Occupational asthma due to cyanoacrylate: a case-report

BACKGROUND: An increased use of acrylic compounds is observed in different industries, home repairs and hobbies. These compounds are known to cause skin sensitisation, irritation of mucous membranes and bronchial asthma. Methyl cyanoacrylate is moderately likely to be a sensitizer, while ethyl cyanoacrylate might be a weak sensitizer. OBJECTIVES: Clinical evaluation of a case of occupational asthma due to cyanoacrylate. METHODS: A female worker, aged 32 years, used ethyl cyanoacrylate daily. After 2 months she experienced dry cough and shortness breath. Some weeks later she developed bronchial asthma. The diagnosis of occupational asthma was based on the work-related symptoms and the inhalation challenge test result. RESULTS: A late asthmatic response was observed with a maximum fall in FEV1 of 26% 345 minutes after exposure. Complete clinical and functional recovery was observed after inhalation of a broncho-dilating agent. CONCLUSIONS: Acrylates are new occupational sensitising agents, causing rhinitis and asthma. It is not possible to perform prick tests or specific IgE measurements for these compounds. The bronchial challenge test is therefore the sole valid test for the diagnosis of occupational asthma.     

Risk of asthma in the general Spanish population attributable to specific immunoresponse. Spanish Group of the European Community Respiratory Health Survey.

BACKGROUND: Individuals with asthma are more atopic than the general population, but few reports have quantified this association, i.e. the proportion of asthma in the community due to specific immunoresponse. We aimed to determine the population attributable risk of asthma in the community due to atopy, and the quantity and quality of specific immunoresponses to common aeroallergens involved. METHODS: We used data from a cross-sectional study in a random sample of the general Spanish population, 20-44 years old, from five areas. In all, 1816 participants were given a symptoms questionnaire, a methacholine challenge and were assessed for atopy. Bronchial responsiveness (BR) was defined as a > or =20% fall in forced expiratory volume in one second (FEV1) after methacholine. Asthma was defined as symptomatic bronchial responsiveness. Atopy was assessed by measuring serum specific IgE or skin tests for sensitivity to Alternaria, birch, cat, Cladosporium, Dermatophagoides pteronyssinus, olive, Parietaria, ragweed or timothy grass. RESULTS: Sensitivity to any of the individual allergens tested significantly increased the risk of being asthmatic, at least twofold compared to non-atopic individuals. The population attributable risk of atopy in explaining asthma is 41.97% (95% CI: 29.2-60.3) when adjusting for area of residence, age, sex, and smoking. In symptomatic individuals, atopy was an independent factor in producing an early measurable PD20 (methacholine dose producing 20% fall in FEV1), especially in those atopic to two or more aeroallergens, and irrespective of the particular aeroallergen. CONCLUSIONS: Specific immunoresponse is strongly associated with asthma, but positivity to single allergens (quality) and the number of positive immunoresponses (quantity) do not change the per se risk of asthma in atopic individuals.     

Longitudinal decline in lung function in patients with occupational asthma due to western red cedar.

BACKGROUND: There are few reports about longitudinal changes in lung function in asthmatic patients. Patients with asthma had a greater loss of lung function than normal healthy adults. To date, there have been no studies about the longitudinal changes in lung function in patients with occupational asthma. METHODS: 280 male patients with red cedar asthma (RCA) who were followed up for at least one year were the study group. The exposed controls consisted of 399 male sawmill workers. Forced expiratory volume in one second (FEV1) was measured with a Collins water spirometer. Changes in FEV1 over time (FEV1 slope) were calculated by a two point method for each subject. Atopy was considered to be present if the subjects showed at least one positive response to three allergens by skin prick test. RESULTS: Multiple regression analysis was carried out to examine factors that might affect longitudinal decline in FEV1. Patients with RCA who were still exposed had a greater decline in FEV1 slope (-26 ml/y) than sawmill workers. Smokers also showed a greater rate of decline in FEV1 (-43 ml/y) than non-smokers. CONCLUSIONS: Patients with RCA who continued to be exposed had a greater rate of decline in FEV1 than sawmill workers. Early diagnosis of occupational asthma and removal of these patients from a specific sensitiser is important in the prevention of further deterioration of lung function and respiratory symptoms.     

Single breath assessment of bronchial responsiveness: a comparison with the astograph method

Bronchial responsiveness to inhaled doubling concentrations of acetylcholine using the astograph and single breath techniques was assessed in 7 males and 11 females (mean age 22.7, SD = 2.05 and 21.2, SD = 1.11 years for male and female respectively) healthy volunteers. Eleven (61%) of the subjects had neither a history of allergy nor wheezes. Five (28%) had allergic rhinitis and two (11%) had asthma. Seven (64%) of the normal subjects, all asthmatic and subjects with allergic rhinitis responded to inhaled acetylcholine. Respiratory conductance (Grs) and the one second forced expired volume (FEV1) expressed as percentages of the baseline values were compared on a semilogarithmic scale against cumulative dose. In most subjects the pattern of the curves showed close similarities in the two methods. The bronchial sensitivity i. e. minimum cumulative dose of acetylcholine just sufficient to start a fall in the FEV1 and Grs (CminS and CminA respectively), showed good correlation (r = 0.750, P less than 0.01). The results indicate that bronchial responsiveness can be reliably assessed using the simple single breath method as well as the more complex astograph method.     

Sensitization to individual allergens as risk factors for lower FEV1 in young adults. European Community Respiratory Health Survey

BACKGROUND: Atopy may impair ventilatory function, but results are controversial. We assess the association between individual reactivity to allergens and the level of baseline maximal one-second forced expiratory volume (FEV1), by smoking and respiratory symptoms. METHODS: The 1472 participants (response 44.5%) of the five Spanish areas of the European Community Respiratory Health Survey (ECRHS) who performed respiratory function tests, skin prick tests and/or specific IgE against common aeroallergens (e.g. mites, pets, mould, pollens) are included. Bronchial hyperreactivity (BHR) was measured with a methacholine challenge. RESULTS: After adjusting for BHR and smoking, in addition to the other allergens, skin reactivity to Alternaria (-208 ml; 95% CI :-451, 35) and IgE antibodies against cat (-124 ml; 95% CI:-269, 21) and Timothy grass (-115 ml, 95% CI:-190, -40) were associated with a decrease in FEV1 in females. Among males, skin reactivity to olive showed the strongest association (-111 ml; 95% CI: -261, 38). The associations were stronger in females. Smoking modifies the association for Alternaria and cat (P for interaction < 0.05). While cat is associated with a decrease in FEV1 in current smokers (-190 ml), Alternaria (-336 ml) was associated among never smokers. The exclusion of subjects with asthma symptoms, or adjustment for respiratory symptoms, led to similar results. CONCLUSIONS: We conclude that immunoresponse to individual allergens (particularly outdoor) is associated with the level of FEV1, and this association occurred independently of asthma, and in smokers and non-smokers, which may be of interest in natural history of chronic obstructive pulmonary disease (COPD).     

Occupational asthma caused by inhalation of cuttlefish bone dust

This report describes a new case of occupational asthma in a goldsmith. A 25-year-old female suffered attacks of urticaria and asthma at each exposure to the dust of cuttle-fish bone used to polish gold jewellery. A specific occupational bronchial provocation challenge showed a dual asthmatic response with a maximum fall in FEV1 of 26% of the baseline value after 6 hours. A prick-test with crude cuttle-fish bone dust in glycerin 10% also gave a positive response.     

Occupational asthma due to spruce wood

Workers exposed to a variety of wood dusts are known to experience work-related respiratory symptoms, including occupational asthma. There are, however, few reports of occupational asthma due to spruce wood. We present the case of a 31-year-old sawmill owner with severe asthma caused by exposure to spruce wood dust, who developed asthmatic symptoms after 2 years of working. Investigations included clinical examination, routine laboratory tests, spirometry, chest X-ray, total serum immunoglobulin E (IgE) and specific serum IgEs against various woods and other occupational allergens. Additionally, we monitored the peak expiratory flow rate (PEFR) and symptom score both at work and when off work. Specific serum IgE for spruce wood was detected (7.8 IU/ml). The results of PEFR and workplace symptom-score monitoring, coupled with an elevated eosinophil count in induced sputum, supported the diagnosis of occupational asthma. To our knowledge, this is the first well-documented case of occupational asthma induced by spruce wood dust. A type I immunological mechanism seems to be responsible.     

Occupational asthma caused by cellulase and lipase in the detergent industry

Three employees from two different detergent companies were investigated for occupational asthma, using skin prick tests, serum specific IgE, and specific bronchial challenge. Two were challenged with lipase and one with cellulase. All three cases had immunological evidence of sensitisation to the detergent enzymes with which they worked. Bronchial challenge in each provoked a reproducible dual asthmatic response, which reproduced their work related symptoms. These are the first reported cases of occupational asthma attributable to cellulase and lipase in the detergent industry. Four of the most common enzymes used in this industry have now been reported to cause occupational asthma; continued vigilance and caution are needed when working with these or other enzymes.     

Bronchial reactivity in green coffee exposure

Respiratory symptoms and lung function were studied in nine coffee workers who complained of job related respiratory symptoms. Six described symptoms characteristic of occupational asthma. Lung function data showed obstructive changes mostly in the smaller airways with no impairment in diffusing capacity. Bronchoprovocation testing with green coffee allergen provoked immediate asthmatic reactions with acute reductions of ventilatory capacity in four workers. The relative fall in FEF25-75% (ranging from 28% to 66%) was greater than in FEV1 (ranging from 18% to 62% of the control values). Eight of the nine workers had an increased total IgE serum level; five had positive intradermal skin tests to green coffee allergen. Most of the six healthy subjects experimentally exposed to green coffee dust in the working environment showed an acute fall in flow rates on maximum expiratory flow-volume curves. These results indicate that bronchoprovocation with green coffee allergen or green coffee dust may be used to identify subjects sensitive to green coffee.     

Bronchial reactivity in green coffee exposure.

Respiratory symptoms and lung function were studied in nine coffee workers who complained of job related respiratory symptoms. Six described symptoms characteristic of occupational asthma. Lung function data showed obstructive changes mostly in the smaller airways with no impairment in diffusing capacity. Bronchoprovocation testing with green coffee allergen provoked immediate asthmatic reactions with acute reductions of ventilatory capacity in four workers. The relative fall in FEF25-75% (ranging from 28% to 66%) was greater than in FEV1 (ranging from 18% to 62% of the control values). Eight of the nine workers had an increased total IgE serum level; five had positive intradermal skin tests to green coffee allergen. Most of the six healthy subjects experimentally exposed to green coffee dust in the working environment showed an acute fall in flow rates on maximum expiratory flow-volume curves. These results indicate that bronchoprovocation with green coffee allergen or green coffee dust may be used to identify subjects sensitive to green coffee.     

Algae-induced occupational asthma in a thalassotherapist

BACKGROUND: Algae powders have been increasingly used in therapeutic preparations. Their potential as inducers of occupational asthma (OA), however, remains to be demonstrated. METHODS: A 33-year-old woman developed asthma following exposure to algae powder used for thalassotherapy. She had positive patch tests to nickel and cobalt in an evaluation for intermittent skin rash. At work, she had a normal forced expiratory flow in 1 s (FEV(1)) but moderate airway hyperresponsiveness. Bronchial provocation tests (BPT) were obtained. RESULTS: On BPT, an isolated early response was observed after a 1-min inhalation of dry algae powder, with a 50% fall in FEV(1) after exposure; the control BPT with lactose powder was negative. CONCLUSIONS: We report a case of algae-powder-induced OA. Such responses could be due to a sensitization to algae proteins or metal contaminants bioabsorbed by the vegetal particles.     

Occupational asthma caused by exposure to neurospora in a plywood factory worker

A 24 year old man developed severe asthma two years after starting to work in a plywood plant. Four years later the patient had to stop working because of the increasing severity of his asthma. Three months after leaving his job, the patient's asthma was greatly improved. His job consisted of placing plywood sheets into a drying machine. The plywood sheets had stayed outside in wet conditions for at least four to six weeks and were usually covered with moulds. Drying the plywood sheets changed the mould into a fine orange powder. Exposure to this in the laboratory induced an isolated immediate asthmatic reaction. The same reaction was seen when the patient was challenged with an extract of the mould powder at a 0.1% w/v concentration. Skin prick test with the mould extract induced a weal and flare reaction and IgE antibodies against the dry mould powder were identified. A control patient with the same degree of bronchial hyperreactivity did not have any asthmatic reaction when challenged with the same mould extract. Culture of the dry mould powder on Sabouraud agar plates grew pure Neurospora sp. This mould has not been previously reported as a cause of occupational asthma. The immunological mechanism is probably related to an IgE mediated mast cell allergy.     

Occupational asthma caused by exposure to neurospora in a plywood factory worker.

A 24 year old man developed severe asthma two years after starting to work in a plywood plant. Four years later the patient had to stop working because of the increasing severity of his asthma. Three months after leaving his job, the patient's asthma was greatly improved. His job consisted of placing plywood sheets into a drying machine. The plywood sheets had stayed outside in wet conditions for at least four to six weeks and were usually covered with moulds. Drying the plywood sheets changed the mould into a fine orange powder. Exposure to this in the laboratory induced an isolated immediate asthmatic reaction. The same reaction was seen when the patient was challenged with an extract of the mould powder at a 0.1% w/v concentration. Skin prick test with the mould extract induced a weal and flare reaction and IgE antibodies against the dry mould powder were identified. A control patient with the same degree of bronchial hyperreactivity did not have any asthmatic reaction when challenged with the same mould extract. Culture of the dry mould powder on Sabouraud agar plates grew pure Neurospora sp. This mould has not been previously reported as a cause of occupational asthma. The immunological mechanism is probably related to an IgE mediated mast cell allergy.     

Airway response to formaldehyde inhalation in asthmatic subjects with suspected respiratory formaldehyde sensitization

The aim of the study was to characterize the mechanism of formaldehyde (FM)-induced nasal and bronchial response in asthmatic subjects with suspected FM allergy. Ten subjects purported to have FM rhinitis and asthma and 10 healthy subjects submitted to an inhalation provocation in an exposure chamber with FM at a dose of 0.5 mg/m³ over 2 hr. Spirometry at rest and following bronchial provocation with histamine (PC₂₀) were recorded before and after FM inhalation. In addition, FM-specific serum IgE antibodies were measured and cellular, biochemical, and mediator changes were assessed in nasal lavage before, and immediately after, provocation and at 4 hr and 24 hr later. Provocation with FM caused only transient symptoms of rhinitis in both groups. None of the subjects supposed to have occupational asthma developed clinical symptoms of bronchial irritation. No specific IgE antibodies to FM were detected in persons with occupational exposure to FM. No differences in the nasal response to FM were found between subjects reporting to have occupational allergic respiratory diseases and healthy subjects (P > 0.05). In summary, inhaled formaldehyde at a level as low as 0.5 mg/m³ did not induce a specific allergic response either in the upper or in the lower part of the respiratory tract. Moreover, there is no difference in nasal response to FM in asthmatic subjects occupationally exposed to FM and healthy subjects. Am. J. Ind. Med. 33:274–281, 1998. © 1998 Wiley-Liss, Inc.     

Monitoring of peak expiratory flow rates during occupational asthma treatment.

The purpose of this study was to evaluate the effect of anti-inflammatory drug treatment on respiratory symptoms and lung function in twelve subjects with occupational asthma while at work. PEFR was monitored for four weeks and antiasthmatic drugs (salbutamol, chromolyn sodium and beclomethasone dipropionate) were administered for three weeks, starting after the first week of PEFR monitoring, in an unchanged working environment. After treatment five subjects became asymptomatic, six improved and one continued to have unchanged work-related asthmatic symptoms. There were only minor increases in forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1) and mean forced expiratory flow during the middle half of FVC (FEF25-75). Bronchial reactivity was studied in eleven subjects: six worsened and five improved. PEFR at 0600 h increased by 9.4% in nine responders and decreased by 5.8% in three non-responders. After treatment diurnal variation (DV) in PEFR decreased by 28.4% in responders and 30.8% in non-responders, even if at the fourth week it was 1.75 higher in non-responders compared to responders. In conclusion, in this study a continuous treatment of occupational asthma with anti-inflammatory drugs minimized respiratory symptoms, slightly increased PEFR and greatly reduced DV in PEFR.     

A cross sectional study of chemical industry workers with occupational exposure to persulphates.

OBJECTIVES: Hair bleaches containing persulphates have been identified as the cause of occupational asthma in hairdressers. Also employees in persulphate production with occupational asthma have been described. It was the aim of this study to give an estimate of the prevalence of asthma due to persulphates in chemical workers with exposure to ammonium and sodium persulphate. METHODS: A cross sectional study was performed in 32 of 33 employees of a persulphate producing chemical plant. Eighteen of 23 workmen from the same plant with no exposure to persulphates were taken as controls. Also, information was collected from medical records of the seven subjects who had left the persulphate production for medical reasons since 1971. Data were recalled by a questionnaire, skin prick tests were performed with five environmental allergens, and ammonium and sodium persulphate (80 mg/ml). Specific immunoglobulin E (IgE) to the same environmental allergens as in the skin test, and total IgE were measured. Lung function and bronchial responsiveness to histamine were assessed by standard procedures. Workplace concentrations of ammonium and sodium persulphate were estimated by area and personal monitoring. The amount of persulphate was analysed as sulphur by inductively coupled plasma emission spectrometry. RESULTS: Work related rhinitis was reported by one subject with exposure to persulphates, conjunctivitis and bronchitis were reportedly related to work by two controls. There were no cutaneous reactions to persulphates in either group. Four non-atopic subjects exposed to persulphates, and two controls, one atopic and one non-atopic, were considered to be hyperresponsive to histamine. Three subjects exposed to persulphates with bronchial hyperresponsiveness (provocation dose of histamine causing a 15% fall in forced expiratory volume in one second (PD15 FEV1) < or = 1 mg) did not show variability in peak expiratory flow of > or = 20%, the rest refused peak flow measurements. None of the variables showed significant differences between the groups (P > 0.05). Six of the exworkers left because of work related contact dermatitis. Mean values for workplace concentrations of ammonium and sodium persulphate within the bagging plant were below 1 mg/m3, and the maximal concentrations were 1.4 mg/m3 and 3.6 mg/m3, respectively. CONCLUSION: Exposure to workplace concentrations of ammonium and sodium persulphate of about 1 mg/m3 in this chemical plant was not associated with a risk of occupational asthma.     

Specific IgE to colophony?

BACKGROUND: Colophony (rosin) is a natural product obtained from coniferous trees. It is used in a diverse range of products such as adhesives, ink, paints and soldering fluxes. Some workers exposed to colophony during soldering can develop occupational asthma; at present, no specific IgE test is available to assess sensitization to colophony. METHODS: Serum samples were obtained from exposed symptomatic individuals (n = 7), some with a likely diagnosis of occupational asthma, exposed asymptomatic individuals (n = 10) and unexposed individuals (n = 11). Serum was tested for specific IgE antibodies against a protein extract produced following in vitro challenge of mono-mac-6 cells with colophony extract. RESULTS: Serum from exposed symptomatic individuals showed increased binding of specific IgE antibodies to a range of colophony-cell protein conjugates [29% (2/7) of samples tested when cut-off > 0.1 or 86% (6/7) of samples tested when cut-off > 0%] compared with both the exposed asymptomatic [0% when cut-off > 0.1, or 20% when cut-off > 0% (2/10)] and the non-exposed control populations [0% when cut-off > 0.1, or 27% when cut-off > 0% (3/11)]. CONCLUSIONS: This novel approach for the production of conjugates to assess sensitization to colophony was able to detect specific IgE in colophony-exposed workers with a likely diagnosis of occupational asthma.     

Analysis of the clinical state of patients with occupational asthma following cessation of exposure to allergens

The purpose of this study was to evaluate the health state of patients with occupational asthma after cessation of occupational exposure to bakery allergens. A follow-up study of 56 subjects with occupational asthma was carried out. Subjects were examined twice: 1-6 months after removal from occupational exposure and 36 or 48 months later. Clinical state analysis both at diagnosis and re-examination was performed with the use of a questionnaire. Functional spirometric tests and skin prick tests and/or specific serum IgE were carried out during both examinations at points of time at which the subjects regarded their asthma symptoms as least severe. According to the subjective evaluation of the patients' clinical state, some improvement could be noticed 36 or 48 months after removal from work. Forced expiratory volume in one second (FEV1) and peak respiratory flow (PEF) did not change significantly. Total serum IgE concentration decreased in only two subjects, but the mean value of total IgE level did not significantly differ at the first and second examination after the cessation of occupational exposure. There was no significant difference in the number of positive skin prick tests to common and occupational allergens between the first and second examination. The majority of patients with occupational asthma reporting subjectively on their symptoms indicated an improvement in their clinical state 2-3 years after removal from occupational exposure. The intensity of skin prick tests was not reduced in the studied group. Non-specific bronchial hyper-responsiveness was not reduced in the majority of subjects with occupational asthma at least 2 years after cessation of occupational exposure.     

Health, employment, and financial outcomes in workers with occupational asthma.

OBJECTIVE--To study the health, employment, and financial outcome of occupational asthma. DESIGN--A follow study of workers with confirmed occupational asthma. SETTING--A specialist occupational lung disease clinic. SUBJECTS--All workers had a diagnosis of occupational asthma made at least one year earlier. Diagnosis was confirmed by serial peak expiratory flow measurement, specific bronchial provocation testing, or specific immunology. MAIN OUTCOME MEASURES--Respiratory symptoms, medication, pulmonary function, employment state, and financial position. RESULTS--112 of a total of 140 eligible workers were followed up. 32% of patients remained exposed to the causative agent. These workers had more symptoms at follow up than those removed and a greater number were taking inhaled steroids. Continued exposure was also associated with a fall in % predicted forced expiratory volume in one second (FEV1) of 3% compared with that at presentation. Their median loss of annual income due to occupational asthma was 35%. Those removed from exposure were worse off financially (median loss 54% of annual income), had fewer respiratory symptoms than the group who remained exposed, and their % predicted FEV1 had improved by 4.6%. Statutory compensation and that obtained by common law suits did not match the loss of earnings due to the development of occupational asthma. Of the workers removed from exposure, those who no longer complained of breathlessness had been diagnosed significantly earlier after the onset of their first symptom (48 v 66 months, p = 0.001) and had a significantly higher FEV1 at presentation (90% v 73% predicted, p = 0.008) compared with those who were still breathless. They had developed symptoms earlier after first exposure (48 v 66 months, p > 0.05) and had been removed from exposure sooner (eight v 12 months, p > 0.05). CONCLUSION--Removal from exposure after diagnosis of occupational asthma is beneficial in terms of symptoms and lung function, but is associated with a loss of income. Early diagnosis is important for symptomatic improvement after removal from exposure. Inadequate compensation may contribute to the workers' decision to remain exposed after diagnosis.     

Effect of whey protein to modulate immune response in children with atopic asthma

BACKGROUND: Levels of glutathione (GSH) in antigen-presenting cells promote a T-helper type 2 (Th2) cytokine response in mice. We have previously demonstrated that we can increase intracellular GSH levels in healthy young adults using a whey-based oral supplement (HMS90). We hypothesized that such supplementation in children with atopic asthma, a Th2 cytokine disease, would improve lung function and decrease atopy. METHODS: Eleven children (six females, five males; mean+/-standard deviation age, 12.6+/-3.6 years; baseline forced expired volume in 1 sec (FEV1), 82.4+/-15.4%predicted), underwent spirometry, methacholine provocation testing, and blood analysis for serum IgE and lymphocyte GSH before and after 1 month of supplementation (10 g twice daily). RESULTS: Initially the IgE was 1689+/-1596 microg/l (normal range 相似文献