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Quaternary ammonium compounds (QACs, quats) belong to organic ionic chemical agents which display unique properties of both surfactants and disinfectants. Their wide distribution in the work environment and also in private households brings about new occupational hazards. This paper reviews reports about the health effects of QACs. QACs could play a role of sensitizers and irritants to the skin and mucous membranes. It is suspected that particular QACs can display an immunologic cross-reactivity between each other and with other chemical compounds containing ammonium ion, such as muscle relaxants widely used in anesthesia. They may promote the development of airway allergy, however, the background mechanisms are still unclear and need to be further investigated. Until now, a few cases of occupational asthma induced by QACs have been described and their involvement in contact dermatitis has been documented. The possibility of anaphylaxis due to QACs cannot be excluded as well.

Objectives: Savinase is one of the endopeptidases widely used in washing detergents. Its ability to cause respiratory allergy has been known. Up to now, most cases of occupational asthma (OA) to savinase have been described among workers involved in the manufacture of laundry detergents. We present a case study of 51-year-old female worker of a dishwashing tablets factory, who had been packaging ready-made tablets into foil wrappers for 4 years and developed respiratory symptoms, such as cough, dyspnoea and wheezing., Methods: A number of clinical procedures were performed, including the clinical examination, routine laboratory tests, evaluation of total and allergen-specific serum IgE (asIgE) to enzymes, skin prick tests for common allergens, rest spirometry, inhalation methacholine challenge test and a single-blind, placebo-controlled specific inhalation challenge test (SICT) with dishwashing tablets., Results: Clinical findings and results of routine laboratory tests were within normal limits. Baseline nonspecific bronchial hyperreactivity was revealed. In patient's serum blood we found significantly elevated asIgE to savinase. Decline of FEV1 and PEF in late phase of asthmatic reaction was observed during the specific challenge test. The patient reported chest tightness between 5-12 hours after exposure to dishwashing tablet ingredients. Cytological assessment of an induced sputum revealed increase in the percentage of eosinophils 24 hours after specific challenge in comparison to values noted before the SICT., Conclusions: Positive clinical response to the challenge confirmed in objective method tests validated the diagnosis of OA.

Respiratory diseases are a cause of long-term sickness absence, and even of partial or complete inability to work. This paper presents the first in Poland description of principles of good practice in occupational health service provided for people with respiratory diseases. The issues concerning the certification of the ability to work in this group of patients are discussed. The key-principles of preventive care of workers with obstructive and interstitial lung diseases with particular attention paid to the control of major risk factors are also presented. The importance of possible contraindications for job performance by workers affected by these diseases, as well as the responsibilities of occupational health physicians were highlighted. M

An increase in the frequency of allergic diseases, including bronchial asthma, in the children population has been observed over several last decades. This trend is reflected in the increasing number of young workers who suffer from allergy and asthma. The problem determines a new challenge to physicians responsible for medical prophylactic care of this group of patients. Active occupational counseling should be performed especially by general practitioners and occupational medicine specialists in in cooperation with allergologists. Apprenticeship is a period of increased risk of work-related respiratory allergic diseases, particularly in the case of occupational exposure to high molecular weight agents. An adequate prophylactic care of apprentices exposed to aeroallergens at workplace may help to reduce work-related allergic health problems, mainly by supporting adolescents in choosing their jobs.

Asthma is the most common occupational allergic respiratory disease. The results of several current studies reveal also high risk of work-related asthma among cleaners. This kind of work may increase the risk of allergic as well as non-allergic asthma. However, the mechanism by which inflammation in respiratory airways is induced by cleaning chemicals is still unknown. This paper shows the results of numerous studies regarding exposure and respiratory symptoms among cleaning personnel. The increased risk of respiratory diseases among cleaners suggests the need to educate workers and to devise safety methods during multiuse cleaning both in occupational settings and in private households.

Background: The aim of the study was to analyze the data obtained during the diagnostic process and their real values in the final diagnosis of patients exposed to diisocyanates amd suspected of occupational allergic disease of the respiratory system The patients have been hospitalized in the Nofer Institute of Occupational Medicine over recent 11 years., Material and Methods: In 1999-2009 we hospitalized 37 patients exposed to diisocyanates and suspected of occupational asthma., Results: Test results of 37 patients were analyzed. The patients were divided into three groups of those with diagnosed occupational asthma, with diagnosed non-occupational asthma and those without any allergic airway disease. 40.0% of patients with occupational asthma, 64.3% of patients with non-occupational asthma and 15.4% of patients without any allergic disease were sensitized to at least one of common allergens. We did not find any specific IgE to diisocyanates. Specific challenge tests were performed in all the 37 subjects. We observed positive results of SIT with diisocyanates in 10 patients., Conclusions: Only specific challenge test with diisocyanates showed the real diagnostic value in case of a 7.5-year cessation of exposure. Determination of serum specific IgE to diisocyanates does not seem to be of clinical value in the diagnosis of diisocyanate-induced asthma in case of a 7.5 year cessation of exposure. Atopy is not the risk factor in diisocyanate-induced asthma.

Objectives: Various indirect or direct airway challenge tests are used to measure nonspecific bronchial hyper-responsiveness (NSBHR). The evaluation of NSBHR in diagnosing occupational asthma (OA) is performed, e.g., to monitor the specific inhalation challenge test (SICT). The aim of this study was to preliminarily compare the results of methacholine and mannitol inhalation challenge tests in SICT monitoring in bakers with work-related airway symptoms.Material and Methods: Four bakery workers with a suspicion of OA underwent single-blind placebo-controlled SICTs involving workplace allergens, accompanied by the evaluation of NSBHR with mannitol and methacholine, both before and after SICTs. Clinical examinations, spirometry tests, skin prick tests (SPTs) to common aeroallergens and occupational allergens, as well as tests to determine serum specific IgE antibodies to occupational aeroallergens were also performed.Results: Positive SPTs results to occupational aeroallergens were found in all bakery workers, and specific IgE antibodies to flour were detected in 2 subjects. Three patients displayed positive SICT reactions. In all of these 3 patients, airway responsiveness to methacholine increased significantly. In 2 patients, airway reaction to mannitol was significant, whereas in 1 subject there was no increase in NSBHR after mannitol inhalation. The patient with a negative SICT result did not reveal any changes in NSBHR before and after the test, either to methacholine or mannitol.Conclusions: The data obtained by the authors show that there is no clear correlation between the methacholine and mannitol inhalation challenge tests in SICT monitoring. Preliminary results indicate the need for further investigations to evaluate the usefulness of the mannitol challenge test in the diagnostics of OA. Int J Occup Med Environ Health. 2020;33(2):235-9. [ABSTRACT FROM AUTHOR]