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Study Objectives: To determine whether the use of respiratory protective equipment would reduce the incidence of occupational asthma due to exposure to hexahydrophthalic anhydride (HHPA)., Design: Prospective cohort study., Setting: A facility that makes an epoxy resin product requiring HHPA for its manufacture., Participants: Sixty-six individuals newly hired at a facility that makes an epoxy resin product requiring HHPA for its manufacture., Intervention: Employees who wished to use respiratory protective equipment could choose from three types of masks: dust mask, half-face organic vapor respirator, or full-face organic vapor respirator., Measurements: Workers were evaluated annually for development of positive antibody to HHPA and occupational, immunologic respiratory disease, including occupational asthma., Results: With use of respiratory protective equipment, the rate of developing an occupational immunologic respiratory disease was reduced from approximately 10 to 2% per year. Occupational asthma developed in only three individuals, and they were all in the higher exposure category. Statistically, one respirator was not superior to the others., Conclusion: Respiratory protective equipment can reduce the incidence of occupational immunologic respiratory disease, including occupational asthma, in employees exposed to HHPA.

This is a descriptive study of six men who had been occupationally exposed to heated epoxy resin containing hexahydrophthalic anhydride (HHPA) who presented with rhinitis, nasal mucosal erosions, and significant epistaxis; three also had asthma. When they were removed from exposure to HHPA, the rhinitis symptoms, nasal erosions, and epistaxis resolved spontaneous. All six had high titers of IgG and IgE against HHP-HSA as determined by an enzyme-linked immunosorbent assay (ELISA). Other asymptomatic workers with similar HHPA exposure had ver low or negative titers of IgG and IgE against HHP-HSA. We conclude that these results are very suggestive of an immunologic mechanism being responsible for the rhinitis, nasal mucosal erosions, and epistaxis that occurred in the six described HHPA workers.

The asthma severity index (ASI) is proposed as a tool to monitor the course of patients with increased risk of asthma-related morbidity and mortality. The ASI is a weighted summary of the diagnostic features of potentially fatal asthma (PFA). Fifteen patients with PFA were evaluated with ASIs calculated for the intervals 1 year prior to and 1 year following management by our allergy-immunology service. In each patient, a reduction was noted in the ASI following management, which corresponded to a reduction in asthma events. The ASI will have utility in the evaluation of chronic asthma treatment and in patient education.

Diagnosis and particularly the management of erythema multiforme and Stevens-Johnson syndrome are controversial in medical textbooks and thus in individual cases. In these diseases, fatalities may result from various causes, including secondary infection or visceral organ damage to lung, liver, or kidneys. We present a series of 13 cases managed by one group of physicians which demonstrates the controversy in certain cases, and we review the controversy in the medical literature. Corticosteroid therapy used in this series was considered beneficial in every case by the managing physician and lifesaving in some cases. There were no fatalities in this series. Although the summation may be considered as our opinion only, the frequently suggested "controlled trial of corticosteroid therapy" can probably never be done for ethical reasons, and series such as this will have to establish the standard of therapy.