Abstract
Occupational asthma (OA) represents one of the major public health problems due to its high prevalence, important social and economic burden. The aim of this review is to summarize current data about clinical phenotypes, biomarkers, diagnosis and management of OA, a subtype of work-related asthma. Most studies have identified two phenotypes of OA. One is sensitizer-induced asthma, occuring after a latency period and caused by hypersensitivity to high- or low-molecular weight agents. The other is irritant-induced asthma, which can occur after one or more exposures to high concentrations of irritants without latency period. More than 400 agents causing OA have been identified and its list is growing fast. The best diagnostic approach for OA is a combination of clinical history and objective tests. An important tool is a specific inhalation challenge. Additional tests include assessments of bronchial hyperresponsiveness to methacholine/histamine in patients without airflow limitations, monitoring peak expiratory flow at- and off-work, sputum eosinophil count, exhaled nitric oxide measurement, skin prick tests with occupational allergens and serum specific IgE. Treatment of OA implies avoidance of exposure, pharmacotherapy and education. OA is a heterogeneous disease. Mechanisms of its different phenotypes, their diagnosis, role of new biomarkers and treatment require further investigation.
Highlights
Asthma is a heterogeneous disease characterized by a chronic airway inflammation and defined by recurring episodes of wheezing, shortness of breath, chest tightness and coughing that vary over time and in intensity, associated with variable expiratory flow limitation [1]
The aim of this review is to summarize current data about clinical phenotypes, biomarkers, diagnosis and management strategies of Occupational asthma (OA) which represents a major public health problem due to its high prevalence and its important financial-societal burden
Despite that currently the utility of these factors in practice to determine the ability of a worker to do a job with a risk of sensitization is limited [13], the identification of workers at risk according to their individual characteristics and worker’s education about the workplaces with high levels of occupational allergens/irritants represent very important steps in the prevention of OA [6] Most of high-molecular weight (HMW) and a limited number of LMW agents induce asthma through immunoglobulin E (IgE)-dependent mechanism, while the immunologic pathways involved into the sensitization to LMW agents are poorly understood [3,5]
Summary
Asthma is a heterogeneous disease characterized by a chronic airway inflammation and defined by recurring episodes of wheezing, shortness of breath, chest tightness and coughing that vary over time and in intensity, associated with variable expiratory flow limitation [1]. Despite that currently the utility of these factors in practice to determine the ability of a worker to do a job with a risk of sensitization is limited [13], the identification of workers at risk according to their individual characteristics and worker’s education about the workplaces with high levels of occupational allergens/irritants represent very important steps in the prevention of OA [6] Most of HMW and a limited number of LMW agents (e.g., reactive dyes, platinum salts, obeche wood) induce asthma through immunoglobulin E (IgE)-dependent mechanism, while the immunologic pathways involved into the sensitization to LMW agents (e.g., diisocyanates, persulphate salts, aldehydes, anhydride acids, acrylates) are poorly understood [3,5].
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