Case Of Occupational Asthma Research Articles

БРОНХІАЛЬНА АСТМА ЯК ПРОБЛЕМА ПРОФЕСІЙНОЇ ПАТОЛОГІЇ (КЛІНІЧНИЙ ВИПАДОК)

BRONCHIAL ASTHMA AS A PROBLEM OF OCCUPATIONAL PATHOLOGY (CLINICAL CASE) A. V. Basanets, O. V. Ermakova State Institution «Kundiiev Institute of Occupational Health of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine Abstract. Aim of the study: to analyze a clinical case of occupational bronchial asthma in a librarian with many years of experience, which was diagnosed in the Clinic of occupational diseases of the State Institution «Kundiiev Institute of Occupational Health of the National Academy of Medical Sciences of Ukraine». Materials and research methods: Patient`s medical history, results of clinical, radiological, laboratory and functional examinations. Research results. The examined patient B., 63 years old, worked as a librarian for more than 40 years. The diagnosis was established: Bronchial asthma, ІІІ stage, moderate-severe course, uncontrolled, persistent, phase of exacerbation, basal and lower lobe pneumosclerosis, pulmonary insufficiency І-ІІ stage. Year-round allergic rhinitis — occupational diseases (in the profession for more than 40 years, has been in contact with dust of plant and animal origin) Diagnoses are confirmed by physical examination data, results of clinical laboratory, functional and imaging examination, and data on working conditions. Conclusion: An analysis of epidemiological data on occupational bronchial asthma in Ukraine in recent years has shown a decrease in the incidence, while this indicator is increasing throughout the world. Given the current situation, special attention should be paid to the need for a serious improvement in the training of family doctors, therapists and pulmonologists in occupational pathology. Improving the quality of preliminary (hiring) and periodic medical examinations is of great importance for improving the diagnosis of occupational bronchial asthma. Key words: occupational bronchial asthma, allergic rhinitis, allergens. Angela V. Basanets State Institution «Kundiiev Institute of Occupational Health | of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine Head of the department of occupational pathology Corresponding member of NAMS of Ukraine, professor 75, Saksaganskogo str., 01033, Kyiv, Ukraine a_basanets@meta.ua Аsthma and Allergy, 2021, 3, P. 56–60.

The diagnosis of occupational asthma confirmed by serial peak expiratory flow rate monitoring

Abstract Occupational asthma, the most common occupational respiratory disease in industrialized societies, accounts for 5-10% of all cases of asthma diagnosed in the world. The number of cases is increasing given the development of the “consumer society”. We aim to discuss a case of occupational asthma that we have confirmed using internationally validated methods.

A case of lactoferrin-induced occupational asthma

A case of lactoferrin-induced occupational asthma

Occupational allergy to methacrylates: a deadly risk in workplace

Allergic contact dermatitis (ACD) caused by (meth) acrylates (MA) is common in exposed persons. Moreover, Exposure to MA may rise the predisposition to rhinitis and asthma. However, the occurrence of both asthma and ACD due to MA in the same patient seems to be exceptional. Aim: Report a case of a complex allergy to MA in workplace and stress the difficulty of professional reclassification. A 36-year-old female worker in an electric factory presented to the department of occupational medicine for rhino conjunctivitis, asthma and ACD. Symptoms of weezing dyspnea, rhino conjunctivitis and ACD appeared a few months after recruitment and followed a professional rythmicity (improved during vacation time and aggravated when return to work). The patient’s occupational history revealed that she used a glue containing Hydroxy ethyl methacrylates. Asthma was diagnosed by spirometry, a reversibility test was positive (the FEV1 went up by 12% and 250 ml), nonspecific inhalation challenge test to methacholin was not performed because of a recent history of inadequately controlled asthma. Exhaled NO revealed bronchial inflammation and eosinophilia. The skin-prick test reactions to common environmental allergens and MA were negative. On patch testing, positive reactions were found to several MA including dimethacrylates ethyglycol (++) and mainly the 2-hydroxyethylmethacrylate (2-HEMA) (++). Diagnosis of occupational asthma, rhino conjunctivitis, and ACD to MA was retained. A professional reclassification prohibiting handling all products containing MA was indicated. While resumption of work, the patient presented two episodes of severe acute asthma with hospitalization in intensive care unit and use of endotracheal intubation. Investigation concluded that effective avoidance of use and exposure to glue was not insured imposing a long work stoppage (3 years). Yet, the patient has suffered from a non-controlled severe asthma. To the best of the authors' knowledge, nowadays, there is only one previous reported case of a dentist with both occupational skin and respiratory hypersensitivity from MAs. The case we reported revealed a serious case of occupational asthma, rhino conjunctivitis and ACD caused by MA and threatening the patient's life. Patients with allergy to MA should stop handling it but in practice, professional reclassification finds its limit in severe immediate hypersensitivity forms.

Occupational asthma caused by peracetic acid-hydrogen peroxide mixture.

Healthcare practice in the UK has moved away from using aldehyde disinfectants for the decontamination of endoscopes, in part due to the risk of respiratory sensitization. Peracetic acid (PAA) in combination with hydrogen peroxide (HP) is a commonly used alternative. We describe a case of occupational asthma (OA) diagnosed at our specialist occupational lung disease clinic and caused by occupational exposure to PAA-HP mixture, used as a disinfectant in an endoscope washer-disinfector machine. A 48-year-old man employed as a mycologist and environmental microbiologist at a Birmingham city hospital, UK, presented following an acute exposure to PAA-HP mixture causing lacrimation, burning optic pain and headache. He had also experienced symptoms suggestive of OA for the preceding 10 months, and the diagnosis was confirmed through OASYS analysis of serial peak expiratory flow measurements. He had been exposed to PAA-HP mixture whilst working in the endoscopy department for 12 months prior to the acute episode, and a subsequent specific inhalation challenge test was positive with a late asthmatic response to PAA-HP mixture. This case provides evidence for a sensitization mechanism in OA caused by PAA-HP mixture.

Occupational asthma caused by sensitization to a cleaning product containing triclosan

A recent consensus statement has highlighted the increased risk of developing asthma after exposure to workplace and domestic cleaning products. [1] Siracusa A. De Blay F. Folletti I. et al. Asthma and exposure to cleaning products: a European Academy of Allergy and Clinical Immunology task force consensus statement. Allergy. 2013; 68: 1532-1545 Crossref PubMed Scopus (122) Google Scholar Specific cleaning agents, such as benzylalkonium chloride, have been recognized as causes of occupational asthma by sensitization and now comprise a significant burden of work-related asthma. European Respiratory Society guidelines recommend that sensitizer-induced occupational asthma should be diagnosed by identifying the workplace as the cause and confirming sensitization to an asthmagen by specific inhalation challenge (SIC) in the absence of any available specific IgE tests. [2] Baur X. Sigsgaard T. Aasen T.B. et al. ERS Task Force on the Management of Work-Related AsthmaGuidelines for the management of work-related asthma [published correction appears in Eur Respir J. 2012;39:1553.]. Eur Respir J. 2012; 39: 529-545 Crossref PubMed Scopus (147) Google Scholar We present the first case of occupational asthma caused by the biocide triclosan, commonly used in cleaning and personal care products.

A refined QSAR model for prediction of chemical asthma hazard.

A previously developed quantitative structure-activity relationship (QSAR) model has been extern ally validated as a good predictor of chemical asthma hazard (sensitivity: 79-86%, specificity: 93-99%). To develop and validate a second version of this model. Learning dataset asthmagenic chemicals with molecular weight (MW) <1 kDa were identified from reports published in the peer-reviewed literature before the end of 2012. Control chemicals for which no reported case(s) of occupational asthma had been identified were selected at random from UK and US occupational exposure limit tables. MW banding was used in an attempt to categorically match the control group for MW distribution of the asthmagens. About 10% of chemicals in each MW category were excluded for use as an external validation set. An independent researcher utilized a logistic regression approach to compare the molecular descriptors present in asthmagens and controls. The resulting equation generated a hazard index (HI), with a value between zero and one, as an estimate of the probability that the chemical had asthmagenic potential. The HI was determined for each compound in the external validation set. The model development sets comprised 99 chemical asthmagens and 204 controls. The external validation showed that using a cut-point HI of 0.39, 9/10 asthmagenic (sensitivity: 90%) and 23/24 non-asthmagenic (specificity: 96%) compounds were correctly predicted. The new QSAR model showed a better receiver operating characteristic plot than the original. QSAR refinement by iteration has resulted in an improved model for the prediction of chemical asthma hazard.

In this issue of Occupational Medicine.

Our two editorials consider the impact of the UK's 1974 Health & Safety at Work etc. Act, 40 years after it became the central piece of legislation intended to protect work- ers and the public from harm caused by work activities. Karen Clayton of the Health & Safety Executive (HSE) (1) highlights the reduction in the number of workplace fatalities and of working days lost through work-related illnesses in the past 40 years, but acknowledges the con- tinuing toll of work-related illness on the UK workforce. This is not simply explained by long-latency diseases caused by workplace exposures many years ago, and she assures us health remains high on HSE's agenda, empha- sizing its current partnership approach. Hugh Robertson of the Trades Union Congress (2) reflects on the political consensus supporting the Act's introduction and acknowledges its early successes but voices concern about declining rates of improvement in key indices of workplace health and safety, the near-total disappearance of Employment Medical Advisory Service doctors and the slowing or halting of work on health- related topics, as well as significant recent changes in the scope of the Act and arrangements for enforcing it, despite successive independent reviews confirming it remains fit for purpose and broadly supported. He criticizes politi- cal 'short-termism', prioritizing high-profile safety issues at the expense of occupational health, often concerned with preventing diseases that take years to develop. The key question to be answered is whether recent changes in arrangements for enforcing the Act will cause a decrease in health and safety standards throughout Great Britain, and if so with what costs to society. Against this background we have papers showing that 'old' hazards to health are still causing serious disease in UK workplaces, and that new ones are always waiting to be identified and controlled. Nicol et al. (3) report six cases of silicosis in young asymptomatic Scottish stonema- sons with workplace exposures ranging from 7 to 20 years, despite a low predicted probability of pneumoconiosis based on respiratory symptom questionnaires, spirometry and duration of exposure. Despite silicosis being one of the oldest known occupational lung diseases and long- established legislation intended to prevent harmful expo- sure to respirable crystalline silica, these cases emphasize once again the importance of enforcing effective expo- sure control and of comprehensive health surveillance programmes, with a low threshold for early radiological screening to promote early and effective disease detection. By contrast to this long-known hazard, Cannon et al. (4) report a first case of occupational asthma and rhinitis in a pharmacist, linked to airborne exposure to a novel antimalarial drug and confirmed on inhalation test - ing. Using an established quantitative structure-activ- ity relationship (QSAR) model with high sensitivity and specificity, the molecule concerned has an asthmagen hazard index of zero. As they observe, this false negative provides an opportunity for improving the QSAR model by its inclusion in learning data sets to generate further models based on a wider range of chemical structures shown to be asthmagenic, adding incrementally to our store of knowledge and the resulting opportunity to identify hazards and manage risks to health before harm results. Meanwhile, in the developing world, workplace haz- ards that many here may view as historical curiosities continue to cause harm, too often invisible to us as we enjoy the resulting cheap manufactured goods. Dianne Baxendine describes her experiences in an Indian 'slum clinic' (5). As she observes, the priority needs to be improved public health with simple, regular, preventive health care and education, provided by local trained people. Those who vilify the 'stranglehold of health and safety' in the UK and press for further deregulation may care to consider the evidence, readily available elsewhere in the world, of the consequences for health of inade- quate legislation and enforcement.

Occupational asthma from sensitisation to 4,4-methylene-bismorpholine in clean metalworking fluid

To the Editor: European Respiratory Society guidelines on the management of work-related asthma recommend that occupational asthma with an allergic mechanism should be diagnosed by both identifying the workplace as the cause, and confirming sensitisation to the asthmagen by specific inhalational challenge (SIC), in the absence of any available specific IgE tests [1, 2]. Used (contaminated) metalworking fluid is the usual cause of occupational asthma in exposed workers. We present the first case of occupational asthma due to the biocide additive 4,4-methylene-bismorpholine present in clean metalworking fluid. A 54-year-old Kenyan male presented with a 2-year history of rhinitis, wheeze, dry cough and chest tightness, which were worse at night and while at work, and improved away from work on holiday. He had had rhinitis from grass pollen, perfumes and cleaning agents intermittently for 15 years, and acne due to metalworking fluid 5 years previously. There was no childhood or family history of asthma and he had never smoked cigarettes. He had been employed as a machine tool setter operator for 22 years manufacturing car axles. For the past 6 years he had worked on an enclosed computer numerical controlled milling, drilling and boring machine, with its own oil sump, using carbide-tipped tools. It was loaded by a robot but there was no delay between the end of machining and door opening, which produced a visible mist about 3 m from his work station. The machines used …

Occupational asthma due to polyvinyl chloride and methylmethacrylate, “hidden in an adhesive”

Polyvinyl chloride (PVC) is a thermoplastic polymer widely used in industry, reflected in the number of tons consumed annually in the world. We present a 48 year old male patient with no history of atopy, plumber by profession for 30 years, developed progressive dyspnea and dry cough in the last 3 years, triggered in the work environment and persist outside it, related it to manipulate an adhesive called Tangit, whose components are PVC powder and methylmethacrylate. Never presented skin lesions, or used protection. Were performed blood tests, chest radiography, skin tests, spirometry, bronchodilator test and fraction of exhaled nitric oxide, methacholine challenge test was positive (PC 20, 8 mg/dl). After signing informed consent, we performed specific bronchial provocation (SBP) in a 7m 3 dynamic chamber for 30 minutes of cumulative exposure, simulating working conditions with placebo, the Tangit adhesive provoked a late asthmatic response with a maximal fall in FEV1 of 33% at 7 hours, PVC powder and methylmethacrylate generated dual asthmatic responses, with a maximum drop of 17% at 30 minutes and 17.3% at 7 hours, 22% at 2 minutes and 20% at 9 hours, respectively. The patient during the study was on sick leave from to 24 months. We report a case of occupational asthma by PVC and methylmethacrylate, shown by specific bronchial challenge in a plumber exposed to these agents. There are cases of occupational asthma published by the degradation products of PVC or manipulated workers manufacturing bottle caps1 and packaging. It is the first case of occupational asthma by PVC content in an adhesive. So far been known that adhesives containing acrylates, capable of inducing asthma.

Occupational asthma and rhinitis caused by cyanoacrylate-based eyelash extension glues

Eyelash extensions are applied on top of customers' lashes using instant glue containing cyano acrylate, known to cause occupational rhinitis (OR) and occupational asthma (OA). The number of beauty professionals applying these extensions is increasing due to their popularity. To report on a case of OA with OR and a case of OR attributable to lash extension glue and to evaluate respiratory exposure in lash extension work. Two beauty professionals with suspected OA and/or OR underwent inhalation challenge, including both control challenge and work-mimicking challenges using the lash extension glue, each with a 24-h follow-up. Volatile organic compounds (VOCs) present were assessed during the lash extension glue challenge. The glues were analysed for their (meth)acrylate content. Both beauty professionals (case 1 and case 2) applied lash extensions regularly for several hours per day as part of their work and had work-related rhinitis. Case 1 had a longer history of lash extension work and also had asthmatic symptoms. The first lash extension glue challenge was negative in both cases, but positive OR reactions were detected in the second test. Case 1 also had a late asthmatic reaction. During the lash extension glue challenge, VOC were present in total concentrations below the irritant threshold and ethylcyanoacrylate (ECA) was detected in a concentration of 0.4mg/m(3). Chemical analysis of the glues revealed ECA was the major component. Application of eyelash extensions using small amounts of cyanoacrylate-based glues can cause OA and OR.

Occupational allergy to squid (Loligo vulgaris)

Occupational allergy from exposure to squid has been rarely described, mainly as contact dermatitis or urticaria. Our report presents the first case of occupational asthma, rhinitis, conjunctivitis and contact urticaria to squid in a 33-year-old seafood production worker, with documented increased eosinophilia in the nasal and tear fluids after specific inhalation challenge test (SICT) with squid. IgE-mediated sensitization to squid was confirmed by positive skin prick test and opened skin test with squid extract. SICT demonstrated a direct and significant link between the exposure to squid and the allergic response from the respiratory system and conjunctiva.

A Case of Occupational Asthma in a Plastic Injection Process Worker

ObjectivesWe report a case of death due to asthma attack in a plastic injection process worker with a history of asthma.MethodsTo assess task relevance, personal history including occupational history and medical records were reviewed. Samples of the substances utilized in the injection process were collected by visiting the patient’s workplace. The work environment with the actual process was reproduced in the laboratory, and the released substances were evaluated.ResultsThe medical records confirmed that the patient’s conventional asthma was in remission. The analysis of the resins discharged from the injection process simulation revealed styrene, which causes occupational asthma, and benzenepropanoic acid, 3,5-bis(1,1-dimethylethyl)-4-hydroxy-, and octadecyl ester. Even though it was not the case in the present study, various harmful substances capable of inducing asthma such as formaldehyde, acrolein, and acetic acid are released during resin processing.ConclusionA worker was likely to occur occupational asthma as a result of the exposure to the harmful substances generated during the plastic injection process.

Case Report of Occupational Asthma Induced by Polyvinyl Chloride and Nickel

Polyvinyl chloride (PVC) is a widely used chemical for production of plastics. However occupational asthma (OA) caused by PVC has been reported only rarely. We report a 34-yr-old male wallpaper factory worker with OA due to PVC and nickel (Ni) whose job was mixing PVC with plasticizers. He visited the emergency room due to an asthma attack with moderate airflow obstruction and markedly increased sputum eosinophil numbers. A methacholine challenge test was positive (PC20 2.5 mg/mL). Bronchoprovocation tests with both PVC and Ni showed early and late asthmatic responses, respectively. Moreover, the fractional concentration of exhaled nitric oxide (FeNO) was increased after challenge with PVC. To our knowledge, this is the first case of OA in Korea induced by exposure to both PVC and Ni. We suggest that eosinophilic inflammation may be involved in the pathogenesis of PVC-induced OA and that FeNO monitoring can be used for its diagnosis.

Occupational asthma due to spruce wood

Workers exposed to a variety of wood dusts are known to experience work-related respiratory symptoms, 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 occupational 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 immunological mechanism seems to be responsible.

Occupational respiratory and skin diseases among Finnish machinists: findings of a large clinical study

Machinists are exposed to many sensitizing and irritant substances, but no previous study has assessed the occurrence of clinically verified occupational diseases in an unselected large workforce of machinists. Our aim was to study the occurrence of clinically verified occupational respiratory and skin diseases cross-sectionally in a large sample of machinists in southern Finland. A computer-assisted telephone interview on occupational exposures and health was carried out in a sample of 961 machining workers from 64 metalworking companies. Of these, 757 (79%) answered the interview. A total of 245 subjects reported work-related respiratory or skin symptoms and were invited to clinical examinations; 138 of these underwent a clinical interview and examination by an occupational health physician. On the basis of this examination, 32 subjects were further examined at the Finnish Institute of Occupational Health (FIOH) for occupational skin or respiratory diseases. One case of occupational asthma (OA) and seven cases of occupational dermatoses (OD) were diagnosed, giving a prevalence of 0.13% (95% CI 0-0.39) for OA, and 0.92% (95% CI 0.24-1.16) for OD. The OA was induced by the patient's own MWF. Additional five cases of newly diagnosed non-occupational asthma (0.79%, 95% CI = 0.16-1.42) were detected. No cases of occupational rhinitis or COPD were diagnosed. The dermatoses diagnoses consisted of four cases of allergic contact dermatitis and three cases of irritant contact dermatitis. The most common causes of the ODs were MWFs. This large clinical study of machinists representing metalworking in South Finland showed a prevalence of 0.13% of OA and 0.92% of OD. This relatively low occurrence of occupational diseases may reflect the strict Finnish criteria for the diagnosis of these occupational diseases and the relatively good level of occupational hygiene in machining workshops in Finland. Reported respiratory and skin symptoms were common, and these milder conditions may be linked to irritant rather than sensitizing exposures.

Occupational asthma induced by exposure to lima bean (Phaseolus lunatus)

We report the first case of occupational asthma (OA) due to the exposure to vapors from boiling Phaseolus lunatus in a food processing industry. Phaseolus lunatus, commonly known as the lima bean or butter bean, belongs to the Leguminosae family and is native of the Central America and Andean regions.

Abstract Title

Title AbstractBackground. Bakery and hairdressing rank high among occupations at risk of asthma. We explored the early incidence of occupational asthma (OA) along the first years of activity among young workers.Methods. Subjects who graduated between 2001 and 2006 underwent telephone interviews on the occurrence of respiratory symptoms. Workers in occupations not exposed to known airways irritants or allergens were also included. Subjects who had asthma when starting apprenticeship were excluded. Those who declared work-related respiratory or ENT symptoms and a sample of asymptomatic subjects were proposed a medical visit (spirometry tests, exhaled NO measurements, daily surveillance of peak flow values, blood sample for assessment of common allergens and work-specific IgE). Diagnosis of OA was established by expert judgment and the sensitivity and specificity of symptoms declared during the telephone interviews were assessed.Results. 866 subjects were interviewed (mean age: 25.3 years), among which 282 underwent a medical visit.The cumulative incidence of ‘probable’ OA among bakers was high in the first quartile of exposure duration (median value=3.0 years; risk = 15.8 % [95%CI=9.9–21.7]); several had to quit this activity because of this condition. It was reduced to 13.1 % [7.2–19.0] in the second exposure duration quartile (5.3 years) and increased regularly across the third (7.4) and fourth (9.5) quartiles, with 14.7 % [7.8– 21.7]) and 17.2 % [8.7–25.6]), respectively. The corresponding figures among hairdressers are 8.3 % [0.6–16.0]), 6.1 % [0.7–11.5], 4.3 % [0.1–8.6] and 6.4 % [1.5– 11.3]. Atopy is highly associated with incidence of OA among bakers (RR= 7.4), and, to a lesser extent, among hairdresser (RR= 3.6). No new case of OA occurred in the reference group.Conclusion. Incidence of OA starts soon after engaging in bakery and hairdressing, activities that entail exposure to low or high molecular weight agents.

Occupational asthma and rhinitis due to detergent enzymes in healthcare

The use of proteolytic enzymes to improve the cleaning efficacy of washing powders was introduced in the mid 1960s. Many microbial enzymes are known to be potent respiratory sensitizers but previously there has been only one case of occupational asthma associated with workplace exposure in a healthcare worker. To report two cases of occupational asthma associated with exposure to biological enzymes in health-care workers and related occupational cases. Reporting of clinical case reports from three different work places. One case of occupational asthma and three other cases with work-related asthma or rhinitis occurred in one workplace. A single case of probable occupational asthma presented at a second workplace with another case of work-related asthma at a third workplace. Exposures occurred in areas used for cleaning medical instruments and endoscopy suites. Hygiene measurements confirmed the potential for exposure. Control measures were not in place and recognition of the hazard was missing in these workplaces. Detergent enzymes when used in healthcare settings should be recognized as potential respiratory sensitizers. Healthcare institutions and professional bodies that recommend the use of detergent enzymes should review their risk assessments to ensure that the most appropriate methods for preventing or reducing exposure are in place.

P7 Occupational eosinophilic constrictive bronchiolitis with asthma in a foam cutter caused by Soya bean products

Introduction and backgroundSoya bean dust is a recognised cause of asthma. More recently Soya bean has bean used in the manufacture of foam. The main market for this ‘environmentally friendly...