Role of histamine in the aetiology of byssinosis. I Blood histamine concentrations in workers exposed to cotton and flax dusts

The formation or the accumulation, or both, of histamine in the lungs may be potentiated by agent(s) present in cotton dust at higher level(s) than in flax dust and negligible in cottonseed dust. It has been suggested that such potentiation may be due to the activation of the ability of the lung to produce histamine and/or produce or recruit mast cells; this may present an acceptable explanation of the mechanism by which the propagation of the chronic effect of the dust proceeds in cotton and flax workers. Histamine accumulated in the lung over the weekend is released on exposure to dust causing the symptoms of byssinosis. The difference in the rate of histamine metabolism relative to the rate of histamine formation in byssinotic subjects leads to a more prolonged histamine accumulation than in symptom free subjects, with the consequent appearance of the symptoms of byssinosis. Continuous exposure to dust, without weekend interruption, leads to equivalent rates of histamine formation and metabolism with non-considerable histamine accumulation in the lungs and consequent absence of the symptoms of byssinosis.     

Role of histamine in the aetiology of byssinosis. I Blood histamine concentrations in workers exposed to cotton and flax dusts.

The formation or the accumulation, or both, of histamine in the lungs may be potentiated by agent(s) present in cotton dust at higher level(s) than in flax dust and negligible in cottonseed dust. It has been suggested that such potentiation may be due to the activation of the ability of the lung to produce histamine and/or produce or recruit mast cells; this may present an acceptable explanation of the mechanism by which the propagation of the chronic effect of the dust proceeds in cotton and flax workers. Histamine accumulated in the lung over the weekend is released on exposure to dust causing the symptoms of byssinosis. The difference in the rate of histamine metabolism relative to the rate of histamine formation in byssinotic subjects leads to a more prolonged histamine accumulation than in symptom free subjects, with the consequent appearance of the symptoms of byssinosis. Continuous exposure to dust, without weekend interruption, leads to equivalent rates of histamine formation and metabolism with non-considerable histamine accumulation in the lungs and consequent absence of the symptoms of byssinosis.     

Prevalence of Byssinosis and Dust Levels in Flax Preparers in Northern Ireland

The association between the prevalence of both byssinosis and chronic bronchitis and the level of airborne dust was examined in workers in preparing departments in flax mills in Northern Ireland. A weak association between the dust level and byssinosis was found but not between the dust level and chronic bronchitis. It is suggested that the disparity of these associations may have arisen because the diagnosis of byssinosis, as in most recent published studies, was based on relatively acute and reversible symptoms which are more likely to be closely related to the current dust levels than the slowly developing symptoms on which the diagnosis of chronic bronchitis was based. Furthermore an association between chronic bronchitis and the dust levels is likely to be obscured to some extent by the effects of other non-industrial respiratory irritants such as tobacco smoke. Some hypotheses of the basic aetiology of byssinosis are discussed.     

Some Pharmacological Actions of Cotton Dust and Other Vegetable Dusts

Aqueous extracts of cotton and other vegetable dusts cause contraction of the isolated ileum and tracheal muscle of the guinea-pig, and of isolated human bronchial muscle. The levels of this contractor activity place the dusts of cotton, flax, and jute in the order of the probable incidence of byssinosis occurring in the mills spinning these fibres.

Extracts of cotton dust possess a histamine-liberating activity and contain a permeability-increasing component. These actions are of plant origin and are found in the pericarp and bracts of the cotton boll. Histamine and 5-hydroxytryptamine have also been found in some cotton dust samples. The formation of histamine by bacterial action in cotton dust does not take place under conditions found in cotton mills. The smooth muscle contractor substance is organic in nature, relatively heat-stable, and dialysable. The relevance of these results to the symptoms of byssinosis is discussed.

     

An investigation of allergy in byssinosis: sensitization to cotton, hemp, flax and jute antigens

Popa, V., Gavrilescu, N., Preda, N., Teculescu, D., Plecias, M., and Cîrstea, M. (1969).Brit. J. industr. Med.,26, 101-108. An investigation of allergy in byssinosis: sensitization to cotton, hemp, flax, and jute antigens. The authors investigated allergy to cotton, hemp, flax, and jute in 41 subjects with byssinosis. In contrast with immediate skin reactions, which were seldom observed, delayed reactions were nearly always present. The incidence of positive skin tests in byssinosis was similar to that observed in all textile workers. Inhalation tests with textile allergens were negative in all but four subjects who also had a concomitant bronchial asthma. Fifteen out of 31 subjects with byssinosis had positive inhalation tests to acetylcholine but only one of the 13 tested had a positive response to the inhalation of textile macerate. Haemagglutinating antibodies to low titres could be observed in byssinosis as well as in chronic bronchitis, in bronchial asthma, and in the general population. The significance of various types of antibodies existing in byssinosis is further discussed. The authors stress the need to standardize textile allergens.     

Effects of Histamine Aerosol in Byssinotic Subjects

The changes in symptoms and lung function tests of 26 cotton cardroom workers were investigated before and after inhalation of histamine aerosols. Three subjects with no chest symptoms and 11 with uncomplicated byssinosis showed no evidence of any pulmonary reaction, but 12 bronchitic byssinotic subjects showed evidence of the pulmonary hypersensitivity found in patients with chronic bronchitis alone.

These findings cast doubt on the possible role of non-antigenic histamine liberators in the mechanism of production of `return-to-work' tightness in byssinosis.

     

Dust Diseases in Dundee Textile Workers: An Investigation into Chronic Respiratory Disease in Jute and Flax Industries

A survey of respiratory symptoms and function was carried out in Dundee among 123 men and women in the jute industry and 242 in the flax industry. The selection of workers was biassed in favour of those working in the dustier departments as judged by eye and those in the older age groups. A group of 72 men in a heavy engineering firm were also selected as controls for comparison.

Chronic bronchitis, as defined by Ogilvie and Newell (1957) was recorded in 27% of those interviewed, whose average age was 49. Byssinosis of various grades was recorded in 30% of all working in flax; of these 35 had cough alone worse on Monday, 34 had other respiratory symptoms worse on Monday and in only four persons did the exacerbation persist longer in the week.

In spite of the occurrence of byssinosis, chronic bronchitis was no more prevalent among flax workers than among the others, the average ventilatory function was no worse, and radiographs of the chest revealed no differences. The characteristic fall in expiratory flow rate during the course of exposure to flax dust on Mondays is similar to that found in cotton workers, and is absent in jute workers and in flax workers not admitting to symptoms of byssinosis.

     

The health investigation of cotton textile workers in Beijing

This study reports findings from a survey of byssinosis among 289 cotton workers in certain cotton textile mills in Beijing. Incidence of byssinosis was 4.2% (12 cases). It decreased with a lower concentration of cotton dust and increased with yearly increment of cotton dust exposure. An elevation in body temperature over 37 degrees C was present among 14.2% of the workers on the first working day after rest. Acute lung function decrement was related to high dust concentration in the rooms. The higher the dust concentration in the rooms, the more evident was the chronic lung function decrement. Chronic bronchitis in cotton workers was higher than in controls. Incidence of byssinosis in smoking cotton workers was higher than in nonsmoking cotton workers.     

Current trends in research on the etiology and pathogenesis of byssinosis

The features of the cotton dust syndrome which need to be considered when formulating a hypothesis on mechanism(s) are: 1) the presence of fever, 2) the "Monday effect," 3) the slow onset of forced expiratory volume in 1 second (FEV1) changes, and 4) the presence of bronchitis in chronic sufferers but the absence of emphysema or fibrosis. The main hypotheses concerning the mechanisms are direct release of histamine triggered by cotton dust components, immune reactions (principally antibody mediated) to cotton dust antigens, and inflammatory response(s) triggered by endotoxins released from bacterial contaminants on the dust. While histamine release and immune reactions may occur as a result of cotton dust inhalation, it is suggested that they are of secondary importance in comparison to inflammation. Evidence is reviewed that implicates bacterial lipopolysaccharide (LPS) present in the dust as the principal etiologic agent in this process. It is postulated that LPS inhalation stimulates a secretory response by lung macrophages, involving the release of effector molecules which trigger coagulation, bronchoconstriction, fever, and mucus production. LPS-induced macrophage secretory products also promote the local sequestration and activation of both neutrophils and platelets, which serve to amplify the inflammatory response. Evidence is presented implicating both interstitial and alveolar macrophages in this process. The problems associated with the identification of "high risk" groups of cotton workers will be discussed, from a number of viewpoints; consideration will be given to the role of a variety of environmental factors (including tobacco smoking) in this context, as well as possible genetic factors.(ABSTRACT TRUNCATED AT 250 WORDS)     

Experimental Byssinosis

The symptoms of byssinosis were produced experimentally in one of three cotton-mill workers with pronounced byssinosis, by a dust prepared from leaves of cotton plants. Dusts of calcium carbonate, bacteria, and fungi did not reproduce the symptoms. Two mild cases of byssinosis and two cases of chronic bronchitis did not react specifically to any of these dusts.     

Role of histamine in the aetiology of byssinosis. II. Lung histamine concentrations in guinea pigs chronically exposed to cotton and flax dusts.

Data presented in this study support the finding that cotton and flax dusts contain agents which potentiate the formation or accumulation of histamine or both in the lungs of guinea pigs exposed to dust, and that such agents are present at much higher levels in cotton dust than in flax dust. The potentiating effect may be through the recruitment of mast cells into the lung. Both cotton and flax dusts contain methylating enzyme inhibitory agents, whereas cotton dust also contains agents that inhibit histaminase activity; flax dust contains agents potentiating histamine activity. These agents working together result in the accumulation or depletion of histamine observed in the different groups of animals exposed to either cotton or flax dust in this study.     

The study of byssinosis in China: a comprehensive report

Cross-sectional studies were conducted during 1981-1983 among 861 textile workers in 3 cotton mills and 822 controls in 2 silk factories. Questionnaire and lung function tests were taken and inhalable dust concentrations were measured. Prevalence of byssinosis was 5.6%. Average dust concentrations were highest in carding rooms, 1.47-1.99 mg/m3. The correlations (r) between prevalence of byssinosis and dust concentrations was 0.64 (p less than 0.05). The prevalence of chronic bronchitis was 14.4% in cotton workers and 5.1% in controls (p less than 0.05). Acute FEV1 percent decrement (greater than 5%) was higher among cotton workers (32.1%) compared to controls (14.5%) (p less than 0.001). In one cotton blanket factory, the prevalence of byssinosis and chronic bronchitis was higher among workers in the high-dust work areas. Long-term effect studies included pulmonary function test among 173 cotton workers and 373 controls, retired 1-10 years, using the flow volume curve (FVC); chest X-rays of 140 pairs of cotton workers and controls with working tenures over 20 years; and examination of lobectomy specimens of 8 textile workers matched with 16 controls. In male cotton workers, only smokers had a prominent decrement of lung function indices, except FVC. For non-smoking females, there was no difference between the two groups. Additive effects were seen between smoking and dust exposure. According to the International Labor Organization (ILO) Pneumoconiosis Classification, the prevalence of abnormality (profusion greater than 1/0) was 4.3% and 8.7% in non-smoking controls and cotton workers. The interstitial changes on X-ray due to smoking would be much heavier. Additive effects also existed between smoking and dust exposures. No significant changes attributable to dust exposure were seen on pathological section of lobectomy specimens.     

Respiratory disease in cotton textile workers in the People's Republic of China. I. Respiratory symptoms

The prevalence of byssinosis and nonspecific respiratory symptoms was studied in 887 textile workers with at least two years of employment in two cotton mills and one silk mill in Shanghai, the People's Republic of China. A standardized respiratory questionnaire was used, and environmental sampling was performed with vertical elutriators and colorimeter grading. Eight percent of the cotton textile workers complained of byssinosis. The reports of byssinosis were mostly mild (grade 1/2), more prevalent among women, and unrelated to duration of employment or elutriator dust levels. Nonspecific respiratory symptoms were significantly more prevalent among cotton textile workers than silk workers. After adjustment for age, gender, and smoking in logistic regression models, the odds ratios for the effect of working in cotton textile mills on chronic bronchitis, chronic cough, and frequent chest illness were 3.3, 2.9 and 4.7, respectively. Although none of the symptoms were related to current dust levels, the range of exposures was narrow, and information was only available on current levels of cotton dust. This study represents the first respiratory survey of the textile industry in China using diagnostic criteria similar to that used in the United States and England; it defines a cohort for prospective investigation.     

Prevalence of byssinosis in Swedish cotton mills.

The prevalence of byssinosis and of chronic bronchitis was studied in a questionnaire investigation among workers in bale opening areas, carding rooms, and spinning rooms in five Swedish cotton mills. Airborne dust and Gram-negative bacteria was measured. Nineteen per cent of the interviewed workers reported symptoms of light byssinosis (grade 1/2). The prevalence of symptoms was not related to the duration of employment, and cases of byssinosis were found among people who had worked in cotton mills for only a few years. A significantly higher proportion of male than female workers reported symptoms. No difference in the extent of byssinosis was found between smokers and non-smokers, but the prevalence was significantly higher among those workers who had ceased smoking. The prevalence of byssinosis was related to the number of airborne viable Gram-negative bacteria as well as to the dust level in the different mills.     

Discrepancies in the study of byssinosis in China

The existence of byssinosis in China was first reported in 1964. Detailed studies only started in the late 1970s and early 1980s. The work of the WHO study group as edited by the Technical Report Series no. 684, "Recommended health-based occupational exposure limits for selected vegetable dusts," promotes the further study of occupational disease in China; a few points need further discussion. The word byssinosis translated in Chinese is misleading as to the real pathogenesis of the disease. Some still believe cotton dust causes interstitial fibrosis, while the majority of researchers agree with the WHO study group. A poorly designed animal model may have led to the (incorrect) conclusion that dust from carding room is toxic if it is injected intratracheally. The reasons for the controversy in the prevalence of byssinosis in different reports in earlier years are the different diagnosis criteria and the fact that dust sampling methods were not standardized; pulmonary function tests were not used as a routine index; chronic bronchitis and smoking are now recognized as confounders and should have been considered. This Institute initiated the hygiene standards study on cotton dust and recommended 1 mg/m3 for respirable dust and 3 mg/m3 for total dust. If a reduction in dust levels could prevent byssinosis, it would likely also control the risk factor for developing bronchitis.     

Effects of different vegetable dust exposures

Valić, F., and Žuškin, E. (1972).Brit. J. industr. Med.,29, 293-297. Effects of different vegetable dust exposures. In order to establish the rank of biological activity of vegetable dusts, five groups of non-smoking female workers exposed to similar concentrations of hemp, flax, cotton, sisal, and jute airborne dust, respectively, were compared as to the prevalence of byssinosis, chronic respiratory symptoms, and one-second expiratory volume changes over the Monday shift. The groups were selected in such a way as to differ in the distribution of age and length of exposure to the respective dust as little as possible.

The prevalence of byssinosis in hemp and flax workers was approximately equal (44% and 43% respectively), in cotton workers it was considerably lower (27%), while no byssinosis was caused by either sisal or jute dust. The highest prevalence of other chronic respiratory symptoms was recorded in hemp workers (39%), followed by flax (36%) and cotton workers (27%), while in sisal (13%) and jute workers (13%) it was the lowest.

Significant mean FEV_1·0 reductions over the shift were recorded in all the groups of textile workers with the largest reductions in hemp workers (19%) followed by flax (11%), cotton (8%), sisal (7%), and jute workers (5%). The application of orciprenaline before the shift diminished the mean acute FEV_1·0 falls over the work shift in all the groups studied.

     

Comparative study of the smooth muscle contractor activity of airborne dusts and of dustiness in cotton, flax, and jute mills.

A bioassay technique using isolated guinea-pig ileum was employed to compare the smooth muscle contractor activity of various dusts from mills in which the prevalence of byssinosis was known. The activity of dust from a mill spinning a coarse grade of cotton was several times greater than that in dust from a mill processing a fine grade of cotton. There was a similar order in the difference of the prevalence of byssinosis in these mills. However, the activities of fine cotton, flax, and jute dusts were very similar to each other, in spite of marked differences in the prevalence of byssinosis in these mills. For cotton dust, smooth muscle contractor activity was associated with all particle sizes, although the lowest level of activity was found in the largest sized fraction (less than 2 mm). Activity in the cotton dust extracts was not correlated with nitrogen, carbohydrate, or potassium content. However, about one-fifth of the activity of a cotton dust extract was associated with an insoluble particulate fraction. The possible chemical nature of the water-soluble contractor agent is discussed. It is concluded that, until the role of this agent in the pathogenesis of byssinosis has been established, the bioassay technique cannot be employed as a means of assessing the byssinogenic potential of cotton dust.     

Comparative study of the smooth muscle contractor activity of airborne dusts and of dustiness in cotton, flax, and jute mills.

A bioassay technique using isolated guinea-pig ileum was employed to compare the smooth muscle contractor activity of various dusts from mills in which the prevalence of byssinosis was known. The activity of dust from a mill spinning a coarse grade of cotton was several times greater than that in dust from a mill processing a fine grade of cotton. There was a similar order in the difference of the prevalence of byssinosis in these mills. However, the activities of fine cotton, flax, and jute dusts were very similar to each other, in spite of marked differences in the prevalence of byssinosis in these mills. For cotton dust, smooth muscle contractor activity was associated with all particle sizes, although the lowest level of activity was found in the largest sized fraction (less than 2 mm). Activity in the cotton dust extracts was not correlated with nitrogen, carbohydrate, or potassium content. However, about one-fifth of the activity of a cotton dust extract was associated with an insoluble particulate fraction. The possible chemical nature of the water-soluble contractor agent is discussed. It is concluded that, until the role of this agent in the pathogenesis of byssinosis has been established, the bioassay technique cannot be employed as a means of assessing the byssinogenic potential of cotton dust.     

First report of byssinosis in Hong Kong.

There has been no report of byssinosis in Hong Kong although the textile industry has been one of the leading industries for many years. Three workers with a long history of exposure to cotton dust had chronic obstructive airways disease precipitated by their work environment. One had irreversible airways obstruction but none had chronic bronchitis, emphysema, or asthma. Only one gave a history of "Monday morning tightness," and this was attributed to the fact that most of the textile workers in Hong Kong work seven days a week. It was suggested that a survey be carried out to ascertain the importance of byssinosis in the textile workers of Hong Kong and tha byssinosis should there be added to the list of notifiable occupational diseases.     

Relationships between dust level and byssinosis and bronchitis in Lancashire cotton mills

Berry, G., Molyneux, M. K. B., and Tombleson, J. B. L. (1974). British Journal of Industrial Medicine,31, 18-27. Relationships between dust level and byssinosis and bronchitis in Lancashire cotton mills. A prospective survey of workers in 14 cotton and two man-made fibre spinning mills was carried out. A questionnaire on respiratory symptoms was completed at the start of the survey by 1 359 cotton workers and 227 workers in man-made fibre mills and again two years later by about half of these workers. Dust measurements were available for 772 women and 234 men cotton workers.

The prevalence of bronchitis was found to be unrelated to dust level but for women was related to years of exposure. The change in symptoms of bronchitis was unrelated to dust level or to length of exposure. There was, however, an increased prevalence of bronchitis in the cotton mills when compared with the man-made fibre mills, and also over the two-year period a greater proportion of symptom-free workers developed symptoms and a lower proportion of those with symptoms lost their symptoms in the cotton mills than in the man-made fibre mills.

The prevalence of byssinosis was related to smoking habits, the smokers having about 1·4 times as much byssinosis as the non- and ex-smokers after allowing for exposure. Byssinosis was associated with the dust level and years of exposure, more so for the women, and an association between the incidence of new cases over the two years and dust level was also found. After allowing for dust level, years of exposure, and smoking there were still differences between the occupational groups in byssinosis prevalence. Strippers and grinders had the highest prevalence followed by drawframe tenters. Speedframe tenters, card tenters, and comber tenters had similar prevalences and ring spinners the lowest.