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Introduction Health promotion activities should be an element of occupational health services. While performing prophylactic examinations of workers, a physician has an opportunity not only to implement primary prevention activities, but also detect health disorders at an early stage. Objectives The aim of the study was to obtain information from patients whether during prophylactic examinations of employees, activities were undertaken in the field of health promotion. Material and methods Analysis included a group of 204 people (163 females, 41 males; mean age 43.6 +/- 8.87) who had undergone periodic occupational health examinations in the past. The study was performed in the form of a survey. Results For 74 people (36.3%) in the study group an occupational health physician was the only physician with whom they had contact within the last 3 years. BP, HR, body weight and height were measured in the majority of patients. Glycaemia, lipid profile and peripheral blood smear were performed in a small percentage of patients. Only one-third of respondents were asked about smoking and only two persons about physical activity. Only 13.7% of people received recommendations for further diagnosis/therapy. Advice on health promotion (diet, healthy lifestyle, smoking cessation, physical activity) was received by only five people (2.5%). Conclusions Prophylactic examinations of employees are a unique opportunity to carry out prevention activities for healthy/asymptomatic patients and to promote a healthy lifestyle. Unfortunately, occupational health physicians do not seize this opportunity often enough. Occupational health services in the current system are usually reduced to the minimum required by regulations.

The observed global climate change is an indisputable cause of the increased frequency of extreme weather events and related natural disasters. This phenomenon is observed all over the world including Poland. Moreover, Polish citizens as tourists are also exposed to climate phenomena that do not occur in our climate zone. Extreme weather events and related disasters can have a significant impact on people with allergic diseases, including asthma. These effects may be associated with the exposure to air pollution, allergens, and specific microclimate conditions. Under the auspices of the Polish Society of Allergology, experts in the field of environmental allergy prepared a statement on climate changes, natural disasters and allergy and asthma to reduce the risk of adverse health events provoked by climate and weather factors. The guidelines contain the description of the factors related to climate changes and natural disasters affecting the course of allergic diseases, the specific microclimate conditions and the recommendations of the Polish Society of Allergology for vulnerable population, patients suffering from asthma and allergy diseases, allergologists and authorities in the event of climate and weather hazards.

Objectives: About 5–10% of asthmatics do not respond well to standard treatment plan. Occupational exposure may be one of the factors that can be linked with treatment failure. The aim of the study was to assess the prevalence of workrelated asthma (WRA) among adult asthmatics under follow up in an outpatient allergy clinic and to create a useful tool for detecting individuals with possible WRA. Material and Methods: Preliminary 5-question questionnaire designed to recognize WRA was presented to 300 asthmatics. All patients with positive preliminary verification along with 50 subjects from control group were asked to fill up a detailed questionnaire. The WRA was diagnosed by positive match for asthma symptoms in combination with workplace exposure indicated in the detailed WRA questionnaire followed by confirmation of each WRA case by detailed exposure analysis. Results: Work-related asthma was recognized in 63 subjects (21% of study group). The preliminary questionnaire has 76.9% sensitivity and 94% specificity in recognition of WRA. Occupational exposure to irritants is a risk factor of WRA recognition (relative risk (RR) = 2.09 (1.44:3.03)). Working in exposure-free environment is a factor against WRA recognition (RR = 0.38 (0.24:0.61)). Among subjects with work-related asthma, the uncontrolled course of the disease is significantly more frequent (p = 0.012). Subjects with WRA more often report sickness absenteeism due to asthma than those without WRA (9.6% vs. 3.2%, respectively), but the observed differences did not reach the statistical significance. Conclusions: Short 5-question questionnaire seems to be a promising tool to detect individuals with possible work-related asthma in the outpatient setting for further evaluation and additional attention. Statutory funding of Nofer Institute of Occupational Medicine program No. IMP 11.5/2012/2014

Objectives: Several studies, mostly based on questionnaire-derived data, have shown an increased risk of allergic diseases, especially asthma, among cleaners. The risk factors and etiological mechanisms are still being investigated. Occupational exposure to various chemical and biological agents may induce specific sensitization and/or irritant effects. The aim of our study was to estimate the prevalence of work-related symptoms suggesting the presence of allergic disease reported by cleaners, and to relate them to the results of commercially available and standardized objective tests used for screening detection of occupational sensitization and chronic respiratory disorders. Material and Methods: A cross-sectional study was performed among 142 Polish workers of cleaning service in their workplaces. A detailed questionnaire, skin prick tests to common allergens and chemicals used by these workers for cleaning purposes (chloramine T, chlorhexidine, formaldehyde, glutaraldehyde, benzalconium chloride), total and specific serum IgE antibodies to disinfectants and rest spirometry were performed in all the subjects. Results: Fifty nine percent of all the subjects declared occurrence of at least 1 symptom suggesting allergic ailment during cleaning activities at work. Skin prick tests and specific serum IgE antibodies to disinfectants were negative in all the subjects. In 8 cases wheezing was detected during auscultation, but only in 5 of them obstructive pattern in rest spirometry was found. Conclusions: Occupational allergic causation of symptoms among cleaners could be less likely than work-related symptoms associated with exacerbations of new-onset or pre-existing respiratory diseases. Therefore, in this group of workers, mainly the non-specific irritant impact of chemicals on airways should be taken into consideration.

Chlorhexidine is a low molecular weight occupational sensitizer that can cause different delayed and immediate-type allergic reactions including anaphylaxis. It is widely used as an antiseptic and disinfectant and not only in the occupational environment as it is present in toothpaste, mouthwash, nose and eye drops and ointments. We present three cases of occupationally exposed workers with airway allergy to chlorhexidine. The role of chlorhexidine as an occupational allergen was confirmed by placebo-controlled specific inhalative challenge tests monitored by spirometry and analysis of induced sputum (influx of eosinophils after provocation has been observed). One of these patients presented with a systemic reaction with ordinary environment exposure. These findings are a reminder to clinicians of chlorhexidine's ability to cause various hypersensitivity reactions and the potential risk of this widely used antiseptic.

Objectives: The aim of the study was to evaluate health effects of occupational exposure to diisocyanates (DIC) among polyurethane foam products factory workers. Material and Methods: Thirty workers had a physical examination, skin prick tests with common allergens, allergen-specific immunoglobulin E (IgE) antibodies to diisocyanates and pulmonary function tests. Concentrations of selected isocyanates in the workplace air samples as well as concentration of their metabolites in the urine samples collected from the workers of the plant were determined. Results: The most frequent work-related symptoms reported by the examined subjects were rhinitis and skin symptoms. Sensitization to at least 1 common allergen was noted in 26.7% of the subjects. Spirometry changes of bronchial obstruction of a mild degree was observed in 5 workers. The specific IgE antibodies to toluene diisocyanate (TDI) and 4,4’-methylenebis(phenyl isocyanate) (MDI) were not detected in any of the patients’ serum. Cellular profiles of the collected induced sputum (ISP) did not reveal any abnormalities. Air concentrations of TDI isomers ranged 0.2–58.9 μg/m3 and in 7 cases they exceeded the Combined Exposure Index (CEI) value for those compounds. Concentrations of TDI metabolites in post-shift urine samples were significantly higher than in the case of pre-shift urine samples and in 6 cases they exceeded the British Biological Monitoring Guidance Value (BMGV – 1 μmol amine/mol creatinine). We didn’t find a correlation between urinary concentrations of TDI, concentrations in the air and concentrations of toluenediamine (TDA) in the post shift urine samples. Lack of such a correlation may be an effect of the respiratory protective equipment use. Conclusions: Determination of specific IgE in serum is not sensitive enough to serve as a biomarker. Estimation of concentrations of diisocyanate metabolites in urine samples and the presence of work-related allergic symptoms seem to be an adequate method for occupational exposure monitoring of DIC, which may help to determine workers at risk as well as to recognize hazardous workplaces. local statutory funds IMP 11.4 “Assessment of the health effects of inhalation exposure to diisocyanates among factory workers polyurethane foam” and IMP 4.8 entitled “Evaluation of reliability of chosen isocyanates determinations in the air of workplace based on the biological monitoring of their metabolites eliminated with urine”

Background: In Poland small, nonspecialized farms, growing different crops and raising usually a few animals of various species constitute the majority. Objective: The aim of the case–control study was to evaluate the risk factors of work-related respiratory symptoms and occupational asthma and/or rhinitis in Polish farmers and investigate whether the farming characteristics may have influence on the prevalence of atopy and allergic diseases. Methods: The study groups comprised 100 cases who were farmers reporting work-related asthmatic and/or rhinitis symptoms from randomly selected family doctors practices (80 of 353) and 102 healthy controls. All subjects were examined by means of a questionnaire, skin prick tests (SPT) to common and occupational allergens, total serum immunoglobulin (Ig)E level and the presence of specific IgE and allergen-specific inhalation challenge tests were performed. The provocation tests were monitored with the spirometry, histamine challenge test and evaluation of nasal symptoms score and nasal washings. Results: Respiratory allergic disease was recognized in 68 symptomatic patients, including 41 cases because of occupational allergens (asthma n = 38, rhinitis n = 41). Step-wise logistic regression analysis confirmed the protective role of small farms against the development of work-related symptoms (OR 0.23; 95% CI 0.11, 0.47) as well as the significance of positive SPT to cereals (OR 5.55; 95% CI 1.6, 19.21) and storage mites (OR 3.73; 95% CI 1.27, 10.96) as a risk factor of these symptoms. Cereal farming (OR 13.75; 95% CI 2.39, 78.83) and positive SPT to cereals (OR 26.92; 95% CI 5.33, 135.9) and storage mites (OR 44.07; 95% CI 8.40, 231.1) were found to be significant risk factors of occupational asthma and/or rhinitis. Conclusions: Cereal farming and hypersensitivity to cereals plays the significant role in the development of occupational asthma among Polish farmers. It also seems that working on small farms may protect farmers against work-related respiratory symptoms that are mostly because of allergy.

Background: Eotaxin and MCP-3 (CC chemokines), owing to their preferential action on eosinophils, seem to be the very importance in the patophysiology of allergic rhinitis and asthma. The purpose of this study was to examine the effect of intranasally administered eotaxin and MCP-3 after specific allergen priming on the influx of inflammatory cells and their soluble mediators into the nasal mucosa. Methods: Eotaxin and MCP-3 have been applied intranasally at the increasing doses of 1, 5 and 10 µg to allergic patients after allergen priming. The ‘nasal pool’ technique was used. The cell count and biochemical parameters in nasal lavage were evaluated before 30 min, and 4 and 24 h after the challenge with chemokines. Results: Both eotaxin and MCP-3 induced the increase in clinical ‘score’ lasting till 24 h. Eosinophil influx into nasal mucosa after provocation with eotaxin was also observed. The challenge with MCP-3 did not induce any significant changes in nasal lavage fluid. Conclusions: Eotaxin is likely to play an important role in the pathogenesis of allergic conditions in humans. MCP-3 did not induce inflammatory cell influx into nasal mucosa. The role of this chemokine in the pathogenesis of allergic inflammation is difficult to assess and requires further studies.

Objectives The purpose of this study was to evaluate bronchoalveolar lavage fluid (BALF) components and Clara cell protein (CC16) concentration in serum and BALF in patients with glutaraldehyde (GA)-induced asthma, before and after a specific inhalatory provocation test (SIPT) with GA, in comparison to atopic asthmatics and healthy individuals. Methods Spirometry and bronchoalveolar lavage were performed before and after SIPT. The serum and BALF concentrations of CC16 and cytogram content in BALF were evaluated. Results In GA-sensitized asthmatics, the level of CC16 in BALF and serum was significantly lower at 24 h after SIPT in comparison with the values recorded prior to the experiment. There was a significant increase in the proportion of eosinophils, basophils and lymphocytes in BALF of GA-sensitized asthmatics obtained after SIPT. Conclusions The determination of CC16 either in serum or in BALF is a non-invasive test to detect Clara cell damage.

Lyme borreliosis is a multisystem infectious disease that can occur from bites by infected ticks. It can appear at persons exposed professionally for staying in tick feeding environment as well as persons staying in such an environment occasionally. For a few years the Lyme disease is taking the leading place amongst occupational diseases and first amongst infectious occupational diseases. Lyme disease is a major problem especially in wooded areas of Poland however it can occur throughout the country. The variety of clinical and serological pictures is creating everyday diagnostic problems. The aim of this publication is to collect, methodize and remind the medical knowledge about pathogenesis, symptoms, diagnostics, prevention and medical certification of this disease. Disease symptoms were specified to appearing in various organs and systems in order to clarify this difficult to diagnose disease. Diagnostics of Lyme disease was divided into standard and highly specialized, performed in special cases.

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

Transport workers, subjected to variable direct exposure to allergens in the workplace, are an occupational group at risk of developing occupational allergic diseases of the respiratory system as well as the skin. Their work environment is characterized by considerable diversity of both chemical and biological sensitizers. Sensitization occurs due to occupational exposure to allergens mainly by inhalation or direct skin contact. Therefore, it is necessary to be aware of the presence of strong allergens in the work environment to introduce appropriate preventive measures and to reduce the adverse health effects resulting from the exposure. This publication presents the most important allergens described as causal factors of occupational allergy among transport workers and the basic principles of diagnostics and medical certification of these diseases.

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.In 1999-2009 we hospitalized 37 patients exposed to diisocyanates and suspected of occupational asthma.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.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.

The aim of this study was to evaluate the coexisting factors and usefulness of diagnostic methods in metal-induced asthma in Polish welders.Examination of 50 welders occupationally exposed to metals and with suspicion of metal-induced asthma (group A), 100 welders occupationally exposed to metals but without suspicion of metal-induced asthma (group B), and two control groups (10 patients with atopic asthma and 10 healthy subjects) was carried out. Questionnaire survey, clinical examination, skin prick tests to common aeroallergens and metal salts, rest spirometry tests, X-ray, metacholine challenge and a single-blind, placebo controlled specific inhalation challenge tests with metals (or work-like conditions challenge tests) were performed.In group A--in 9 cases we obtained positive results of specific inhalation challenge tests with metals (in 3 cases with nickel, in 4 cases with chromium, in 1 case with cobalt and in 1 case with manganese). Nine cases of metal-induced occupational asthma were recognized. In group B--only in one case we obtained positive results of work-like conditions challenge test (clinical and spirometry changes, eosinophil influx in induced sputum), which confirmed the diagnosis of occupational asthma. In most of examined welders (62%), pulmonary changes in chest X-ray images were noted. The statistical analysis revealed that working as a welder for more than 10 years is the coexisting factor of presence of chest X-ray changes (p- or q-type nodular changes or interstitial changes). Positive results of skin prick tests with metal salts were the coexisting factors of occupational asthma due to metals among examined group of welders.Specific inhalation challenge plays the key role in diagnostics of metal-induced asthma in welders. Pulmonary changes in chest X-ray were found in a significant percentage of examined welders.

Recently, infectious diseases have been found to be the most frequent among occupational diseases. Borreliosis, the most common among them, as well as tick-borne encephalitis is transmitted by ticks. Recognition of occupational etiology of such diseases is possible only when the relationship between the infection, occupational exposure and performed work is proved. A case report of a forest worker with borreliosis coexisting with tick-borne encephalitis is presented. Despite nonconcurrent recognition of both diseases it was highly possible that contagion took place at the same time or at a very short time interval. Despite high prevalence of tick-borne diseases, occupational etiology of these two infectious diseases in one patient is very rarely recognized.

Diagnosis of occupational infectious diseases gives rise to a number of problems in the practice of occupational medicine. Similar symptoms of many infections, including parasitic diseases, can limit the range of applied diagnostic and certification procedures only to diseases induced by pathogenic agents or exposures occurring in the occupational environment. In some cases this makes difficult or even impossible to explain a real cause of patients' complaints. We present a case report on the patient with suspected occupational borreliosis. Due to many diagnostic doubts during hospitalization, including long term presence of some clinical manifestations reported by the patient, which could occur in the course of borreliosis and also suggest earlier infection by trichinae, a wider span of specialist examinations was applied. Finally, the invasion of trichinae was diagnosed and later confirmed by serologic tests.

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.

Decorative flowers are known to be a cause of occupational allergy in the floral industry. The allergic manifestations induced by flowers include asthma, rhinoconjunctivitis and urticaria. We present a case of a 55-year-old woman, who has been working for the last 30 years as a gardener with various kinds of flowers, e.g., Limonium sinuatum (LS), chrysanthemum, sweet William (Dianthus barbatus) and Lilium. During the last 10 years she has developed nasal and eyes symptoms, dry cough, dyspnoea, chest tightness and wheezing. Clinical examination, routine laboratory testing, chest radiography, skin prick tests (SPT) involving common allergens, native plants pollens and leaves by the prick-prick technique, rest spirometry, methacholine challenge test and specific inhalation challenge test (SICT) were conducted. SPT results to common allergens were positive for grass pollens. SPT with native plants pollens and leaves showed a positive reaction only for LS. SICT induced an isolated early asthmatic reaction and significant increase in the number of eosinophils in the nasal lavage fluid. Additionally, significant increase in non-specific bronchial hyperreactivity was observed after SICT. To our knowledge, the presently described report is the first one of Limonium sinuatum induced occupational asthma and rhinitis in a Polish gardener.

Welders are exposed to fumes containing different gases, fumes and particles, depending on the composition of the welding electrodes, welded material and the welding method used. Welders are workers at risk of developing various respiratory signs and symptoms. Health effects associated with welding include different lung function abnormalities, including metal fume fever, bronchial asthma, chronic obstructive pulmonary disease, pneumoconiosis and other pulmonary fibrosis (chronic beryllium disease, cobalt lung), and lung cancer. The authors describe some aspects of etiology, pathogenesis, diagnostics, prophylaxis, and medical certification of welding-related respiratory diseases.

Turpentine is a fluid obtained by distillation of wood resins containing mixture of terpens. It can act as an irritant and sensitiser. Most common health problem among workers exposed to turpentine is contact dermatitis. Little is know about turpentine to cause type I hypersensitivity reaction. We present a case of a 27-year old art painter using turpentine as a thinner for oil-based paints. She developed asthmatic reactions after 5 years of working with turpentine. A number of clinical procedures were performed, including clinical examination, routine laboratory tests, total serum IgE, skin prick tests to common aeroallergens, metal salts, oil-based paints and balsamic turpentine, resting spirometry test, histamine challenge, and a single-blind, placebo-controlled specific inhalation challenge with balsamic turpentine. Clinical findings and laboratory test results were normal but a significant bronchial hyperreactivity was found. During the specific challenge, dyspnoea and decreased forced expiratory volume (FEV1) were observed in late phase of asthmatic reaction. An increased proportion of eosinophils in induced sputum could also be noted 24 h after the challenge. Positive clinical response to the specific challenge as well as the morphological changes found in induced sputum served as the basis for diagnosing occupational asthma. To our knowledge, this is the first well-documented case of turpentine-induced occupational asthma.

Manganese belongs to a group of agents called “transitional metals” that are known to induce occupational asthma. How ever, well-documented cases of manganese-induced asthma have been lacking thus far. We have discussed a case of a 42-year-old non-smoking welder with work-related dyspnea. A number of clinical procedures were performed including clinical examination, routine laboratory tests, total serum IgE, skin prick tests to common aeroallergens and manganese nitrate, resting spirometry test, histamine challenge, and a single-blind, placebo-controlled specifi c inhalation challenge with 0.1% manganese chloride solution. Clinical fi ndings and laboratory test results remained normal but a signifi cant bronchial hyperreactivity was found. During the specifi c inhalation challenge, dyspnea and a signifi cant decrease in forced expiratory volume (FEV1) were observed. An increased proportion of eosinophils and basophils in induced sputum could also be noted at 4 and 24 h after the challenge. The argument for recognizing the condition as occupational asthma was a positive clinical response to the specifi c challenge test as well as the morphological changes found in induced sputum. To our knowledge, this is the fi rst well-documented case of manganese-induced occupational asthma

Objectives: The authors discuss the outcomes of a study on IL-18 concentration in nasal washings after the inhalatory challenge test with fl our allergens (ICHT-F) in bakers with fl our-induced occupational airway allergy (OAA) Methods: We measured IL-18 concentration using ELISA kit and assessed morphological changes in nasal lavage fl uid (NLF) before, and 4 h and 24 h after ICHT-F in three groups of subjects: Group A — 9 patients with diagnosed OAA (occupational asthma and rhinitis), Group B — 10 patients with atopic asthma and rhinitis, and Group C — 9 healthy volunteers. Results: In Group A, signifi cant differences in the basophil proportion in NLF were noted only 24 h after ICHT-F. Both the basophil proportion and total eosinophil count were higher in Group A than in Group C at this time-point. Group A also showed a statistically signifi cant increase in IL-18 levels 4 h after the challenge. A signifi cant relationship was noted between the proportion of basophils 4 h after ICHT-F and IL-18 level at 24 h after the test. Conclusions: This is the fi rst study demon- strating an increased expression of IL-18 in nasal washings of subjects diagnosed with OAA to fl our allergens. The observed higher concentrations of IL-18 in nasal washings after ICHT as well as the increase in the proportion of basophils provide evidence for the important role of IL-18 in persistent allergic infl ammation.

The eye is one of the first organs to encounter environmental and occupational allergens. Due to this fact, ocular inflammation is a common problem among patients suffering from allergies. The most common form of ocular allergy is allergic conjunctivitis (AC). This term comprises different forms of this disease. Occupational allergic conjunctivitis (OAC), occurring at the workplace (induced by occupational allergens) is a specific kind of AC. This disease is not well recognized and probably underestimated. The authors describe pathogenesis, symptoms, etiology, diagnostics, prophylaxis and medical certification procedures of this condition.

Background Providing evidence for the allergic aetiology of ocular symptoms developing as a result of occupational exposure is important for compensation procedures in many countries. Aim To perform cellular analysis of tear fluid before and after a specific challenge test with high-molecular weight allergens in symptomatic subjects. Methods The subjects were 23 bakers with a history of conjunctivitis or rhinoconjunctivitis associated with occupational exposure to wheat flour and positive skin prick test with this allergen. A specific inhalation challenge test with wheat flour and a placebo test were performed. The symptom score (SS) and cellular changes in tear fluid and nasal washings were assessed. Results Specific provocation test induced significant eosinophil influx in tear fluid in only six patients. No changes in the proportion of other cells could be observed. Cytological changes in tear fluid did not correlate with either ocular SS (Pearson r = 0.18, P = 0.40) or changes in the nasal lavage fluid or SS (Pearson r = 0.13, P = 0.56). However, an analysis of SS results obtained at 30 min and at 24 h after the challenge revealed that cellular changes in tear fluid correlated significantly both with the early and late changes in SS (Pearson r = 0.52, P < 0.05 and Pearson r = 0.81, P < 0.001, respectively). Conclusions Analysis of cellular changes in tear fluid during specific inhalation challenge test seems to be a valuable diagnostic tool in occupational ocular allergy. However, the discrepancy between the findings of cellular analysis and SS revealed by the present study requires further research.

Objectives: A changing character of lead exposure has been observed over many years. However, construction workers involved in the renovation of painted steel structures are still severely exposed to lead and its compounds. In 2004, we observed an outbreak of lead poisoning in high voltage tower conservators working abroad. Materials and Methods: As many as 27 male workers with suspected lead poisoning were hospitalized in the Department of Occupational Disease, Nofer Institute of Occupational Medicine, Łodź, Poland. They were involved in removing an old lead-containing paint from high voltage towers. Results: On admission to the department, 70% of treated workers showed laboratory signs of anemia in their blood count. After treatment the signs persisted in 25% of patients. Also alkaline dotting in erythrocytes was present in 13 subjects. Sub-acute lead poisoning manifested by abdominal cramps with coexisting anemia and increased lead absorption symptoms was most frequently diagnosed. Conclusions: The high lead exposure of the examined high voltage tower cleaners was due to specific working conditions. In such cases overprotection of the environment may lead to severe health effects in humans.

"Sick building syndrome" (SBS) is a group of symptoms experienced by people working in various buildings. This or another term "building-related illness" (BRI) is used to define illnesses related to modern buildings, mainly offices, in which people spend many working hours. SBS applies to a group of diseases with a fairly homogenous clinical picture and etiology (specific - infectious, allergic and non-specific--for example irritant symptoms). A case of a 51-year-old non-smoking female office worker is reported. After having her working premise renovated, she started to suffer from irritation of mucous membrane of the throat, sore throat and dysphonia. She claimed that these symptoms were associated with exposure to pentachlorophenol (PCP) emitted by the elements of ceiling impregnated with PCP-containing varnish. The concentration of PCP was below the hygiene standards adopted for the work environment. There were no grounds for recognizing occupational intoxication, but the case met the criteria for the sick building syndrome.

Investigate the risk factors for the development of occupational airway allergy (OAA) from exposure to laboratory animal allergens (LAA) among Polish veterinarians. Two hundred veterinarians responded to the questionnaire and were subjected to skin prick test (SPT) to common allergens and LAA (rat, mouse, hamster, guinea pig, rabbit). Evaluation of total serum IgE level and specific IgE against occupational allergens was performed. In addition, bronchial hyperreactivity (BHR) and peak expiratory flow rate (PEFR) were measured before and after specific challenge testing (SCT) only in the subjects with work-related symptoms suggestive of occupational asthma (OA). The prevalence of asthmatic and ocular symptoms was statistically more prevalent in the group of veterinarians sensitised to LAA versus non-sensitised subjects. The most frequent occupational allergens of skin and serum reactivity were LAA (44.5 and 31.5%, respectively). In 41 (20.5%) and in 22 (11%) subjects out of 200 veterinarians, serum specific IgE to natural rubber latex (NRL) allergens and disinfectants was also found. Serum sensitisation to cat allergens and daily contact with laboratory animals (LA) increased the risk for developing isolated occupational rhinitis. Furthermore, working time of more than 10 years and daily contact with LA were also significant risk factors for the development of OAA. Measuring PEFR and BHR before and after SCT is a useful method to confirm the presence of OA. Allergy to LAA is an important health problem among veterinary medicine practitioners in Poland.

Food-processing is one of the industries characterized by high exposure to occupational allergens. Exposure to allergens of plant or animal origin is most extensive during food processing, including meat, fish, fruit, vegetables, dairy products, and grain products as well as during production of animal feed and other foodstuffs. Respiratory diseases are the major problem in the food processing industry. It is essential to better recognize the structure of food allergens and mechanisms by which they induce diseases to identify risk factors and health problems which may occur in workers. The authors describe the most essential food allergens responsible for occupational diseases, reactions resulting from exposure to food allergens in the occupational context, their diagnosis and prevention in food processing workers.

The paper reviews the etiology of chronic fatigue syndrome (CFS), its clinical symptoms and diagnostic procedures. Forasmuch the fatigue is the main symptom of CFS and it may appear in many somatic and mental disorders. The principles of differential diagnostics are reviewed and the methods of management and treatment are presented. The knowledge of CFS is needed among occupational medicine physicians, especially from the point of view of health protection.

There is insufficient data on the prevalence of latex allergy in the general population in Poland. The aim of the study was to evaluate natural rubber latex (NRL) sensitization and its risk factors among Polish blood donors.The study group comprised 1000 consecutive blood donors attending the Regional Centre for Transfusion Medicine. Total IgE and allergen specific IgE to NRL (asNRL-IgE) were assayed using the EIA (enzyme immunoassay) test. In the subjects with asNRL-IgE equal to or above Class II further surveys were performed: questionnaire, skin prick tests (SPT) to common allergens, NRL and food allergens cross reactive to NRL, asNRL-IgE with FDA (Food and Drug Administration) approved FEIA (fluorescent enzyme immunoassay) test and antigen profile of asNRL-IgE.asNRL-IgE (EIA) was observed in 17.9% of blood donors. Only 10% of positive results equal to or above Class II were confirmed with the FEIA test. The positive FEIA results were confirmed with SPT to NRL in 60% and the negative FEIA results in 5.4% of cases. The specific IgE to Hev b 3, 5, 6 and 13 were observed in the subjects with occupational exposure to NRL. The highest concentration of Hev b 8 was observed in the subjects not symptomatic to NRL with positive SPT to grass and tree pollens.The EIA test showed the high prevalence of antigen specific IgE to NRL among Polish blood donors. There was low concordance between EIA and FEIA tests. Therefore, the EIA test should be used only for screening purposes along with the establishment of sensitivity and specificity of the method. Elevated total IgE level, active tobacco smoking, and history of atopic disease symptoms were revealed to be risk factors for the presence of asNRL-IgE.

The aim of the study was to evaluate the usefulness of skin prick tests and serum allergen-specific IgE determination in diagnosis of occupational airway allergies.The study group comprised 152 patients with suspected occupational asthma and occupational allergic rhinitis. In all subjects, skin prick tests (SPT) to occupational allergens and specific challenge test were performed, and serum allergen-specific IgE (as-IgE) was determined. The sensitivity, specificity and predictive values of SPT and serum as-IgE were evaluated for different types of allergens (flour, grain, natural rubber latex and cotton).SPT sensitivity ranged from 22.2 to 68.2%, and specificity from 74.1 to 88.2%, depending on the allergen. Positive predictive values for SPT ranged from 30 to 68.2% and negative predictive values from 74 to 82.4%. As-IgE sensitivity was evaluated from 42.8 to 83.3%, and specificity from 57.1 to 81.5%. Positive predictive values for as-IgE ranged from 35.7 to 76.2% and negative predictive values from 72.4 to 92.3%.The results showed that neither SPT nor serum as-IgE determination indicated sufficient sensitivity and specificity to play a key role in diagnosis of occupational asthma and rhinitis. The sensitivity, specificity and predictive values varied depending on the type of allergen. During the diagnostic process of occupational asthma and rhinitis the specific inhalant challenge test should be taken into consideration to confirm the final diagnosis.

Occupational bronchial asthma is one of the most frequent occupational lung diseases in many countries throughout the world. The diagnosis of this disease is based on clinical and occupational histories, positive immunological tests with potentially allergic agents and functional respiratory tests. However, over the recent years, the induced sputum method has become a new test with promising results for the study of occupational airway diseases. The current state of knowledge of the role of induced sputum in occupational asthma and other respiratory diseases is presented in this article.

Chloramine T is a known sensitising agent in the occupational environment of health care workers. In cases of occupational hazards induced by this agent, a clinical history may be far from conclusive, hence appropriate provocation tests are absolutely essential. The aim of the study was to evaluate the usefulness of the nasal challenge test in diagnostics of respiratory allergy to chloramine T.A single-blind, placebo-controlled study was conducted in 6 subjects with chloramine T asthma and rhinitis. Two control groups comprised 7 atopic subjects with asthma and rhinitis and 6 healthy persons. All the controls had negative results of skin prick tests with chloramine T and none displayed any respiratory symptoms under exposure to the agent. A "nasal pool" technique was used to evaluate morphological and biochemical parameters (mast cell tryptase, eosinophil cationic protein, permeability index) in nasal washings before and 30 min, 4 h and 24 h after the provocation with chloramine T and placebo.A significant increase was found in the total count and percentage of eosinophils and basophils, albumin, tryptase and eosinophil cationic protein levels in the nasal lavage fluid from patients with chloramine T respiratory allergy when compared to both control groups. Also a dual asthmatic reaction in 4 patients and an isolated late reaction in 2 cases were observed in chloramine-sensitive subjects.The results indicate the applicability of the "nasal pool" technique as a diagnostic procedure in chloramine T-induced airway allergy.

It is a case report on a 55-year-old non-smoking female, dental technician, with a 36-year history of cobalt exposure. The patient suffered from dyspnea, coughing and decrease in physical load tolerance about 20 years after the first occupational contact with cobalt-containing metal dentures. Skin tests performed with a battery of common allergens (metals: nickel, chrome, cobalt; acrylates; disinfectants; and natural rubber latex) were negative. In the patient, interstitial radiological changes, respiratory insufficiency and decrease in diffusion capacity were observed. While performing a provocation test with 0.05% cobaltous chloride, the patient developed dyspnea with concomitant decrease in 1 second forced expiratory volume (FEV1) and peak respiratory flow (PEF) from the beginning of the 3rd hour after provocation and maximum intensity at the 8th hour. These symptoms persisted until the 24th hour. The authors conclude that occupational exposure of the dental technician to cobalt dust derived from metal dentures may cause chronic airway disease with interstitial inflammation, fibrosis and occupational asthma.

This review focuses on the major cellular and structural changes in the airways in occupational asthma and underlines mechanisms that contribute to airflow limitation found in asthmatic patients. Asthma is characterized by thickening of the airway wall and developing of the inflammatory process, including infiltration of inflammatory cells, release of a wide spectrum of molecules (fibronectin, growth factors, cytokines and chemokines), deposition of immunoglobulins and collagen, smooth muscle hyperplasia and fibrosis. These cellular and structural changes may contribute to thickening of the reticular basement membrane and the stable increase in airflow limitation. Airway remodeling is of clinical importance in occupational asthma because it is the main reason for persistent, progressive impairment of respiratory function and makes it necessary to re-evaluate the patient's respiratory disability two years after cessation of occupational exposure.

The aim of the study was to evaluate the risk factors for hypersensitivity to occupational allergens in apprentice bakers. The study group comprised 287 persons. A questionnaire survey, as well as skin prick tests (SPT) with common and occupational allergens were performed in all subjects prior to occupational exposure and one and two years after starting vocational training. In addition, the total IgE level was evaluated in all of them at the beginning of the study. In selected cases, specific anti-flour and alpha-amylase IgE were estimated. Almost 2% of the study subjects showed positive SPT with occupational allergens before vocational training. After two years of occupational exposure, the occurrence of at least one positive SPT increased from 19.2 to 30.7%, including common (from 18.8 to 30%) and occupational (from 1.7 to 12.9%) allergens. In 18.1% of subjects, hypersensitivity to occupational allergens assessed by positive SPT, and/or the presence of antigen specific IgE developed during the study period. Logistic regression analysis revealed that positive SPT with common allergens is a significant risk factor for the development of hypersensitivity to occupational allergens (OR = 9.06, 95% CI: 2.53-32.46). The results of the study suggest that skin prick tests with common and occupational allergens should be performed in bakers prior to occupational exposure. The outcome of the tests should enable better identification of subjects at the highest risk of occupational allergy and their referral to more frequent screening. A relatively high prevalence of positive SPT with occupational allergens (2%) at the beginning of vocational training should be taken into account to avoid possible future diagnostic mistakes.

Objectives. The aim of the study was to assess the predictive value of known risk factors of asthma, such as atopy, exposure to pet allergens at home, and tobacco smoking, in predicting the occurrence of occupational respiratory allergy due to high-molecular-weight allergens. Methods. A questionnaire study, skin-prick tests (SPTs) for common and occupational allergens, and evaluation of total and – in selected cases – specific IgE, were performed in 357 apprentice bakers before and after a year of vocational training. Results. Mean age of examined subjects was 17.2±0.5 years. The prevalence of newly developed symptoms was 7% for rhinitis, 3.1% for chest symptoms, and 3.6% for skin symptoms. The frequency of at least one positive SPT result changed from 17.9% to 24.4% after the 1st year of vocational training, including SPTs for common allergens – from 16.8% to 22.7%, and for occupational allergens – from 2% to 8%. The proportion of subjects with elevated total IgE level increased from 38.7% to 44.3%. Generally, after a year of vocational training 9.2% of examined subjects presented hypersensitivity to occupational allergens. Logistic regression analysis revealed that positive results of SPTs for common allergens (odds ratio (OR) =4.4; 95% confidence intervals (CI) 1.9, 10.27) and elevated IgE level (OR=3.6; 95%CI 1.55, 8.57) were significant risk factors of hypersensitivity to occupational allergens. Conclusions. In apprentice bakers hypersensitivity to occupational allergens develops even during vocational training. SPTs for common allergens, performed before apprentices started their vocational training, would enable the identification of subjects at the highest risk of sensitisation to occupational allergens.

Objectives. This study determined the prevalence of respiratory symptoms and immediate hypersensitivity to feather and fur allergens and pulmonary function among zoological garden workers. Methods. Skin-prick test (SPT) reactivity to common and epithelium (hair) animal fur and feather allergens were examined in 68 zoological garden workers. All subjects responded to a questionnaire and underwent spirometry. Total and antigen-specific IgE were estimated among subjects claiming respiratory symptoms. Results. Forty-five subjects revealed positive SPTs with any inhalant allergen. Twelve reacted to feather extracts and 18 reacted to animal fur extracts. IgE specific for occupational allergens was seen in the serum of five subjects with SPTs positive to feather allergens and in the serum of 12 subjects with SPTs positive to fur allergens. Nose or eye symptoms were reported most frequently. Rhinitis and asthma were reported by atopic subjects more often than by non-atopic subjects. Occupational asthma due to feathers was diagnosed in 2% of zoo workers, and to fur in 10% of subjects working in contact with birds and furred animals. Discussion. The results suggest that occupational asthma caused by feathers is very rare in contrast to asthma caused by animal fur. Atopy predisposes to the development of allergic diseases caused by animal fur and feathers.