The prevalence of IgE sensitization to formaldehyde in asthmatic children

Prick testing with chemicals in the diagnosis of occupational contact urticaria and respiratory diseases

BACKGROUND

Little is known about the use of prick tests with chemicals in diagnosing occupational diseases.

OBJECTIVE

To evaluate the use of prick tests in the diagnosis of occupational contact urticaria, asthma and rhinitis caused by chemicals (undertaken at the Finnish Institute of Occupational Health).

MATERIAL AND METHODS

We retrospectively reviewed the patient and test files for the period 1 January 1991 to 31 May 2011. Prick tests were performed with chemical solutions and human serum albumin (HSA)-chemical conjugates.

RESULTS

Positive prick test reactions to isocyanate-HSA conjugates were associated with isocyanate-specific IgE in all 20 patients, and 17 patients had a relevant occupational disease. Positive reactions to chloramine-T-HSA conjugates in 10 patients also indicated the presence of specific IgE, although occupational diseases were not always diagnosed. Eleven of 17 patients with positive reactions to persulfate solutions were diagnosed with an occupational disease. Methacrylates, colophonium-related substances, amine hardeners, ethanolamines, glutaraldehyde, glyoxal, pyrocatechol and ammonium thioglycolate did not elicit any relevant prick test reactions. No generalized reactions were detected.

CONCLUSION

Prick tests can be safely used for diagnosing contact urticaria, asthma and rhinitis caused by isocyanates, chloramine-T, persulfates, and chlorhexidine, but the results should be carefully interpreted and related to clinical symptoms and other diagnostic tests.

Formaldehyde and tobacco smoke as alkylating agents: the formation of N-methylenvaline in pathologists and in plastic laminate workers

OBJECTIVE

Aim of this study was to investigate the relationships between the concentration of formaldehyde in air and the alkylation of hemoglobin to form a terminal N-methylenvaline residue in three occupationally exposed groups: a) technicians of pathology wards, b) workers of the plastic laminates industry, and c) a control group. All subjects recruited in this study were also tested on their smoking habits.

METHODS

Formaldehyde adsorbed on passive air samplers was quantified by HPLC with UV detection (360 nm), cotinine was quantified by GC-MS. Terminal hemoglobin N-methylenvaline was determined by treating globine under reducing conditions with pentafluorophenyl isothiocyanate to yield a derivative, subsequently detected by GC-MS. One-way analysis of variance was performed to compare among the three groups the biomarkers considered in this study.

RESULTS

For air-FA and N-methylenvaline a difference between the three groups was detected (p < 0.0001) and a significant higher concentration in the two professionally exposed groups was proved. Mean values for FA (μg/m(3)): group a) 188.6, group b) 210.1, and group c) 41.4; mean values for N-methylenvaline (nmol/g of globin): group a) 377.9, group b) 342.8, and group c) 144.8. Conversely, the comparison between the two professionally exposed groups, a) vs b), does not show any significant difference highlighting similar exposition to FA and, consequently, similar biological response. Tobacco smoke proves to have a minor impact on the formation of N-methylenvaline molecular adduct.

CONCLUSIONS

A positive correlation was demonstrated between professional exposition to air-formaldehyde and hemoglobin alkylation to form N-methylenvaline molecular adduct in two occupationally exposed groups of subjects considered in the present study. In comparison with occupational exposition, tobacco smoke proved to have a minor impact on the formation of N-methylenvaline molecular adduct.

The influence of environmental exposure to formaldehyde in nasal mucosa of medical students during cadaver dissection

BACKGROUND

Environmental exposure to formaldehyde is commonly associated with clinical symptoms such as mucosal irritation and olfactory disorders. However, the impact of such exposure on the development of mucosal inflammation and its outcome has not been carefully evaluated.

METHODS

The observational non-comparative study was planned. The study population consisted of group of 41 medical students who had signed up for a cadaver dissection course as part of their gross anatomy teaching at the school of medicine Chiba University in Japan. During such dissection course, the students are exposed to variable levels of environmental formaldehyde routinely employed for the preservation the cadavers. The subjects were evaluated by a detailed medical examination. We measured their serum IgE levels. In addition, an olfaction test and nasal mucosal sensitivity to histamine was serially determined, immediately before and after the course and 6 months after the completion of the course.

RESULTS

Olfactory abnormalities were observed in 13/41 (32%) subjects and increased nasal mucosal hypersensitivity to histamine was observed in 17/41 (41%) during and immediately after completion of the course. These subjects had evidence of preexisting allergic rhinitis. 6/41 (15%) other students with no prior evidence of allergic rhinitis also exhibited formaldehyde associated clinical symptoms during the dissecting course. However, the symptoms disappeared upon completion of the course in all subjects studied.

CONCLUSIONS

Temporary abnormalities in the olfaction test and increased nasal mucosal hypersensitivity to histamine were observed in a few students with preexisting allergic rhinitis after environmental exposure of high concentrations of formaldehyde. These effects appeared to be transient.

Non-cancer effects of formaldehyde and relevance for setting an indoor air guideline

There is considerable recent focus and concern about formaldehyde (FA). We have reviewed the literature on FA with focus on chemosensory perception in the airways and lung effects in indoor environments. Concentrations of FA, both personal and stationary, are on average in the order of 0.05 mg/m(3) or less in Europe and North America with the exception of new housing or buildings with extensive wooden surfaces, where the concentration may exceed 0.1 mg/m(3). With the eye the most sensitive organ, subjective irritation is reported at 0.3-0.5 mg/m(3), which is somewhat higher than reported odour thresholds. Objective effects in the eyes and airways occur around 0.6-1 mg/m(3). Dose-response relationships between FA and lung function effects have not been found in controlled human exposure studies below 1 mg/m(3), and epidemiological associations between FA concentrations and exacerbation of asthma in children and adults are encumbered by complex exposures. Neither experimental nor epidemiological studies point to major differences in susceptibility to FA among children, elderly, and asthmatics. People with personal trait of negative affectivity may report more symptoms. An air quality guideline of 0.1 mg/m(3) (0.08 ppm) is considered protective against both acute and chronic sensory irritation in the airways in the general population assuming a log normal distribution of nasal sensory irritation.

Formaldehyde exposure and asthma in children: a systematic review

OBJECTIVE

Despite multiple published studies regarding the association between formaldehyde exposure and childhood asthma, a consistent association has not been identified. Here we report the results of a systematic review of published literature in order to provide a more comprehensive picture of this relationship.

DATA SOURCES

After a comprehensive literature search, we identified seven peer-reviewed studies providing quantitative results regarding the association between formaldehyde exposure and asthma in children. Studies were heterogeneous with respect to the definition of asthma (e.g., self-report, physician diagnosis). Most of the studies were cross-sectional.

DATA EXTRACTION

For each study, an odds ratio (OR) and 95% confidence interval (CI) for asthma were either abstracted from published results or calculated based on the data provided. Characteristics regarding the study design and population were also abstracted.

DATA SYNTHESIS

We used fixed- and random-effects models to calculate pooled ORs and 95% CIs; measures of heterogeneity were also calculated. A fixed-effects model produced an OR of 1.03 (95% CI, 1.021.04), and random effects model produced an OR of 1.17 (95% CI, 1.011.36), both reflecting an increase of 10 microg/m3 of formaldehyde. Both the Q and I2 statistics indicated a moderate amount of heterogeneity.

CONCLUSIONS

Results indicate a significant positive association between formaldehyde exposure and childhood asthma. Given the largely cross-sectional nature of the studies underlying this meta-analysis, further well-designed prospective epidemiologic studies are needed.

[Review of sick house syndrome]

'Sick house syndrome' (SHS) is a health issue that closely resembles sick building syndrome (SBS) that had occurred in European countries. The aim of this review is to clarify the characteristics of SHS by reviewing previous reports rigorously. We propose the definition of SHS as "health impairments caused by indoor air pollution, regardless of the place, causative substance, or pathogenesis". Cases of SBS are reported to occur predominantly in offices and sometimes schools, whereas those of SHS are usually found in general dwellings. In many cases, SHS is caused by biologically and/or chemically polluted indoor air. Physical factors might affect the impairments of SHS in some cases. It is considered that symptoms of SHS develop through toxic, allergic and/or some unknown mechanisms. Psychological mechanisms might also affect the development of SHS. It is still unclear whether SBS and SHS are very close or identical clinical entities, mostly because a general agreement on a diagnostic standard for SHS has not been established. Previous research gradually clarified the etiology of SHS. Further advances in research, diagnosis, and treatment of SHS are warranted with the following measures. Firstly, a clinical diagnostic standard including both subjective and objective findings must be established. Secondly, a standard procedure for assessing indoor air contamination should be established. Lastly, as previous research indicated multiple causative factors for SHS, an interdisciplinary approach is needed to obtain the grand picture of the syndrome.