Occupational Hypersensitivity Pneumonitis Research Articles

Occupational respiratory disease in Eastern Slovakia between 1990-2021: a shift from agriculture to industrial manufacturing.

Occupational allergic respiratory diseases frequently occur in individuals working in the agricultural and food production sectors, textile manufacturing, and industries involving exposure to isocyanates. The study aimed to describe trends surrounding the prevalence of occupational asthma (OA), occupational rhinitis (OR), and occupational hypersensitivity pneumonitis (OHP) in Eastern Slovakia between 1990-2021. All cases of OA, OR, and OHP registered in a database at the Louis Pasteur University Hospital in Košice, Slovakia, between 1990 and 2021, were divided into categories based on economic sector (agricultural, food production sectors, textile manufacturing, healthcare, industrial manufacturing, and tertiary sector) and causal agent. Changes in disease prevalence, causal agents, and economic sector association over time were analysed. There were 287 occupational respiratory cases (179 OA, 65 OR, and 43 OHP cases). The annual prevalence of OA declined significantly over the study period (p < 0.05). Overall, there was a significant decrease in cases from the agricultural (p < 0.001) and an increase in the industrial manufacturing (p < 0.01). The number of cases due to farming agents fell markedly over the study period, while metalworking fluids (MWFs) were found to be the most common causes of allergic respiratory diseases since 2018. This study found a decrease in the number of OA cases, as well as changes in economic sectors and causal agents associated with OA and OHP, specifically, in the agricultural sector, with MWFs from the industrial manufacturing sector now being the most common aetiological agent.

Trends in occupational respiratory conditions with short latency in the UK.

Occupational short-latency respiratory disease (SLRD; predominantly asthma, rhinitis, hypersensitivity pneumonitis, and occupational infections) prevalence is difficult to determine but certain occupations may be associated with increased susceptibility. This study aimed to examine which occupations and industries are currently at high risk for SLRD and determine their respective suspected causal agents. SLRD cases reported to the SWORD scheme between 1999 and 2019 were analysed to determine directly standardized rate ratios (SRR) by occupation against the average rate for all other occupations combined. 'Bakers and flour confectioners' and 'vehicle spray painters' showed significantly raised SRR for SLRD in general, mostly due to occupational rhinitis (234.4; 95% CI 200.5-274.0) and asthma (63.5; 95% CI 51.5-78.3), respectively. Laboratory technicians also showed significantly raised SRR for occupational rhinitis (18.7; 95% CI 15.1-23.1), primarily caused by laboratory animals and insects. Metal machining setters and setter-operators showed increased SRR for occupational hypersensitivity pneumonitis (42.0; 95% CI 29.3-60.3), largely due to cutting/soluble oils. The occupation mostly affected by infectious disease was welding trades (12.9; 95% CI 5.7-29.3), mainly attributable to microbial pathogenicity. This study identified the occupational groups at increased risk of developing an SLRD based on data recorded over a recent two-decade period in the UK. Occupational asthma and rhinitis were identified as the prevailing conditions and hypersensitivity pneumonitis as a potentially rising respiratory problem in the metalworking industry.

Hypersensitivity Pneumonitis: Challenges of a Complex Disease.

Hypersensitivity pneumonitis (HP) is a complex interstitial lung disease caused by chronic inhalation of a wide variety of antigens in susceptible and sensitized individuals, commonly associated with an occupational exposure. An impressive number of inciting antigens causing hypersensitivity pneumonitis have been found to cover a wide range of occupations. As working practices have changed over time, especially in industrialized countries, new names for occupational HP have emerged. This review emphasizes the main diagnostic issues arising from the high variability of clinical presentation and the broad spectrum of causal antigens. Furthermore, it provides an overview of current methods to unveil possible causes of hypersensitivity pneumonitis, highlights HP's current diagnostic and treatment challenges and the remaining areas of uncertainty, and presents prevention strategies.

Current views on diagnosis, treatment and prevention of occupational hypersensitivity pneumonitis

In the structure of interstitial lung diseases (ILD), hypersensitive pneumonitis (HP) is quite common in the world. However, to date, the disease is often diagnosed at a late stage (fibrosis), which requires improving the methods of early diagnosis of the disease and timely examination of the connection of the disease with the profession. The analysis of domestic and foreign literature devoted to the peculiarities of the formation of a professional GP in modern socio-economic conditions is given. The authors have described the evolution of ideas about the disease, modern classification, occupational risk factors and methods of diagnosis of HP. Due to the complexity of the etiology and pathogenesis of the disease, we have drawn the attention to the need for an interdisciplinary integrated approach to the diagnosis of professional HP. The scientists have considered modern methods of treatment of the diseas from the standpoint of occupational health, the prospects for improving the diagnosis, treatment and prevention of occupational HP.

Occupational hypersensitivity pneumonitis after polyurethane adhesive exposure.

KEY POINTS A 47-year-old woman presented to hospital with a 3-month history of dry cough, wheeze, dyspnea and intermittent fever. She had been briefly admitted 2 months earlier to treat a presumed lower respiratory tract infection or bronchitis; she had been prescribed inhalers (salbutamol,

Occupational respiratory and skin diseases among workers exposed to metalworking fluids.

To examine respiratory and skin diseases that occur among workers exposed to metalworking fluids (MWFs) used during machining processes. Five cases of a severe and previously unrecognized lung disease characterized by B-cell bronchiolitis and alveolar ductitis with emphysema (BADE) were identified among workers at a machining facility that used MWFs, although MWF exposure could not be confirmed as the etiology. In the United Kingdom, MWF is now the predominant cause of occupational hypersensitivity pneumonitis (HP). Under continuous conditions associated with respiratory disease outbreaks, over a working lifetime of 45 years, workers exposed to MWF at 0.1 mg/m3 are estimated to have a 45.3% risk of acquiring HP or occupational asthma under outbreak conditions and a 3.0% risk assuming outbreak conditions exist in 5% of MWF environments. In addition to respiratory outcomes, skin diseases such as allergic and irritant contact dermatitis persist as frequent causes of occupational disease following MWF exposure. Healthcare providers need to consider MWF exposure as a potential cause for work-related respiratory and skin diseases. Additional work is necessary to more definitively characterize any potential association between MWF exposures and BADE. Medical surveillance should be implemented for workers regularly exposed to MWF.

Assessment and Management of Occupational Hypersensitivity Pneumonitis

The diagnosis and treatment of occupational hypersensitivity pneumonitis (OHP) remain complex and challenging in the absence of diagnostic gold standards or clinical guidelines. This review provides an update of the recent literature regarding the different presentations of OHP and the diagnostic yield and value of the diagnostic tests currently available, which include occupational and medical history, laboratory tests (serum-specific immunoglobulins, environmental sampling), imaging, bronchoalveolar lavage, transbronchial biopsy, transbronchial cryobiopsy, surgical lung biopsy, and specific inhalation challenges. These tools provide a precise differential diagnosis within the framework of interstitial lung diseases. However, among the chronic fibrotic forms, distinguishing OHP from sarcoidosis, nonspecific interstitial pneumonia and idiopathic pulmonary fibrosis remains a diagnostic challenge. Avoidance of exposure is pivotal for OHP management, whereas corticosteroids are fundamental in the pharmacological approach to this disease. In addition, studies describing the long-term benefits of immunosuppressive and antifibrotic agents have increased the use of these treatments in OHP.

Assessment and Management of Occupational Hypersensitivity Pneumonitis

Assessment and Management of Occupational Hypersensitivity Pneumonitis

BAGASSOSIS: A CASE REPORT ON RARE HYPERSENSITIVITY PNEUMONITIS

Bagassosis is a rare form of occupational hypersensitivity pneumonitis (HP) caused by inhalation of bagasse. The incidence is significantly low after 1970 due to public awareness and an increase in organized sector industries. Being one of the largest sugar manufacturing countries and still the presence of industries in the unorganized sector, it is one of unnoticed diseases in some part of our country. In the present case, we describe the case of a 60-year-old male who presented with signs of respiratory failure. There was a history of occupational exposure to residuals of the sugarcane industry (bagasse) dust for the past 25 years with recent exposure before admission. The chest X-ray depicted bilateral opacity and computed tomography showed bilateral patchy opacities, septal thickening, and ground-glass opacities. His bronchoalveolar lavage revealed lymphocytosis. He was diagnosed as a case of bagassosis (occupation-related HP). He was admitted and treated with systemic corticosteroid and other supportive treatment and recovered gradually from respiratory failure. The treatment continued with a tapering dose of corticosteroid for the next 6 months, which improved him clinically, radiologically, and physiologically.

Cladosporium herbarum Hot-Tub Lung Hypersensitivity Pneumonitis in a Greenhouse Worker.

Hypersensitivity pneumonitis is understood to be a delayed allergic reaction to the repeated exposure of a usually innocent inhaled agent, causing inflammatory damage to the pulmonary parenchyma, alveoli and terminal bronchioles. With ongoing exposure, it can cause respiratory compromise and pulmonary fibrosis. Recognizing the heterogeneity of the causative agents and the low incidence of the disease, we considered it important to report the case of a greenhouse worker who developed a Cladosporium sp. related hot-tub lung hypersensitivity pneumonitis. We believe it to be the first reported case of a greenhouse occupational hypersensitivity pneumonitis due to Cladosporium sp.LEARNING POINTSEnquiring about environmental and occupational exposure during anamnesis is fundamental, particularly when addressing respiratory tract symptoms.The mainstay management of hypersensitivity pneumonitis is based on eviction of the offending agent and control of inflammation, currently with corticosteroids.Antigen source removal may entail important psychological, social and economic consequences for the patient and will need a multidisciplinary approach.

Diagnosis of occupational hypersensitivity pneumonitis.

To discuss the diagnostic methods currently used in the study of patients with hypersensitivity pneumonitis, with special emphasis on the most recent contributions published in the medical literature regarding the diagnosis of occupational hypersensitivity pneumonitis (OHP). This review presents an update of the use of these diagnostic tests, a controversial issue among experts. In spite of the multiple attempts at systematization and the publication of expert consensus statements, standardizing and diagnostic methods and criteria remain particularly difficult. As a result, centers tend to rely on their own experience and establish diagnosis by consensus among their multidisciplinary teams. Though recommendable in many ways, this method presents significant limitations. Diagnosis of OHP should be made with a thorough clinical history of the symptoms and clinical signs as well as a meticulous review, if possible by an expert, of possible exposures in the working environment; a meticulous physical examination; high-resolution computed tomography of the thorax; serum determination of specific immunoglobuline Gs; bronchoalveolar lavage and possibly cryobiopsy; fungal culture; and, when appropriate, a specific inhalation challenge test with the suspected antigen.

Possibilities of x-ray computer densitometry in diagnosis of occupational hypersensitivity pneumonitis

The article presents results of assessing lung parenchyma density within X-ray diagnostic pattern “Opal glass” in patients with changes characteristic for occupational hypersensitivity pneumonitis(60 patients) and interstitial pneumonia (65 patients of reference group) vs. reference group (70 individuals), by modified method of X-ray computer tomography of high resolution. Quantitative characteristics as native parameter (HU units), density gradient (IDG), with consideration of homogeneity degree of the evaluated zone by SD value enabled considerable objectification of the changes direction in diagnostic monitoring of the studied lung disorders.

Actualités en allergologie respiratoire professionnelle

Recent data show that the diagnosis of occupational asthma and occupational hypersensitivity pneumonitis requires a multidisciplinary approach and relies on a combination of diagnostic tests.

Clinical analysis of occupational hypersensitivity pneumonitis

Clinical analysis of occupational hypersensitivity pneumonitis

Hypersensitivity Pneumonitis Due to Metalworking Fluid Aerosols.

This review summarises the clinical knowledge of hypersensitivity pneumonitis in workers exposed to aerosols of metalworking fluid, reviewing published outbreaks and clinical cases. Metalworking fluid exposure has become the commonest recognised cause of occupational hypersensitivity pneumonitis, having been rare before 2000. There are many possible agents in the metalworking fluid which may be the cause of disease including bacteria, mycobacteria, fungae, biocides, emulsifiers, reodorants and dissolved chrome and cobalt. Causes are likely to be different in different outbreaks. Mycobacteria growing in the metalworking fluid have generated immune responses in some workers, but their role in disease causation is not yet established. Many outbreaks have been identified in large workplaces using common sumps. It is not possible to prevent microbial contamination of metalworking fluids in use. Disease prevention should focus on stopping inhalation of aerosols, particularly by re-engineering to remove recirculation.

T-cell antigens of Mycobacterium immunogenum, an etiological agent of occupational hypersensitivity pneumonitis.

The T lymphocyte-mediated immune lung disease hypersensitivity pneumonitis (HP) in machinists is poorly understood for disease mechanisms and diagnosis due in part to lack of information on causative T-cell antigens of the etiological agent Mycobacterium immunogenum (MI). Therefore, overall objective of the current study was to identify T-cell reactive antigens of this recently recognized pathogen. In this direction, purified recombinant form of five of the seroreactive proteins (reported in our initial study), including three cell wall-associated (arbitrarily designated as antigens A through C) and two secretory (AgD & AgE), were examined for their potential to activate antigen-presenting cells (APCs) viz. alveolar macrophages and human monocyte-derived dendritic cells (DCs) and for T-cell reactivity. All five proteins strongly activated APCs by inducing inflammatory cytokines (TNF-α, IL-6 & IL-1α) and nitric oxide (NO), albeit to a varying extent (AgE≥AgD>AgB≥AgA≥AgC), implying their differential potential for activation of APCs. However, only two of the five proteins (AgA, AgD) showed significant T-cell response (T lymphocyte proliferation and IFN-γ secretion) when tested using sensitized T-cells from MI-induced HP mouse model. These antigens also activated the human naïve CD4(+) T cells in presence of autologous DCs as measured using ELISPOT for IFN-γ. Immuno-informatic analysis predicted that the identified T-cell antigens (AgA and AgD) bind more number of class I and class II HLA alleles as compared with the reference immuno-dominant antigens ESAT-6 and CFP-10 from the tuberculous mycobacterial species M. tuberculosis. Predicted human population coverage for the epitopes of AgA (90.87%) and AgD (88.09%) was also higher as compared to those for the reference antigens ESAT-6 (82.42%) and CFP-10 (80.21%). These two antigens were further predicted to be highly immunogenic for class I peptide MHC (pMHC) complex as compared to the reference antigens. Collectively, our results imply that AgA and AgD are T-cell antigens with a high HLA binding frequency as well as population coverage for HLA alleles. This first report on T-cell antigens and epitopes of M. immunogenum is significant as it is expected to open up avenues for understanding pathogenesis mechanisms and developing T-cell-based immunodiagnostic tools for this poorly investigated occupational lung disease.

Allergen component analysis as a tool in the diagnosis of occupational allergy.

Rapid developments have been seen in molecular allergy diagnosis, based on the detection and quantification of specific IgE to single allergens. This review summarizes and discusses studies on allergen component analysis as a tool in the diagnosis of occupational allergy. More than 400 agents are identified as sensitizers of occupational asthma, but only very few are characterized on the molecular level and available for routine diagnosis. Baker's asthma is one of the most frequently occurring forms of occupational asthma caused by workplace-related inhalation of cereal flour mainly wheat. Wheat sensitization profiles of bakers show great interindividual variability and no wheat allergen could be classified as the major allergen. Component-resolved diagnosis is a useful tool for diagnosing natural rubber latex (NRL) allergy. In cases with unexpected high-latex IgE but without clinical symptoms application of crossreactive carbohydrate determinants are helpful to clarify the cause of IgE binding. Latex is an excellent model for component-resolved diagnosis and demonstrates well how to improve the diagnosis by using single allergens. For diagnosis of baker's asthma, a whole wheat extract is still the best option for specific IgE determination, but single wheat allergens might help to discriminate between wheat-induced food allergy, grass-pollen allergy, and baker's asthma. New diagnostic tools and platforms are promising, but further knowledge of molecules relevant for occupational asthma (as in wood dust allergens, enzymes, laboratory animal allergens, etc.) and for occupational hypersensitivity pneumonitis is necessary to improve and standardize the diagnostic tools.

Occupational hypersensitivity pneumonitis: an EAACI position paper.

The aim of this document was to provide a critical review of the current knowledge on hypersensitivity pneumonitis caused by the occupational environment and to propose practical guidance for the diagnosis and management of this condition. Occupational hypersensitivity pneumonitis (OHP) is an immunologic lung disease resulting from lymphocytic and frequently granulomatous inflammation of the peripheral airways, alveoli, and surrounding interstitial tissue which develops as the result of a non-IgE-mediated allergic reaction to a variety of organic materials or low molecular weight agents that are present in the workplace. The offending agents can be classified into six broad categories that include bacteria, fungi, animal proteins, plant proteins, low molecular weight chemicals, and metals. The diagnosis of OHP requires a multidisciplinary approach and relies on a combination of diagnostic tests to ascertain the work relatedness of the disease. Both the clinical and the occupational history are keys to the diagnosis and often will lead to the initial suspicion. Diagnostic criteria adapted to OHP are proposed. The cornerstone of treatment is early removal from exposure to the eliciting antigen, although the disease may show an adverse outcome even after avoidance of exposure to the causal agent.

Occupational Hypersensitivity Pneumonitis

Hypersensitivity pneumonitis (HP), or extrinsic allergic alveolitis, is a relatively rare condition with a variable natural history (acute, subacute, or chronic) and fairly nonspecific features. Patients present with pulmonary symptoms with or without constitutional disturbance. HP can be caused by >300 different agents, which broadly comprise microbial agents (bacteria, fungus), animal antigens, and chemicals, and exposure to these agents may occur in occupational settings—the focus of this article—or elsewhere. HP, particularly due to occupational exposures, is underdiagnosed due to a lack of awareness of the condition and difficulties in identifying and confirming the diagnosis. Bird fancier’s lung and farmer’s lung have historically been the most common causes of HP. More recently, metalworking fluids used in engineering have emerged as an increasingly common etiological agent for occupational HP and several outbreaks have been reported. Making a diagnosis of occupational HP is crucial both for the individual, so as to remove them from exposure and maximize the chance of a full recovery, and for the employer, so that they can identify other cases and put into place strategies to prevent further cases. There is no single gold standard test used to confirm HP, and a combination of a careful occupational exposure history, clinical history, radiology, and immunology findings can help ascertain a diagnosis. Certain key questions can be useful in eliciting a work-related pattern to symptoms.

Allergen of the Month—Mucor

Allergen of the Month—Mucor