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Cockroach allergy is a health problem in many parts of the world. In urban environments, indoor exposure to cockroach allergens involves a risk of asthma. The aim of this study was to measure the mass fraction of Bla g 1, a major allergen of the German cockroach (Blatella germanica) in 30 house samples, collected at random from Zagreb area households, Croatia. Dust samples were collected on cellulose filters by vacuuming living rooms floors. After extraction, Bla g 1 was detected using the commercial enzyme-linked immunosorbent assay (ELISA). Only four of the thirty households had detectable Bla g 1 levels, and only in one was its concentration higher than 2.0 U g(-1), the threshold associated with sensitisation. The Bla g 1 ELISA proved highly sensitive, with the detection limit of 0.12 U g(-1). The within- and between-assay imprecision was 8.9 % and 14.4 %, respectively, and accuracy 85 % to 120 %. Low Bla g 1 levels in the household dust support previously reported low prevalence of skin sensitisation to B. germanica among Zagreb residents. Further monitoring should reveal if there are differences in cockroach allergen exposure and sensitisation between households from other geographic areas in Croatia.

Acute effects of food and cigarette consumption on exhaled breath condensate (EBC) acidity are insufficiently explored. The study aimed to evaluate potential changes in EBC pH within 2 hours following cigarette or food consumption. In 15 healthy smokers, samples were obtained after 10 hours of abstinence from smoking and then 15, 30, 60, and 120 minutes after smoking 1 cigarette. In 19 healthy nonsmoking adults, EBC samples were obtained in the morning after an overnight fast, and then 30, 60, and 120 minutes following standardized breakfast. Smoking of 1 cigarette after overnight tobacco abstinence induced significant increase in EBC pH during the 2-hour observation period, for approximately 0.60 logarithmic units (repeated-measures analysis of variance [ANOVA], P < .0001). The average presmoking pH value in smokers (7.00 ± 0.50) was significantly lower than average value in nonsmokers (7.62 ± 0.31; P = .0001). No effect of food consumption was found. These results show that cigarette smoking acutely increases EBC pH in healthy smokers. Smoking status and abstinence from smoking before EBC sampling seems to be important in studies evaluating EBC pH and should be standardized or at least stated in the methodology. Acute effects of food were not found under described study conditions in healthy adults.

Little research has been published on the indicators of spoilage in Mediterranean molluscan shellfish and crustaceans. Thus is why we studied changes in the concentrations of endotoxin and four biogenic amines (histamine, putrescine, tyramine and cadaverine) in European common squid (Loligo subulata, Lamarck, 1798), musky octopus (Eledone moschata, Lamarck, 1798), Norway lobster (Nephrops norvegicus, Linnaeus, 1758), and mussel (Mytilus galloprovincialis, Lamarck, 1819) from the Adriatic Sea stored at room temperature for 24 h. Endotoxin load in fresh squid, Norway lobster, and mussel (<1 EU mg-1) indicated good microbiological quality of raw samples. Biogenic amine index (as the sum of histamine, putrescine, tyramine, and cadaverine) correlated well with endotoxin load in squid (r=0.978, p<0.001) and musky octopus (r=0.874, p<0.01). A good correlation was also found between endotoxin and putrescine in Norway lobster (r=0.777, p<0.05). The highest endotoxin load was found in decomposed mussels and was associated with histamine alone. In conclusion, increase in biogenic amine levels is species-specific. Endotoxin analysis could be used for rapid assessment of microbiological quality of cephalopods and shellfish.

We report a case of immeasurable levels of serum phosphate in a patient with juvenile type Diabetes mellitus and diabetic ketoacidosis who developed respiratory failure. A 27-year-old female with juvenile type insulin-dependent Diabetes mellitus was admitted because of suspected acute mediastinitis and respiratory failure, probably, among other responsible factors, caused and complicated by undetectable levels of serum phosphate. The serum phosphate concentration three days after aggressive treatment was only 0.2 mmol/L. Furthermore, a significant improvement in weakness and lethargy was observed. To the best of our knowledge, this is the first described case of immeasurable levels of serum phosphate. In patients with Diabetes mellitus, serum phosphate concentrations should be routinely checked in order to avoid additional complications.

Poultry farms contain high levels of allergenic fungi, and Aspergillus spp. is the most common genus of moulds. Aspergillus fumigatus antigens are responsible for the development of several respiratory diseases including asthma. The aim of this study was to measure the mass fraction of Asp f 1, a major allergen of Asperillus fumigatus in 37 indoor dust samples collected from four poultry farms in a rural area of the Zagreb County (Croatia) using the enzyme-linked immunosorbent assay. More than 62 % of dust samples had detectable Asp f 1 levels (limit of detection 3.6 ng g(-1)). The overall mean Asp f 1 level was 17.9 ng g(-1) [range (3.8 to 72.4) ng g(-1)]. Satisfactory results were obtained for analytical within-run imprecision (6.7 %), between-run imprecision (10.5 %), and accuracy (91 % to 115 %). Microclimate parameters (air temperature, relative humidity, and velocity) were within the recommended ranges in all poultry farms. This study has shown that Asp f 1 settles on dust at poultry farms and that occupational exposure to this allergen deserves monitoring in livestock buildings.

Wood processing is usually performed in environments with large amounts of endotoxin-rich bioaerosols that are associated with a variety of health effects. The aim of this preliminary study was to assess the relation between endotoxin levels in settled and airborne dust in wood-processing industry. Ten pairs of airborne and settled dust samples were collected in a sawmill and parquet manufacture of two wood-processing plants in Croatia. Endotoxin was assayed with a chromogenic end-point LAL (Limulus amebocyte lysate) method. The results showed that endotoxin levels in airborne respirable dust were above the proposed occupational exposure limit of 125 EU m(-3) and could be considered hazardous for the respiratory system. In settled dust they ranged between 229.7 EU mg(-1) and 604.3 EU mg(-1) and in airborne dust between 166.8 EU mg(-1) and 671.6 EU m(-3), but there was no significant correlation between them (Spearman's rho=0.358, P=0.310). This study points to sawmill settled dust as endotoxin reservoir and suggests that it may add to already high exposure to airborne endotoxins associated with wood processing. Investigations of the relation between settled and airborne endotoxin levels should be continued to better understand the sources and sites of endotoxin contamination in wood-processing industry.

Farm and sawmill workers are exposed to high levels of allergenic fungi, such as Alternaria alternata, which are associated with respiratory diseases and asthma. The aim of this study was to measure the concentration of Alt a 1, a major allergen of A. alternata, in indoor dust samples collected in poultry farms and a sawmill using a monoclonal antibody-based enzyme immunoassay. A total of 45 dust samples were collected in poultry farms (30) and the sawmill (15) in Zagreb County (Croatia). The Alt a 1 allergen was detected in all dust samples (100%) collected in three poultry farms. The levels of Alt a 1 were in the range of 0.1-14 microg/g, and the median value was 0.37 microg/g. About 86% of dust samples contained Alt a 1 in the range of 0.1-1.0 microg/g. In the sawmill, no detectable level of Alt a 1 was found (limit of detection =0.12 microg/g). This study has shown that occupational exposure to Alt a 1 allergen in poultry farms deserves monitoring.

Purpose: The aim of the study was to evaluate exposure to moulds and house dust mite Dermatophagoides pteronyssinus in poultry farms, and related health effects in poultry workers (PW)., Methods: The study involved 41 PW and 45 control office workers. Working environment was evaluated for D. pteronyssinus allergen (Der p 1), moulds and endotoxin. In workers, eye, skin and respiratory symptoms, ventilatory lung function, atopy markers (skin prick test to inhalatory allergens, total IgE) and specific IgG to moulds were assessed., Results: Der p 1 levels ranged <0.1-3.3 microg/g, exposure to fungi was 4.9 x 10(3)-6.8 x 10(4) cfu/m(3), with prevailing Aspergillus, Penicillium and Mucor species, and endotoxin levels ranged 230-284 EU/m(3). In comparison to control subjects, significantly higher prevalence of work-related nose, asthma, eye and skin symptoms, and slight decline in ventilatory lung function was found in PW. PW had significantly higher prevalence of IgG antibodies to moulds comparing to controls (63 vs. 36%, respectively, P = 0.01), especially to Alternaria and Aspergillus species. The prevalence of atopy markers in PW was lower than in population-based studies., Conclusions: Hazardous levels of Der p 1, endotoxin and moulds were determined in poultry houses. High prevalence of work-related symptoms and IgG antibodies to moulds was found in PW. Healthy worker effect is proposed as an explanation of low atopy markers prevalence among PW.

New regulations on the protection and rights of workers occupationally exposed to asbestos were introduced in Croatia in 2007 and 2008. They have been harmonised with the European Union (EU) and International Labour Organization (ILO) regulations, and make a step forward in safety at work, health protection, social rights, and pension schemes for Croatian workers occupationally exposed to asbestos. The 2007 Croatian regulation on the protection of workers from the risks related to exposure to asbestos at work defines and describes activities in which workers can be occupationally exposed to asbestos, defines the threshold value of asbestos in the air at work, defines valid methods for measurement of asbestos concentrations in the air, and establishes measures to reduce asbestos exposure at work or protect the exposed workers. Croatian law regulating obligatory health surveillance of workers occupationally exposed to asbestos from year 2007 defines activities and competent authorities to implement health surveillance of workers occupationally exposed to asbestos and to diagnose occupational diseases related to asbestos. This law also defines "occupational exposure to asbestos", and "occupational asbestos-related diseases", including asbestosis (pulmonary asbestos-related fibrosis), pleural asbestos-related disorders (plaques, pleural thickening, and benign effusion), lung and bronchial cancer, and malignant mesothelioma of serous membranes. These regulations have been harmonised with ILO, Directive 2003/18/EC amending Council Directive 83/477/EEC on the protection of workers from the risks related to exposure to asbestos at work, and with the Commission Recommendation 2003/670/EC concerning the European schedule of occupational diseases. The 2008 Croatian regulation on conditions of health surveillance, diagnostic procedures and criteria for confirmation of occupational asbestos-related diseases "defines the terms and the content of medical examination of workers exposed to asbestos, and criteria for the confirmation of occupational asbestos-related diseases which are harmonised with the Helsinki criteria acknowledged by ILO and EU, particularly concerning the level and length of exposure. Croatian law on compensation of workers occupationally exposed to asbestos from 2007 regulates compensation claims for workers with occupational asbestos-related disease, authorities competent to process these claims, and funds and coefficients for compensation payments. Accordingly, Croatia is responsible for compensation claims payment for workers with occupational asbestos-related disease. The 2007 law on conditions for entitlement to full pension for workers exposed to asbestos at work defines the conditions for fulfilling criteria for retirement pension for workers exposed to asbestos at work.

Life-threatening hemoptysis is very rare and, fortunately, not many physicians have experienced it. The unpredictability of massive hemoptysis is often underestimated in seemingly stable patients and becomes fatal within a few minutes. The current definitions of massive and/or life-threatening hemoptysis in the medical literature are inadequate and the specific recommendations for the management of such conditions, based on sporadic case reports, are inadequate as well. We report herein a case of active tuberculosis-related exsanguinating hemoptysis (>1500 mL of blood within minutes) in a 26-year-old male, which illustrates the essential issues in the management of this condition; the pertinent literature is also reviewed. After a cardiac arrest with successful resuscitation, in an effort to reduce the risk of recurrent hemoptysis, we introduced a bronchial blocker (i.e., a Fogarty catheter), as guided by a fiberoptic bronchoscope, into the right main bronchus through several days earlier performed percutaneous tracheostomy because of patient's respiratory insufficiency. Several factors played a crucial role in the patient's survival. The main purpose of this case report is to contribute to the management of hemoptysis that leads to exsanguination within minutes and the originality of this report entails the introduction of bronchial blocker through the percutaneous tracheal cannula.

Different psychosocial characteristics have been associated with allergic disorders. The aim of this study was to examine whether atopic constitution and reports of allergic symptoms were related to personality trait of neuroticism, exposure to stressful life events and estimates of quality of life. Atopy was determined by skin prick test and reports of nasal and pulmonary allergy-related symptoms. Actively working individuals of both genders took part in the study (n=145, age range: 20 to 66 years). The participants were divided in three groups. The first group was composed of those with negative skin prick test and without symptoms (n=57), the second of those with positive skin prick test but without symptoms (n=28), and the third of those with positive skin prick test and symptoms (n=60). The groups did not differ significantly in neuroticism, exposure to stressful life events, or quality of life. Women reported more pronounced neuroticism and anxiety, higher exposure to stressful life events, and were less satisfied with their environment than men. In our sample of active workers we found no association of neuroticism, exposure to stressful life events, and quality of life with atopy and allergic symptoms.

The aim of this study was to obtain preliminary exhaled breath condensate (EBC) pH values for healthy adult Croatian subjects, and to evaluate criteria for defining respiratory health of population providing normal EBC pH values in epidemiologic studies. In 109 adults without a history of lower airway symptoms (AS), four groups were described by narrowing the definition of "health" down to 1) without lower AS; 2) without lower and upper AS; 3) without AS, with normal FEV(1) and bronchial normoreactivity; 4) without AS, with normal FEV(1), bronchial normoreactivity, normal total IgE, and with negative skin prick test. Median EBC pH values did not differ between the groups (7.72, 7.73, 7.73, 7.73), but as health criteria got stricter, we observed a slight, nonsignificant increase in minimal pH values (6.95, 7.10, 7.20, 7.37). Median EBC pH values with interquartile range in the total sample (7.72; 7.63 to 7.76) were within the range previously reported by other authors. They did not differ regarding sex, smoking habit and atopic status, and were not associated with age, FEV(1) or total IgE. The non-significant trend in EBC pH observed with stricter criteria of respiratory health and atopic status indicates the need for further research on criteria for defining healthy population in a larger sample.

Whole Atlantic mackerel (Scomber scombrus), sardine (Sardina pilchardus) and Mediterranean hake (Merluccius merluccius) from the Croatian Adriatic were stored at 22 degrees C and changes in histamine, putrescine, tyramine and cadaverine levels were monitored in relation to bacterial endotoxin. After 12 h, histamine levels in sardine were above the legal limit of 50 mg kg(-1), set by the US Food and Drug Administration, and an increase in putrescine content preceded the increase in histamine. After 24 h, histamine contents in mackerel and sardine reached 1090 +/- 101 and 577 +/- 275 mg kg(-1), respectively, which exceeded the toxic threshold of 500 mg kg(-1). At the same time, the putrescine content was also high in both fish (353-420 mg kg(-1)). The time-course of endotoxin production was similar in all fish species stored at 22 degrees C. A high correlation was found between endotoxin and histamine, and between endotoxin and putrescine in mackerel and sardine. On the other hand, high endotoxin levels in hake, after 24 h, were associated with the low histamine and putrescine content (40-60 mg kg(-1)).

The association of age, smoking, alcohol, superoxide dismutase (SOD), glutathione peroxidase (GPx), blood lead (BPb) and cadmium (BCd) levels, and serum levels of copper (SCu), zinc (SZn) and selenium (SSe) with atopic status and ventilatory function was examined in the groups of 166 women and 50 men with no occupational exposure to metals or other xenobiotics. Markers of atopy included serum total IgE, skin prick test (SPT) to common inhalatory allergens, non-specific nasal reactivity (NNR) and non-specific bronchial reactivity (NBR). Parameters of ventilatory function included forced vital capacity (FVC) and forced expiratory volume in the first second (FEV(1)). Significantly higher BPb, SZn, IgE and prevalence of positive SPT, and lower SCu and NNR was found in men than in women. Fifteen women taking female sex hormones (HT) had significantly higher SCu than women without HT. Regression models showed significant inverse associations between IgE and SCu (P=0.021) and NNR and SCu (P=0.044) in women. When excluding women with HT, the association of SCu and total IgE became of borderline significance (P=0.051), association between SCu and NNR disappeared, and significant positive association between total IgE and BPb emerged (P=0.046). In men, significant inverse association was found between positive SPT and SSe, and between NBR and SSe. A decrease in FVC% and FEV(1)% was associated with an increase in smoking intensity (P<0.001) and a decrease in SZn (P=0.043 and P=0.053, respectively). These results were observed at the levels of the metals comparable to those in general populations worldwide. The observed differences between men and women may partly be explained by different levels of relevant toxic and essential metals, and their combination. The role of female HT in associations of atopy markers and SCu should be further investigated.

The aim of this study was to determine the level of two major mite allergens Dermatophagoides pteronyssinus (Der p 1) and Dermatophagoides farinae (Der f 1) in 30 urban homes in Zagreb, Croatia, using the enzyme immunoassay with two monoclonal antibodies which has been established as the reference method for indoor allergen analysis. Dust samples were taken by vacuuming a carpeted area and collected on cellulose filters. The ranges of Der p 1 and Der f 1 were (0.1-12.5) microg g-1 (median 0.32 microg g-1) and (0.1-31.2) microg g-1 (median 0.35 microg g-1), respectively. Der p 1 and Der f 1 (>2 microg g-1) associated with increased risk of sensitization to mite allergens were found in approximately 16% homes for each allergen. The sum of allergen (Der p 1 + Der f 1) exceeded the lower threshold in 27% of homes. Analytical evaluation of the ELISA assay showed satisfactory results for precision (intra-assay CV <6.9%, inter-assay CV<13.3%), accuracy (91% to 93%), and sensitivity (2 ng mL-1). The ELISA assay for the measurement of dust mite allergens demonstrated very good analytical characteristics for routine laboratory use, and will provide the essential basis for our future studies of various indoor allergens.

The authors aimed to examine potential relationships between work-related symptoms attributed to sick building syndrome (SBS) and certain psychological, somatic, and environmental factors. The multidisciplinary, cross-sectional study comprised 171 female subjects working in air-conditioned and naturally ventilated nonindustrial office buildings. The authors collected information concerning symptoms related to SBS and made assessments of quality of life by using appropriate questionnaires. They assessed the women's levels of emotional stability or neuroticism using the Cornell Index. They determined skin and airway reactivity markers and indoor microclimate data by using standardized methods. The study showed that the subjects had a high prevalence of fatigue (60.2%), sore and dry eyes (57.9%), and headache (44.4%), as well as a generally high score according to the SBS Index. Neuroticism and subjectively estimated physical health as well as the type of building ventilation significantly contributed to the prediction of the SBS Index, explaining 15% of the variance.

Background: Reports on hypersensitivity reactions to azithromycin associated with therapy or occupational exposure have been rare., Objectives: A case series describing clinical characteristics, diagnostic pathways and risk factors in occupational allergic contact dermatitis (ACD) caused by azithromycin in pharmaceutical workers is presented., Patients/methods: 7 out of 21 pharmaceutical workers exposed to powdered intermediate and final substances in azithromycin synthesis were referred with workplace-related skin and respiratory symptoms. They all underwent diagnostic procedure involving medical history and examination, patch testing with standard allergens and azithromycin, prick testing with inhalatory allergens and total immunoglobulin E measurement., Results: Airborne ACD caused by azithromycin was established in 4 examined workers with positive patch test to azithromycin. 2 workers additionally had positive patch test to intermediate substances. Occupation-related symptoms of urticaria, rhinoconjunctivitis, laryngitis and/or dyspnoea were described in additional 2 workers without clearly positive patch test to azithromycin. 2 atopic workers had a shorter asymptomatic period between the beginning of the exposure to azithromycin and occurrence of skin symptoms than non-atopics (2-3 months versus 1-3 years, respectively)., Conclusions: Our results suggest that daily manipulation with powdered azithromycin and intermediates is a main route of sensitization. Besides contact sensitization, other possible workplace-related azithromycin hypersensitivity reactions are indicated.

Exposure to toxic gases which can induce serious health effects, can occur in the working as well as in general environment, including home. The severity of gas poisoning is determined by its physical and chemical characteristics, intensity and duration of exposure, and concomitant diseases and injuries in the poisoned person. Manifestations of gas toxic action involve simple asphyxia, local irritation of respiratory mucosa, systemic toxicity, and a combination of these mechanisms. This article describes the characteristics, modes of exposure and health effects of most common gases causing poisoning at home. These include gas fuels, carbon monoxide, ammonia, chlorine, and fire gases such as nitrogen and sulphur oxides, hydrogen cyanide and phosgene. First aid as well as preventive measures to avoid exposure to toxic gases and prevent fire at home are also given. The Croatian Poison Control Centre gathered data on toxic gas exposures in households between November 2005 and July 2006. During this period 30 persons (3 % of the total number of cases) were exposed to toxic gases at home, including carbon monoxide, irritating vapours from cleaning agents and disinfectants, gas fuels, septic tank gases, tear-gas, and chlorofluorocarbons from refrigerators.

Pyrethrins, natural extracts of Chrysanthemum cinerariaefolium and Chrysanthemum cocineum flowers, and pyrethroids, synthetic analogues and derivatives of pyrethrins, are powerful insecticides. They are widely used in households and insect control in pets or livestock, in textiles such as carpets, wallpapers, furniture and clothes, as well as in agriculture, forestry and public health services. This article brings a list of pyrethrin and pyrethroid insecticides registered for use in plant protection in Croatia. Pyrethrins and pyrethroids can enter the organism by ingestion (accidental or suicidal ingestion or in food), by inhalation and/or by skin contact. Although these pesticides pose a relatively low risk to mammals due to rapid metabolism with no significant accumulation, they can induce adverse health effects, more often in acute poisoning, but also due to chronic exposure. The primary target of pyrethrin and pyrethroid toxicity is the nervous system, since they act directly on the sodium channels of nerve cell axons, leading to hyperexcitation. Another important toxicological mechanism is allergenicity, which is more pronounced with pyrethrins than with synthetic pyrethroids. Because there is no antidote for pyrethrin and pyrethroid poisoning, treatment is symptomatic and supportive. The article discusses the measures for poisoning prevention and alleviation of exposure to pyrethrins and pyrethroids in occupational settings and in general population.

A 70-year old female patient was admitted to the hospital because of scheduled thoracotomy and biopsy of posterior mediastinal retrocardiac tumor of unrecognized etiology. The patient had no complaints regarding the tumor. Routine anesthesiological preoperative examination revealed status ASA III. Induction in anesthesia was usually stable. At the moment when the surgeon intraoperatively touched the tumor, hemodinamic instability started and arterial blood pressure and heart rate dramatically increased. Our first reaction was to deepen the anesthesia. Very soon it was obvious that blood pressure increased by the surgeon's manipulation of the tumor and we started to doubt on catecholamine-secreting tumor. During the course of the operation there were several hypertensive episodes and we managed them by alternately using atenolol, glyceroltrinitrate and anesthetic drug. The patient was extubated 5 hours after transfer to the intensive care unit. Postoperative period was hemodynamically stable. The level of catecholamines in 24-hour urine collection was significantly increased. Pathohistologic diagnosis was mediastinal paraganglioma.

This study estimated the exposure to dust mites in various occupational environments in Croatia. In total, 29 occupational dust samples were collected: 10 from urban areas (offices, archive of an insurance company, tobacco, paper-recycling, fish-processing and textile plants, animal unit for experimental rats, winery), nine from rural areas (barley, hay, animal food and flour warehouses, tailor's shops, wood processing plant, swine confinement house, grocer's storeroom), and 10 samples from cabins of five fishing boats (five floor and five bed samples). Mites were microscopically identified, and the levels of Der p 1, Der f 1, and Der 2 allergens measured using the DUSTSCREEN test (Heska AG, Switzerland). Microscopy showed no mites in urban areas. Pyroglyphid mites (D. pteronyssinus) were found in all bed samples from fishing boats. Non-pyroglyphid mites were found in samples taken from barley, hay and animal food warehouses, the swine confinement house, grocer's storeroom, and fishing boats. Pyroglyphid mite allergens were detected in eight of 10 dust samples from the fishing boats. Median levels of Der p 1, Der f 1, and Der 2 in cabin bed samples were 10 microg g(-1), 0.2 microg g(-1), and 3.5 microg g(-1), respectively. Our findings on fishing boats suggests that pyroglyphid mites could be considered work-related allergens for fishermen. The results of this study confirmed non-pyroglyphid mites as occupational risk factors in various rural environments.

The aim of this study was to see which harmful substances and which occupational settings most often required toxicological assessment, to evaluate exposure data provided by employers and to see to what extent could this assessment rely on actual measurements of harmful substances in a working environment. We reviewed the documentation that was submitted for toxicological assessment in all patients referred from occupational health physicians between 1992 and 2001. From 1992 to 2001, the Poison Control Centre performed a total of 260 toxicological evaluations of occupational exposure to harmful chemicals. In 162 cases (62%), measurements of harmful substance concentrations in the working environment would have been of primary significance for the best comparison of potential adverse effects and the level of exposure. The most frequent was exposure to organic solvents in the production line and the use of various paints and varnishes, adhesives and thinners in shoe, chemical and metal-processing industry. Follows exposure to respiratory irritants, mostly in plastic and metal processing. However, measurement data of harmful substances in the working environment were available only in 24 cases, that is, in 9% of all documents submitted for toxicological assessment. Exposure to organic solvents is characteristic for a large number of work places in industry and small enterprises in Croatia, and it is necessary to carry out a more comprehensive study about the real levels of exposure and modes of effective control. It is important because the EU regulations on the indicative occupational exposure limits (OELs) of harmful substances in the working environment, that will soon be implemented into Croatian legislation, recommend a reduction of maximum allowable concentrations (MAC) for commonly used solvents.

This paper gives a review of the most important impacts of exposure to dust mites in general and working environment on human health. The Institute for Medical Research and Occupational Health in Zagreb, Croatia, has been investigating the frequency and exposure levels of allergies to pyroglyphid and non-pyroglyphid mites in Croatia for the last 10 years. Investigations were performed in general urban and rural population from the inland and coastal Croatia, and several industrial inland populations occupationally exposed to organic dusts. Mite species and levels of pyroglyphid mites allergens (Der p 1, Der f 1) were established in house dust samples taken from the floors of bedrooms and living rooms and in several industrial dust samples. The frequency of allergies to pyroglyphid mites in general urban population of inland Croatia is about 20%, with significant general indoor exposure to these mites (median value for Der p 1: 0.85 microg/g of dust). General adult population of the coastal region had a significantly higher exposure to pyroglyphid mites (median value for Der p 1: 4.5 microg/g of dust), yet showed a significantly lower frequency of allergies to these mites (about 5%). New studies are necessary to investigate possible genetic and environmental factors involved in the mechanisms which protect coastal population from the development of mite allergy. Acarological and statistical analyses have shown that the high frequency of sensitisation to non-pyroglyphid mites found in the general and working populations of the inland region is not related to environmental exposure to these mites, but to the cross-reactivity between pyroglyphid and non-pyroglyphid mites and to false positive skin reactions in prick testing, particularly to T. putrescentiae. So far, results do not indicate that pyroglyphid mites are occupational allergens in paper-recycling, fish-processing and tobacco-processing.

The aim of this study was to investigate skin reactivity to organic dust extracts and total serum IgE and their relation to the prevalence of respiratory symptoms and ventilatory capacity in workers occupationally exposed to organic aerosols. It included workers employed in processing coffee, tea, dried fruits, spices, animal food, soy, hemp, cotton, swine farmers, and control groups of workers non-exposed to organic dust. All underwent a skin prick test (SPT) with water extracts of organic dust 1:10 w/v, Dermatophagoides pteronyssinus, mixed moulds, bacteria, histamin solution (1 mg/ml) and buffer solution. SPT was considered positive if the diameter of the observed wheal was 3 mm greater than that of buffer solution. The total IgE was measured by the PRIST method (Pharmacia Diagnostics AB, Upsala) and the values > 125 kU/L were considered increased. Data on respiratory symptoms were collected by standardized questionnaire. Ventilatory capacity was measured by recording MEFV curve. Airborne industrial dust were measured as total and respirable fraction. The exposed workers had a greater prevalence of positive SPT to organic dust extracts, except in soy processing. Increased IgE was found in workers processing coffee, tea, hemp, cotton and animal food, compared to non-exposed workers (P<0.05). Workers with positive SPT had a significantly higher total IgE. As there was no correlation between acute and chronic changes in ventilatory function, positive SPT, and level of total IgE, our findings could not predict objective respiratory impairment.

The aim of this study was to compare exercise-induced bronchial reaction between healthy control subjects and subjects with allergic rhinitis (AR) and allergic asthma (AA). It included 16 controls, 16 subjects with AR and 19 subjects with AA. A skin prick test, pulmonary function test, histamine challenge test and exercise challenge test (ECT) were performed in all subjects. Bronchial reaction to exercise was expressed as the fall index FEV1 (%), AUC(0-30) (min x %), and fall index FEF(25-75) (%). After ECT, subjects with AA had a significantly greater bronchial reaction to exercise than subjects with AR and controls (respective fall index FEV1 8.4, 2.9, and 2.4%, P=0.0083; AUC(0-30) 127.7, 29.6, and 33.1 min x %, P=0.025; and fall index FEF(25-75) 14.6, 0.06, and 1.9%, P<0.001). No difference was found between subjects with AR and controls. In conclusion, ECT induced a significantly greater bronchial reaction in patients with AA and bronchial hyperreactivity to histamine than in patients with AR and bronchial normoreactivity to histamine and controls. This difference was not found between subjects with AR and controls.

Stress is one of the components in the complex interaction of environmental, genetic, physiological, psychological, behavioural and social factors that can influence the body's ability to remain healthy or become healthy, to resist or overcome a disease. Stress can alter neuroendocrine and immune mechanisms of health and disease through various psychosocial processes. In addition, it can affect health through the impact on health-impairing behaviours and on compliance with medical regimens. At the same time, the relationship between stress and health is not unidirectional but bi-directional. Current views on the relation between stress and allergy vary from the denial of any relationship that could fundamentally help in allergy treatment to the widespread opinion that psychological stress can exacerbate some skin symptoms and precipitate asthma. The role of stress in the genesis, incidence and symptomatology of allergy still remains a controversial issue since the mechanisms of that relationship are not well understood. Starting from the biopsychosocial model of disease, we introduced the Social Readjustment Rating Scale which measures stressful life events, and the WHOQOL-BREF which measures subjective quality of life, into an extensive multidisciplinary study of immunotoxic effects of indoor bioaerosols and lifestyle. This paper describes the characteristics of those two questionnaires and discusses the relationship between stress and various domains of the quality of life. The Social Readjustment Rating Scale proved to be a reliable predictor for quality of life in the domains of physical health and environment. Future analyses will examine the role of stress and subjective quality of life in allergy.

Endotoxin is a lipopolysaccharide, a part of gram-negative bacteria cell membrane commonly present in general and many occupational environments. This paper describes sample preparation and endotoxin measurement in 16 samples of house dust from urban homes (Zagreb, Croatia) using end-point chromogenic Limulus amoebocyte lysate (LAL) bioassay. House dust was collected on cellulose filters by vacuuming bedroom and living room floors, and was kept frozen until assayed. Samples were extracted from filters with a 0.05% solution of Tween-20 in endotoxin-free water. Serial dilutions of samples were measured in duplicates. The linearity of the standard curve was satisfying (r=0.983), as well as the recovery (92 and 110%) and repeatability (coefficient of variation from 0 to 8.5%). The endotoxin levels found in the house dust samples ranged from 4.8 to 200 EU/mg, with the arithmetic mean of 49.5 EU/mg (standard error of the mean of 12.1 EU/mg), and were in the range of house dust endotoxin values obtained by other authors.

Background: Tobacco workers develop respiratory changes following occupational exposure to tobacco dust., Methods: This study investigated 102 tobacco workers as well as a group of 30 matched control workers. Immunological testing, symptom questionnaire, and lung function measurements were performed in all workers., Results: Increased total IgE was found in 12.7% of tobacco workers but in none of the controls (P < 0.05). Increased specific IgE (tobacco allergen) was recorded in 26.7% of tobacco workers with positive skin tests to tobacco extract but in none of the controls (P < 0.05). Regression analysis of ventilatory tests in female tobacco workers indicated a significant association of FEF75 to employment and smoking among workers with positive skin tests to tobacco. There were, however, no other associations between positive immunologic findings and lung function abnormalities and symptoms., Conclusions: Our study found increased immunological reactions in the tobacco workers. However, with the possible exception of lung function at low lung volume in female workers, these reactions do not appear to contribute significantly to the symptoms and lung function abnormalities seen in these workers. Am. J. Ind. Med. 45:76-83, 2004., (Copyright 2003 Wiley-Liss, Inc.)

Aim: To evaluate German cockroach (Blattella germanica) allergen levels in house dust and skin reactivity to German cockroach in adult atopic and non-atopic subjects in inland areas of Croatia., Methods: Blattella germanica group 2 (Bla g 2) allergen was measured using the enzyme-linked immunosorbent assay (ELISA) on test strips (Dustscreen(TM) test, Heska AG, Switzerland) in 94 house dust samples collected from living room and bedroom floors, 35 from rural and 59 from urban areas. Skin prick testing with common inhalatory allergens, Blatella germanica, storage mites Lepidoglyphus destructor and Tyrophagus putrescentiae (ALK-Abello, Denmark) was performed in 187 adult outpatients, 131 from urban and 56 from rural areas. Total serum IgE levels were measured using the ELISA method. Subjects with relevant respiratory and/or skin symptoms, at least one positive skin prick test, and/or increased total IgE were considered atopic., Results: Positive skin prick test to cockroach was observed in 18/187 subjects (9.6%). The frequency of skin prick test positive subjects to cockroach was higher in atopic than in non-atopic subjects, but not significantly (12.2% vs. 4.7%; p=0.098). Of 15 atopic subjects with positive skin prick test to cockroach, 14 also had positive skin prick test to storage mites, 8 to house dust mites, 1 to pollens, and none to cockroach only. Positive skin prick test to storage mites was the only factor which significantly increased the risk for having positive skin prick test to cockroach (n=187; odds ratio, 109.82; 95% confidence interval, 2.06- 5853.5; p= 0.020). In all 94 house dust samples, Bla g 2 was not detectable., Conclusions: Our results suggest that there is no relevant exposure to cockroach allergen in house dust samples from inland areas of Croatia. Consequently, positive skin prick test to cockroach is rare in adult subjects, even in atopics. Positive skin prick test to cockroach in atopics is in the majority of cases related to positive skin prick test to storage mites, probably due to cross-reactivity.

The prevalence of allergic diseases is rapidly increasing over the last 40 years, especially in most industrialized countries of the world. Manifestations of allergic diseases are observed in about 35% of the general population. In this paper, the most frequent allergic respiratory and skin diseases are described (rhinitis, asthma, atopic eczema/dermatitis syndrome, contact eczema/dermatitis, urticaria). The most important individual and environmental factors involved in the occurrence of allergic diseases are described: genetic predisposition, exposure to allergens, environmental pollution and modern life style are discussed. The results of our investigations related to the prevalence of allergy markers in general and working population are presented. The preventive measures concerning allergic diseases are considered.

The aim of this study was to determine the prevalence of markers of atopy and contact sensisation in asymptomatic young adults and to assess their role in pre-employment screening. The study included 351 subjects, of whom166 women (mean age 28.0 + / - 6/4 years) and 185 men (mean age 26.3 + / - 5.4 years). The pre-employment examination commissioned by a pharmaceutical company included a questionnaire, the patch test with the European standard series of contact allergens prick test with common inhalatory allergens, and the serum-specific IgE measurement. According to the medical history 115/166 (69.3%) women and 142/185 (76.8%) men were asymptomatic, but 28 (24.3%) asymptomatic women and 40 (28.2%) showed atopy and/or contact sensitization. Pre-employment allergy examination can be considered a reliable detection procedure for the majority of asymptomatic persons with atopy and contact sensitization. The knowledge of these conditions gives the opportunity for secondary prevention and better diagnostic validation of occupational allergic diseases.

Of 4736 poisoning incidents registered in the Poison Control Centre in Zagreb from 1985 to 1999, household chemicals caused 23%. In the group of cleaning products, 11% of poisoning incidents were caused by corrosives, 9% by liquid detergents and 4% by hypochlorite. Organic solvents caused 18% of household chemical poisonings; among them gasoline and thinners were the most frequent. Cosmetics were responsible for 7% of poisoning incidents; the most frequent were hair shampoo, hydrogen peroxide, and acetone. In the group of other chemicals, the most common were ingestion of thermometer mercury and of silica gel, while poisonings with highly toxic antifreeze, mothballs, or liquid fertilisers were rare. Ingestion or other exposure to household chemicals often caused excessive concern and therapeutic measures. It is therefore advisable to consult a Poison Control Centre in order to get proper information about the composition of a chemical and toxicity of a product.

The aim of this study was to analyse the frequency of poisoning with psychoactive drugs (benzodiazepines, antidepressants and neuroleptics) over the last 15 years in Croatia. The analysis was based on poisoning incidents reported over the phone (hot line) to the Zagreb Poison Control Center and included two periods: 1985-1991 (period I) and 1992-1999 (period II). The data were analysed separately for children and adults. Each phone call was counted as one poisoning incident. Child poisoning with neuroleptics was significantly higher in period II than in period I and so was the adult poisoning with antidepressants, amytriptyline, and combined psychoactive drugs. The frequency of total psychoactive drug poisoning was significantly higher in adults than in children in both periods. From 1992, the frequency of adult poisoning with antidepressants considerably increased as one of the many consequences of war-related stress. The results indicate a need for careful psychiatric evaluation and more critical use of antidepressants in affected individuals.

Exercise-induced bronchospasm (EIB) is a type of nonspecific bronchial hyperreactivity. It affects mostly children and younger adults with asthma (75%-95%) and allergic rhinitis (40%), but it is also found in 3-11% of the nonasthmatic and nonatopic younger population. Pathophysiology of this phenomenon is not clear and there are some attempts to explain it with hyperosmolality of bronchial epithelia, exchange of heat and water (reactive hyperemia) in airways and reflex vagal bronchospasm. Unrecognized and uncontrolled symptoms of EIB can lead patients to avoid general and occupational physical activities and sports. Diagnosis of EIB is focused on medical history and on pulmonary function testing after standardized exercise testing protocols on treadmill, cycle ergometer or by free running. Non-pharmacological and pharmacological prophylactic measures are the most important approach in the therapy of EIB. Inhalation of beta 2-agonists or cromolyns is the first choice in pharmacological prevention of EIB. With adequate therapy, symptoms of EIB can be controlled enough to maintain everyday as well as sports activities.

This paper gives an overview of common outdoor and indoor allergens which cause sensitisation of the respiratory tract and considers relevant biological and ecological hallmarks and symptoms of allergies. Grass, tree, and weed pollens as well as moulds (Cladosporium and Alternaria species) are a major source of allergens in the outdoor environment whereas mites (Pyroglyphidae, Acaridae, and Glycyphagidae), animals (pets, rodents, and insects), and moulds (Aspergillus, Penicillium, and Mucor species) are a major source in the indoor environment. The paper pays attention to the seasonal, geographical, and climatic influence on the concentration of allergen in the environment. The authors discuss differences between exposure to outdoor and indoor allergens, as well as the impact of pollutants on sensitisation of the respiratory tract. The paper proceeds with a short description of the primary prevention measures such as avoidance of the allergens and the secondary measures which are intended to prevent the occurrence or deterioration of respiratory symptoms in sensitised persons.

Aim: Determination of prevalence of sensitization to Dermatophagoides pteronyssinus, Dermatophagoides farinae (pyroglyphid mites), Lepidoglyphus destructor, and Tyrophagus putrescentiae (non-pyroglyphid mites) in urban continental Croatia., Methods: Specific IgE (sIgE) and skin prick test (SPT) for D. pteronyssinus, D. farinae, L. destructor, and T. putrescentiae were performed in 67 men. SPT was performed with Epipharm-ALK allergens. A urtica (D+d)/2 of 3 mm or greater was considered a positive skin reaction. SIgE was measured by immunoCAP technology (UNI CAP). Values <0.35 kUA/L were considered nonspecific and >0.35 kUA/L increased., Results: The prevalence of subjects with positive SPT was 35.8% for T. putrescentiae, 26.8% for L. destructor (26.8%), and 22. 4% for D. pteronyssinus and D. farinae. The prevalence of increased sIgE for D. pteronyssinus and D. farinae was 23.9%, followed by T. putrescentiae (22.4%), and L. destructor (14.9%). Among subjects with increased IgE to D. pteronyssinus there were also increased IgE for D. farinae in 94%, for T. putrescentiae in 75%, and for L. destructor in 50%. Mean urtica diameter differed only for L. destructor between nonspecific and increased sIgE values in subjects with positive SPT (3.7+/-0.7 mm vs. 6.2+/-2.8 mm; p = 0.004). Sensitization to storage mites was accompanied by respiratory symptoms in similar proportions as that to house dust mites (51.8% and 54.5%, respectively; p = 0.8527)., Conclusion: Sensitization to non-pyroglyphid mites is present in the general urban population of Croatia in similar proportions as to pyroglyphid mites, with the same range of respiratory symptoms. Testing with storage mites should be considered routine allergological diagnostic procedure.

Sensitization to dust mites is in significant increase in the world and is known as independent risk factor for development of bronchial asthma. In this paper, important biological markers and environmental spread of dust mites are described as well as the epidemiology, the most frequent clinical patterns and standard diagnostic procedures of sensitization to dust mites. The importance of the environmental dust mites control is emphasized, particularly as a part of primary and secundary prevention of sensitization to dust mites.

The study included 17 female workers employed in latex glove rubber manufacturing plants. The mean age was 42 years and the mean duration of employment 19 years. Subjects were predominantly nonsmokers. A control group of 17 nonexposed workers was also studied. Chronic respiratory symptoms and diseases as well as acute work-related symptoms were recorded for these workers. Ventilatory capacity was measured by recording maximum expiratory flow-volume (MEFV) curves on which forced vital capacity (FVC), one second forced expiratory volume (FEV1) and maximum expiratory flow at 50% and the last 25% of the vital capacity (FEF50, FEF25) were read. Skin prick tests were performed with three types of latex (original material-latex 1, extract from gloves-latex 2, and extract of latex company Epypharm-latex 3). The prevalence of chronic respiratory symptoms was greater among latex workers (varying from 5.9% for occupational asthma to 58.8% for dyspnea) than among control workers (0%). There was a high prevalence of acute work-related symptoms, particularly for eye irritation (76.5%), dryness of the nose (70.6%), throat burning (70.6%), dryness of the throat (64.7%) and cough (58.8%). Measured ventilatory capacity data in latex workers were significantly lower in comparison to control, particularly for FEF25 (75.1 +/- 19.5%). Among latex gloves making workers one had positive skin reaction to latex 3 along with the symptoms of occupational asthma. Our data indicate that employment in latex making gloves may be associated with the development of occupational asthma, in addition to frequent nonspecific respiratory findings.

Background: Occupational exposure of brewery workers to organic dusts such as hops, barley, and brewery yeast has the potential to change respiratory function and immunological status., Methods: Ninety-seven male workers employed in a brewery plant were studied. The mean age of the workers in this plant was 40 years, the mean duration of their employment was 16 years. In addition, a group of 76 unexposed workers was studied as a control. Respiratory symptoms were recorded. Lung function was measured by recording maximum expiratory flow-volume (MEFV) curves. Immunological testing was performed on all brewery workers and some control volunteers using skin prick testing with hops, barley, and yeast antigens as well as other nonoccupational allergens, and by determining total serum IgE levels., Results: There was a significantly higher prevalence of most of the chronic respiratory symptoms in brewery workers compared to controls (P < 0.01). Occupational asthma, however, was recorded in only 2 (2.1%) of the brewery workers. Logistic regression analysis showed that smoking was the major studied factor responsible for the high prevalence of chronic respiratory symptoms in workers. A large number of brewery workers complained of acute symptoms that developed during the work shift. Lung function tests were decreased compared to predicted. Multivariate analysis of these respiratory function parameters suggested the importance of workplace exposure in explaining lung function abnormalities. Significantly higher prevalences of positive skin prick tests were recorded in 37 brewery workers for molds, hops, and barley than in controls. Increased serum levels of total IgE were documented in 34/97 (45.1%) brewery workers and in 1/76 (2.7%) of the control workers (P < 0.01). However, workers with positive skin prick tests had prevalences of chronic respiratory symptoms and lung function changes similar to those of workers with negative skin prick tests., Conclusion: Our data suggest that both smoking and dust exposure in the brewery industry may be responsible for the development of respiratory impairment and immunological reactions.

The respiratory function and immunological status of workers employed in the paper recycling industry were studied. The mean age of the 101 studied workers was 41 years, and the mean duration of their exposure was 17 years. A group of 87 unexposed workers of similar age, duration of employment, and smoking history was studied for the prevalence of chronic respiratory symptoms. Lung function in the paper workers was measured by recording maximum expiratory flow volume (MEFV) curves and recording forced vital capacity (FVC), 1-second forced expiratory volume (FEV1), and maximum expiratory flow rates at 50% and the last 25% of the FVC (FEF50, FEF25). Immunological studies were performed in all 101 paper workers and in 37 control workers (volunteers). These included skin-prick tests with paper-dust extracts and other nonoccupational allergens, as well as the measurement of total serum immunoglobulin E. Significantly higher prevalences of all chronic respiratory symptoms were found in paper compared with control workers (P < 0.01). The highest prevalences were found for chronic cough (36.6%), chronic phlegm (34.7%), chronic bronchitis (33.7%), sinusitis (31.7%), and dyspnea (18.8%). Occupational asthma was diagnosed in four (4.0%) of the paper workers. A logistic regression analysis performed on chronic respiratory symptoms of paper workers indicated significant effects of smoking and exposure, with the smoking effect being the most important. Multivariate analysis of lung-function parameters indicate significant effects of exposure. For paper workers, the measured FEF50 and FEF25 were significantly decreased, compared with predicted values, suggesting obstructive changes located primarily in smaller airways. Among 101 tested paper workers, 16 (15.8%) had positive skin-prick tests to at least one of the paper extracts; none of the control workers reacted to these extracts. Increased serum IgE levels were found in 21% of the paper workers and in 5% of control workers (P < 0.05). Paper workers with positive skin-prick tests to any of the paper and/or other tested extracts had higher prevalences of chronic respiratory symptoms and lower measured lung-function tests compared with predicted than did those with negative skin-prick tests, but the differences were not statistically significant. The measured concentrations of total and respirable dust in this industry were higher than those recommended by Croatian standards. Our study suggests that work in the paper-recycling industry is associated with respiratory impairment and that sensitive workers employed in this industry may be at particular risk of developing chronic respiratory abnormalities.

Sensitization to latex and rubber additives has been acknowledged during the last 10 years as a major occupational health problem among health-care workers. In sensitized persons, respiratory and/or skin symptoms may be present. Pathophysiologic mechanisms of senzitisation involve allergic reactions types I and IV (Coombs and Gell). In this case report we described a female health-care worker with sensitization to latex and rubber additives simultaneously present on the skin and in the respiratory system, caused by wearing protective rubber gloves. The complex diagnostic procedure involved in determination of occupational allergic diseases is discussed.

Respiratory function and allergic reactions were studied in 101 male workers in paper recycling and in 87 nonexposed male control workers. Ventilatory capacity was measured by recording maximum expiratory flow-volume (MEFV) curves with readings on forced vital capacity (FVC), one-second forced expiratory volume (FEV1), and maximum expiratory flows at 50% and the last 25% (FEF50 and FEF25, respectively). Skin prick test with paper dust allergens, some nonoccupational allergens, and total immunoglobulin IgE analysis were used to assess immunological status. Significantly higher prevalences of all chronic respiratory symptoms were recorded in the exposed workers than in controls. The highest prevalence was recorded for chronic cough (36.6%), followed by chronic phlegm (34.7%), chronic bronchitis (33.7%), sinusitis (31.7%), nasal catarrh (29.7%), and dyspnea (16.8%). Occupational asthma was diagnosed in four paper recycling workers only (4.0%). Values of FEF50 and FEF25 were significantly lower than predicted, indicating obstructive changes located mostly in the smaller airways. Skin tests to paper allergens were found positive in 16 (15.8%) paper recycling workers and none in controls. An increase in total immunoglobulin IgE was found in 21 of 101 paper recycling workers and in two of 37 of controls (P < 0.05). Our data indicate that exposure to air pollutants in paper recycling industry may lead to the development of respiratory symptoms accompanied by lung function and immunological impairment.