Abstract
Background. The risks of occupational asthma (OA) from antibiotics are uncertain. We report 4 new cases and a systematic review of the literature. Methods. Cases were identified through a specialist clinic, each underwent specific provocation testing (SPT). We subsequently reviewed the published literature. Results. The patients were employed in the manufacture of antibiotics; penicillins were implicated in three cases, in the fourth erythromycin, not previously reported to cause OA. In two, there was evidence of specific IgE sensitisation. At SPT each developed a late asthmatic reaction and increased bronchial hyperresponsiveness. 36 case reports have been previously published, 26 (citing penicillins or cephalosporins). Seven cross-sectional workplace-based surveys found prevalences of 5–8%. Conclusions. OA in antibiotic manufacturers may be more common than is generally recognised. Its pathogenesis remains unclear; immunological tests are of uncertain value and potential cases require confirmation with SPT. Further study of its frequency, mechanisms, and diagnosis is required.
Highlights
Among the several hundred workplace agents implicated as causes of occupational asthma (OA), several are encountered in the pharmaceutical manufacturing industry [1]
Each of the four cases was involved in the primary manufacture or formulation of antibiotics in the United Kingdom and had presented with new onset, work-related asthmatic symptoms
Our cases add three to the previously reported eight cases of OA attributed to inhalation of synthetic penicillins during their manufacture, and the first case of disease arising from workplace exposure to erythromycin
Summary
Among the several hundred workplace agents implicated as causes of occupational asthma (OA), several are encountered in the pharmaceutical manufacturing industry [1]. These include antibiotics which, through inhalation, may induce asthma in exposed employees. The reports are supplemented by a systematic literature review of antibiotic occupational asthma. We report 4 new cases and a systematic review of the literature. The patients were employed in the manufacture of antibiotics; penicillins were implicated in three cases, in the fourth erythromycin, not previously reported to cause OA. Its pathogenesis remains unclear; immunological tests are of uncertain value and potential cases require confirmation with SPT. Further study of its frequency, mechanisms, and diagnosis is required
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