhagen, Denmark
| | - Martie van Tongeren
- Centre for Occupational and Environmental Health; Centre for Epidemiology; Division of Population Health, Health Services Research and Primary Care; School of Health Sciences; Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Torben Sigsgaard
- Dept of Public Health, Section of Environment, Occupation and Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark
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Bittner C, Garrido MV, Harth V, Preisser AM. IgE Reactivity, Work Related Allergic Symptoms, Asthma Severity, and Quality of Life in Bakers with Occupational Asthma. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 921:51-60. [PMID: 27161107 DOI: 10.1007/5584_2016_226] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In Germany, bakers with occupational asthma willing to stay in their job are included in an interdisciplinary program of the Social Accident Insurance for Foodstuff and Catering Industry (BGN). The primary aim is to reduce flour dust exposure, and to provide adequate medical treatment. Our aim was to evaluate the program's effect on the disease's course using routinely collected data. Forty three bakers with allergic occupational asthma and with the available baseline level of IgE (f4, f5) were investigated. Changes in IgE related to wheat and rye flour exposure were measured by ImmunoCAP test during follow-up visits. A questionnaire on work-related allergic complaints (WRAC), the Asthma Control Test (ACT), a 10-point scale of asthma severity grade, and quality of life instruments (EQ-5D-5L, Mini-AQLQ) were administered. We found an improvement of asthma severity in 88.4 % of the bakers. WRAC were reported by 65 %; 77 % had good asthma control (ACT ≥ 20); and 81 % had regular asthma medication. A relevant reduction of ≥2 CAP-classes for both allergens was seen in 12 % of the subjects. Health-related and asthma-specific quality of life was high. We conclude that satisfactory asthma control is probably the result of adequate medical management. In a subgroup of bakers with decreased specific IgE, it may also be attributed to reduced allergen exposure.
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Affiliation(s)
- C Bittner
- Division of Clinical Occupational Medicine, Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf, 10 Seewartenstraße, 20459, Hamburg, Germany.
| | - M V Garrido
- Division of Clinical Occupational Medicine, Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf, 10 Seewartenstraße, 20459, Hamburg, Germany
| | - V Harth
- Division of Clinical Occupational Medicine, Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf, 10 Seewartenstraße, 20459, Hamburg, Germany
| | - A M Preisser
- Division of Clinical Occupational Medicine, Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf, 10 Seewartenstraße, 20459, Hamburg, Germany
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Heederik D. Occupational exposure and asthma control. Eur Respir J 2017; 50:50/4/1701951. [PMID: 29074549 DOI: 10.1183/13993003.01951-2017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 09/26/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Dick Heederik
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
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Cullinan P, Muñoz X, Suojalehto H, Agius R, Jindal S, Sigsgaard T, Blomberg A, Charpin D, Annesi-Maesano I, Gulati M, Kim Y, Frank AL, Akgün M, Fishwick D, de la Hoz RE, Moitra S. Occupational lung diseases: from old and novel exposures to effective preventive strategies. THE LANCET RESPIRATORY MEDICINE 2017; 5:445-455. [PMID: 28089118 DOI: 10.1016/s2213-2600(16)30424-6] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 10/22/2016] [Accepted: 11/02/2016] [Indexed: 02/06/2023]
Abstract
Occupational exposure is an important, global cause of respiratory disease. Unlike many other non-communicable lung diseases, the proximal causes of many occupational lung diseases are well understood and they should be amenable to control with use of established and effective approaches. Therefore, the risks arising from exposure to silica and asbestos are well known, as are the means of their prevention. Although the incidence of occupational lung disease has decreased in many countries, in parts of the world undergoing rapid economic transition and population growth-often with large informal and unregulated workforces-occupational exposures continue to impose a heavy burden of disease. The incidence of interstitial and malignant lung diseases remains unacceptably high because control measures are not implemented or exposures arise in novel ways. With the advent of innovative technologies, new threats are continually introduced to the workplace (eg, indium compounds and vicinal diketones). In developed countries, work-related asthma is the commonest occupational lung disease of short latency. Although generic control measures to reduce the risk of developing or exacerbating asthma are well recognised, there is still uncertainty, for example, with regards to the management of workers who develop asthma but remain in the same job. In this Review, we provide recommendations for research, surveillance, and other action for reducing the burden of occupational lung diseases.
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Affiliation(s)
- Paul Cullinan
- Department of Occupational and Environmental Medicine, Imperial College, London, UK; MRC-PHE Centre for Environment and Health, London, UK
| | - Xavier Muñoz
- Servei de Pneumologia, Hospital Universitari Vall d'Hebron (CIBER de Enfermedades Respiratorias), Barcelona, Spain; CIBER de Enfermedades Respiratorias, Barcelona, Spain
| | - Hille Suojalehto
- Occupational Medicine, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Raymond Agius
- Centre for Occupational and Environmental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Surinder Jindal
- Department of Respiratory Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Anders Blomberg
- Department of Public Health and Clinical Medicine, Division of Medicine, and Division of Respiratory Medicine, Umeå University, Umeå, Sweden
| | - Denis Charpin
- Clinique des Bronches, Allergie et Sommeil, Hôpital Nord, Marseille, France; INSERM, Aix-Marseille Université, Marseille, France
| | - Isabella Annesi-Maesano
- Epidémiologie des Maladies Respiratoires et Allergiques, iPLESP INSERM et UPMC, Paris, France
| | - Mridu Gulati
- Section of Pulmonary, Critical Care, and Sleep Medicine, and Yale Occupational and Environmental Medicine Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Yangho Kim
- Department of Occupational and Environmental Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Arthur L Frank
- Division of Environmental and Occupational Health, Drexel University School of Public Health, Philadelphia, PA, USA
| | - Metin Akgün
- Department of Chest Diseases, Ataturk University School of Medicine, Erzurum, Turkey
| | - David Fishwick
- Centre for Workplace Health, University of Sheffield, Sheffield, UK
| | - Rafael E de la Hoz
- Department of Preventive Medicine, Division of Occupational and Environmental Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Subhabrata Moitra
- Department of Respiratory Medicine and Allergology, Faculty of Clinical Sciences, Lund University Lund, Sweden; Department of Pneumology, Allergy and Asthma Research Centre, Kolkata, India.
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Merget R, Pham N, Schmidtke M, Casjens S, van Kampen V, Sander I, Hagemeyer O, Sucker K, Raulf M, Brüning T. Medical surveillance and long-term prognosis of occupational allergy due to platinum salts. Int Arch Occup Environ Health 2016; 90:73-81. [PMID: 27734174 DOI: 10.1007/s00420-016-1172-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 10/02/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Medical surveillance of workers in precious metals refineries and catalyst production plants is well established in many countries as a measure to prevent occupational asthma due to platinum (Pt) salts. It was the aim of this study to evaluate the impact of medical surveillance and to define prognostic factors with an emphasis on exposure determinants. METHODS As part of an observational longitudinal study, 96 workers from German precious metals refineries and catalyst production plants with Pt salt allergy underwent a second examination several years (median 67 months) after the initial diagnosis was made. RESULTS When the second examination was conducted, 92 subjects (96 %) had already been transferred to jobs with very low or no exposure to Pt salts. The number of subjects with sensitization to Pt salt as assessed by skin prick test (SPTPt) decreased from 86 to 52 %, and there was a clear improvement for rhinitis, conjunctivitis and contact urticaria between both examinations. Although the number of subjects with asthma symptoms decreased significantly, at the second examination 74 subjects (77 %) continued to suffer from asthma and 51 subjects (53 %) received asthma medication. Airway obstruction or bronchial hyperresponsiveness persisted in 83 subjects (86 %). CONCLUSIONS Secondary prevention in subjects with occupational exposure to Pt salts, as practiced for over 25 years in Germany could not avoid persistent asthma in the majority of cases, although improvements occurred. This study reveals the limitations of the concept that removal from exposure after the occurrence of respiratory symptoms may prevent chronic asthma. It is recommended that removal from exposure should be done immediately after the occurrence of a positive SPTPt, irrespective of symptoms.
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Affiliation(s)
- Rolf Merget
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.
| | - Ngoc Pham
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Maike Schmidtke
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Swaantje Casjens
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Vera van Kampen
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Ingrid Sander
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Olaf Hagemeyer
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Kirsten Sucker
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Monika Raulf
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Thomas Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
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Radon K, Nowak D, Vogelberg C, Ruëff F. Career Advice for Young Allergy Patients. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 113:519-24. [PMID: 27581504 PMCID: PMC5012160 DOI: 10.3238/arztebl.2016.0519] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 04/14/2016] [Accepted: 04/14/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND One-third of all young persons entering the work force have a history of atopic disease. Occupationally induced allergy and asthma generally arise in the first few months on the job, while pre-existing symptoms tend to worsen. Young persons with a history of an atopic disease should receive evidence-based advice before choosing a career. METHODS We systematically searched PubMed for cohort studies investigating the new onset of asthma, rhinitis, or hand eczema among job trainees from before the start of training and onward into the first few years on the job. The search revealed 514 articles; we read their abstracts and selected 85 full-text articles for further analysis. 24 of these met the inclusion criteria. RESULTS According to present evidence, atopy and a history of allergic disease (allergic rhinitis, atopic dermatitis) are the main risk factors for occupationally induced disease. The predictive value of a personal history of allergic diseases for the later development of an occupationally induced disease varies from 9% to 64% in the studies we analyzed. It follows that only young people with severe asthma or severe atopic eczema should be advised against choosing a job that is associated with a high risk of allergy, e.g., hairdressing or working with laboratory animals. Young people with a history of other atopic diseases should be counseled about their individual risk profile. CONCLUSION In view of the relatively poor predictive value of pre-existing atopic disease, secondary prevention is particularly important. This includes frequent medical follow-up of the course of symptoms over the first few years on the job. If sensitization or allergic symptoms arise, it should be carefully considered whether exposure reduction will enable the apprentice to stay on the job.
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Affiliation(s)
- Katja Radon
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, AllergieZENTRUM, Klinikum der Universität München
- Comprehensive Pneumology Center, DZL, Deutsches Zentrum für Lungenforschung, München
| | - Dennis Nowak
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, AllergieZENTRUM, Klinikum der Universität München
- Comprehensive Pneumology Center, DZL, Deutsches Zentrum für Lungenforschung, München
| | | | - Franziska Ruëff
- Department of Dermatology and Allergology, AllergieZENTRUM, Klinikum der Universität München
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Meca O, Cruz MJ, Sánchez-Ortiz M, González-Barcala FJ, Ojanguren I, Munoz X. Do Low Molecular Weight Agents Cause More Severe Asthma than High Molecular Weight Agents? PLoS One 2016; 11:e0156141. [PMID: 27280473 PMCID: PMC4900572 DOI: 10.1371/journal.pone.0156141] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 05/09/2016] [Indexed: 11/26/2022] Open
Abstract
Introduction The aim of this study was to analyse whether patients with occupational asthma (OA) caused by low molecular weight (LMW) agents differed from patients with OA caused by high molecular weight (HMW) with regard to risk factors, asthma presentation and severity, and response to various diagnostic tests. Methods Seventy-eight patients with OA diagnosed by positive specific inhalation challenge (SIC) were included. Anthropometric characteristics, atopic status, occupation, latency periods, asthma severity according to the Global Initiative for Asthma (GINA) control classification, lung function tests and SIC results were analysed. Results OA was induced by an HMW agent in 23 patients (29%) and by an LMW agent in 55 (71%). A logistic regression analysis confirmed that patients with OA caused by LMW agents had a significantly higher risk of severity according to the GINA classification after adjusting for potential confounders (OR = 3.579, 95% CI 1.136–11.280; p = 0.029). During the SIC, most patients with OA caused by HMW agents presented an early reaction (82%), while in patients with OA caused by LMW agents the response was mainly late (73%) (p = 0.0001). Similarly, patients with OA caused by LMW agents experienced a greater degree of bronchial hyperresponsiveness, measured as the difference in the methacholine dose-response ratio (DRR) before and after SIC (1.77, range 0–16), compared with patients with OA caused by HMW agents (0.87, range 0–72), (p = 0.024). Conclusions OA caused by LMW agents may be more severe than that caused by HMW agents. The severity of the condition may be determined by the different mechanisms of action of these agents.
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Affiliation(s)
- Olga Meca
- Servicio de Neumología, Hospital General Universitario Morales Messeguer, Murcia, Spain
| | - María-Jesús Cruz
- Servicio de Neumología, Hospital Universitario Vall d’Hebron, Barcelona, Catalonia, Spain
- Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
- * E-mail:
| | - Mónica Sánchez-Ortiz
- Servicio de Neumología, Hospital Universitario Vall d’Hebron, Barcelona, Catalonia, Spain
- Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | | | - Iñigo Ojanguren
- Servicio de Neumología, Hospital Universitario Vall d’Hebron, Barcelona, Catalonia, Spain
- Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Xavier Munoz
- Servicio de Neumología, Hospital Universitario Vall d’Hebron, Barcelona, Catalonia, Spain
- Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
- Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Catalonia, Spain
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Abstract
PURPOSE OF REVIEW This review summarizes recent advances concerning respiratory impairment and disability. RECENT FINDINGS The traditional impairment assessment approach, depending heavily on clinical pulmonary function testing to estimate the match between the patient's sustainable oxygen consumption and the workplace requirements, continues to be widely used. Recent work indicates the need to reassess underlying concepts for several reasons: The relationship between basic pulmonary function tests and sustainable oxygen consumption varies among patients and conditions. Studies of the respiratory demands of modern workplaces need to be updated. The concepts are less easily applied to asthma than other disorders. Research studies present differing definitions of 'disability', and therefore the methods of relating impairment (function loss) and disability require reassessment. Recent advances provide improved understanding of the large societal and personal impacts of respiratory impairment and disability. SUMMARY Clinicians, policymakers, and researchers should carefully consider how well the current highly specified impairment rating systems can be improved for accuracy and relevance to current home and work activities. In addition to measuring 'impairment', clinicians should consider factors affecting how impairments lead to disability.
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Merget R, Sander I, van Kampen V, Raulf-Heimsoth M, Hagemeyer O, Marek E, Brüning T. Serial measurements of exhaled nitric oxide at work and at home: a new tool for the diagnosis of occupational asthma. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 834:49-52. [PMID: 25252906 DOI: 10.1007/5584_2014_67] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Whereas serial measurements of lung function at work and at home are a well-known diagnostic tool for the diagnosis of occupational asthma (OA), little is known about the serial measurements of non-invasive parameters such as exhaled nitric oxide (eNO). A 51-year-old baker with variable shortness of breath without relation to work was examined for suspected OA. Skin prick test showed weak sensitizations to wheat and rye flour (without sensitizations to environmental allergens) that were corroborated by in vitro testing (CAP class 3). Baseline FEV1 of 58% predicted and a decrease of forced expiratory volume in 1 s (FEV1) after placebo (sugar powder) of 17% did not allow inhalational challenge testing. The patient performed daily measurements of FEV1 and eNO for about a month during a holiday at home and at work. Whereas symptoms and FEV1 did not show differences between holidays and work periods, eNO showed a clear increase from below 10 ppb to a maximum of 75 ppb. A diagnosis of baker's asthma was made, and the patient quit his job immediately after medical advice. A year afterwards, the patient was still taking asthma medication, but his symptoms had improved, FEV1 had increased to 73% predicted, and eNO was 25 ppb. We conclude that serial measurements of eNO at home and at work may be a useful tool for the diagnosis of OA.
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Affiliation(s)
- Rolf Merget
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), 1 Bürkle-de-la-Camp-Platz St., D-44789, Bochum, Germany,
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Froidure A, Vandenplas O, D'Alpaos V, Evrard G, Pilette C. Persistence of asthma following allergen avoidance is associated with proTh2 myeloid dendritic cell activation. Thorax 2015; 70:967-73. [PMID: 26103997 DOI: 10.1136/thoraxjnl-2014-206364] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 06/05/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND The natural history of asthma includes in some patients periods of disease remission, but the underlying mechanisms are unknown. OBJECTIVES We explored whether type 1 myeloid dendritic cell (mDC) dysfunction could be involved in the persistence of asthma, studying the controlled setting of occupational asthma after allergen avoidance. METHODS We recruited 32 patients with occupational asthma to flour or latex ascertained by specific inhalation challenge and who were no longer exposed to the causal allergen. Leukapheresis was performed in each patient to isolate and characterise blood type 1 mDCs, and their functionality was studied in coculture with allogeneic CD4(+) T cells from controls. RESULTS At follow-up, 11/32 patients (34%) were characterised by the absence of symptoms and non-specific bronchial hyper-responsiveness to histamine and were considered to be cured. When compared with cured patients, mDCs from patients with persistent disease increased the production of interleukin (IL) 5 and IL-13 by CD4(+) T cells, and upregulated programmed death ligand 2 (PD-L2) upon allergen pulsing. In addition, IL-5 and IL-13 responses could be reversed by exogenous IL-12, as well as by PD-L2 blockade. CONCLUSIONS This study indicates that pro-Th2 features of mDCs correlate with disease activity in asthma after cessation of exposure to the causal allergen. The findings also highlight that the Th2 programming by dendritic cells is flexible and partly mediated by PD-L2.
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Affiliation(s)
- Antoine Froidure
- Institut de Recherche Expérimentale et Clinique, Pôle de Pneumologie, Université catholique de Louvain, Brussels, Belgium Walloon Institute for Excellence in Lifesciences and Biotechnology (WELBIO), Brussels, Belgium Department of Chest Medicine, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Olivier Vandenplas
- Institut de Recherche Expérimentale et Clinique, Pôle de Pneumologie, Université catholique de Louvain, Brussels, Belgium Walloon Institute for Excellence in Lifesciences and Biotechnology (WELBIO), Brussels, Belgium Department of Chest Medicine, Centre Hospitalier Universitaire de Mont-Godinne, Université catholique de Louvain, Yvoir, Belgium
| | - Vinciane D'Alpaos
- Department of Chest Medicine, Centre Hospitalier Universitaire de Mont-Godinne, Université catholique de Louvain, Yvoir, Belgium
| | - Geneviève Evrard
- Department of Chest Medicine, Centre Hospitalier Universitaire de Mont-Godinne, Université catholique de Louvain, Yvoir, Belgium
| | - Charles Pilette
- Institut de Recherche Expérimentale et Clinique, Pôle de Pneumologie, Université catholique de Louvain, Brussels, Belgium Walloon Institute for Excellence in Lifesciences and Biotechnology (WELBIO), Brussels, Belgium Department of Chest Medicine, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
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Talini D, Novelli F, Bacci E, Bartoli M, Cianchetti S, Costa F, Dente FL, Di Franco A, Latorre M, Malagrinò L, Vagaggini B, Celi A, Paggiaro P. Sputum eosinophilia is a determinant of FEV1 decline in occupational asthma: results of an observational study. BMJ Open 2015; 5:e005748. [PMID: 25564139 PMCID: PMC4289723 DOI: 10.1136/bmjopen-2014-005748] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To evaluate the potential determinants of forced expiratory volume in 1 s (FEV1) decline in workers with occupational asthma (OA) still exposed to the causative agent. We hypothesised that sputum eosinophilia might be a predictor of poor asthma outcome after diagnosis. SETTING, DESIGN AND PARTICIPANTS In a specialistic clinical centre of the University Hospital of Pisa, we studied 39 participants (28 M, 11 F) diagnosed as having OA, routinely followed up between 1990 and 2009. They were a subgroup of 94 participants diagnosed as affected by OA in that period: 9 had been removed from work at the diagnosis, 21 were excluded for having ceased occupational exposure after few months from diagnosis, and 25 were lost at the follow-up or had no acceptable sputum measurements at the diagnosis. Estimates of the decline in FEV1 were obtained by means of simple regression analysis during the period of occupational exposure after diagnosis. Logistic regression was used to analyse the effects of factors (baseline FEV1 and sputum inflammatory cells, duration and type of exposure) that may potentially influence FEV1 decline. RESULTS At follow-up (5.7+3.7 years), most participants were still symptomatic despite inhaled corticosteroids (ICS) treatment and had their occupational exposure reduced. Participants with higher sputum eosinophils (>3%) at baseline had a significantly greater decline of FEV1 (-52.5 vs -18.6 mL/year, p=0.012). Logistic regression showed that persistent exposure and sputum eosinophilia were significantly associated with a greater decline in FEV1 (OR 11.5, 95% CI 1.8 to 71.4, p=0.009 and OR 6.7, 95% CI 1.1 to 41.7, p= 0.042, respectively). CONCLUSIONS Sputum eosinophilia at diagnosis, together with the persistence of occupational exposure during follow-up, may contribute to a greater decline in FEV1 in patients with OA still at work. Further long-term studies are required as to whether intensive ICS treatment may be beneficial for patients with OA and increase ad eosinophilic inflammation.
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Affiliation(s)
| | - Federica Novelli
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Elena Bacci
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Marialaura Bartoli
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Silvana Cianchetti
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Francesco Costa
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Federico L Dente
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Antonella Di Franco
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Manuela Latorre
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Laura Malagrinò
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Barbara Vagaggini
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Alessandro Celi
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
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Lemière C, To T, de Olim C, Ribeiro M, Liss G, Lougheed MD, Hoy R, Forget A, Blais L, Zhu J, Tarlo SM. Outcome of work-related asthma exacerbations in Quebec and Ontario. Eur Respir J 2014; 45:266-8. [PMID: 25359335 DOI: 10.1183/09031936.00096114] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Catherine Lemière
- Hôpital du Sacré Coeur de Montréal, Université de Montreal, Montreal, QC, Canada
| | - Teresa To
- The Hospital for Sick Children, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Carlo de Olim
- Hôpital du Sacré Coeur de Montréal, Université de Montreal, Montreal, QC, Canada
| | - Marcos Ribeiro
- University Health Network, University of Toronto Dept of Medicine and Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Gary Liss
- University Health Network, University of Toronto Dept of Medicine and Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Ryan Hoy
- Dept of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Amélie Forget
- Hôpital du Sacré Coeur de Montréal, Université de Montreal, Montreal, QC, Canada
| | - Lucie Blais
- Hôpital du Sacré Coeur de Montréal, Université de Montreal, Montreal, QC, Canada
| | - Jingqin Zhu
- The Hospital for Sick Children, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Susan M Tarlo
- University Health Network, University of Toronto Dept of Medicine and Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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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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Munoz X, Viladrich M, Manso L, del Pozo V, Quirce S, Cruz MJ, Carmona F, Sánchez-Pla A, Sastre J. Evolution of occupational asthma: does cessation of exposure really improve prognosis? Respir Med 2014; 108:1363-70. [PMID: 25160572 DOI: 10.1016/j.rmed.2014.08.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 07/28/2014] [Accepted: 08/01/2014] [Indexed: 01/02/2023]
Abstract
AIM To assess the evolution of occupational asthma (OA) depending on whether the patient avoids or continues with exposure to the offending agent. METHODS Study in patients diagnosed with OA using a specific inhalation challenge. Patients underwent the following examinations on the same day: clinical interview, physical examination, forced spirometry, methacholine test and determination of total IgE. Clinical improvement, deterioration or no change were defined according to the changes seen on the GINA severity scale at the time of diagnosis. RESULTS Of the 73 patients finally included, 55 had totally ended exposure and 18 continued to be exposed at work. Clinical improvement was observed in 47% of those who had terminated exposure and in 22% of those who remained exposed; clinical deterioration was observed in 14% and 17% respectively (p = 0.805). Logistical regression analysis, including the type of agent and the persistence or avoidance of exposure among the variables, did not show any predictive factors of clinical evolution. Similarly, the changes in FEV1 and in bronchial hyperresponsiveness were not associated with the avoidance or continuation of exposure to the causative agent. CONCLUSIONS Avoiding exposure to the causative agent in patients with OA does not seem to improve prognosis in this disease. Despite these findings, there is insufficient evidence to recommend a change in current management guidelines.
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Affiliation(s)
- X Munoz
- Servicio de Neumología, Hospital Vall d'Hebron, Barcelona, Spain; Ciber Enfermedades Respiratorias (CibeRes), Spain.
| | - M Viladrich
- Servicio de Neumología, Hospital Vall d'Hebron, Barcelona, Spain
| | - L Manso
- Ciber Enfermedades Respiratorias (CibeRes), Spain; Servicio de Alergia, Fundación Jiménez Díaz, Madrid, Spain
| | - V del Pozo
- Ciber Enfermedades Respiratorias (CibeRes), Spain; Servicio de Inmunología, IIS Fundación Jiménez Díaz, Madrid, Spain
| | - S Quirce
- Ciber Enfermedades Respiratorias (CibeRes), Spain; Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - M J Cruz
- Servicio de Neumología, Hospital Vall d'Hebron, Barcelona, Spain; Ciber Enfermedades Respiratorias (CibeRes), Spain
| | - F Carmona
- Departamento de Estadística, Universidad de Barcelona, Spain
| | - A Sánchez-Pla
- Departamento de Estadística, Universidad de Barcelona, Spain
| | - J Sastre
- Ciber Enfermedades Respiratorias (CibeRes), Spain; Servicio de Alergia, Fundación Jiménez Díaz, Madrid, Spain
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Martínez-González I, Cruz MJ, Moreno R, Morell F, Muñoz X, Aran JM. Human mesenchymal stem cells resolve airway inflammation, hyperreactivity, and histopathology in a mouse model of occupational asthma. Stem Cells Dev 2014; 23:2352-63. [PMID: 24798370 DOI: 10.1089/scd.2013.0616] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Occupational asthma (OA) is characterized by allergic airway inflammation and hyperresponsiveness, leading to progressive airway remodeling and a concomitant decline in lung function. The management of OA remains suboptimal in clinical practice. Thus, establishing effective therapies might overcome the natural history of the disease. We evaluated the ability of human adipose-tissue-derived mesenchymal stem cells (hASCs), either unmodified or engineered to secrete the IL-33 decoy receptor sST2, to attenuate the inflammatory and respiratory symptoms in a previously validated mouse model of OA to ammonium persulfate (AP). Twenty-four hours after a dermal AP sensitization and intranasal challenge regimen, the animals received intravenously 1 × 10(6) cells (either hASCs or hASCs overexpressing sST2) or saline and were analyzed at 1, 3, and 6 days after treatment. The infused hASCs induced an anti-inflammatory and restorative program upon reaching the AP-injured, asthmatic lungs, leading to early reduction of neutrophilic inflammation and total IgE production, preserved alveolar architecture with nearly absent lymphoplasmacytic infiltrates, negligible smooth muscle hyperplasia/hypertrophy in the peribronchiolar areas, and baseline airway hyperreactivity (AHR) to methacholine. Local sST2 overexpression barely increased the substantial efficacy displayed by unmodified hASCs. Thus, hASCs may represent a viable multiaction therapeutic capable to adequately respond to the AP-injured lung environment by resolving inflammation, tissue remodeling, and bronchial hyperresponsiveness typical of OA.
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Rüegger M, Droste D, Hofmann M, Jost M, Miedinger D. Diisocyanate-induced asthma in Switzerland: long-term course and patients' self-assessment after a 12-year follow-up. J Occup Med Toxicol 2014; 9:21. [PMID: 24949081 PMCID: PMC4063686 DOI: 10.1186/1745-6673-9-21] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 05/08/2014] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Isocyanates are among the most common causes of occupational asthma (OA) in Switzerland. Patients with OA have been shown to have unfavourable medical, socioeconomic and psychological outcomes. We investigated long-term asthma and the socio-economic outcomes of diisocyanate-induced asthma (DIA) in Switzerland. PATIENTS AND METHODS We conducted an observational study on 49 patients with DIA and followed 35 of these patients over a mean exposure-free interval of 12 ± 0.5 (range 11.0-13.0) years. At the initial and follow-up examinations, we recorded data on respiratory symptoms and asthma medication; measured the lung function; and tested for bronchial hyperreactivity. We allowed the patients to assess their state of health and overall satisfaction using a visual analogue scale (VAS) at these visits. RESULTS The 35 patients whom we could follow had a median symptomatic exposure time of 12 months, interquartile range (IQR) 26 months and a median overall exposure time of 51 (IQR 104) months. Their subjective symptoms (p < 0.001) and the use of asthma medication (p = 0.002), particularly the use of inhaled corticosteroids (p < 0.001), decreased by nearly 50%. At the same time, the self-assessment of the patients' state of health and overall satisfaction increased considerably according to both symptomatology and income. In contrast, slight reductions in terms of FVC% predicted from 102% to 96% (p = 0.04), of FEV1% predicted from 91% to 87% (p = 0.06) and of the FEV1/FVC ratio of 3%; (p = 0.01) were observed while NSBHR positivity did not change significantly. In univariate as well as multivariate logistic analyses we showed significant associations between age, duration of exposure and FEV1/FVC ratio with persistent asthma symptoms and NSBHR. CONCLUSIONS We found that the patients' symptoms, the extent of their therapy and the decrease in their lung volumes during the follow-up period were similar to the findings in the literature. The same hold true for some prognostic factors, whereas the patients' self-assessment of their state of health and overall satisfaction improved considerably.
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Affiliation(s)
- Martin Rüegger
- Department of Occupational Medicine, Swiss National Insurance Fund Suva, Fluhmattstr. 1, CH 6002 Lucerne, Switzerland
| | - Doreen Droste
- Department of Occupational Medicine, Swiss National Insurance Fund Suva, Fluhmattstr. 1, CH 6002 Lucerne, Switzerland
| | - Markus Hofmann
- Department of Occupational Medicine, Swiss National Insurance Fund Suva, Fluhmattstr. 1, CH 6002 Lucerne, Switzerland
| | - Marcel Jost
- Department of Occupational Medicine, Swiss National Insurance Fund Suva, Fluhmattstr. 1, CH 6002 Lucerne, Switzerland
| | - David Miedinger
- Department of Occupational Medicine, Swiss National Insurance Fund Suva, Fluhmattstr. 1, CH 6002 Lucerne, Switzerland
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Moscato G, Pala G, Cullinan P, Folletti I, Gerth van Wijk R, Pignatti P, Quirce S, Sastre J, Toskala E, Vandenplas O, Walusiak-Skorupa J, Malo JL. EAACI Position Paper on assessment of cough in the workplace. Allergy 2014; 69:292-304. [PMID: 24428394 DOI: 10.1111/all.12352] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2013] [Indexed: 12/13/2022]
Abstract
Cough is a nonspecific and relatively common symptom that can present difficulties in diagnosis and management, particularly when it is reported to be associated with the workplace. The present consensus document, prepared by a taskforce of the Interest Group on Occupational Allergy of the European Academy of Allergy and Clinical Immunology by means of a nonsystematic review of the current literature, is intended to provide a definition and classification of work-related chronic cough (WRCC) to assist the daily practice of physicians facing with this symptom. The review demonstrates that several upper and lower airway work-related diseases may present with chronic cough; hence, the possible link with the workplace should always be considered. Due to the broad spectrum of underlying diseases, a multidisciplinary approach is necessary to achieve a definite diagnosis. Nevertheless, more epidemiological studies are necessary to estimate the real prevalence and risk factors for WRCC, the role of exposure to environmental and occupational sensitizers and irritants in its pathogenesis and the interaction with both upper and lower airways. Finally, the best management option should be evaluated in order to achieve the best outcome without adverse social and financial consequences for the worker.
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Affiliation(s)
- G. Moscato
- Allergology and Immunology Unit; Fondazione ‘Salvatore Maugeri’; Institute of Care and Research; Scientific Institute of Pavia; Pavia Italy
| | - G. Pala
- Allergology and Immunology Unit; Fondazione ‘Salvatore Maugeri’; Institute of Care and Research; Scientific Institute of Pavia; Pavia Italy
| | - P. Cullinan
- Department of Occupational and Environmental Medicine; Imperial College; London UK
| | - I. Folletti
- Department of Clinical and Experimental Medicine; Occupational Allergy Unit; Terni Hospital; University of Perugia; Terni Italy
| | - R. Gerth van Wijk
- Section of Allergology; Department of Internal Medicine; Erasmus MC; Rotterdam the Netherlands
| | - P. Pignatti
- Allergology and Immunology Unit; Fondazione ‘Salvatore Maugeri’; Institute of Care and Research; Scientific Institute of Pavia; Pavia Italy
| | - S. Quirce
- Department of Allergy; Hospital La Paz Institute for Health Research (IdiPAZ), and CIBER de Enfermedades Respiratorias CIBERES; Madrid Spain
| | - J. Sastre
- Department of Allergy; Fundación Jiménez Díaz, and CIBER de Enfermedades Respiratorias CIBERES; Madrid Spain
| | - E. Toskala
- Department of Otolaryngology, Head and Neck Surgery; School of Medicine; Temple University; Philadelphia PA USA
| | - O. Vandenplas
- Department of Chest Medicine; Centre Hospitalier Universitaire de Mont-Godinne; Université Catholique de Louvain; Yvoir Belgium
| | - J. Walusiak-Skorupa
- Department of Occupational Diseases; Nofer Institute of Occupational Medicine; Lodz Poland
| | - J. L. Malo
- Department of Chest Medicine; Hôpital du Sacré-Coeur de Montréal; Université de Montréal; Montreal Canada
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Tarlo SM. When should specific occupational challenge tests be performed? Chest 2013; 143:1196-1198. [PMID: 23648899 DOI: 10.1378/chest.12-2776] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Susan M Tarlo
- Department of Medicine and Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
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Management of sensitizer-induced occupational asthma: avoidance or reduction of exposure? Curr Opin Allergy Clin Immunol 2013; 13:132-7. [PMID: 23407122 DOI: 10.1097/aci.0b013e32835ea249] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To address the following question: in the management of occupational asthma does current evidence support complete avoidance of further exposure to the causative agent, or is reduction in exposure sufficient to control asthma and less likely to result in loss of income or job loss? RECENT FINDINGS A recently published Cochrane review of workplace interventions in the management of occupational asthma compared complete removal from exposure to the causative agent with reduction of exposure and continued exposure. Results suggested that complete removal from exposure resulted in the best outcome in terms of symptoms, lung function, and airway hyper-responsiveness. Reduction of exposure appeared to be less effective in terms of improving asthma but was also less likely to result in loss of income or unemployment. A second systematic review reported similar results. SUMMARY There is no single solution to the question about ongoing workplace exposure for an individual with occupational asthma. There are good reasons for removing an individual from exposure in terms of clinical improvement, but this may have consequences in terms of income and employment. It is necessary to consider all these aspects when advising patients if their health is to be maximized.
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Current world literature. Curr Opin Allergy Clin Immunol 2013; 13:217-21. [PMID: 23434741 DOI: 10.1097/aci.0b013e32835f8a7a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Prospective Outcome Assessment of Occupational Rhinitis After Removal From Exposure. J Occup Environ Med 2013; 55:579-85. [DOI: 10.1097/jom.0b013e318289ee17] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Jares EJ, Baena-Cagnani CE, Gómez RM. Diagnosis of occupational asthma: an update. Curr Allergy Asthma Rep 2013; 12:221-31. [PMID: 22467203 DOI: 10.1007/s11882-012-0259-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Work-related asthma (WRA) includes patients with sensitizer- and/or irritant-induced asthma in the workplace, as well as patients with preexisting asthma that is worsened by work factors. WRA is underdiagnosed; thus, the diagnosis is critical to prevent disease progression and its potential for morbidity and mortality. The interview is the first diagnostic tool to be used by physicians, and the question, "Does asthma improve away from work?" is of the highest sensitivity. However, history can show numerous false positives, and the relationships between asthma worsening and work should be confirmed by objective methods such as peak expiratory flow (PEF) at and away from work. PEF sensitivity and specificity can be enhanced in combination with nonspecific bronchial hyperresponsiveness to histamine/methacholine (NSBP) before and after 2 weeks at work and a similar period off work. Immunologic testing, especially skin prick test (SPT) or specific IgE, is useful for high molecular weight allergens and some low molecular weight agents. Other immunologic tests, as well as induced sputum, measurement of exhaled nitric oxide, exhaled breath condensate, and specific inhalation challenge (SIC) are methods that contribute to the diagnosis and are typically performed at specialized facilities. A diagnosis of occupational asthma (OA) should no longer be based on a compatible history only but should be confirmed by means of objective testing. SIC is the diagnostic gold standard. When SIC is not available, the combination of PEF measurement, NSBP test , a specific SPT, or specific IgE may be an appropriate alternative in diagnosing OA.
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Affiliation(s)
- Edgardo J Jares
- Immunology and Allergy Unit, Hospital Nacional Alejandro Posadas, Pcia de Buenos Aires, Argentina.
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Kim MH, Jung JW, Kang HR. The usefulness of job relocation and serum eosinophil cationic protein in baker's asthma. Int Arch Allergy Immunol 2013; 161:252-7. [PMID: 23548438 DOI: 10.1159/000346541] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 12/12/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Although the most widely recommended treatment for occupational asthma is to completely avoid the causative agents, job relocation within the same company is often substituted for a complete career change. However, there is not much data on the efficacy of job relocation within the workplace and appropriate follow-up parameters. We investigated baker's asthma patients to validate the efficacy of job relocation and follow-up markers. METHODS Twelve bakery plant workers diagnosed with baker's asthma were enrolled in the study. Asthma-related symptoms and methacholine provocation test were followed up 6 months after a job relocation. Skin prick test and ELISA to detect wheat flour-specific IgE and eosinophil cationic protein (ECP) in sputum and serum were also followed up to evaluate the status of allergic inflammation. RESULTS After a 6-month job relocation, all 12 workers showed an improvement in symptoms, and airway hyperresponsiveness to methacholine was negatively converted in 9 of them. There were no significant differences in skin reactivity and serum flour-specific IgE levels before and after the relocation. While sputum ECP levels did not show a significant difference (338.3 ± 93.0 μg/l vs. 175.0 ± 78.9 μg/l, p = 0.118), there was a remarkable difference in serum ECP levels before and after the relocation (12.2 ± 3.0 μg/l vs. 2.8 ± 3.1 μg/l, p = 0.004). CONCLUSIONS Job relocation was effective in managing baker's asthma. Serum ECP level was a useful follow-up marker of baker's asthma.
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Affiliation(s)
- Min-Hye Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Abstract
PURPOSE To examine the long-term effects on work ability among patients previously diagnosed with occupational asthma (OA) or work-exacerbated asthma (WEA) or symptoms in relation to workplace dampness. METHODS A questionnaire follow-up was used to study 1,098 patients (of whom 87 % were female) examined because of a suspected occupational respiratory disease caused by building dampness and mold. Self-rated work ability and early withdrawal from work were the two outcomes of the study. As determinants, we investigated the influence of the asthma diagnosis given in the initial examinations (OA or WEA), the number of persistent indoor air symptoms, and the psychosocial factors at work. RESULTS With a mean follow-up of 7.8 years, 40 % of the OA patients, under 65 years of age, were outside worklife versus 23 % of the WEA patients and 15 % of the patients with only upper respiratory symptoms at baseline. The diagnosis of OA was associated with a nearly sixfold risk for early withdrawal from work in a comparison with a reference group with upper respiratory symptoms. A perceived poor social climate at work and poor experiences with supervisory co-operation were associated with impaired work ability outcomes. Those with multiple, long-term indoor air symptoms considerably more often perceived their work ability to be poor when compared with those with less significant symptoms. CONCLUSIONS Adverse work ability outcomes are associated with asthma in relation to workplace dampness. The study raises the need for effective preventive measures in order to help workers with indoor air symptoms sustain their work ability.
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Papadopoulos NG, Agache I, Bavbek S, Bilo BM, Braido F, Cardona V, Custovic A, Demonchy J, Demoly P, Eigenmann P, Gayraud J, Grattan C, Heffler E, Hellings PW, Jutel M, Knol E, Lötvall J, Muraro A, Poulsen LK, Roberts G, Schmid-Grendelmeier P, Skevaki C, Triggiani M, Vanree R, Werfel T, Flood B, Palkonen S, Savli R, Allegri P, Annesi-Maesano I, Annunziato F, Antolin-Amerigo D, Apfelbacher C, Blanca M, Bogacka E, Bonadonna P, Bonini M, Boyman O, Brockow K, Burney P, Buters J, Butiene I, Calderon M, Cardell LO, Caubet JC, Celenk S, Cichocka-Jarosz E, Cingi C, Couto M, Dejong N, Del Giacco S, Douladiris N, Fassio F, Fauquert JL, Fernandez J, Rivas MF, Ferrer M, Flohr C, Gardner J, Genuneit J, Gevaert P, Groblewska A, Hamelmann E, Hoffmann HJ, Hoffmann-Sommergruber K, Hovhannisyan L, Hox V, Jahnsen FL, Kalayci O, Kalpaklioglu AF, Kleine-Tebbe J, Konstantinou G, Kurowski M, Lau S, Lauener R, Lauerma A, Logan K, Magnan A, Makowska J, Makrinioti H, Mangina P, Manole F, Mari A, Mazon A, Mills C, Mingomataj E, Niggemann B, Nilsson G, Ollert M, O'Mahony L, O'Neil S, Pala G, Papi A, Passalacqua G, Perkin M, Pfaar O, Pitsios C, Quirce S, Raap U, Raulf-Heimsoth M, Rhyner C, Robson-Ansley P, Alves RR, Roje Z, Rondon C, Rudzeviciene O, Ruëff F, Rukhadze M, Rumi G, Sackesen C, Santos AF, Santucci A, Scharf C, Schmidt-Weber C, Schnyder B, Schwarze J, Senna G, Sergejeva S, Seys S, Siracusa A, Skypala I, Sokolowska M, Spertini F, Spiewak R, Sprikkelman A, Sturm G, Swoboda I, Terreehorst I, Toskala E, Traidl-Hoffmann C, Venter C, Vlieg-Boerstra B, Whitacker P, Worm M, Xepapadaki P, Akdis CA. Research needs in allergy: an EAACI position paper, in collaboration with EFA. Clin Transl Allergy 2012; 2:21. [PMID: 23121771 PMCID: PMC3539924 DOI: 10.1186/2045-7022-2-21] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 10/23/2012] [Indexed: 12/16/2022] Open
Abstract
In less than half a century, allergy, originally perceived as a rare disease, has become a major public health threat, today affecting the lives of more than 60 million people in Europe, and probably close to one billion worldwide, thereby heavily impacting the budgets of public health systems. More disturbingly, its prevalence and impact are on the rise, a development that has been associated with environmental and lifestyle changes accompanying the continuous process of urbanization and globalization. Therefore, there is an urgent need to prioritize and concert research efforts in the field of allergy, in order to achieve sustainable results on prevention, diagnosis and treatment of this most prevalent chronic disease of the 21st century.The European Academy of Allergy and Clinical Immunology (EAACI) is the leading professional organization in the field of allergy, promoting excellence in clinical care, education, training and basic and translational research, all with the ultimate goal of improving the health of allergic patients. The European Federation of Allergy and Airways Diseases Patients' Associations (EFA) is a non-profit network of allergy, asthma and Chronic Obstructive Pulmonary Disorder (COPD) patients' organizations. In support of their missions, the present EAACI Position Paper, in collaboration with EFA, highlights the most important research needs in the field of allergy to serve as key recommendations for future research funding at the national and European levels.Although allergies may involve almost every organ of the body and an array of diverse external factors act as triggers, there are several common themes that need to be prioritized in research efforts. As in many other chronic diseases, effective prevention, curative treatment and accurate, rapid diagnosis represent major unmet needs. Detailed phenotyping/endotyping stands out as widely required in order to arrange or re-categorize clinical syndromes into more coherent, uniform and treatment-responsive groups. Research efforts to unveil the basic pathophysiologic pathways and mechanisms, thus leading to the comprehension and resolution of the pathophysiologic complexity of allergies will allow for the design of novel patient-oriented diagnostic and treatment protocols. Several allergic diseases require well-controlled epidemiological description and surveillance, using disease registries, pharmacoeconomic evaluation, as well as large biobanks. Additionally, there is a need for extensive studies to bring promising new biotechnological innovations, such as biological agents, vaccines of modified allergen molecules and engineered components for allergy diagnosis, closer to clinical practice. Finally, particular attention should be paid to the difficult-to-manage, precarious and costly severe disease forms and/or exacerbations. Nonetheless, currently arising treatments, mainly in the fields of immunotherapy and biologicals, hold great promise for targeted and causal management of allergic conditions. Active involvement of all stakeholders, including Patient Organizations and policy makers are necessary to achieve the aims emphasized herein.
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Ochmann U, Nowak D. Berufsbedingte Allergien der Atemwege. ALLERGO JOURNAL 2012. [DOI: 10.1007/s15007-012-0354-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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The current diagnostic role of the specific occupational laboratory challenge test. Curr Opin Allergy Clin Immunol 2012; 12:119-25. [PMID: 22391752 DOI: 10.1097/aci.0b013e328351137c] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Classically, the specific occupational challenge test has been considered as the reference test in the diagnosis of occupational asthma. The present study assesses the usefulness of this test for diagnosing this disease and compares it with other diagnostic methods. RECENT FINDINGS Occupational asthma is the most frequent work-related respiratory disease in developed countries. Its correct diagnosis is vitally important not only from the medical point of view, but also in view of the disease's major socio-economic repercussions both for the patient and for society as a whole. Diagnosis is based on clinical suspicion of bronchial asthma and of a possible association with the patient's occupation. Various diagnostic strategies have been proposed, including clinical history, immunological test, spirometry, the study of peak flow, the methacholine test and the specific occupational challenge test, as well as studies of bronchial inflammation using noninvasive methods. SUMMARY The specific occupational challenge test remains the reference test for the diagnosis of occupational asthma for causal agents of both high and low molecular weight.
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Is specific IgE antibody analysis feasible for the diagnosis of methylenediphenyl diisocyanate-induced occupational asthma? Int Arch Occup Environ Health 2012; 86:417-30. [PMID: 22544379 PMCID: PMC3633778 DOI: 10.1007/s00420-012-0772-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 04/02/2012] [Indexed: 11/20/2022]
Abstract
Purpose Early recognition improves the prognosis of isocyanate asthma. A major unanswered question is whether IgE-dependent mechanisms are of diagnostic value? Our objective was to appraise serological methods using various methylenediphenyl diisocyanate (MDI)-albumin conjugates and weigh up the data versus the outcome of standardized comprehensive clinical diagnostics to evaluate the viability of immunological analysis in supportive MDI-asthma diagnosis (OAI). Methods Specific IgE (sIgE) and IgG (sIgG) binding was measured with fluorescence enzyme immunoassay in 43 study subjects (using conjugates prepared in-vapor, in-solution and commercial preparations). The differential clinical diagnosis included standardized measurement of pulmonary function, non-specific bronchial hyper-responsiveness, specific MDI-prick test (MDI-SPT) and specific inhalation challenge (MDI-SIC). Results Detailed diagnostic scheme allows the differential OAI and MDI-induced hypersensitivity pneumonitis (PI). The presumed OAI diagnoses were confirmed in 84 % (45 % cases having demonstrable sIgE antibodies) with RR 5.7, P > 0.001, when OAI diagnosis is correlated with MDI-SIC/MDI-SPT (RR 1.28 for MDI-SIC alone); sIgG antibodies were clinically relevant for PI and not for the OA diagnosis. MDI-specific IgE data generated with commercial ImmunoCAP preparations show high correlation with our in-vapor generated MDI conjugates. Conclusions Isocyanate-specific IgE antibodies are not always detectable but their presence is strongly predictive of OAI and supportive for the diagnosis. MDI-SPT can be a valuable parameter differentiating OAI and PI. We have confirmed and extended published data showing that isocyanate-albumin conjugates perform better in specific antibody assays when prepared with volatile phase formulations and would like to stress additionally the necessity for further refinements and standardization in clinical diagnostics procedures. Electronic supplementary material The online version of this article (doi:10.1007/s00420-012-0772-6) contains supplementary material, which is available to authorized users.
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