Prevalence of occupational allergy to bell pepper pollen in greenhouses in the Netherlands

BACKGROUND: An increasing number of allergic complaints appear to have occurred among bell pepper greenhouse employees. OBJECTIVE: The aim of this study was to estimate the prevalence of work-related allergic symptoms and the prevalence of sensitization to specific occupational allergens and its determinants. METHODS: We studied 472 employees who were invited to answer an extensive questionnaire and to be tested on location with inhalant allergens and home-made extracts of the bell pepper plant. In addition, peak expiratory flow monitoring and RASTs were performed. RESULTS: Work-related symptoms were reported in 53.8% of all cases. Sensitization to the bell pepper plant was found in 35.4%. Positive reactions to leaf, stem and/or juice, however, were associated in nearly 90% with sensitization to pollen, which appeared to be most important allergen of the plant. Sensitization to the bell pepper plant and inhalant atopy were considered the most important risk factors for the occurrence of work-related symptoms of the upper airways (PRR 2.63, CI 2.11-3.25 and PRR 2.25, CI 1.82-2.79) as well as of the lower airways (PRR 4.08, CI 2.38-7.00 and PRR 3.16, CI 1.87-5.33). CONCLUSION: There is a surprisingly high prevalence of work-related respiratory symptoms (53.8%) in bell pepper horticulture. In two-thirds of the employees, symptoms at work were associated with an IgE-mediated allergy due to the high and chronic exposure to bell pepper pollen. Complaints at work without specific sensitization to bell pepper pollen can be caused by non-specific hyper-reactivity or atopy to other occupational allergens. The extent of this occupational allergy has important consequences for the health care of this large, still growing occupational group.     

Immunological methods for diagnosis and monitoring of IgE‐mediated allergy caused by industrial sensitizing agents (IMExAllergy)

Industrial sensitizing agents (allergens) in living and working environments play an important role in eliciting type 1 allergic disorders including asthma and allergic rhinitis. Successful management of allergic diseases necessitates identifying their specific causes (ie, identify the causative agent(s) and the route of contact to allergen: airborne, or skin contact) to avoid further exposure. Identification of sensitization by a sensitive and validated measurement of specific IgE is an important step in the diagnosis. However, only a limited number of environmental and occupational allergens are available on the market for use in sIgE testing. Accordingly, specific in‐house testing by individual diagnostic and laboratory centers is often required. Currently, different immunological tests are in use at various diagnostic centers that often produce considerably divergent results, mostly due to lack of standardized allergen preparation and standardized procedures as well as inadequate quality control. Our review and meta‐analysis exhibited satisfactory performance of sIgE detection test for most high molecular weight (HMW) allergens with a pooled sensitivity of 0.74 and specificity of 0.71. However, for low molecular weight (LMW) allergens, pooled sensitivity is generally lower (0.28) and specificity higher (0.89) than for HMW tests. Major recommendations based on the presented data include diagnostic use of sIgE to HMW allergens. A negative sIgE result for LMW agents does not exclude sensitization. In addition, the requirements for full transparency of the content of allergen preparations with details on standardization and quality control are underlined. Development of standard operating procedures for in‐house sIgE assays, and clinical validation, centralized quality control and audits are emphasized. There is also a need for specialized laboratories to provide a custom service for the development of tests for the measurement of putative novel occupational allergens that are not commercially available.     

Gender and occupational allergy: Report from the task force of the EAACI Environmental and Occupational Allergy Interest Group

Women's work has traditionally been considered less hazardous to health in comparison with men's work. The increased women's participation in the workforce has led to an increased attention to women's working conditions. Women and men are unequally represented in individual professions or sectors (horizontal segregation), with women also under-represented in leadership positions (vertical segregation). The selection of specific occupations can result in differences between types and levels of occupational exposures among women and men and can affect prevalence of occupational allergy. Gender distribution of work-related asthma appears to vary across countries without clear global difference. Occupational rhinitis tends to be higher in women, although is not clear if this is related to a sex/gender effect or to differences in work exposure. Women are more likely to have occupational contact dermatitis, mainly due to wet work. No clear effects of gender on rates of hypersensitivity pneumonitis have been shown. Besides variation in exposures, physical and physiological characteristics, different behaviours and health consciousness have an impact on the occupational health hazards of women and men. Occupational allergy health promotion strategies need to consider approaches for women and men adjusted by gender, and legislative actions similarly could be implemented in a more gender-sensitive way .     

Prevalence of occupational allergy to Chrysanthemum pollen in greenhouses in the Netherlands

BACKGROUND: An increasing number of allergic complaints appear to have occurred among Chrysanthemum greenhouse employees. The aim of this study was to estimate the prevalence of work-related allergic symptoms and the prevalence of sensitization to pollen of different members of the Chrysanthemum family. METHODS: We studied 104 employees who were invited to answer an extensive questionnaire and to complete a rhinitis quality of life questionnaire. In addition, they were skin prick tested on location with inhalant allergens and home-made pollen extracts of seven different members of the Chrysanthemum family. Radio-allergo-sorbent tests were performed to confirm IgE-mediated reactions. RESULTS: Work-related symptoms were reported in 56.7% of all cases, with the main symptom being rhinitis. Sensitization to Chrysanthemum pollen was found in 20.2% of the employees without one member of the Chrysanthemum family in particular being most prevalent. Sensitization to Chrysanthemum pollen was considered to be an important risk factor for the occurrence of work-related symptoms of the upper airways. Furthermore, inhalant atopy as well as sensitization to common airborne pollen including mugwort were closely associated with sensitization to Chrysanthemum what might be suggestive for cross-sensitization. CONCLUSIONS: There is a high prevalence of work-related symptoms in Chrysanthemum greenhouses. In one-third of the employees these symptoms were caused by an IgE-mediated allergy caused by the pollen of the flowers. Inhalant atopy appeared to have a great impact on the development of such a sensitization. Measurements to reduce the pollen exposure are necessary to prevent a further increase of this occupational allergy.     

Sputum eosinophilia: an early marker of bronchial response to occupational agents

Background: False‐negative responses to specific inhalation challenge (SIC) with occupational agents may occur. We explored whether assessing changes in sputum cell counts would help improve the identification of bronchial reactivity to occupational agents during SICs. Methods: The predictive value of the changes in sputum cell counts after a negative FEV₁ response to a first challenge exposure to an occupational agent was determined using the changes in airway calibre observed during repeated challenges as the ‘gold standard’. The study included 68 subjects investigated for work‐related asthma in a tertiary centre. After a control day, the subjects were challenged with the suspected occupational agent(s) for up to 2 h. All subjects who did not show an asthmatic reaction were re‐challenged on the following day. Additional challenges were proposed to those who demonstrated a ≥ 2% increase in sputum eosinophils or an increase in nonspecific bronchial hyperresponsiveness to histamine after the second challenge day. Results: Six of the 35 subjects without changes in FEV₁ on the first challenge developed an asthmatic reaction on subsequent challenges. ROC analysis revealed that a >3% increase in sputum eosinophils at the end of the first challenge day was the most accurate parameter for predicting the development of an asthmatic response on subsequent challenges with a sensitivity of 67% and a specificity of 97%. Conclusions: An increase in sputum eosinophils is an early marker of specific bronchial reactivity to occupational agents, which may help to identify subjects who will develop an asthmatic reaction only after repeated exposure.     

The prognosis of occupational asthma due to detergent enzymes: clinical, immunological and employment outcomes

BACKGROUND: Little is known about the prognosis of occupational asthma induced by high molecular weight proteins. OBJECTIVE: Our objective was to measure the clinical, immunological and employment outcomes of individuals with occupational asthma induced by detergent enzymes. METHODS: We undertook a workforce-based follow-up study in 35 (78%) of the 45 ex-employees from a single factory with occupational asthma. In each case the diagnosis was supported by evidence of specific sensitization and characteristic changes in peak flow or a positive response to specific bronchial provocation testing. RESULTS: This group had left the factory on average 37 months before study. On review 25 (71%) reported chest symptoms during the last month. Compared with when working at the factory, most (86%) reported that their symptoms had improved. Twenty continued to attend their general practitioner for respiratory symptoms and 19 still used asthma medications. Since leaving the factory 16 (46%) and four (11%) had found full-time or part-time employment, respectively; of these 16 found they were paid less than when they worked at the factory. The remaining 15 subjects had not had any paid employment. All but two had positive skin prick tests to one or more three detergent enzymes. The estimated half-life of serum-specific IgE antibodies was 20 months for protease, and 21 months for cellulase and amylase. CONCLUSIONS: Population-based follow-up studies of the prognosis of occupational asthma are rare but probably avoid the bias in clinic-derived surveys. This study demonstrates that 3 years after the avoidance of exposure with detergent enzymes most patients continue to be troubled by, albeit improved, symptoms and experience difficulty in re-employment.     

Pets in the home and the development of pet allergy in adulthood. The Copenhagen Allergy Study

BACKGROUND: The aim of the study was to investigate the association between exposure to cat and dog in the home and the development (incidence) of IgE sensitization to cat and dog. METHODS: Participants in a population-based study of 15-69-year-olds in 1990 were invited to a follow-up in 1998. Serum IgE antibodies against common inhalant allergens was assessed in 734 subjects (participation rate 69.0%) on two occasions 8 years apart. Information about current or previous keeping of cats and dogs in the home was obtained in a questionnaire at baseline. RESULTS: A cat in the home currently was significantly associated with the development of IgE sentisization to cat (adjusted odds ratio 8.4, 95% confidence interval (CI) 1.7-42.7). Moreover, an atopic predisposition in terms of IgE sensitization to allergens other than cat at baseline was an independent risk factor for the development of IgE sensitization to cat. A dog in the home was not significantly associated with the development of IgE sensitization to dog. CONCLUSIONS: In this adult population, exposure to a cat in the home increased the risk of developing IgE sensitization to cat. More prospective data are needed on this issue.     

Fine-scale mapping of type I allergy candidate loci suggests central susceptibility genes on chromosomes 3q, 4q and Xp

BACKGROUND: Type I allergy globally affects an increasing number of individuals with the consequence of considerable personal morbidity and socio-economic costs. Identification of disease susceptibility genes would render enormous medical perspectives in terms of improved diagnosis, treatment and prevention. Like for other complex disorders, achievement of the knowledge necessary depends on confirmation of reported genomic candidate regions. METHODS: We performed a two-stage fine-scale linkage analysis in 11 selected candidate regions on chromosome 3p, 3q, 4p, 4q, 5q, 6p, 9p, 12q, 12qter, 18q and Xp. We analysed 97 polymorphic markers in 424 individuals from 100 sib-pair families and evaluated the data for five phenotypes: Allergic asthma, atopic dermatitis, allergic rhinitis and total and specific immunoglobulin E. RESULTS: The highest maximum likelihood scores (MLS) were obtained on chromosomes 3q (MLS = 2.69), 4p (MLS = 2.34), 4q (MLS = 2.75), 6p (MLS = 2.22), 12qter (MLS = 2.15) and Xp (MLS = 2.23). All five phenotypes showed MLS >/= 2 in one or more of the candidate regions. CONCLUSIONS: Susceptibility genes in the 3q, 4q and Xp regions may play a central role in the inheritance of allergic disease, as positive results were obtained for all five phenotypes in these three regions.     

Prevalence of food allergy and its relationship to asthma and allergic rhinitis in schoolchildren

BACKGROUND: Food allergy (FA) is an important health problem. However, epidemiological studies at the population level are scarce. We assessed the prevalence of FA and its associations with respiratory manifestations among schoolchildren. METHODS: A total of 6672 schoolchildren aged 9-11 years recruited from 108 randomly chosen schools in six French cities underwent a clinical examination including skin prick test (SPT) to common food and aeroallergens and the standardized protocol of the run test to assess exercise-induced bronchial hyper-responsiveness (EIB). Asthma, allergic rhinitis (AR) and clinical symptoms of FA were determined using a standardized questionnaire completed by parents. RESULTS: About 2.1% of the children reported symptoms of FA, 1.9% were sensitized to food allergens, and 0.1% had SP-tested FA. The AR was more prevalent than asthma (20.0% lifetime, 11.9% past year vs 9.8%, 8.7% respectively). Reported FA, food sensitization and SP-tested FA were all positively associated with asthma and AR (P < 0.001). These associations persisted also for FA not manifesting as respiratory symptoms (P < 0.001). Asthma and AR remained significantly associated with reported symptoms of FA and allergic sensitization to food allergens after adjustment for confounders as well as for sensitization to aeroallergens. No relationship existed between EIB (9.0%) and FA. CONCLUSION: The relationships between FA and asthma and AR could be totally explained neither by the existence of respiratory manifestations of FA nor by sensitization to aeroallergens. The FA might intervene differently in asthma and AR.     

Prevalence of antibodies to swine influenza viruses in humans with occupational exposure to pigs,Thuringia, Germany, 2008–2009

The Eurasian lineages of swine influenza viruses are different genetically from classical swine H1N1 influenza viruses and comprise avian‐like H1N1 and human‐like H1N2 and H3N2 subtypes. Although sporadic isolation of such viruses from human specimens has been reported, the prevalence of human infections is not known. In the present study, the seroprevalence against Eurasian swine influenza viruses was investigated. Sera were collected in Thuringia, Germany, from December 2007 to April 2009. The study group comprised 118 professionals with occupational exposure to pigs (50 pig slaughterers/meat inspectors, 46 pig farmers, 22 veterinarians caring for pig herds). The control group included 118 age‐ and gender‐matched blood donors from Thuringia. As a result, 18 sera of the study group were identified with raised hemagglutination‐inhibition titers against a panel of nine swine influenza viruses (three strains/ subtype). For 17/18 sera this finding was confirmed in the neutralization assay. For 11/18 sera the raise of titers was significant, that is, a fourfold increase of hemagglutination‐inhibition titers was observed. No gender‐specific bias of the high titer sera was observed. Twelve sera of the control group showed increased hemagglutination‐inhibition titers against swine influenza viruses. Hemagglutination‐inhibition titers of 2/12 control sera were raised fourfold but did not exhibit a significant increase of neutralization titers. All increased hemagglutination‐inhibition titers of the control group may be explained by cross‐reactivity with seasonal influenza virus strains, as all these sera also reacted with human strains. J. Med. Virol. 82:1617–1625, 2010. © 2010 Wiley‐Liss, Inc.     

Comparison of peak expiratory flows and FEV1 in assessing immediate asthmatic reactions due to occupational agents

BACKGROUND: FEV1 is more sensitive than PEF in assessing late asthmatic responses (LAR) after specific inhalation challenges (SIC) with occupational agents. As immediate asthmatic reactions (IAR) mainly involve proximal airways, PEF may, however, be as valid as FEV1. METHODS: Thirty-seven subjects who experienced an immediate fall in FEV1 of > or =20% during SIC with occupational agents and 20 subjects with fall of < or =10% in FEV1 were included. Both FEV1 and PEF were measured in a random order every 10 min for 1 h after exposure. We corrected PEF (PEFc) for inaccuracies of the mini-Wright meters by the Miller equation. RESULTS: Maximum changes in PEFc (30+/-11%) were not significantly different from changes in FEV1 (27+/-5%) (P=0.13). Their timings after exposure were 14+/-11 min and 17+/-17 min, respectively (P=0.4). High sensitivity (92%), specificity (95%), accuracy (93%), and positive predictive value (97%) were found for a 20% fall in PEFc to detect a significant IAR. Results were better and not influenced by meter inaccuracies with a cutoff point of 15% change in noncorrected PEF (PEFnc). An absolute decrease in PEF of 70 l/min gave a good discrimination between reactions with and without an asthmatic response. CONCLUSIONS: PEF is as satisfactory as FEV1 for detecting a significant IAR after exposure to an occupational agent if one considers a cutoff point of 1) 15% fall in PEF 2) 20% fall in PEFc 3) 20% fall and/or 70 l/min decrease in PEFnc.