Occupational Allergens Research Articles

Targeted micronutrition for allergic patients—possible applications of a food for special medical purposes

SummaryA novel and recently launched food for special medical purposes was discussed by a multidisciplinary expert panel as an option for allergic patients. The newly developed lozenge contains the whey protein beta-lactoglobulin (BLG) as well as the micronutrients iron, zinc and vitamin A. BLG loaded with ligands (holo-BLG) is discussed as one factor of the allergy-protective farm effect in numerous scientific studies. Further studies reveal that holo-BLG shuttles its ligands specifically to immune cells, where it balances the specific nutrient demand and can thus lead to immune resilience. Based on the scientific background, the experts see a broad range of possible applications for holo-BLG in the form of a lozenge, for example in patients suffering from multiple allergies, with sensitisation to rare allergens (including occupational allergens), tree pollen-associated food allergies or in general difficult treatment situations (e.g. allergies to animal dander or refusal of allergen immunotherapy). The expert panel describes the holo-BLG lozenge as an innovative and additional option for allergic patients.

Neue Allergene für die Berufsdermatologie?

The environment is continuously subject to change. Exposures in the work environment and therefore the importance of occupational typeI and typeIV allergens may change. The most important trends concerning occupational allergens, new occupational allergens/allergen exposures, the diagnostic procedure to detect new allergens in practice and regulatory developments are presented. Building on known relevant allergen exposures in occupational dermatology, published trends from clinical cohorts are evaluated and asystematic literature search (PubMed 2016-2021) for new occupational allergens is also performed RESULTS: Occupations with the highest incidence of occupational allergic contact urticaria and/or protein contact dermatitis include bakers, farmers and farm workers, veterinary technicians, veterinarians, cooks, dairy and livestock workers, gardeners, and hairdressers. The highest risk of developing occupational contact dermatitis is in health care, agriculture, metalworking occupations and machine operators, the food sector, service industries, and construction occupations. The search strategy "new occupational allerg*" yielded 603 hits and "novel occupational allerg*" 158 hits. Atotal of 25papers included results relevant to the research question and were processed. New protein-based immediate-type allergens, as well as contact allergens (haptens) relevant for occupational dermatology, are presented. Current trends on known occupational allergens and new occupational allergens in the period 2016-2021 can be identified. Only athorough individual workplace history and testing of patients' own materials can identify new allergens in occupational dermatology.

Occupational contact dermatitis: Retrospective analysis of North American Contact Dermatitis Group Data, 2001 to 2016

Patch testing is an important diagnostic tool for suspected allergic contact dermatitis (ACD) in occupational settings. Provide an overview of occupational skin disease (OSD) and an analysis of occupational ACD in North American patients undergoing patch testing between 2001and 2016. Patients with OSD were analyzed for frequency of allergic reactions to a screening series of allergens, occupational relevance, location of skin disease, and exposure sources. Demographic, occupation, and industry information were recorded. Of 38,614 patients evaluated, 4471 (11.6%) had OSD, of whom 3150 (70.5%) had ACD. The most common occupationally related allergens included rubber accelerators, preservatives, and bisphenol A epoxy resin. Hands (75.8%), arms (30.0%), and face (15.9%) were common sites of dermatitis. The occupations most affected were service workers and machine operators. Our cohort may not reflect the general working population. This study identified common occupational allergens, exposure sources, and occupations/industries at risk. This information may help the clinician evaluate and manage patients with occupational contact dermatitis.

Sensitization to Aspergillus Mix Among Atopic Sickle Cell Disease Patients in Abidjan, Côte d’Ivoire

The objective of this study was to determine the epidemiological characteristics of sensitization to Aspergillus in these atopic sickle cell patients who present respiratory disorders unrelated to taking NSAIDs. This is a prospective study with a descriptive and analytical aim which was conducted at the University Hospital Center (CHU) of Cocody (Abidjan). It took place from September 2017 to May 2018 on 117 atopic sickle cell disease patients, with no known history of allergy to aeroallergens, to any foods or to occupational allergens. These patients were interviewed and clinically examined for an atopic site. They were subsequently subjected to skin tests. Statistical analyzes were performed using Epi info 6.0 software using Fisher's test and odds ratio. The significance level was located at an odds ratio greater than 1. The comparison of the percentages was carried out by Fisher's test with a significance level p = 0.05. The majority of patients with sensitization to Aspergillus mix were over 15 years of age, with a predominance of women (Sex ratio: 0.56). Neither sex nor age appeared to influence the state of sensitization in our study (p> 0.05). The overall prevalence of sensitization to Aspergillus mix was 7.7%. Our results correlated asthma severity with sensitization to Aspergillus mix (p<0.05). However, there was no significant correlation between severity of allergic rhinitis and sensitization to Apergillus mix. This study confirms the low prevalence of sensitization to Aspergillus mix. Allergy to Aspergillus mix is an uncommon phenomenon in sickle cell patients but its monitoring in this population should be given special attention as it is subject to many complications.

Contact Allergy to Ammonium Persulfate: An Epidemiologic Study of 2138 Consecutive Dermatitis Patients.

Background:Persulfate is an oxidizing agent used for multiple purposes, including bleaching hair, bleaching flour, and as pool/spa water disinfectant.Objective:To identify the prevalence and clinical characteristics of patients allergic to ammonium persulfate (APS) among patients who underwent patch testing in our clinic.Methods:A retrospective chart review of 2138 patients who underwent patch testing at Brigham and Women's hospital in Boston between July 2015 to November 2019. All patients were tested to our standard series including APS 2.5% petrolatum. Given the irritant nature of APS, we included for analysis only patients with 2+ or 3+ reactions.Results:Among 2138 patients, 61 (2.85%) had 2+ or 3+ reactions to APS. In this study, 72% were female. 75% had an atopic diathesis; 56% had 2+ reactions, and 44% had 3+ reactions. Clinical relevance was definite in 11%, probable in 10%, and unknown/possible in 79%. In patients with definite clinical relevance, 6/7 had occupational allergic contact dermatitis: 4 hairdressers, 1 hair salon cleaner, and 1 aquarium worker; 1/7 was bleaching her hair.Conclusion:Prevalence of 2+ or 3+ APS reactions in this single-center study was higher than that reported by the North American Contact Dermatitis Group, 2015–2016, (0.75% vs. 2.85% in our study). APS is an important occupational allergen, and clinicians should be aware of this when treating patients with exposure to APS.

Allergic rhinitis.

Allergic rhinitis (AR) is caused by immunoglobulin E (IgE)-mediated reactions to inhaled allergens and is one of the most common chronic conditions globally. AR often co-occurs with asthma and conjunctivitis and is a global health problem causing major burden and disability worldwide. Risk factors include inhalant and occupational allergens, as well as genetic factors. AR impairs quality of life, affects social life, school and work, and is associated with substantial economic costs. The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative classified AR into intermittent or persistent and mild or moderate/severe. The diagnosis is based on the clinical history and, if needed in patients with uncontrolled rhinitis despite medications or with long-lasting symptoms, on skin tests or the presence of serum-specific IgE antibodies to allergens. The most frequently used pharmacological treatments include oral, intranasal or ocular H1-antihistamines, intranasal corticosteroids or a fixed combination of intranasal H1-antihistamines and corticosteroids. Allergen immunotherapy prescribed by a specialist using high-quality extracts in stratified patients is effective in patients with persistent symptoms. Real-world data obtained by mobile technology offer new insights into AR phenotypes and management. The outlook for AR includes a better understanding of novel multimorbid phenotypes, health technology assessment and patient-centred shared decision-making.

Animal- free skin permeation analysis using mass spectrometry imaging

Here we demonstrate an animal-free skin permeation analytical approach suitable for testing pharmaceuticals, cosmetics, occupational skin hazards and skin allergens. The method aims to replace or significantly reduce existing in-vivo models and improve on already established in-vitro models. This by offering a more sensitive and flexible analytical approach that can replace and/or complement existing methods in the OECD guidelines for skin adsorption (no 427 and no 428) and measure multiple compounds simultaneously in the skin while being able to also trace endogenous effects in cells. We demonstrate this here by studying how active ingredients in sunscreen permeate through left-over human skin, from routine surgery, in a in a Franz-cell permeation model. Two common sunscreens were therefore applied to the human skin and Time of flight secondary ion mass spectrometry (ToF-SIMS) was used to trace the molecules through the skin. We show that that ToF-SIMS imaging can be applied in visualizing the distribution of Avobenzone, Bemotrizinol, Biscotrizole and Ethyl hexyl triazine at subcellular resolution in the skin. The UV-blockers could be visualized at the same time in one single experiment without any probes or antibodies used. The UV-blockers mostly remained in the stratum corneum. However, in certain features of the skin, such as sebaceous glands, the penetration of the UV-blockers was more prominent, and the compounds reached deeper into the epidermis.

Hairdressers’ occupational skin diseases in the Finnish Register of Occupational Diseases in a period of 14 years

Hairdressers have a high risk of occupational contact dermatitis caused by exposure to wet work and allergens in hairdressing chemicals. To examine the distribution of diagnoses of occupational skin diseases (OSDs) and their main causes in hairdressers based on a national register data on occupational diseases. We retrieved cases of recognized OSDs in hairdressers from the Finnish Register of Occupational Diseases (FROD) in years 2005-2018. During the 14-year period, a total of 290 cases of recognized OSD in hairdressers were registered in the FROD. Allergic contact dermatitis (ACD) was diagnosed in 54%, irritant contact dermatitis in 44%, and contact urticaria (CU) in 5% of them. ACD was most commonly caused by hair dye products and their ingredients (N = 57), persulfates (N = 35), and preservatives (N = 35; mainly isothiazolinones). Acrylates emerged as hairdressers' occupational contact allergens (N = 8) probably due to introduction of structure nails into hair salons. Persulfates was the most common cause of CU. ACD was the most common OSD in hairdressers. Our analysis confirms that preservatives are important causes of ACD in hairdressers in addition to hair dye products and persulfates. Acrylates emerged as hairdressers' occupational contact allergens, but contact allergy to perming agents remained rare.

Upper and Lower Respiratory Signs and Symptoms in Workers Occupationally Exposed to Flour Dust

A group of 142 bakers was studied in order to investigate the relationship between higher/lower respiratory signs/symptoms and inflammation biomarkers and occupational exposure to flour dust. A complete upper and lower respiratory tract evaluation was performed. Seven percent of bakers complained of lower respiratory symptoms, while 22% of them complained of upper respiratory symptoms. Fifty five percent of the bakers were allergic, and 37.1% showed sensitization to occupational allergens. Abnormal spirometries were found in 15% of bakers, while fractional exhaled nitric oxide (FeNO) was above the normal reference in 24.5% of them. Moreover, 23.8% of bakers were found to be hyposmic. Population mean peak nasal inspiratory flow (PNIF) was in the normal range even if almost all the workers suffered from neutrophilic rhinitis at nasal cytology with the number of nasal neutrophils increasing with the increase of the duration of exposure to flour dust (p = 0.03). PNIF and FEV1 (forced expiratory volume in the 1st second) showed a positive correlation (p = 0.03; r = 0.19). The Tiffeneau index decreased with the increase of dust (p = 0.017). A similar result was obtained once we divided our population into smokers and non-smokers (p = 0.021). Long-term exposure to bakery dusts can lead to a status of minimal nasal inflammation and allergy.

Particle matter, volatile organic compounds, and occupational allergens: correlation and sources in laboratory animal facilities

Exposure to airborne allergens from mice and rats can lead to laboratory animal asthma or allergy. Several biological methods can measure allergens contained in aerosols; however, they are time and cost intensive. An innovative methodology is proposed to warn laboratory animal facility workers of a possible rise in mouse and rat allergens by measuring the relationships between airborne allergens, particulate matter (PM), and volatile organic compounds (VOCs). By using a low-cost sensor (average difference respect to reference methods of 3 and 9% for PM2.5 and VOC, respectively), Spearman’s rank correlation between allergens and time-averaged PM and VOCs was found to be 0.3 and − 0.07, respectively. These numbers indicate a poor correlation between allergens and PM2.5 and VOC; however, by considering only the spikes in PM minute-by-minute data, the relation between time-average PM and allergens increases up to 0.71. This high value indicates the applicability of PM low-cost sensors in laboratory animal centers as a warning sign of raising values of allergens. Mouse and rat allergens are present in the animals’ urine, which can become aerosolized during animal activity, or task activities carried out in the laboratory facility. While previous references established a correlation between activities and mouse and rat allergens, the results are outdated and refer to a limited number of activities. For example, washing lab coats, changing uniforms, sitting in an office space, having lunch, or walking in any corridor are shown in this study to contain on average 1.77, 0.96, 0.65, 0.88, and 1.62 ng/m3 of rat allergens, respectively. Thus, locations that do not contain any direct source of allergens are positive to the presence of mouse and rat allergens.

Demographic and clinical features and subsectoral differences in occupational contact allergens in clothing manufacturing workers.

Epidemiologic data on the occurrence of contact dermatitis (CD) and the contact allergens involved in clothing manufacturing and its subsectors are scarce. This study aimed to determine the extent of occupational contact allergy and differences between work subsectors in clothing employees with CD. A cross-sectional study was conducted with 272 clothing employees, who complained of CD and were diagnosed with occupational allergic contact dermatitis (OACD). Participants worked in accessory, dyeing, sewing, cutting, knitting, packing, cleaning, and ironing subsectors. Data on demographics, working-subsector, working-duration, and lesion-duration were collected, and participants were examined and patch tested. Participants included 173 females and 99 males. Dyeing workers were most frequently diagnosed with OACD, whereascutting workers were least. Lesions were mostly located on the hands only. The most frequently detected allergens were nickel sulfate in accessory work; disperse blue-106 in dyeing, sewing, cutting, and knitting; cobalt chloride in packing; p-phenylenediamine in cleaning; and budesonide in ironing. Contact allergens show significant differences in frequency by work subsectors in clothing employees. Careful monitoring of workers for excessive exposures and for early signs of CD is warranted.

Work-related Asthma in Crop Farmers

AIM: The objective of the study was to evaluate the influence of occupational exposure on asthma development among crop farmers. METHODS: A cross-sectional study was performed, comprising 87 crop farmers, and 80 office workers, matched by gender and age. Evaluation of subjects included completion of a standard questionnaire on chronic respiratory symptoms, spirometry tests, histamine challenge, serial peak expiratory flow rates (PEFR) measurements, and skin prick tests to occupational and common inhalant allergens. RESULTS: The prevalence of chronic respiratory symptoms in the past 12 months was higher, while the mean values of spirometric parameters were lower in crop farmers. Sensitization to workplace and common inhalant allergens was similar in both groups, whereas frequencies of bronchial hyperresponsiveness (BHR) and asthma were non-significantly higher in crop farmers. The prevalence of allergic was significantly higher compared to non-allergic asthma in both groups. Asthma was registered in 8% of crop farmers and was significantly associated with atopy, and positive family history of asthma. Occupational allergic asthma (OA) was registered in 2.3% of crop farmers, while the frequency of work-aggravated asthma was 5.7%. A causal relationship between workplace and asthma, suggesting allergic OA, was documented in two crop farmers with asthma, based on serial PEFR monitoring, but specific workplace agent causing asthma in the affected subjects was not identified. CONCLUSION: The obtained results can contribute in the detection of critical points for action, and serve as a predictive factor in the development of work-related asthma, indicating the need for reduction of adverse occupational exposures through adequate preventive measures, regular health examinations, obligatory use of respiratory protective equipment, and implementation of engineering controls.

The Role of Immunotherapy and Biologic Treatments in Occupational Allergic Disease

Occupational exposures are estimated to account for 15% to 25% of all adult asthma in the general population. In some cases, workplace allergen exposures can be reduced but not entirely eliminated. Given the potentially significant impact of job change, some workers may choose to continue working in a job in which there is an ongoing occupational allergen exposure. In these cases, a combined approach including personal safety measures, pharmacotherapy, and allergen immunotherapy may result in the best clinical outcomes. This review presents existing evidence for the use of immunotherapy and biologic treatments in occupational allergic disease for various occupational allergens, including wheat flour, mammalian proteins, natural rubber latex, and Hymenoptera venom. There is increasing but modest evidence on beneficial short-term and long-term effects of allergen immunotherapy and safety in worker populations. Available data suggest that allergen immunotherapy can reduce skin and respiratory symptoms and therefore allow workers to continue their current occupation.

Occupational allergy to phytase: case series of eight production workers exposed to animal feed additives.

In agricultural meat production, adding enzymes such as phytase to animal feed is widespread, but there is little awareness of the allergenic potential and health risks of these fungal enzymes. We report on eight patients working in a plant producing phytase granulates. All patients complained about work-related rhinitis occurring within six months of the onset of exposure to phytase dust. Asthmatic symptoms and contact urticaria also occurred. To detect sensitizations to phytase, skin prick-, patch-, and basophil activation test were carried out with the factory product. Levels of IgE and IgG against phytase were also measured. There was a positive reaction to phytase with skin prick testing in seven of the eight patients. IgE specific to phytase was detectable in four of the eight patients, and IgG specific to phytase was detectable in six of the eight patients. The basophil activation test was positive in four out of seven patients tested, but the patch test was negative in all patients tested. Transfer to a different workplace with no exposure to phytase completely eliminated the symptoms. Mold enzymes such as phytase are highly potent occupational allergens. Occupational safety measures must be strictly implemented in order to protect the health of workers.

Progress in Occupational Asthma.

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.

Mannitol vs. methacholine in the evaluation of airway responsiveness in bakers' asthma.

Various indirect or direct airway challenge tests are used to measure nonspecific bronchial hyper-responsiveness (NSBHR). The evaluation of NSBHR in diagnosing occupational asthma (OA) is performed, e.g., to monitor the specific inhalation challenge test (SICT). The aim of this study was to preliminarily compare the results of methacholine and mannitol inhalation challenge tests in SICT monitoring in bakers with work-related airway symptoms. Four bakery workers with a suspicion of OA underwent single-blind placebo-controlled SICTs involving workplace allergens, accompanied by the evaluation of NSBHR with mannitol and methacholine, both before and after SICTs. Clinical examinations, spirometry tests, skin prick tests (SPTs) to common aeroallergens and occupational allergens, as well as tests to determine serum specific IgE antibodies to occupational aeroallergens were also performed. Positive SPTs results to occupational aeroallergens were found in all bakery workers, and specific IgE antibodies to flour were detected in 2 subjects. Three patients displayed positive SICT reactions. In all of these 3 patients, airway responsiveness to methacholine increased significantly. In 2 patients, airway reaction to mannitol was significant, whereas in 1 subject there was no increase in NSBHR after mannitol inhalation. The patient with a negative SICT result did not reveal any changes in NSBHR before and after the test, either to methacholine or mannitol. The data obtained by the authors show that there is no clear correlation between the methacholine and mannitol inhalation challenge tests in SICT monitoring. Preliminary results indicate the need for further investigations to evaluate the usefulness of the mannitol challenge test in the diagnostics of OA. Int J Occup Med Environ Health. 2020;33(2):235-9.

The value of pantomiming for allergic contact dermatitis

To the Editor: Pantomiming enables humans to communicate through mimicry in a context in which the physical tools of reference are not present.1Broadbent R. History of Pantomime. International Business Publications, Alexandria, VA2018Google Scholar,2Lausberg H. Kazzer P. Heekeren H.R. Wartenburger I. Pantomiming tool use with an imaginary tool in hand as compared to demonstration with tool in hand specifically modulates the left middle and superior temporal gyri.Cortex. 2015; 71: 1-14Crossref PubMed Scopus (7) Google Scholar Pantomime in dermatology can be useful to help understand the pattern of allergic contact dermatitis (ACD). For example, Alstroemeria, the Peruvian lily, is a well-documented occupational allergen for florists (Fig 1).3McGovern T.W. Alstroemeria L. (Peruvian lily).Am J Contact Dermat. 1999; 10: 172-176Crossref PubMed Scopus (10) Google Scholar The distribution of ACD can be clarified when a florist pantomimes how he or she places the hand on the flower to strip the stem.3McGovern T.W. Alstroemeria L. (Peruvian lily).Am J Contact Dermat. 1999; 10: 172-176Crossref PubMed Scopus (10) Google Scholar Garlic is another well-recognized cause of ACD; pantomime can help explain a distribution involving the nondominant thumb and index finger, which hold the garlic as the dominant hand cuts it (Fig 2).4Hughes T.M. Varma S. Stone N.M. Occupational contact dermatitis from a garlic and herb mixture.Contact Dermatitis. 2002; 47: 48Crossref PubMed Scopus (17) Google ScholarFig 2Allergic contact dermatitis. A classic distribution of a rash due to garlic allergen involving the nondominant hand.View Large Image Figure ViewerDownload Hi-res image Download (PPT) We present 3 cases for which pantomime was useful in diagnosing ACD. Case 1: Explaining rash distribution. A patient presented with sharply demarcated dermatitis of the left side of the neck. She had positive reactions on patch tests to gold, neomycin, and budesonide. Pantomiming the application of topical medications was helpful in understanding the distribution of her ACD (Fig 3). If the hands are spared (and, therefore, the relevance of topical medicament is questioned), it can be useful to ask what was used to apply the medication (eg, fingertips, cotton applicators, gauze, tissues). Sparing of fingertips may be explained if an applicator was used or if the hands were washed immediately after application. Case 2: Guiding selection of patch test allergens. An auto body shop worker presented with bilateral dorsal hand dermatitis. When pantomiming daily work tasks, the patient demonstrated using the dorsal aspect of his hands to put pressure on panels after applying an adhesive. Possible exposure to acrylate adhesive residue on the panels prompted testing an acrylate adhesive series. He showed allergy to ethylene glycol dimethacrylate and other acrylates that may have been missed on testing with only a standard screening series. Case 3: Identifying the primary source of relevance. A pipefitter presented with dermatitis of the left hand and periumbilical region. Overlying the rash were splotches of dried white material on his shirt, which prompted a request for him to pantomime how that substance got there. The patient pantomimed holding a paint tray with his left hand lodged against his periumbilical region while using a paintbrush to dip into the tray. The lubricant substance in the tray would splash over the edge onto his left hand and the clothing over his abdomen. The patch testing result was positive for lanolin, relevant to the lubricant and to the medicament used to treat the dermatitis. When using pantomime, prompt the patient by saying, “Let's pretend” or “Show me,” referring to the use of an object. Statements such as “How do you use this?” should be avoided because they may confuse the patient and make the process awkward. It may be helpful to hand any object to the patient that approximates the size of the item he or she is pretending to handle. Pantomiming can be very helpful in understanding unusual patterns of dermatitis. Pantomiming can be a powerful diagnostic modality that allows the physician to observe how patients may interact with various products to better diagnose ACD.

Assessment of occupational exposure and spectrum of contact sensitization in metalworkers with occupational dermatitis: results of a cohort study within the OCCUDERM project.

Metalworkers occupationally exposed to metals, tools, metalworking fluids (MWFs), technical oils, gloves, skin care products etc. frequently suffer from occupational dermatitis (OD). To investigate occupational exposure and to identify relevant occupational sensitizers in metalworkers with OD, and to evaluate suitability of current German patch test recommendations for this occupational group. As part of the OCCUDERM project, occupational exposure of 230 metalworkers with suspected OD patch tested in the departments of dermatology in Göttingen and Osnabrück (both Lower Saxony, Germany) in 2012-2017 was recorded by questionnaire. These data, as well as results, of patch testing with standardized allergens and with workplace material were analysed. Metalworking fluids and skin care products were the most important exposures. Among MWF allergens, most frequently sensitizations to formaldehyde and formaldehyde releasers, colophony/abietic acid and monoethanolamine were observed. Sensitization to methylisothiazolinone (MI) was frequent, probably as part of the general European epidemic of contact allergy to MI in leave-on cosmetics. Sensitization to glove ingredients only played a minor role. The known occupational allergen spectrum could largely be confirmed. In order not to miss relevant sensitizations, patch testing with material from the patients' workplaces in parallel to baseline and MWF series is recommended. Sensitizations diagnosed could not always be linked to particular occupational exposures.

Bronchial Response to High and Low Molecular Weight Occupational Inhalant Allergens.

PurposeOccupational asthma may be induced by high- or low-molecular weight allergens (HMWA or LMWA, respectively). The study was conducted to compare the pattern of bronchial response in 200 HMWA-induced asthmatics (n = 130) and LMWA-induced asthmatics (n = 70).MethodsThe study participants underwent a single-blind, placebo-controlled specific inhalation challenge (SIC) with workplace allergens, accompanied by evaluation of non-specific bronchial hyperresponsiveness (NSBHR) with methacholine before and after the SIC.ResultsA single early bronchial response more frequently occurred in HMWA-induced asthmatics than in LMWA-induced asthmatics (86.2% vs. 20%). An isolated late bronchial response or atypical patterns were more frequently observed in LMWA-induced asthmatics than in LMWA-induced asthmatics (45.7% vs. 3.8% or 34.3% vs. 10%, respectively). Baseline NSBHR before SIC was more often detected in LMWA-induced asthmatics than in HMWA-induced asthmatics (81.4% vs. 54.6%), and the median value of the provocation concentration of methacholine was relevantly lower in these patients before and after SIC. A significant 3-fold increase in NSBHR after SIC was observed more often in LMWA-induced asthmatics than in HMWA-induced asthmatics (82.8% vs. 66.1%). In addition, compared to LMWA-induced asthmatics, HMWA-induced asthmatics were older, were more frequently active smokers, showed lower level of NSBHR, and more frequently continued their work in harmful occupational exposure.ConclusionsThe results of this study suggest that HMWA-induced asthmatics may have milder clinical courses and that there is a possibility of job continuation despite asthma exacerbation requiring medical surveillance.

Predicting occupational allergy in culinary and hairdressing apprentices.

Apprentices are usually exposed to the same workplace agents as qualified professionals. There is therefore a risk of the development of occupational allergy in apprentices exposed to high (HMW-A) and low molecular inhalant allergens (LMW-A). To evaluate and compare the occurrence of work-related allergy-like symptoms in apprentices exposed to HMW-A and LMW-A in a culinary and hairdressing school during the first and second year of vocational training. We asked culinary and hairdressing apprentices in their first and second year of vocational training to complete a questionnaire about work-related allergy-like symptoms. In first-year apprentices, we undertook spirometry, skin prick tests for occupational allergens and blood tests for allergen-specific Immunoglobulin E (IgE) antibodies. Hypersensitivity to occupational allergens was more frequent in first-year apprentices exposed to HMW-A compared to LMW-A (P < 0.05). Apprentices exposed to LMW-A reported increasing occurrence of skin disorders and upper respiratory tract symptoms between the first and second years of training. First-year apprentices exposed to HMW-A more frequently reported rhino-conjunctivitis and dyspnoea (approximately P < 0.001 and P < 0.05) and those exposed to LMW-A more often reported skin symptoms (P < 0.05). Periodic skin and respiratory health surveillance for apprentices exposed to LMW-A or HMW-A might help with early identification and management of occupational allergy.