Occupational Allergy Research Articles

Der Nachweis beruflich verursachter Allergien ist ein komplexes Unterfangen: ein Fallbeispiel

The detection of occupational allergies is a complex undertaking: A case study According to the recommendations for the diagnosis of occupational asthma, suspected cases require a confirmed asthma diagnosis, work-associated symptoms, evidence of sensitization to an occupational allergen and a close relationship between the occupation and the symptoms. In addition to a detailed medical history, several examinations and tests and a differentiated consideration of them are required in order to arrive at a final expert assessment. We report the case of a 58-year-old butcher who had been complaining of shortness of breath and coughing at his workplace in a slaughterhouse for 5 years. It was only after extensive investigations and a detailed medical history that a powdered kebab spice used in an adjacent room was suspected as the potential allergen. Diagnostic tests showed that the patient was sensitized to the spice. While the specific inhalation challenge (SIC) with kebab spice did not elicit an asthmatic reaction, a non-specific bronchial hyperreactivity in the insured person was observed. On the day after the SIC, the bronchial hyperreactivity was increased by a factor of three and there were further indications of eosinophilic or allergic reaction. In summary, the individual diagnostic components led to the assessment of this case as allergic occupational asthma. This case illustrates that an assessment of the individual diagnostic components in the diagnosis of occupational asthma is quite complex and not without pitfalls. Keywords: occupational asthma – diagnosis – sensitization – bronchial hyperreactivity

Entomophilous Pollen and Bees as Biomonitors and Bioindicators of the Anthropogenic Triad

The progressive increase in the concentration of harmful pollutants in the environment threatens human health. To record them, researchers use biomonitors; plant pollen and honeybees (Apis mellifera) have proven themselves well in this capacity. The peculiarity of bees is that while searching for food, they collect pollutants from the environment: air, soil and water within a radius of no more than 3 km. Not only plant pollen, but also honeybees can act as bioindicators of the anthropogenic triad: climate change and traditional land use systems and environmental pollution. In various search engines, Internet users are interested in these issues, because their point of refraction is beekeeping products, including honey. It includes almost the entire spectrum of allergenic pollen, starting from wormwood pollen — the regional allergen of the republic and ending with pollen of trees and shrubs. The problem of allergies to ornamental plants is still poorly understood. Reports of occupational flower allergies are few and usually involve gardeners, greenhouse workers, landscapers, and florists. Handling, smelling and caring for flowers can cause rhino conjunctivitis, asthma, urticaria, and contact dermatitis. When studying the pollen spectrum in the air of cities, entomophilous pollen grains of the families Malvaceae, Fabaceae, Asteraceae, and Rosaceae were identified. In the modern world, the concept of “One Health” has gained popularity, which recognizes the interconnectedness of the health of people, animals and ecosystems, therefore it is accepted both at the national and global levels. Within its framework, we are forming a new concept: “Entomophilous pollen and bees as biomonitors and bioindicators of the anthropogenic triad: climate change and land use systems; environmental pollution”. The purpose of the presented article is to systematize the results obtained and literature sources within the framework of the formulated concept.

CD12 A case of occupational acrylate allergy: a success story!

CD12 A case of occupational acrylate allergy: a success story!

Severely compromised supply of patch test allergens in Europe hampers adequate diagnosis of occupational and non-occupational contact allergy. A European Society of Contact Dermatitis (ESCD), European Academy of Allergy and Clinical Immunology (EAACI), European Academy of Dermatology and Venereology (EADV) task forces 'Contact Dermatitis' and 'Occupational Skin Disease' position paper.

Patch testing is the only clinically applicable diagnostic method for Type IV allergy. The availability of Type IV patch test (PT) allergens in Europe, however, is currently scarce. This severely compromises adequate diagnostics of contact allergy, leading to serious consequences for the affected patients. Against this background, the European Society of Contact Dermatitis (ESCD) has created a task force (TF) (i) to explore the current availability of PT substances in different member states, (ii) to highlight some of the unique characteristics of Type IV vs. other allergens and (iii) to suggest ways forward to promote and ensure availability of high-quality patch testing substances for the diagnosis of Type IV allergies throughout Europe. The suggestions of the TF on how to improve the availability of PT allergens are supported by the ESCD, the European Academy of Allergy and Clinical Immunology, and the European Academy of Dermatology and Venereology and intend to provide potential means to resolve the present medical crisis.

Risk of Trace Element Imbalance in Cases of Occupational Allergic Diseases

Introduction: The relevance of the study is attributed to the lack of knowledge of the mechanisms of development and specifics of the clinical picture of occupational allergic diseases. Objective: To establish the levels of essential trace elements in biological substrates of patients with occupational allergies. Materials and methods: In 2014–2018, we analyzed zinc and copper levels in urine, blood serum, and lymphocytes of patients with occupational allergic skin and respiratory diseases by the atomic absorption method. Relative risk was calculated using a four-field contingency table. Results: In patients with work-related allergic contact dermatitis and bronchial asthma, zinc and copper concentrations in blood serum increased while urinary excretion of these elements decreased. Quantitative patterns of the concentrations of trace elements in body fluids of the patients with skin and respiratory allergies were unidirectional compared to the reference group. Relative risk values showed that lower levels of copper in urine and zinc in blood serum and lymphocytes, as well as higher serum copper indicated the risk of trace element imbalance in the body. Conclusion: The risk of trace element imbalance due to occupational allergic diseases is associated with impaired copper and zinc balance. Our findings prove that the levels of microelements are additional factors that aggravate the course of occupational allergic disorders.

Diagnostics of IgE-mediated occupational allergies: Between reality, requirements, and opportunities.

Occupational skin and respiratory allergies are among the most common occupational diseases in Germany. The identification of the allergy trigger is essential for the recognition of an occupational allergy as well as for effective individual prevention. However, occupational type I allergens are among the "rare" allergens and the possibilities of guideline-compliant diagnosis using quality-tested skin test solutions is becoming increasingly difficult due to the reduction in commercially available test allergens. In order to guarantee meaningful diagnostic workup for all affected insured persons with suspected occupational type I allergies and to ensure this in the future, a durable optimization, standardization, and availability of allergy tests for occupational allergic diseases is urgently required. The need for action has been recognized by the German Social Accident Insurance (DGUV), and steps to eliminate the diagnostic gaps have been initiated by a joint research project at the Institute for Prevention and Occupational Medicine of the DGUV (IPA) and the Paul Ehrlich Institut (PEI). The evaluation of alternative methods for the production of standardized test allergen solutions can also be used for newly emerging allergens in the workplace. New allergen sources at workplaces and thus also sensitization and allergies among employees can be expected as a result of changes in work processes and the introduction of new technologies and/or working materials, which are also introduced in connection with climate change and the concept of sustainability.

Mapeo de la literatura sobre el enfoque cualitativo del asma infantil desde 1996 hasta 2018: un análisis bibliométrico

Resumo Objectives: to describe the scientific production of qualitative studies in childhood asthma. Methods: bibliometric analysis. Articles were from Web of Science, Scopus, Cochrane, and PubMed (1996-2018), using the search terms asthma, children, qualitative research, qualitative study, qualitative analysis, ethnographic, phenomenology and narrative. Results: 258 articles were retrieved from 143 journals, representing 1.2% of scientific articles on childhood asthma. The growth rate was high. Authorship included 969 authors (85.3% occasional) from 279 institutions. 94.2% were co-authored and 3.5% were international collaborations. The greatest number of articles were from the United States (45.3%), United Kingdom (17.4%) and Canada (7.4%). The categories with the highest number of articles were Nursing & Public, Environmental & Occupational Health (18.2%), Respiratory System (10.1%) and Allergy (7.7%). 99.7% of the articles were in English. Conclusion: these results show a lack of consolidation of the literature based on qualitative studies on childhood asthma with a high percentage of occasional authors and limited international collaboration, indicating a need to strengthen this approach.

Occupational hops allergy with nonspecific lipid transfer protein sensitization: Cross-reactivity with food nonspecific lipid transfer protein

Occupational hops allergy with nonspecific lipid transfer protein sensitization: Cross-reactivity with food nonspecific lipid transfer protein

Fatal Occupational Asthma in Cannabis Production - Massachusetts, 2022.

Multiple respiratory hazards have been identified in the cannabis cultivation and production industry, in which occupational asthma and work-related exacerbation of preexisting asthma have been reported. An employee working in a Massachusetts cannabis cultivation and processing facility experienced progressively worsening work-associated respiratory symptoms, which culminated in a fatal asthma attack in January 2022. This report represents findings of an Occupational Safety and Health Administration inspection, which included a worksite exposure assessment, coworker and next-of-kin interviews, medical record reviews, and collaboration with the Massachusetts Department of Public Health. Respiratory tract or skin symptoms were reported by four of 10 coworkers with similar job duties. Prevention is best achieved through a multifaceted approach, including controlling asthmagen exposures, such as cannabis dust, providing worker training, and conducting medical monitoring for occupational allergy. Evaluation of workers with new-onset or worsening asthma is essential, along with prompt diagnosis and medical management, which might include cessation of work and workers' compensation when relation to work exposures is identified. It is important to recognize that work in cannabis production is potentially causative.

Interaction between Air Pollutants and Pollen Grains: Effects on Public and Occupational Health

There has been an insurgence of allergic respiratory diseases such as asthma and rhinitis in industrialized countries in the last few decades as a result of the interaction between air pollutants and pollen, which has become a global and dramatic health problem. Air pollutants such as nitrogen dioxide, sulfur dioxide, ozone, and carbon dioxide affect the physical, chemical and biological properties of pollen such as the pollen content, production, and allergenicity, exacerbating symptoms in vulnerable subjects. When investigating these interactions and their effects, the environmental impact of climate change, weather variables and urbanization should be taken into account as well as the pollen species, type of pollutant, conditions of exposure, and individual susceptibility. Up to 25% of asthma adult cases are work-related, because several categories of workers in different sectors are exposed to aeroallergens and outdoor air pollutants. Thus, in this study, we evaluated the significant impacts of occupational allergies on worker’s health and quality of life. In summary, to assess the effect of interactions between air pollutants and pollen on public and occupational health, all the factors that play a role in this context will be investigated, including environmental factors, individual susceptibility in relation to pollen species, type of pollutants, and conditions of exposure.

Frequent Allergic Sensitization to Farmed Edible Insects in Exposed Employees

Exposure to insects used in pet food, scientific research, or live fish bait can cause an occupational allergy. The recent shift toward enhanced insect production for human consumption and animal feed will likely expose more employees. To investigate sensitization and symptoms in employees exposed to edible insects in Flanders. Fifteen insect-exposed employees were recruited and sensitization was explored by skin prick test, basophil activation test, and immunoblotting. Lung function, FeNO, histamine provocation, and sputum induction were studied. Airborne dust sampling was performed and proteins were studied by silver stain and immunoblotting. Sixty percent of employees self-reported upper respiratory tract symptoms related to insect exposure. Ten employees (71.4%) had a positive histamine provocation test concentration causing a 20% drop in FEV1 less than 8 mg/mL and four (26.7%) had FeNO levels above 25 ppb. Four employees (30.7%) had a positive skin prick test for at least one insect, and seven (58.3%) had a positive basophil activation test. In eight participants with insect sensitization, four (50%) had co-occurring house dust mite sensitization. Two participants had strong IgE binding to a 50-kDa migratory locust allergen, one to a 25-kDa mealworm allergen, and one to mealworm α-amylase. In one center, facility adjustment resulted in a substantial decrease in the inhalable dust fraction. Insect exposure leads to high levels of sensitization among employees. Most employees reported symptoms of the upper respiratory system, and two-thirds of employees had bronchial hyperreactivity. Prevention and health surveillance will be important in the developing insect-rearing industry.

Alergia ao Látex em Contexto Ocupacional

Introduction/framework/objectives Latex allergy is recognized as a widespread health problem that assumed serious proportions in the 1990s. Although preventive measures have markedly decreased its incidence, recent studies have shown that it remains an important health problem in certain population groups, particularly in developing countries. This work aims to provide a comprehensive review of the current status of occupational latex allergies. We summarize various aspects of this condition, such as prevalence, risk groups, latex allergens, the diagnostic approach, prevention, and treatment. Methodology A bibliographic review was carried out in January 2023 in the following databases: PubMed/Medline, Cochrane Library, Evidence-based Medicine, Canadian Medical Association, Practice Guidelines and National Guideline Clearinghouse. Content Repeated exposure to latex in an occupational context can lead to worker sensitivity, with a significant clinical and socio-economic impact. We summarize various aspects of this condition, such as prevalence, risk groups, latex allergens, the diagnostic approach, prevention and treatment. Discussion and Conclusions The history of latex allergies has demonstrated that potent allergens such as Natural Rubber Latex proteins can cause rapid immunoglobulin-E-mediated sensitization and clinical allergies, reaching serious proportions in highly exposed individuals. Occupational exposure has a decisive influence on the allergen sensitivity profile, with important clinical and therapeutic consequences. The effectiveness of secondary prevention measures is limited. Thus, it is essential to implement early primary prevention measures in individuals belonging to risk groups, to avoid or minimize exposure to latex allergens. KEYWORDS: Healthcare Professionals, Latex allergy, Latex gloves, Latex hypersensitivity, Natural rubber latex, Occupational diseases, Occupational health, Occupational Medicine.

Lessons from Dairy Farmers for Occupational Allergy and Respiratory Disease.

Exposure to bioaerosols at dairies has long been associated with allergy, respiratory disease, and decreases in lung function. Recent advancements in exposure assessments have aided our understanding on the size distribution and composition of these bioaerosols, but investigations focusing solely on exposures may overlook important intrinsic factors impacting worker's susceptibility to disease. In our review, we discuss the most recent studies examining the exposures and genetic factors that contribute to occupational disease in dairy work. We also review more recent concerns in livestock work associated with zoonotic pathogens, antimicrobial resistant genes, and the role of the human microbiome. The studies highlighted in this review demonstrate the need for further research to better understand bioaerosol exposure-response relationships in the context of extrinsic and intrinsic factors, antibiotic-resistant genes, viral pathogens, and the human microbiome to help inform effective interventions that improve respiratory health among dairy farmers.

Evaluation of the "Health management guideline on occupational allergy in nursing occupations and its primary prevention" by nursing managers

Individuals in nursing occupations are often exposed to various materials such as rubber products and drugs, and they comprise a population at high risk of developing occupational allergies. We therefore created a "Health management guideline on occupational allergy in nursing occupations and its primary prevention" (hereinafter referred to as "HMG") and conducted a questionnaire survey to elucidate its potential use and the challenges of implementing it in clinical practice. The HMG includes the following content: A. Basic knowledge of occupational allergies; B. Common occupational allergies in nursing occupations; C. Occupational allergies triggered by specific antigens in nursing occupations; D. Eczema and skincare for hands; and E. Health management for occupational allergies. A questionnaire survey was conducted on one nursing manager each from 80 hospitals, with at least 400 beds. The survey included questions to gauge the level of understanding the content described in the HMG and opinions on incorporating the management method. The ethics committee of the researcher's institution approved the study. Responses were obtained from 30 nursing managers. Over 70% responded that they understood the instructions for [occupational allergies], [common occupational allergies in nursing occupations], and [eczema and skincare for hands] presented in the HMG, and 100% said they either understood or mostly understood them. For [work management], 57% said they understood the content and 90% wanted to incorporate it. Furthermore, 10% responded that they wanted to incorporate the guidelines but did not believe it was feasible, given that "achieving general awareness and efforts involving other occupations are difficult." For [work environment management], 53% said they understood the content and 83% wanted to incorporate it. Additionally, 17% responded that they wanted to incorporate it but did not believe it was feasible, amid concerns that "allergen monitoring is difficult in reality" and "installation of local ventilation systems seems difficult." The HMG was postulated to be useful in providing knowledge on occupational allergy and health management methods, and for employing in clinical practice. The study recommended that in order to specifically incorporate the management methods, it is imperative that the entire hospital, including staff from other occupations, understand the guidelines and make adjustments accordingly.

Epoxy allergy, investigation of a modern industry.

Five workers from an industry manufacturing various articles from carbon fibre reinforced epoxy plastics were referred to our department because of suspected occupational allergic contact dermatitis (OACD). When patch tested, four of them had positive reactions to components of epoxy resin systems (ERSs) that could explain their current skin problems. All of them had been working at the same workstation at a specially designed pressing machine, with operations including manually mixing epoxy resin with hardener. Multiple cases of OACD in the plant prompted an investigation including all workers with possible risk exposures at the plant. To investigate the prevalence of occupational dermatoses and contact allergies among the workers at the plant. Totally 25 workers underwent investigation that included a brief consultation with a standardized anamnesis and clinical examination followed by patch testing. ERSs-related reactions were found in 7 of the 25 investigated workers. None of the seven had a history of previous exposure to ERSs and they are regarded as sensitized through work. Twenty-eight percent of investigated workers showed reactions to ERSs. Of these the majority would have been missed if supplementary testing would not have been added to testing with the Swedish base line series.

Pru p 10: the polygalacturonase described as a new peach tree pollen allergen

Peach tree pollen (PTP) is responsible for the induction of respiratory and ocular symptoms in a population exposed to peach cultivars, with great relevance in occupational allergy. In its allergenic profile, several high molecular mass proteins with significant IgE recognition were described. In order to deepen into these allergens, the main objective was the purification, identification and verification of the allergenic capacity of the 46 kDa band protein.

Occupational contact allergy: The European perspective-Analysis of patch test data from ESSCA between 2011 and 2020.

Occupational skin diseases have led the occupational disease statistics in Europe for many years. Especially occupational allergic contact dermatitis is associated with a poor prognosis and low healing rates leading to an enormous burden for the affected individual and for society. To present the sensitization frequencies to the most relevant allergens of the European baseline series in patients with occupational contact dermatitis (OCD) and to compare sensitization profiles of different occupations. The data of 16 022 patients considered having OCD after patch testing within the European Surveillance System on Contact Allergies (ESSCA) network between January 2011 and December 2020 were evaluated. Patients (n= 46 652) in whom an occupational causation was refuted served as comparison group. The highest percentages of OCD were found among patients working in agriculture, fishery and related workers, metal industry, chemical industry, followed by building and construction industry, health care, food and service industry. Sensitizations to rubber chemicals (thiurams, carbamates, benzothiazoles) and epoxy resins were associated with at least a doubled risk of OCD. After a decline from 2014 onwards, the risks to acquire an occupation-related sensitization to methyl(chloro)isothiazolinone (MCI/MI) and especially to methylisothiazolinone (MI) seem to increase again. Sensitization rates to formaldehyde were stable, and to methyldibromo glutaronitrile (MDBGN) slightly decreasing over time. Among allergens in the European Baseline Series, occupational relevance is most frequently attributed to rubber accelerators, epoxy resins and preservatives.

Berufsbedingte Kontakturtikaria und Verdacht auf allergische Rhinitis durch Sensibilisierung gegen Cannabis sativa

Occupational contact urticaria with suspected allergic rhinitis due to sensitization to Cannabis sativa Case Presentation: A customs employee presented with complaints of allergic rhinitis related to the workplace. Results: Allergy diagnostics (rub test, prick test, specific IgE) revealed evidence of allergies to cannabis sativa and environmental allergens. Measures: The suspected presence of occupational disease no. 4301 was reported to the insurer. The avoidance of exposure to allergens was advised. Conclusions: In the future, due to changes in the legal situation, more persons in cultivation, production, distribution, the health sector, forensic laboratories and law enforcement agencies will come into contact with cannabis sativa in the workplace. Allergies may develop, but to date there are no commercially available type I allergy diagnostics related to cannabis products. Further health effects of occupational exposure and necessary preventive measures are unclear. Keywords: occupational allergy – Cannabis sativa – occupational disease no. 4301

Allergy and immunotoxicology in preventive and clinical medicine from theory to practice: Occupational allergy and isocyanate-induced asthma

Genetic and environmental factors and their interactions cause diseases and deteriorate health (Genetic and Environmental Interaction). Exposure to environmental factors plays a major role in the deterioration of health in the workplace.Occupational asthma (OA) is a common disorder in the workplace. Approaches to OA are well described and discussed in "Japanese Guideline for Diagnosis and Management of Occupational Allergic Diseases" by the Japanese Society of Occupational and Environmental Allergy. According to the guideline, OA and work-aggravated asthma comprise work-related asthma, and OA can be further divided into two disease entities: sensitizer-induced OA and irritant-induced OA. The guidelines also describe diagnostic and therapeutic strategies for OA. Since a definitive diagnosis of OA requires a comprehensive decision based on a detailed interview on clinical symptoms related to employment status and clinical tests, including inhalation tests of suspected substances as needed, the possibility of OA should be considered as the first step toward diagnosis of the patient. Otherwise, OA may not be diagnosed. Therapeutic strategies include exposure avoidance, environmental arrangements in the workplace, utilization of social resources for workers, and conventional pharmacotherapy for asthma.Artificially synthesized small compounds are used in various industries and can cause allergies. For example, isocyanates are small compounds in the -NCO group, which have been toxicologically studied. It was later shown that isocyanate could cause various nontoxic adverse health effects, including allergic reactions. Since small agents with low molecular weights bind to proteins, detecting their specific immunoglobulin E (IgE) antibodies targeting small compounds is generally difficult. In contrast, isocyanate-specific IgE antibodies are detectable in individuals with isocyanate allergies.Suspecting OA is essential in cases exposed to newly synthesized compounds, or to those that are already known but applied to new uses, which can be better understood and predicted by studying the health effects of isocyanates.Academic interest in various issues related to allergies, immunology, and toxicology in the workplace includes clinical medicine, epidemiology, and epigenetics related to environmental exposure. Further advanced research in these areas is necessary and promising.

Reported Cases and Diagnostics of Occupational Insect Allergy: A Systematic Review.

A significant part of adult-onset asthma is caused by occupational exposure to both high- and low-molecular-mass agents. Insects are occasionally described to cause occupational allergy in professions including anglers and fishers, laboratory workers, employees of aquaculture companies, farmers, bakers, sericulture workers and pet shop workers. Occupational insect allergies are often respiratory, causing asthma or rhinoconjunctivitis, but can be cutaneous as well. The European Union recently approved three insect species for human consumption, enabling an industry to develop where more employees could be exposed to insect products. This review overviews knowledge on occupational insect allergy risks and the tools used to diagnose employees. Despite the limited availability of commercial occupational insect allergy diagnostics, 60.9% of 164 included reports used skin prick tests and 63.4% of reports used specific IgE tests. In 21.9% of reports, a more elaborate diagnosis of occupational asthma was made by specific inhalation challenges or peak expiratory flow measurements at the workplace. In some work environments, 57% of employees were sensitized, and no less than 60% of employees reported work-related symptoms. Further development and optimization of specific diagnostics, together with strong primary prevention, may be vital to the health conditions of workers in the developing insect industry.