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Subjects with Nickel sensitization proved by patch test may suffer of contact eczema, but also of a Sistemic Nickel Allergy Syndrome (SNAS) consisting of urticaria-like troubles, itch, erythema, cutaneous rush, headache, intestinal symptoms, recurrent vesicular palmar dermatitis. 160 subjects (130 F, 30 M) were classified into three groups and underwent dosage of Nickel in urines (U-Ni) and blood (B-Ni). The two groups with SNAS showed an higher indicators of Nickel absorption, while the only-eczema group did not. 95 subjects with SNAS were enrolled for a Nickel-scanty diet: most of them improved. 24 ones again symptomatic were admitted to an experimental treatment, by a schedule of oral increasing microdose (nanograms) of Nickel sulphate: all of them improved. In conclusion Nickel pathology is changing, allergy seems to be due to different mechanism, dietary intake is important, an immune-tolerance can be induced.

The risk associated with exposure to chemical carcinogens (as classified by International Agency for Research on Cancer and/or the European Union), during painting activities in construction seems controversial. This study included all 43 activities of professional painting in this sector existing in the area of Cremona, in Lombardy region. The aim was to consider and promote preventive technical and medical solutions, basing on efficacy. The occupational exposure and the already adopted preventive measures were evaluated by investigations at workplaces, supported by standardized questionnaires and registrations. 860 commercial products (402 chemical substances) were classified: in 38% of cases the ingredients were not listed in the Material Safety Data Sheets (retrieved by the manufacturer). The real possibility of a risk exposure to carcinogens has been reported in a small proportion of situations. In all companies the presence of carcinogens was unrecognized or at least had not been taken into account in the risk assessment of workers.

The study was aimed to ascertain a possible pollution by allergenic Mites in 15 samples of leather dust belonging to occupational environments of 4 Italian shoes factories. All dosages were both performed by a quantitative immunologic and ELISA method (Indoor Biotechnology Lmd) and a semi-quantitative colorimetric method (Aclotest Lofarma) and the results were compared according to a five steps risk-evaluation. In all factories allergenic components of Mites were documented. The highest concentration of Der p1 and Der f 1 in dust was 15,4 mcg/g, while allergens prevailed around the working-places, where discards of leather usually were collected. Moulds were studied in 29 samples of 9 shoes factories, adopting specific cultures. In all but one occupational environment moulds were present and taxa of Alternaria, Penicillium, Aspergillus, Cladosporium were prevalent, spores of them have known allergenic propert. Besides the identification, quantitative levels were not planned in this study. Dermatophytes were absent, while four taxa of Keratinophylic non allergenic moulds were observe. When leather dust are disperded in occupational environments a risk due to allergenic agents as secondary contamination must be carefully considered. Such a risk, according to our results, may be classified as "intermediate for allergenic Mites" and temptatively "light for allergenic moulds". Such a risk might be carefully considered for legal and preventive purposes and also monitored by occupational healthcare professionals.

Nowadays nickel is a global problem, related to occupations (mainly metalworkers) and to life habits. The dietary intake, more than environments, is the source of a basic immune identification and also of possible complications after occupational inhalation or contact. Nickel insoluble compounds are proved to be cancerogenic. Nickel ions are very reactive with proteins and oxidant, then also potential irritant for the airways. Metallic nickel and soluble compounds are sensitizers, causing dermatitis, rhinitis and asthma. Recently a Systemic Nickel Allergy Syndrome (SNAS) has been identified in allergic subjects, with a clinical picture of urticaria, general hitching, headache, gastrointestinal troubles. SNAS may affect allergic occupational or non-occupational ones. Studies are in progress aimed to an oral treatment inducing immunotolerance. Nickel in urine seems to be the best tool for monitoring nickel absorption.

The purpose of this study was an integrated assessment of exposure to benzene and Polycyclic Aromatic Hydrocarbons (PAH) in 29 workers employed to manage a controlled-access highways. A campaign was performed in summertime by environmental monitoring (active and passive airborne personal sampler), as well as by biological monitoring (urine samples of the beginning and of the end of daily shift, baseline after two days of vacation). The measured environmental levels did not differ from background environmental concentrations found in a metropolitan area (i.e. benzo[a]pyrene < 1 ng/m3; benzene < 5 mcg/m3), and the results of biological monitoring were in agreement and were compatible with extra-professional habits of the investigated subjects (1-hydroxipyrene 50-990 ng/g creatinine; unmetabolized benzene 15-2010 ng/I; t-t muconic acid < 4-222 mcg/g creatinine).

Wheat flour sensitization may lead to several occupational diseases: persistent rhinitis, intermittent or persistent asthma, conjunctivitis, urticaria, and contact dermatitis. The main allergenic components of wheat have been identified, the prevalent mechanism is IgE-mediated, the worsening after starting of sensitization shows the characters of the "allergy march" till the respiratory functional impairment and disability. Nowadays the occupational rhinitis is the first important step to begin to start prevention, but its relevance is also for quality of life of subjects. Data about the prevalence of the sensitization in Italy seem to be spread, ranging from 4% to 24% in the literature and till 32% in a recent our investigation. A complete and early diagnosis is essential to manage the allergic bakers, aiming relocation in their own activity. A specific immunotherapy by allergenic vaccine has been studied and it is now possible. In our experience 43 bakers and pastry makers were treated by the same vaccine (Lofarma Laboratories, Milan) and revalued after many years; 83% were still at work and 70% claimed only poor or no-symptoms during work, in any way with a tolerable condition. At present the baker's disease may be managed by included interventions "man-environment" avoiding the extreme choice of leaving the working activity. The Lombardy Government published specific Guide Lines on the prevention and proposed a planned project for three years, to be adopted according to local needs in collaboration with the public health service.

This report is aimed to suggest how allergic subjects can be admitted to activities at risk and how workers affected by occupational allergy can be relocated. Allergy is a mechanism strictly joined with the individuality trough the immunologic system of protection of the organism Works are the background of a possible exposure to agents able to rouse a specific hypersensitivity, but also the purposes of everyone for having a normal way of life. Population studies demonstrated that 70% of adults that present themselves for working as craftsmen or in small industries are normally reactive, but about 30% have a condition of a diagnosed allergy or are hyperreactive to the environment. Therefore it is unfeasible to exclude the allergic ones from work even for preventive aims. The true prevention is linked to manage a methodology of assessing and grading the allergologic risk at the workplaces (four levels are proposed) and of classifying the subjects by medical parameters (five class are proposed). The individual job fitness may be so defined, either at the first examination or periodically during working activity, monitoring self-reported symptoms and changement of used materials or of specific tasks. Informal guidelines are proposed to manage three possible situations of occupational allergic diseases and the engagement of the occupational physician also to be connected with allergy specialists and family doctors is recommended.

This survey was carried out in the molding of plastics and rubbers, in the "Professional Cancer Prevention Project" sponsored by the Lombardy region with the objective of developing and implementing protocols for evaluating exposure to carcinogens through the biological monitoring. The realities of molding the thermoplastic polymer ABS, rubber, and thermosetting plastics containing formaldehyde were examined. The carcinogenic substances identified in these processes were: 1,3-butadiene, acrylonitrile and styrene in molding ABS, polycyclic aromatic hydrocarbons (PAH) in molding rubber, and formaldehyde in molding the thermosetting plastics. Only for some of these substances biological indicators are available. The limited exposure to airborne chemicals in molding ABS and the intrinsic characteristics of biological indicators available for 1-3 butadiene have determined the non applicability of biological monitoring to this situation. The absence of a biological indicator of exposure to formaldehyde has made this situation not investigable. Exposure in the rubber molding was studied in 19 subjects applying the determination not metabolized PAH in urine. The levels of these indicators were similar to those measured in other groups of subjects without occupational exposure to PAH, confirming a low airborne contamination in this workplace.

Occupational allergy to components of wheat flour is the main cause of rhinitis and asthma of workers in bakeries and similar activities. An immunological mechanism IgE-mediated is involved and the sensitising properties of some proteins of wheat where assessed. Nowadays it is possible to have an extract to be used for specific immunotherapy. The aim of this treatment should be a reduction of individual immunological reactivity and the possibility of going on the particular activity of allergic bakers, pastry makers or pizza makers. An observational crossectional retrospective study was performed on 41 sensitised workers that were diagnosed in the same occupational health unit. All underwent a subcutaneous specific immunotherapy (SCIT) with the same schedule and the same extract (Lofarma Allergeni, Milan) for 4 or more years, without avoiding their work activity. The outcome was investigated after five or ten years. Data were collected by a questionnaire. 34 subjects on 41 are still at work with an acceptable quality of life and a normal working efficiency, mainly in their small enterprises. In the "old" subgroup (19 cases), treated in the past, several bakers still at work stopped SCIT even from 4-10 years. In the "new" subgroup (15 cases), still in treatment, symptoms and drug use during the work activity resulted to be reduced or absent in the majority of cases. According to results of other immunotherapies by allergenic vaccines (pollens, mites) also for wheat flour occupational allergy a specific treatment seems to be possible and SCIT may be an useful tool to reduce and control the biological individual effects of allergy. By the occupational point of view wheat flour SCIT allows a relocation in many of cases and may be associated to other intervention of environmental prevention at workplaces, improving the relocation of occupational allergic subjects when requested.

This study describe accidents occurred in the period between 1999 and 2006 in the Hospital of Cremona, in which about 2400 subjects operate. The analysis of Accident Register showed a reduction of about 30% of the total number of accidents during the examined period and a non homogeneous distribution of the various types of accidents. The most frequent accidents were prick (25.8%), trauma (22.9%) and "in itinere" accidents (7.8%). One type of accident has been little considered up to now: the aggressions. Professional nurses were the most frequently involved and the most affected units were those that belong to the Internal Medicine Department. "In itinere" accidents had the longest average prognosis (11.6 days). The repetition of accidents occurred to the same operator hasn't been analysed before now: a professional nurse had nine accidents (of various type) in the seven years considered. Probably the reduction of accident must be attributed to the effectiveness of the prevention activities undertaken during the reviewed period. Biological accidents, for which it was possible to implement prevention programs, have been markedly reduced; it was not the same for "In Itinere" accidents, that depend significantly on external factors that are not easily dismissed.

Among various chemical agents present at the workplaces in the rubber industry, a particular attention was adressed to the Polycyclic Aromatic Hydrocarbons (PAH) contained in oil and carbon black, but some questions regarding level of exposure are also controversially discussed. The literature reports that PAH may have irritant effects; moreover some of these have been recognized as probably or possibly carcinogenic to human by the International Agency for Research on Cancer, the European Union, and other institutions. In Lombardy, a study aimed to evaluate the occupational exposure in Benzo[b]fluorantene the rubber forming industry was planned during last two years. The results of environmental air monitoring (the 16 most relevant, according to the American Environmental Protection Agency, EPA) and biological monitoring (urinary 1-hydroxypyrene excretion) show that PAH exposure in these workers is not higher than that observed in other study regarding low level and acceptable exposure.

Evaluating the chemical risks at the workplaces, the potential carcinogenic risk is a primary interest. Particularly, in the rubber forming industry the main attention was directed to the hot processing as a possible source of exposure to chemical agents, several of which were classified as carcinogens by the International Agency for Research on Cancer (IARC) and/or the European Union (EU). A study on occupational exposure to chemical carcinogens in the rubber forming industry was planned during last two years, involving a representative sample of firms. In the first step the occupational exposure and the use of preventive measures were evaluated by an investigation at workplace supported with standardized questionnaires. The presence of above 100 chemical agents was registered; 15 agents were classified to carcinogenic or probably carcinogenic to human. The evaluation of exposure by air sampling and monitoring of most substances of interest (acrylonitrile, 1,3-butadiene, styrene, Polycyclic Aromatic Hydrocarbons), demonstrated a low level of occupational exposure, the common hygienic prevention measure being applied.

Hyperreactivity to environmental factors is objectively expressed as respiratory, cutaneous and gastrointestinal disease. Approaching the diagnosis of an occupational disorder, a practical distinction was made between toxicity and allergy. The study of occupational allergic disease included particular procedures that led to standardized models and concepts. The contribution to the improvement of medical knowledge is reviewed according to selected experiences. The diagnostic aspects of asthma, rhinitis, dermatitis and urticaria are considered as regards to methodology of assessment of the occupational etiology with attention to demonstrative examples, which are worthwhile for the general medicine, too. Basic steps of risk agent identification, exposure assessment, threshold dose response measurement, allergen challenges and interaction are the original contribution of the occupational medicine to the diagnosis of allergic disorder. The clinical picture of asthma was clarified by the results of the specific bronchial provocation test, proving the important role of di-isocyanates and metal salts. Occupational rhinitis showed to be connected to asthma with predictive aspects in bakers' disease. Occupational dermatitis was linked to the development of experimental patch tests. Occupational urticaria included the concept of airborne contact allergy or nickel interactive food and occupational sensitivity. Occupational allergic diseases are emerging as a consequence of low environmental exposure, but they were remarkably studied in the past either for pathogenesis or for diagnostic procedures. Methods and acquisition are available also for the general medicine when an individual's specific reactivity is under investigation.

The authors describe the historical evolution of the prevention in Lombardia, and the role of the Hospital Units for Occupational Medicine, not only on the clinical oriented fields, but also on the areas of formation and training. Hospital Units for Occupational Medicine are today the best synthesis of "occupational-environmental-community health". There development is based on adequate standards of human and instrumental resources, as so as a real financial budget. At last, it's important that these Units are allocated in a so-called "bipolar department", open to the hospital and also open to the territorial structures for prevention and safety (department of occupational health).

Because the widespread use of gloves by health care workers has induced an increase of both irritant and type I or type IV allergic glove-related diseases, the Italian Society of Preventive Medicine for Health Care Workers set up a working group to collect information about glove composition and to standardize procedures for the diagnosis and prevention of glove-related disease and job-fitness evaluation of employees who will be wearing gloves. In addition, the group made recommendations for educational programs focusing not only on users but also on purchasers, who presently favor glove selection for economic reasons. The group's recommendations are summarized in a consensus document, but cannot be considered definitive. More research is needed to achieve answers to questions raised by the working group, indicated in the consensus document. In particular, diagnostic criteria must be standardized to plan multicenter studies to verify the real extent of the problem, and further studies are needed to verify whether limit values for substances contained in the gloves (e.g., latex proteins, residual chemicals) can be established.

A double-blind, placebo-controlled study was carried out to test the clinical efficacy and safety of local nasal immunotherapy (LNIT) in powder form. Twenty-two patients suffering from allergic rhinitis strictly associated with early spring symptoms, with positive skin prick tests and RAST for birch-alder, all responders to a specific nasal provocation test (NPT), received randomly active or placebo treatment for 4 months. Immunotherapy consisted of administration of a set of capsules containing progressively increasing amounts of birch (Betula pendula) and speckled alder (Alnus incana) allergens in powder form with controlled granulometry. The active (birch-alder) and placebo (lactose) group completed the treatment according to a similar schedule. During the pollen season (March-April), the patients who took the active treatment reported less sneezing and rhinorrhea than the placebo group, on the basis of a symptoms score, and the differences were statistically significant; the need for drugs (terfenadine) was also significantly reduced. These findings agreed well with the results of specific NPT after the treatment; only patients in the active group had a higher threshold dose of nasal specific reactivity to birch-alder allergens than in tests before the LNIT.

Several clinical and experimental findings point to cobalt as the only sensitizer and causal agent of hard metal asthma. The clinical features have been clearly defined by bronchial provocation tests, with a prevalence of late phase responses. Epidemiology is still insufficient to configure prevalence and incidence rates for cobalt asthma. IgE and IgG antibodies with cobalt specificity have been demonstrated, but T-lymphocytes and eosinophils involvement seem to be important in the mechanism of an allergic inflammation in the airways. Such an immunological pathogenesis links cobalt asthma with other manifestation of hard metal disease.

Three subject with professional activity in operating theatre and with a diagnosis of chronic viral "C" hepatitis are considered. All cases (Two surgeons and an anesthetist) had been continuously exposed to low level of airborne anesthetic compounds (Nitrous oxide and halogenated compounds). According to possible, but not proved, synergic effects, two cases with a clinical picture of active chronic hepatitis were classified as unqualified to specific work. The third case, affected by a persistent chronic hepatitis, was admitted to operating activities only for four hours a week, i.e. only an operating session a week. Hepatitis B and C markers must be always monitored during the medical surveillance in exposed people of operating theatre.

Up to the early eighties, a variety of epidemiological studies suggest that chronic exposure to low doses of anesthetic gases, as occurs in operating rooms, is an occupational risk factor for spontaneous abortion and congenital defects. Numerous and more recent epidemiologic studies are reviewed; currently it is suggested that there is inadequate evidence to conclude that occupational exposure to anesthetic gases causes increased rates of spontaneous abortion or congenital anomalies. The improvement of environmental conditions, that has reduced airborne levels of anesthetic gases in operating rooms, has been critical in reducing the risk of abortion and congenital defects. In agreement with recent epidemiological reports, we believe that the health surveillance of exposed workers must include the study of pregnancy outcome.

A research was carried out on risk evaluation of workers with different tasks in operating theatre. The airborne concentrations were determined by an IR analyzer with two distinct sampling lines: the first was placed in surgical zone and the second one in anesthesiological zone. The anesthetists resulted more at risk than surgical team. Nevertheless when the evaluation was based on N2O urinary concentration and data were stratified according to task a prevalent inhalation absorption resulted for non medical staff (instrumentist and professional nurse). Our data concerning N2O ranged between 95-764 ppm indoor and between 3-92 mcg/l in the urines of exposed subjects.

17 workers in a thermometer factory exposed to mercury for periods ranging from 1 to 40 years all had high urine and blood mercury levels on undergoing electromyographic examination. All were clinically free from central and peripheral nervous symptoms. 88% had subclinical neuropathy, mainly distal and axonal. There was no correlation between severity of the neuropathy and blood and urine mercury levels or between severity of neuropathy and duration of exposure to mercury. The presence of a subclinical neuropathy in symptomless workers exposed to mercury is perhaps the most reliable index for the detection of the early toxic effects of mercury on the peripheral nerve fiber when it is probably still reversible.

A group of 182 workers exposed to diisocyanates (varnishers, carpenters, producers of polyurethane resins and expanded plastic) were examined to study the immunogenic capacity of these substances. The skin tests, particularly the intradermal tests, revealed reactions of the immediate, accelerated and/or delayed types due to the presence of IgE and IgG, in addition to responses of the cellular type. This was confirmed by passive transfer in guinea-pigs and man and immunohaematological tests such as passive haemagglutination and lymphocyte transformation. In 4 cases it was possible to demonstrate thermoresistant, homocytotropic immunoglobulins, that were not dependent on complement and behaved like reagins (i.e. short-term anaphylactic IgG). Exposure tests were performed on 45 cases; the results are analyzed and compared with those of the skin tests. It is concluded that both these groups of tests are of value in investigating the aetiopathogenesis of the pathology of the isocyanates: the skin tests for initial screening, and then the exposure tests for resolving doubtful diagnoses. Cross-reactions were also demonstrated between toluene-diisocyanate and methylene-diisocyanate. Two phases could be considered in the pathogenesis; in the first phase, signs of inflammation appeared at the primary sites of contact with the irritant, then the ability of the diisocyanates to form a conjugate with organic proteins results in the production of a complete antigen and consequent sensitization of the exposed person. The appearance of symptoms naturally depends on subsequent exposure and the immunogenic capacity of the patient: the response is mainly of the reagin type in atopic patients and of type 3 in non-atopic patients.

Reviewing medical and epidemiological reports, no definite clinical picture could be expected as a result of a low DMF exposure and experimental research on long term toxicity has always demonstrated some adverse effects but has not been sufficient to define a no-effect level in animals. This study was designed to assess the specificity of symptoms and the relevance of adverse effects as consequence of an exposure to airborne DMF concentration in the range of the present TLV (30 mg/m3 - 10 ppm). For this purpose 100 DMF-exposed workers, with homogeneous characteristics, were compared with 100 matched controls. Both groups were selected by a careful pair-matching. Mean DMF exposure was 22 mg/m3 (range 8-58 mg/m3). Exposed subjects and their matched controls were evaluated clinically and a questionnaire was used for the registration and the comparison of subjective complaints. A laboratory assessment was performed, including transaminase and gamma-glutamyl transpeptidase. Statistical analysis was based on McNemar Test procedure. The problem of dietary alcohol intake was particularly investigated. Among symptoms studied, headache, dyspepsia and digestive impairment of hepatic type could be specifically associated with chronic DMF exposure and increased levels of gamma-GT demonstrated minimal hepato-cellular damage, even without ethanol dietary intake. No chronic sickness was diagnosed and the disturbances observed are better considered as indicators of malaise and discomfort due to a toxic effect of DMF, whose consequences are discussed.

A study was performed on twenty-five workers exposed to polyurethane varnishes exclusively catalysed with TDI, who developed asthma to this substance. The aim of the study was to establish, using bronchial provocation tests, whether a cross-response to MDI exists. The results were positive but no definitive evidence has been reached because there was cross-response in only 48% of cases. It is interesting, however, that cross-responders did not predominate among the subjects with a late reaction to TDI (P = 0.0038), whereas cross-responders were in the majority among the subjects with a dual reaction to TDI (P = 0.0334). It is possible that the pattern of the asthmatic reaction to BPT with TDI influences the cross-reaction to other isocyanates.