Search

Making an accurate diagnosis of occupational asthma (OA) is, generally, important. The condition has not only significant health consequences for affected workers, but also substantial socio-economic impacts for workers, their employers and wider society. Missing a diagnosis of OA may lead to continued exposure to a causative agent and progressive worsening of disease; conversely, diagnosing OA when it is not present may lead to inappropriate removal from exposure and unnecessary financial and social consequences. While the most accurate investigation is specific inhalation challenge in an experienced centre, this is a scarce resource, and in many cases, reliance is on other tests. This review provides a technical dossier of the diagnostic value of the available methods which include an appropriate clinical history, the use of specific immunology and measurement of inflammatory markers, and various methods of relating functional changes in airway calibre to periods at work. It is recommended that these approaches are used iteratively and in judicious combination, in cognizance of the individual patient's circumstances and requirements. Based on available evidence, a working diagnostic algorithm is proposed that can be adapted to the suspected agent, purpose of diagnosis and available resources. For better or worse, many of the techniques - and their interpretation - are available only in specialized centres and where there is room for doubt, referral to such a centre is probably wise. Accordingly, the implementation or development of such specialized centres with appropriate equipment and expertise should greatly improve the diagnostic evaluation of work-related asthma. [ABSTRACT FROM AUTHOR]

Background Recombinant Hevea brasiliensis ( rHev b) natural rubber latex ( NRL) allergen components have been developed to assess the patients' allergen sensitization profile and to improve the diagnosis of NRL allergy. Objective To examine whether the determination of specific IgE ( sIgE) reactivity to a panel of recombinant allergen components would be helpful for diagnosing NRL-induced occupational asthma ( OA) in predicting the outcome of a specific inhalation test. Methods sIgE levels to NRL extract and 12 recombinant NRL allergen components were assessed in 82 subjects with OA ascertained by a positive specific inhalation challenge ( SIC) with NRL gloves and in 25 symptomatic subjects with a negative challenge. Results The sensitivity, specificity, positive predictive value, and negative predictive value of a NRL- sIgE level ≥0.35 kUA/l as compared to the result of SICs were 94%, 48%, 86%, and 71%, respectively. The positive predictive value increased above 95% when increasing the cutoff value to 5.41 kUA/l. Subjects with a positive SIC showed a significantly higher rate of sIgE reactivity to rHev b 5, 6.01, 6.02, and 11 than those with a negative SIC. A sIgE sum score against rHev b 5 plus 6.01/6.02 ≥ 1.46 kUA/l provided a positive predictive value >95% with a higher sensitivity (79%) and diagnostic efficiency (Youden index: 0.67) as compared with a NRL- sIgE ≥5.41 kUA/l (49% and 0.41, respectively). Conclusion In suspected OA , high levels of sIgE against rHev b 5 combined with rHev b 6.01 or 6.02 are the most efficient predictors of a bronchial response to NRL. [ABSTRACT FROM AUTHOR]

The aim of this document was to provide a critical review of the current knowledge on hypersensitivity pneumonitis caused by the occupational environment and to propose practical guidance for the diagnosis and management of this condition. Occupational hypersensitivity pneumonitis ( OHP) is an immunologic lung disease resulting from lymphocytic and frequently granulomatous inflammation of the peripheral airways, alveoli, and surrounding interstitial tissue which develops as the result of a non-IgE-mediated allergic reaction to a variety of organic materials or low molecular weight agents that are present in the workplace. The offending agents can be classified into six broad categories that include bacteria, fungi, animal proteins, plant proteins, low molecular weight chemicals, and metals. The diagnosis of OHP requires a multidisciplinary approach and relies on a combination of diagnostic tests to ascertain the work relatedness of the disease. Both the clinical and the occupational history are keys to the diagnosis and often will lead to the initial suspicion. Diagnostic criteria adapted to OHP are proposed. The cornerstone of treatment is early removal from exposure to the eliciting antigen, although the disease may show an adverse outcome even after avoidance of exposure to the causal agent. [ABSTRACT FROM AUTHOR]

We describe a 43-year-old epoxy floor layer who developed work-related asthma while exposed to an epoxy hardener based on isophorone diamine (IPDA). Challenge exposures to the curing of the epoxy resin system and subsequently to the polyfunctional amine hardener containing IPDA both elicited delayed asthmatic reactions. This report further indicates that exposure to epoxy hardeners containing polyfunctional amines should be considered as a potential cause of occupational asthma. Appropriate work hygiene measures should be implemented to minimize airborne exposure to these volatile compounds. [ABSTRACT FROM AUTHOR]

The term irritant-induced (occupational) asthma ( IIA) has been used to denote various clinical forms of asthma related to irritant exposure at work. The causal relationship between irritant exposure(s) and the development of asthma can be substantiated by the temporal association between the onset of asthma symptoms and a single or multiple high-level exposure(s) to irritants, whereas this relationship can only be inferred from epidemiological data for workers chronically exposed to moderate levels of irritants. Accordingly, the following clinical phenotypes should be distinguished within the wide spectrum of irritant-related asthma: (i) definite IIA, that is acute-onset IIA characterized by the rapid onset of asthma within a few hours after a single exposure to very high levels of irritant substances; (ii) probable IIA, that is asthma that develops in workers with multiple symptomatic high-level exposures to irritants; and (iii) possible IIA, that is asthma occurring with a delayed-onset after chronic exposure to moderate levels of irritants. This document prepared by a panel of experts summarizes our current knowledge on the diagnostic approach, epidemiology, pathophysiology, and management of the various phenotypes of IIA. [ABSTRACT FROM AUTHOR]

To cite this article: Vandenplas O, Dramaix M, Joos G, Louis R, Michils A, Verleden G, Vincken W, Vints A-M, Herbots E, Bachert C. The impact of concomitant rhinitis on asthma-related quality of life and asthma control. Allergy 2010; 65: 1290–1297. Background: Characterizing the interactions between the upper and lower airways is important for the management of asthma. This study aimed at assessing the specific impact of concomitant rhinitis on asthma-related quality of life (QOL) and asthma control. Methods: A cross-sectional, observational survey was conducted among 1173 patients with asthma (aged 12–45) recruited by general practitioners and chest physicians. AR was defined by self-reported rhinitis symptoms and previously documented sensitization to inhalant allergens. The primary outcomes were ( 1 ) asthma control assessed by the Asthma Control Questionnaire (ACQ) and ( 2 ) asthma-specific QOL evaluated through the Mini Asthma Quality of Life Questionnaire (mAQLQ). Results: AR was present in 73.9% of the population with asthma and nonallergic rhinitis (NAR) in 13.6%. AR and NAR were associated with an increased risk of uncontrolled asthma (i.e. ACQ score > 1.5) with adjusted odds ratios (OR) of 2.00 (95% confidence interval [CI]: 1.35–2.97) and 1.77 (95%CI: 1.09–2.89), respectively. Multivariate linear regression analysis showed that AR and NAR had a modest, although significant, negative impact on the global mAQLQ score (beta coefficient: −0.293, standard error [SE]: 0.063 and beta coefficient: −0.221, SE: 0.080, P < 0.001, respectively), even after adjustment for the level of asthma control and demographic characteristics. Conclusion: This survey provides direct evidence that AR and NAR are associated with an incremental adverse impact on the disease-specific QOL of patients with asthma and the level of asthma control. Further investigations are required to determine whether appropriate treatment of rhinitis would efficiently reduce asthma morbidity. [ABSTRACT FROM AUTHOR]

Background: False-negative responses to specific inhalation challenge (SIC) with occupational agents may occur. We explored whether assessing changes in sputum cell counts would help improve the identification of bronchial reactivity to occupational agents during SICs. Methods: The predictive value of the changes in sputum cell counts after a negative FEV1 response to a first challenge exposure to an occupational agent was determined using the changes in airway calibre observed during repeated challenges as the ‘gold standard’. The study included 68 subjects investigated for work-related asthma in a tertiary centre. After a control day, the subjects were challenged with the suspected occupational agent(s) for up to 2 h. All subjects who did not show an asthmatic reaction were re-challenged on the following day. Additional challenges were proposed to those who demonstrated a ≥ 2% increase in sputum eosinophils or an increase in nonspecific bronchial hyperresponsiveness to histamine after the second challenge day. Results: Six of the 35 subjects without changes in FEV1 on the first challenge developed an asthmatic reaction on subsequent challenges. ROC analysis revealed that a >3% increase in sputum eosinophils at the end of the first challenge day was the most accurate parameter for predicting the development of an asthmatic response on subsequent challenges with a sensitivity of 67% and a specificity of 97%. Conclusions: An increase in sputum eosinophils is an early marker of specific bronchial reactivity to occupational agents, which may help to identify subjects who will develop an asthmatic reaction only after repeated exposure. [ABSTRACT FROM AUTHOR]

Background: Natural rubber latex (NRL) has become as a major cause of occupational asthma (OA) in workers using NRL gloves. Few population-based studies have assessed the impact of changes in the patterns of glove usage on the incidence of NRL-induced OA. Objective: To characterize the time trends in incident cases of NRL-induced OA in Belgium and examine whether incidence rates were related to the types of gloves used in hospitals. Methods: Incident cases of NRL-induced OA were identified through a retrospective review of all claims submitted to the Workers’ Compensation Board up to December 2004. Based on the results of diagnostic procedures, the diagnosis of NRL-induced OA was categorized as definite, probable, unlikely, or indeterminate. The patterns of glove usage were characterized through a questionnaire survey of Belgian hospitals. Results: A total of 298 claims for NRL-induced OA were identified, including 127 subjects with definite OA and 68 with probable OA. Categorized by the year of asthma onset, the incident cases of definite and probable NRL-induced OA markedly decreased from 1999 onwards. The use of powdered NRL gloves fell from 80.9% in 1989 to 17.9% in 2004. Powdered NRL gloves were predominantly substituted with NRL-free gloves, especially in the case of non-sterile procedures. Conclusion: These national compensation-based data confirm that a persistent decline in the incidence of NRL-induced OA has occurred since late 1990s. This downward trend has temporally been associated with a decreasing usage of powdered NRL, further supporting a beneficial role of changes in glove policies. [ABSTRACT FROM AUTHOR]

The present document is the result of a consensus reached by a panel of experts from European and nonEuropean countries on Occupational Rhinitis (OR), a disease of emerging relevance, which has received little attention in comparison to occupational asthma. The document covers the main items of OR including epidemiology, diagnosis, management, socio-economic impact, preventive strategies and medicolegal issues. An operational definition and classification of OR tailored to that of occupational asthma, as well as a diagnostic algorithm based on steps allowing different levels of diagnostic evidence, are proposed. The needs for future research are pointed out. Key messages are issued for each item. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 43-year-old man who developed work-related rhinoconjunctivitis and asthma symptoms, 11 years after starting his employment as a maintenance worker in a tea-packing plant. The patient noticed that his symptoms occurred electively when chamomile tea was packaged. The article discusses that the inhalation of chamomile dust can induce IgE-mediated rhinitis and asthma among exposed workers.

The article discusses the case of a patient who works as a chemist at an oleochemical plant. He developed occupational rhinitis and asthma induced by the inhalation of linseed oilcake dust. The patient never smoked and never had a history of atopic disease or food allergy. He was constantly exposed to ground linseed oilcake at their extraction department.

The article focuses on a case study of a woman without previous history of allergy, who received an intra-articular injection of corticosteroid preparation. She had developed generalized urticaria, bronchospasm, and systolic hypotension. A skin prick testing with macrogols 400 and 1500/300 did not substantiate a cross-sensitization phenomenon. The findings indicated that the amount of ingested macrogol is a critical factor for eliciting hypersensitivity reactions in sensitized patients.

Presents a case of a 31-year-old male who had been accidentally exposed for about two hours to formaldehyde that leaked from a malfunctioning reactor gasket while working in chemical plant producing urea-formaldehyde resins. Case history; Immunological assessment; Temporal relationship between accidental high-level exposure to formaldehyde and the rapid onset of asthma symptoms; Specific immunoglobulin E antibodies against toluene diisocyanate.

Reports on a case of asthmatic reaction to tetramethrin, a synthetic analog of pyrethrin for insecticidal activity and photostability, in a 47-year-old man. Clinical manifestations; Inhalation challenges findings.

Background. More than 400 agents have been documented as causing occupational asthma (OA). The list of low-molecular-weight (LMW) agents that have been identified as potential causes of OA is constantly expanding, emphasizing the need to continually update our knowledge by reviewing the literature. Objective. The objective of this paper was to identify all new LMW agents causing occupational asthma reported during the period 2000-2010. Methods. A Medline search was performed using the keywords occupational asthma, new allergens, new causes, and low-molecular-weight agents. Results. We found 39 publications describing 41 new LMW causal agents, which belonged to the following categories: drugs (n = 12), wood dust (n = 11), chemicals (n = 8), metals (n = 4), biocides (n = 3), and miscellaneous (n = 3). The diagnosis of OA was confirmed through SIC for 35 of 41 agents, peak expiratory flow monitoring for three (3) agents, and the clinical history alone for three (3) agents. Immunological tests provided evidence supporting an IgE-mediated mechanism for eight (8) (20%) of the newly described agents. Conclusion. This paper highlights the importance of being alert to the occurrence of new LMW sensitizers, which can elicit OA. The immunological mechanism is explained by a type I hypersensitivity reaction in 20% of all newly described LMW agents. [ABSTRACT FROM AUTHOR]

Background Ascertaining the presence of asthma through the assessment of nonspecific bronchial hyperresponsiveness ( NSBH) is a key step in the diagnosis of occupational asthma ( OA). We aimed at investigating whether indices of airway inflammation including fractional exhaled nitric oxide (Fe NO) and sputum eosinophils would be useful adjuncts to the measurement of NSBH in diagnosing OA defined as a positive specific inhalation challenge ( SIC). Methods The study included 240 consecutive subjects with a suspicion of OA who completed a SIC, of whom 133 showed a positive response. The sensitivity, specificity, and predictive values of NSBH, and Fe NO, as well as sputum eosinophil counts assessed at baseline of the SIC were determined. Results A concentration of histamine inducing a 20% decline in FEV1 ( PC20) ≤16 mg/mL showed a sensitivity of 87% and a specificity of 36%. A Fe NO level ≥25 ppb and a sputum eosinophil count ≥2% provided lower sensitivity rates (47% and 39%, respectively) than the PC20 value. Eight of the 17 subjects without baseline NSBH despite a positive SIC showed a sputum eosinophil count ≥2%, a Fe NO level ≥25 ppb, or both outcomes. Combining either a PC20 value ≤16 mg/ mL or a Fe NO ≥25 ppb increased the sensitivity to 91%. Using either a PC20 ≤16 mg/ mL or a sputum eosinophil count ≥1% increased the sensitivity to 94%. Conclusion Adding the assessment of Fe NO level and sputum eosinophils to NSBH improves the identification of subjects who may have OA and require further objective testing before excluding the possibility of OA. [ABSTRACT FROM AUTHOR]

Allergic rhinitis often impairs social life and performance. The aim of this cross-sectional study was to use cell phone data to assess the impact on work productivity of uncontrolled rhinitis assessed by visual analogue scale ( VAS). A mobile phone app ( Allergy Diary, Google Play Store and Apple App Store) collects data from daily visual analogue scales ( VAS) for overall allergic symptoms ( VAS-global measured), nasal ( VAS-nasal), ocular ( VAS-ocular) and asthma symptoms ( VAS-asthma) as well as work ( VAS-work). A combined nasal-ocular score is calculated. The Allergy Diary is available in 21 countries. The app includes the Work Productivity and Activity Impairment Allergic Specific Questionnaire ( WPAI: AS) in six EU countries. All consecutive users who completed the VAS-work from 1 June to 31 October 2016 were included in the study. A total of 1136 users filled in 5818 days of VAS-work. Symptoms of allergic rhinitis were controlled ( VAS-global <20) in approximately 60% of the days. In users with uncontrolled rhinitis, approximately 90% had some work impairment and over 50% had severe work impairment ( VAS-work >50). There was a significant correlation between VAS-global calculated and VAS-work (Rho=0.83, P<0.00001, Spearman's rank test). In 144 users, there was a significant correlation between VAS-work and WPAI: AS (Rho=0.53, P<0.0001). This pilot study provides not only proof-of-concept data on the work impairment collected with the app but also data on the app itself, especially the distribution of responses for the VAS. This supports the interpretation that persons with rhinitis report both the presence and the absence of symptoms. [ABSTRACT FROM AUTHOR]

Cough is a nonspecific and relatively common symptom that can present difficulties in diagnosis and management, particularly when it is reported to be associated with the workplace. The present consensus document, prepared by a taskforce of the Interest Group on Occupational Allergy of the European Academy of Allergy and Clinical Immunology by means of a nonsystematic review of the current literature, is intended to provide a definition and classification of work-related chronic cough ( WRCC) to assist the daily practice of physicians facing with this symptom. The review demonstrates that several upper and lower airway work-related diseases may present with chronic cough; hence, the possible link with the workplace should always be considered. Due to the broad spectrum of underlying diseases, a multidisciplinary approach is necessary to achieve a definite diagnosis. Nevertheless, more epidemiological studies are necessary to estimate the real prevalence and risk factors for WRCC, the role of exposure to environmental and occupational sensitizers and irritants in its pathogenesis and the interaction with both upper and lower airways. Finally, the best management option should be evaluated in order to achieve the best outcome without adverse social and financial consequences for the worker. [ABSTRACT FROM AUTHOR]

There is theoretical evidence that specific airway conductance (SGaw) could be more reliable than forced expiratory volume in 1 s (FEV1) for assessing changes in airway calibre. We investigated the changes in FEV1 and SGaw when assessing bronchial responses to occupational agents. SGaw and FEV1 were measured during inhalation challenges with various occupational agents in 174 consecutive subjects investigated for possible occupational asthma. A decline in SGaw of 50% or greater was documented in 77 of 90 subjects (86%) who showed a ≥20% fall in FEV1 and in 11 of 84 subjects (13%) who failed to demonstrate such a fall in FEV1. Among subjects who developed a ≥20% fall in FEV1, those who failed to develop a ≥50% decline in SGaw had a lower baseline SGaw than those who did. Among the group without a ≥20% fall in FEV1, a ≥50% decrease in SGaw was associated with either an ‘intermediate’ fall in FEV1 (between 15 and 17% from baseline value) ( n = 4), a significant postchallenge increase in nonspecific bronchial hyper-responsiveness to histamine ( n = 2), or both features ( n = 3). A decline in SGaw of 50% or greater may provide useful complementary evidence of a bronchial response during challenges that produce equivocal results in FEV1. [ABSTRACT FROM AUTHOR]

Study Objective: To assess the frequency of cystic fibrosis transmembrane conductance regulator (CFTR) gene mutations in patients with allergic bronchopulmonary aspergillosis (ABPA).Design: Case-control study. All subjects in the study were screened for the presence of 13 mutations in the CFTR gene (R117H, 621 + 1G(-)>T, R334 W, Delta F508, Delta I507, 1717-1G(-)>A, G542X, R553X, G551D, R1162X, 3849 + 10kbC(-)>T, W1282X, and N1303K). Moreover, they were also screened for the presence of the 5T variant in intron 8.Setting: University hospital and community-based hospital.Patients: Twenty-one white patients with ABPA participated in the study. The presence of CFTR mutations was also investigated in 43 white subjects with allergic asthma who did not show sensitization to Aspergillus fumigatus and in 142 subjects seeking genetic counseling for diseases other than cystic fibrosis (CF).Results: Six patients with ABPA were found to be heterozygous for one CFTR mutation, including Delta F508 (n = 2), G542X (n = 1), R1162X (n = 1), 1717-1G(-)>A (n = 1), and R117H (n = 1). The 5T allele was not detected in ABPA patients. None of the ABPA patients showed sweat chloride concentrations > 60 mEq/L. The frequency of CFTR mutation carriers was significantly higher in ABPA patients (6 of 21 patients; 28.5%) than in control asthmatic subjects (2 of 43 subjects; 4.6%; p = 0.01) and in subjects seeking genetic counseling (6 of 142 subjects; p < 0.001).Conclusion: These findings indicate that in patients without a clinical diagnosis of CF, CFTR gene mutations could be involved in the development of ABPA, in association with other genetic or environmental factors. [ABSTRACT FROM AUTHOR]

Background: FEV[sub 1] is more sensitive than PEF in assessing late asthmatic responses (LAR) after specific inhalation challenges (SIC) with occupational agents. As immediate asthmatic reactions (IAR) mainly involve proximal airways, PEF may, however, be as valid as FEV[sub 1]. Methods: Thirty-seven subjects who experienced an immediate fall in FEV[sub 1] of ≥20% during SIC with occupational agents and 20 subjects with fall of ≤10% in FEV[sub 1] were included. Both FEV[sub 1] and PEF were measured in a random order every 10 min for 1 h after exposure. We corrected PEF (PEFc) for inaccuracies of the mini-Wright meters by the Miller equation. Results: Maximum changes in PEFc (30±11%) were not significantly different from changes in FEV[sub 1] (27±5%) (P=0.13). Their timings after exposure were 14±11 min and 17±17 min, respectively (P=0.4). High sensitivity (92%), specificity (95%), accuracy (93%), and positive predictive value (97%) were found for a 20% fall in PEFc to detect a significant IAR. Results were better and not influenced by meter inaccuracies with a cutoff point of 15% change in noncorrected PEF (PEFnc). An absolute decrease in PEF of 70 l/min gave a good discrimination between reactions with and without an asthmatic response. Conclusions: PEF is as satisfactory as FEV[sub 1] for detecting a significant IAR after exposure to an occupational agent if one considers a cutoff point of. 15% fall in PEF. 20% fall in PEFc. 20% fall and/or 70 l/min decrease in PEFnc. [ABSTRACT FROM AUTHOR]