Occupational Allergy Research Articles

Editorial introductions.

Editorial introductions.

Pollen and Fungal Spores Evaluation in Relation to Occupants and Microclimate in Indoor Workplaces

Indoor air quality depends on many internal or external factors mutually interacting in a dynamic and complex system, which also includes indoor workplaces, where subjects are exposed to many pollutants, including biocontaminants such as pollen and fungal spores. In this context, the occupants interact actively with their environment through actions, modifying indoor environmental conditions to achieve their own thermal comfort. Actions such as opening/closing doors and windows and turning on/off air conditioning could have effects on workers’ health. The present study explored the contribution of human occupants to pollen and fungal spore levels in indoor workplaces, combining aerobiological, microclimate, and worker monitoring during summer and winter campaigns. We evaluated the overall time spent by the workers in the office, the workers’ actions regarding non-working days and working days, and non-working hours and working hours, during two campaigns of pollen and fungal spore monitoring. Our results showed that the biocontaminant values depend on many mutually interacting factors; hence, the role of all of the factors involved should be investigated. In this regard, aerobiological monitoring should be a valid tool for the management of occupational allergies, providing additional information to improve occupational health protection strategies.

Third Follow-Up of the Study on Occupational Allergy Risks (SOLAR III) in Germany: Design, Methods, and Initial Data Analysis.

Introduction: Asthma and allergies are complex diseases affected by genetic and environmental factors, such as occupational and psychosocial factors, as well as interactions between them. Although childhood is a critical phase in the development of asthma and allergies, few cohort studies on occupational outcomes followed up participants from childhood onwards. We present design, methods, and initial data analysis for the third follow-up of SOLAR (Study on Occupational Allergy Risks), a prospective and population-based German asthma and allergy cohort.Methods: The SOLAR cohort was initially recruited in 1995–1996 for Phase II of the German branch of the International Study of Asthma and Allergies in Childhood (ISAAC II) and followed up three times since, in 2002–2003, 2007–2009, and 2017–2018. During the third follow-up (SOLAR III), participants were between 29 and 34 years old. Since SOLAR focuses on occupational exposures, follow-ups were conducted at important points in time of the development of participants' career. To evaluate the potential of selection bias, responders and non-responders were compared based on variables from earlier study phases. In responders, frequency and pattern of missing values were examined and compared within the subsets of paper and online versions of the used questionnaires.Results: In total, 1,359 participants completed the questionnaire of the third follow-up (47.3% of eligible participants). Initially, the cohort started with 6,399 participants from the ISAAC II questionnaire study. A selection process led to a study population that is more female, higher educated, smokes less and has a higher proportion of certain asthma and allergy symptoms (also in their parents) than the initial cohort. Pattern and frequency of missing values were different for paper and online questionnaires.Discussion: The third follow-up of the SOLAR cohort offers the opportunity to analyze the course of asthma and allergies and their associations to environmental, occupational and psychosocial risk factors over more than 20 years from childhood to adulthood. Selection processes within the cohort might lead to bias that needs to be considered in future analyses.

Occupational IgE‐mediated psyllium allergy in contemporary gluten‐free and vegan baking: A case of allergic rhinitis

Psyllium (from Plantago ovata; ispaghula) is used as a dietary supplement and is supplied in the form of husk, granules, capsules, or powder. Consumers using psyllium-containing laxatives, healthcare workers handling these, and pharmaceutical workers in laxative-manufacturing plants are known to be at risk of sensitization and subsequent rhinitis, asthma, contact urticaria, and even anaphylaxis. To our knowledge, the case we present here is the first of baker's immunoglobulin E (IgE)-mediated occupational allergy due to psyllium exposure. Our patient, a 24-year-old female baker with no previous allergies, was referred to our clinic with suspected occupational rhinitis. After 1 year of baking with cereal flour or gluten-free flour-mix, she began to suffer from rhino-conjunctival symptoms during workdays. Skin prick tests with agents from the patient's workplace revealed allergies not only to wheat and rye flours but also to psyllium, with a remarkable 10 mm wheal. Subsequently, nasal provocation tests confirmed occupational allergic rhinitis to psyllium. We also found work-related sensitization to buckwheat, which she used in gluten-free baking. Due to the increased prevalence of celiac disease and the popularity of gluten-free and vegan food, psyllium has recently become a common ingredient in baking, used as a substitute for gluten or eggs. Bakers handle allergens such as these in high concentrations and this may lie behind the emergence of respiratory and dermal symptoms. It is essential to consider new or recenlty introduced materials as possible allergens if it is suspected that a baker has work-related respiratory or allergic symptoms.

Occupational morbidity in the Samara Region and its dynamics in the context of the pandemic of the novel coronavirus infection COVID-19

The indicators of occupational morbidity in the Samara Region and its dynamics in the context of the pandemic of the novel coronavirus infection COVID-19 are presented. In 2020, out of 127 acute and chronic occupational diseases diagnosed in 11 months, 22.05 % (28 cases) were diagnosed with professional sensorineural hearing loss, 5.51 % (7 cases) with dust lung diseases, 5.51 % (7 cases) — atrophic rhinopharyngolaryngitis, in 3.94 % (5 cases) — occupational allergies in the form of occupational bronchial asthma and eczema, in 3.94 % (5 cases) — vibration disease, in 1.57 % (2 cases) — chronic occupational radiculopathy, in 0.79 % (1 case) — oncological occupational pathology (dermatosarcoma of the hand), in 3.14 % (4 cases) — occupational infectious diseases (except for COVID-19).

Occupational Respiratory Allergy: Risk Factors, Diagnosis, and Management.

Occupational allergies are among the most common recorded occupational diseases. The skin and the upper and lower respiratory tract are the classical manifestation organs. More than 400 occupational agents are currently documented as being potential "respiratory sensitizers" and new reported causative agents are reported each year. These agents may induce occupational rhinitis (OR) or occupational asthma (OA) and can be divided into high-molecular weight (HMW) and low-molecular weight (LMW) agents. The most common occupational HMW agents are (glycol)proteins found in flour and grains, enzymes, laboratory animals, fish and seafood, molds, and Hevea brasiliensis latex. Typical LMW substances are isocyanates, metals, quaternary ammonium persulfate, acid anhydrides, and cleaning products/disinfectants. Diagnosis of occupational respiratory allergy is made by a combination of medical history, physical examination, positive methacholine challenge result or bronchodilator responsiveness, determination of IgE-mediated sensitization, and specific inhalation challenge tests as the gold standard. Accurate diagnosis of asthma is the first step to managing OA as shown above. Removal from the causative agent is of central importance for the management of OA. The best strategy to avoid OA is primary prevention, ideally by avoiding the use of and exposure to the sensitizer or substituting safer substances for these agents.

Long-term effects of asthma medication on asthma symptoms: an application of the targeted maximum likelihood estimation

BackgroundLong-term effectiveness of asthma control medication has been shown in clinical trials but results from observational studies with children and adolescents are lacking. Marginal structural models estimated using targeted maximum likelihood methods are a novel statistiscal approach for such studies as it allows to account for time-varying confounders and time-varying treatment. Therefore, we aimed to calculate the long-term risk of reporting asthma symptoms in relation to control medication use in a real-life setting from childhood to adulthood applying targeted maximum likelihood estimation.MethodsIn the prospective cohort study SOLAR (Study on Occupational Allergy Risks) we followed a German subsample of 121 asthmatic children (9–11 years old) of the ISAAC II cohort (International Study of Asthma and Allergies in Childhood) until the age of 19 to 24. We obtained self-reported questionnaire data on asthma control medication use at baseline (1995–1996) and first follow-up (2002–2003) as well as self-reported asthma symptoms at baseline, first and second follow-up (2007–2009). Three hypothetical treatment scenarios were defined: early sustained intervention, early unsustained intervention and no treatment at all. We performed longitudinal targeted maximum likelihood estimation combined with Super Learner algorithm to estimate the relative risk (RR) to report asthma symptoms at SOLAR I and SOLAR II in relation to the different hypothetical scenarios.ResultsA hypothetical intervention of early sustained treatment was associated with a statistically significant risk increment of asthma symptoms at second follow-up when compared to no treatment at all (RR: 1.51, 95% CI: 1.19–1.83) or early unsustained intervention (RR:1.38, 95% CI: 1.11–1.65).ConclusionsWhile we could confirm the tagerted maximum likelihood estimation to be a usable and robust statistical tool, we did not observe a beneficial effect of asthma control medication on asthma symptoms. Because of potential due to the small sample size, lack of data on disease severity and reverse causation our results should, however, be interpreted with caution.

Purification and biochemical characterization of Hel a 6, a cross-reactive pectate lyase allergen from Sunflower (Helianthus annuus L.) pollen

Sunflower pollen was reported to contain respiratory allergens responsible for occupational allergy and pollinosis. The present study describes the comprehensive characterization of a major sunflower allergen Hel a 6. Natural Hel a 6 was purified from sunflower pollen by anion exchange and gel filtration chromatography. Hel a 6 reacted with IgE-antibodies from 57% of 39 sunflower-sensitized patient sera suggesting it to be a major allergen. The patients were of Indian origin and suffering from pollinosis and allergic rhinitis. Hel a 6 exhibited allergenic activity by stimulating mediator release from basophils. Monomeric Hel a 6 displayed pectate lyase activity. The effect of various physicochemical parameters such as temperature, pH, and calcium ion on the functional activity of Hel a 6 revealed a stable nature of the protein. Hel a 6 was folded, and its melting curve showed reversible denaturation in which it refolded back to its native conformation from a denatured state. Hel a 6 displayed a high degree of sequence conservation with the pectate lyase allergens from related taxonomic families such as Amb a 1 (67%) and Art v 6 (57%). The IgE-cross reactivity was observed between Hel a 6 and its ragweed and mugwort homologs. The cross-reactivity was further substantiated by the mediator release when Hel a 6-sensitized effector cells were cross-stimulated with Art v 6 and Amb a 1. Several putative B cell epitopes were predicted and mapped on these 3 allergens. Two antigenic regions were found to be commonly shared by these 3 allergens, which could be crucial for cross-reactivity. In conclusion, Hel a 6 serves as a candidate molecule for diagnosis and immunotherapy for weed allergy.

Gender and occupational allergy: Report from the task force of the EAACI Environmental and Occupational Allergy Interest Group.

Women's work has traditionally been considered less hazardous to health in comparison with men's work. The increased women's participation in the workforce has led to an increased attention to women's working conditions. Women and men are unequally represented in individual professions or sectors (horizontal segregation), with women also under-represented in leadership positions (vertical segregation). The selection of specific occupations can result in differences between types and levels of occupational exposures among women and men and can affect prevalence of occupational allergy. Gender distribution of work-related asthma appears to vary across countries without clear global difference. Occupational rhinitis tends to be higher in women, although is not clear if this is related to a sex/gender effect or to differences in work exposure. Women are more likely to have occupational contact dermatitis, mainly due to wet work. No clear effects of gender on rates of hypersensitivity pneumonitis have been shown. Besides variation in exposures, physical and physiological characteristics, different behaviours and health consciousness have an impact on the occupational health hazards of women and men. Occupational allergy health promotion strategies need to consider approaches for women and men adjusted by gender, and legislative actions similarly could be implemented in a more gender-sensitive way.

Occupational Allergies to Cannabis

Occupational Allergies to Cannabis

Occupational Allergies to Cannabis

Within the last decade there has been a significant expansion in access to cannabis for medicinal and adult nonmedical use in the United States and abroad. This has resulted in a rapidly growing and diverse workforce that is involved with the growth, cultivation, handling, and dispensing of the cannabis plant and its products. The objective of this review was to educate physicians on the complexities associated with the health effects of cannabis exposure, the nature of these exposures, and the future practical challenges of managing these in the context of allergic disease. We will detail the biological hazards related to typical modern cannabis industry operations that may potentially drive allergic sensitization in workers. We will highlight the limitations that have hindered the development of objective diagnostic measures that are essential in separating "true" cannabis allergies from nonspecific reactions/irritations that "mimic" allergy-like symptoms. Finally, we will discuss recent advances in the basic and translational scientific research that will aid the development of diagnostic tools and therapeutic standards to serve optimal management of cannabis allergies across the occupational spectrum.

Quality of Life Assessment in Healthcare Professionals with Occupational Diseases

Summary. Introduction: Quality of life (QOL) is an integral concept characterizing the level of comfort of the social and natural environment for human life and work, the level of well-being and social, spiritual and physical health. Currently, the number of scientific disciplines that include this concept as an object of study is expanding. Our objective was to study the impact of the system of rehabilitation measures provided for by the current federal legislation in relation to this category of patients on the quality of life of healthcare professionals with occupational diseases. Materials and methods: We assessed QOL changes related to rehabilitation in 124 healthcare professionals of the North-West Federal District who received full or partial rehabilitation for occupational diseases in 2000–2017. Results: We analyzed the dynamics of QOL indicators and assessed physical condition and the ability to perform certain functions in our subjects. The most significant changes were established for such indicators as concentration of attention (by 0.2 on average; p = 0.0393) and quality of life (by 0.2 on average; p = 0.0256). We found an improved QOL in almost 40 % of healthcare professionals with occupational diseases related to physical workloads compared with the groups of occupational infection and allergy cases. Moreover, the increment was quite small (0.2 in terms of the difference in average values, with the expected growth of at least 1–2 points). Conclusions: Incomplete and inconsistent implementation of rehabilitation measures in healthcare professionals suffering from occupational diseases leads to an insufficiently effective increase in their quality of life. A better QOL improvement in these patients requires appropriate correction of drawbacks in carrying out rehabilitation measures.

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.

Symptoms and Awareness of Latex Allergy Among Healthcare Workers

Objective: To evaluate the knowledge levels, sensitivity status, familial latex sensitivity, and attitudes towards the prevention and treatment of latex allergies of healthcare workers (HCWs) at a tertiary hospital. Materials and Methods: The study was carried out cross-sectionally between December 2012 and March 2013. A total of 566 HCWs at a tertiary hospital were included in the study. Results: The data of a total of 566 [333 (58.8%) female and 233 (41.2%) male] HCWs were analyzed. They consisted of 179 (31.6%) physicians, 48 (8.5%) technicians, 238 (42%) nurses, 48 (8.5%) laboratory technicians and 53 (9.4%) patient care workers. The family history of atopy was significantly higher in female HCWs (24.3%) compared to males (17.2%) (p= 0.041). A significant difference was identified between the occupational groups in terms of the rate of allergic symptoms after coming into contact with medical latex products (nurses 59.7%, doctors 17.6%, technicians 5.7%, laboratory technicians 6.9 %, patient care workers 10.1%; p= 0.001). Latexrelated symptoms were significantly more common in atopic HCWs (52.3%) compared to non-atopic ones (19.4%) (p= 0.001). The rate of latex-food syndrome was significantly more frequent in female HCWs (16%) compared to males (8.9%) (p= 0.038). Symptoms that developed after contact with medical and non-medical latex products were significantly more common in female HCWs (79.9% and 80.5%) compared to the male HCWs (21.1% and 19.5%) (p= 0.001). The rate of non-HCW(s) who shared the same house/room with the HCWs after work and who had allergic symptoms while in the same environment with the HCWs was 18%. The rate of these individuals was reported to be highest among the nurses at 53% and there was a statistically significant difference in terms of occupational groups (physicians 25.5%, technicians 9.8%, laboratory technicians 2.9%, patient care workers 7.8%; p= 0.030). Multivariate regression analysis showed that personal history of atopy (OR= 28.657, 95% CI= 6.548-125.411, p= 0.001) and the type of gloves used (latex gloves) (OR= 8.730, 95% CI= 3.490-21.834, p= 0.001) were independent predictors for latex allergy. Conclusion: In conclusion, latex is not only a cause of occupational allergy but is also an allergen that has the potential to cause allergic symptoms in people who share the same environment with HCWs. Questionnaires questioning the symptoms associated with past latex allergy may be an important tool for demonstrating latex sensitization in HCWs and managing latex-related reactions.

Occupational allergy from cucumber

Occupational allergy from cucumber

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 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.

CORRIGENDUM

AllergyVolume 75, Issue 8 p. 2146-2147 CORRIGENDUMFree Access CORRIGENDUM This article corrects the following: Food processing and occupational respiratory allergy- An EAACI position paper Mohamed F. Jeebhay, Gianna Moscato, Berit E. Bang, Ilenia Folletti, Agnieszka Lipińska-Ojrzanowska, Andreas L. Lopata, Gianni Pala, Santiago Quirce, Monika Raulf, Joaquin Sastre, Ines Swoboda, Jolanta Walusiak-Skorupa, Andrea Siracusa, Volume 74Issue 10Allergy pages: 1852-1871 First Published online: June 23, 2019 First published: 27 July 2020 https://doi.org/10.1111/all.14232AboutReferencesRelatedInformationPDFPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessClose modalShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL In the article,1 there were typesetting errors in Table 5 on page 1862. In the rows, Floor dust, Penicillium, and Tea dust, the superscript “c” should have been corrected to “b” for the following countries: Israel, South Korea, Canada Ontario, Norway, Spain, Sweden and China. In 6th row, Proteolytic enzymes, “suatilisins” was incorrect and should have been changed to “subtilisins.” The correct Table 5 should be: Table 5. List of occupational exposure limits (OELs) for allergens in the food processing industry Food substance OEL (8-h time weighted average, total fraction, unless otherwise specified) Country Grain dust 1 mg/m3 4 mg/m3 5 mg/m3 10 mg/m3 Short term: 10 mg/m3 Japana Austriab, Belgium, Canada (Ontario), Canada (Quebec), Japan, Chinab, Singapore, South Korea, Spain, USA (NIOSH, ACGIH) Austria Ireland, USA (CAL OSHA), UK, South Africa Austriac Flour dust 0.5 mg/m3 1 mg/m3 2 mg/m3 3 mg/m3 4 mg/m3 6 mg/m3 10 mg/m3 Short term: 8 mg/m3 30 mg/m3 Belgium, Israelb, South Koreab, USA (ACGIH, CAL OSHA) Ireland, EU (SCOEL) Finland Canada (Ontario)b, Sweden, Norwayb Austria, Spainb Latvia UK Austriac UKd Penicillium 0.1 mg/m3 Swedenb Tea dust 2 mg/m3 3 mg/m3 Chinab Latvia Poultry dust 10 mg/m3 Canada (Ontario) Proteolytic enzymes (subtilisins, 100% pure crystalline) 15 ng/m3 40 ng/m3 60 ng/m3 1 glycine unit/m3 Short term: 30 ng/m3 60 ng/m3 3 glycine unit/m3 China UK Belgium, Denmark, Ireland, USA (NIOSH)d Swedene Chinad Australiaf, Canada (Ontario)f, Canada (Quebec)f, Denmarkf, Irelandd, New Zealandf, Singapored, Spaind, Switzerlandd, USA (ACGIH)f, USA (NIOSH)g, Norwayf Swedend,e Sources: - National Institute for Occupational Safety and Health (NIOSH): Recommended Exposure Limit (REL), https://www.cdc.gov/niosh/npg/default.html - American Conference of Governmental Industrial Hygienists (ACGIH): Threshold Limit Value (TLV), ISBN 978-1-607260-90-5 - Occupational Safety and Health Administration, California (CAL/OSHA): legal Permissible Exposure Limit (PEL), http://www.dir.ca.gov/title8/5155table_ac1.html#_blank - European Union (EU): European Commission Scientific Committee on Occupational Exposure Limits (SCOEL): http://ec.europa.eu/social/main.jsp?catId=148&intPageId=684&langId=en - Norwegian Ministry of Labour and Social Affairs. https://lovdata.no/dokument/SF/forskrift/2011-12-06-1358 - National Institute for Public Health and the Environment The Netherlands. RIVM Letter report 2014-0151,© RIVM 2014 - Health and Safety Executive (HSE). 2nd edition. ISBN 978 0 7176 6446 7 - OSHA 2017. https://www.osha.gov/dsg/annotated-pels/tablez-1.html Annotations: arespirable fraction, binhalable fraction, c30-min average, d15-min average, eone glycine unit is approximately equivalent to 30 ng of pure subtilisin, fceiling limit value, and g60-min average. REFERENCE 1Jeebhay MF, Moscato G, Bang BE, et al. Food processing and occupational respiratory allergy - An EAACI position paper. Allergy. 2019; 74(10): 1852- 1871. Volume75, Issue8August 2020Pages 2146-2147 ReferencesRelatedInformation RecommendedFood processing and occupational respiratory allergy‐ An EAACI position paperMohamed F. Jeebhay, Gianna Moscato, Berit E. Bang, Ilenia Folletti, Agnieszka Lipińska-Ojrzanowska, Andreas L. Lopata, Gianni Pala, Santiago Quirce, Monika Raulf, Joaquin Sastre, Ines Swoboda, Jolanta Walusiak-Skorupa, Andrea Siracusa, Allergy

Occupational respiratory allergy to lettuce in lettuce farmers.

Lettuce-associated respiratory allergy has never been reported before. The aim of this study was to clarify the clinical condition of lettuce-associated respiratory allergy and to identify the lettuce antigen which induces allergic symptoms. We distributed questionnaires to 1168 lettuce farmers and performed medical examinations in those who exhibited respiratory symptoms related to occupational exposure to lettuce. We analysed specific IgE-binding proteins in the sera of patients through immunoblotting analysis and determined molecular characterization of the IgE-binding bands using liquid chromatography-mass spectrometry. A total of 932 farmers (80%) responded to the questionnaire. Of those, 7% exhibited lettuce-associated respiratory symptoms, during harvesting and packaging. Thirteen patients were diagnosed with allergy to lettuce and agreed to undergo further examinations. The percentage of activated basophils in these patients was significantly higher compared with that reported in negative controls (P<.05). Lettuce-specific IgE (ImmunoCAP® ) and skin prick testing was positive in 46% and 62% of patients, respectively. Notably, occupational lettuce-allergic asthma was detected in one patient through specific bronchial provocation testing. The IgE-binding bands recognized in the sera of >50% of patients were identified as epidermis-specific secreted glycoprotein EP1-like (51kDa). The present analysis identified a novel lettuce allergen. This allergen may have clinically useful applications, such as specific IgE testing and allergen-specific immunotherapy.

Current state of occupational latex allergy.

During the 1980s, natural rubber latex (NRL) emerged as a major cause of occupational allergy and asthma, especially in healthcare workers using powdered NRL gloves. Increased recognition of NRL allergies and transfer of research findings into prevention strategies resulted into an almost elimination of this health problem. Here, the current knowledge on allergens, their use in diagnostics, prevalence data of occupational NRL allergy and the status of prevention strategy are summarized. While the current studies conducted in high-income countries show that prevention measures have reduced NRL allergy, this does not yet apply worldwide. For latex allergy diagnosis, it is important that recombinant allergens as reliable tools are available, because in several European countries and the United States, NRL skin prick test extracts and powdered latex gloves for bronchial challenge test are no longer commercially available, leading to a deficit in diagnostic tools. Due to the fact that latex is suitable with good properties as a raw material for gloves, alternatives with significantly lower protein content and without cross-reactive structures to latex proteins are sought. Awareness of the sensitization risk associated with the use of latex gloves should still be present in all occupational settings.