Work-related Respiratory Symptoms Research Articles

How Allergists Can Perform an Occupational History in Every Patient

The occupational history is often neglected in the routine evaluation of new patients with asthma, chronic rhinitis or dermatologic complaints. Such omissions are inadvertent because work related conditions are often not prioritized. There also may be lack of awareness of the scope of respiratory or cutaneous allergens capable of inducing occupational asthma (OA) or work-related contact dermatitis. Evidence exists suggesting that the occupational history is often neglected among primary care physicians and specialists. Failure to diagnose OA in a timely fashion by identifying occupational sources of exposure, for example, may result in unnecessary morbidity in workers whose exposure is not modified. In this commentary, we propose a brief intake survey to be administered to all patients coming to an allergy practice to quickly screen for possible work-related respiratory symptoms and another for occupational dermatitis. This would require minimal physician time and could be self-administered at the initial encounter and incorporated into the medical record. A positive response to either surveys should trigger a more detailed evaluation by the allergy specialist. More detailed approaches for stepwise clinical evaluation of the worker suspected of OA and contact dermatitis are discussed.

Work-Related Asthma and Its Impact on Quality of Life and Work Productivity

The impact of work-related asthma (WRA) on quality of life (QoL) and work productivity remains largely neglected/uncertain despite its high prevalence. To investigate the association of WRA with QoL and work productivity as compared with subjects with non-WRA and those without asthma and rhinitis. A cross-sectional survey was carried out among workers during their periodic occupational health visit in Belgium. The Mini Asthma Quality of Life Questionnaire, the 8-item Medical Outcome Study Short Form instrument, and the Work Productivity and Activity Impairment-General Health questionnaire were administered. Survey participants were divided into 3 groups: (1) WRA (current asthma with ≥2 respiratory symptoms at work; n= 89); (2) non-WRA (current asthma without work-related respiratory symptoms; n= 119); and (3) the reference group (no asthma and no lower respiratory, nasal, or eye symptoms; n= 815). Associations of QoL and work productivity with WRA were evaluated by multivariable regression analyses. WRA and having poor asthma control were significantly associated with lower global Mini Asthma Quality of Life Questionnaire scores compared with non-WRA. Asthmatic subjects had significantly lower physical and mental health component scores of the 8-item Medical Outcome Study Short Form instrument and overall work productivity compared with the reference group, with greater impairment in workers with WRA than in those without WRA. Moreover, workers with WRA had higher percentages of doctor visits and income reduction because of respiratory symptoms than those with non-WRA. Work-related rhinitis and depression were associated with reduced QoL, independent of the effect of WRA. WRA should be managed comprehensively to reduce the worsening of QoL and work productivity of those affected.

A Cross-Sectional Study of Farmer Health and Wellbeing in Norway: The HUNT Study (2017-2019)

ABSTRACT Objectives Obtain a broad impression of the health and wellbeing of working farmers in a representative population. Methods A cross-sectional study using data from a large, general population-based survey, The HUNT Study, Norway (HUNT survey 4, 2017–2019, response rate 54%). The study included 24,313 occupationally active participants aged 19 to 76 years, including 1,188 farmers. Prevalences are estimated for outcomes covering musculoskeletal, respiratory, and mental health as well as general health and life satisfaction, with adjustment for worker age and sex. The estimates for farmers are compared to skilled white collar workers and skilled manual workers. Results Farmers had a higher estimated prevalence of poor overall health (prevalence ratio [PR] 1.56 [95%CI 1.34,1.82]), chronically impaired mobility (PR 1.83 [1.53, 2.20]), long-standing musculoskeletal pain or stiffness (PR 1.29 [1.21, 1.37]), work-related respiratory attack (PR 4.32 [3.67, 5.08]), depression symptoms (PR 1.30 [1.04, 1.61]) and symptoms of psychological distress (PR 1.23 [1.04, 1.47]) than skilled white collar workers. The estimated prevalence of poor overall health (PR 1.19 [1.00, 1.41]) and work-related respiratory attacks (PR 1.44 [1.24, 1.67]) was also higher for farmers than skilled manual workers, after adjustment for age and sex. Farmers had greater odds of rating themselves less satisfied with life in general than skilled white collar workers (adjusted OR 1.17 [1.04, 1.31]). Conclusions These results are consistent with previous research and add evidence that farm work is associated with high prevalences of a broad range of adverse health outcomes. The associations with chronically impaired mobility, long-standing musculoskeletal pain, and poor self-rated health were strong. The adjusted PRs for work-related respiratory attacks relative to both comparison groups were particularly high. More research is needed to identify and evaluate interventions that can improve farmer health.

Obstructive Lung Disease Linked to Occupational Exposures in Malawian Tobacco Farmers

ABSTRACT Nicotine and pesticide exposure in agricultural settings have been linked to the development of chronic respiratory disease in workers. However, this has not been extensively studied in Africa. The aim of this study was therefore to determine the prevalence of obstructive lung disease and its relationship to concurrent nicotine and pesticide exposure among small-scale tobacco farmers in Malawi. For this purpose, sociodemographic characteristics, occupational and environmental exposures were evaluated in relation to work-related respiratory symptoms and lung function impairment. A cross-sectional study was conducted enrolling 279 workers in flue-cured tobacco farms in Zomba, Malawi. The study instruments used for assessing the health outcomes were a standardised European Community Respiratory Health Survey II (ECRHS) questionnaire and Spirometry testing. The questionnaires were aimed at collecting relevant data on sociodemographic factors and self-reported respiratory health outcomes. Data were also collected on potential pesticide and nicotine exposures. Spirometry was done to evaluate objective respiratory impairment in accordance with American Thoracic Society guidelines. The mean age of participants was 38 years with 68% being male. The prevalence of work-related ocular nasal symptoms, chronic bronchitis, and work-related chest symptoms was 20%, 17%, and 29%, respectively. Airflow limitation (FEV1/FVC <70%) was found in 8% of workers. Self-reported exposure to pesticides varied from 72%- to 83%, whilst the prevalence of recent green tobacco sickness was 26%. Tasks linked to nicotine exposure, such as sowing (OR: 2.5; CI 1.1–5.7) and harvesting (OR: 2.6; CI 1.4–5.1), were significantly associated with work-related chest symptoms. Pesticide application (OR:1.96; CI 1.0–3.7) was associated with an increased risk of work-related oculonasal symptoms. Duration of pesticide exposure was also associated with obstructive impairment FEV1/FVC<LLN (OR: 5.11; CI 1.6–16.7) and FEV1/FVC <70% (OR: 4.68; CI 1.2–18.0). This study demonstrated that tobacco farmers in Malawi had a high prevalence of respiratory symptoms and airflow limitation due to obstructive lung disease. This could be attributed to nicotine or pesticide exposure in small-scale tobacco farming. The implementation of occupational health and safety measures to mitigate these exposures may play an important role in modifying the risk of obstructive lung disease in this population.

Employment Quality and Mental and Self-Reported Health Inequities among Latinx Housecleaners: The Safe and Just Cleaners Study.

Precarious employment, such as housecleaning, is one important structural contributor to health inequities. We used an employment quality (EQ) framework to characterize the impact of employment conditions on mental and self-reported ill-health among Latinx housecleaners in the New York City metropolitan area. Using a community-based participatory research approach, we collected cross-sectional survey data from 402 housecleaners between August 2019 and February 2020 to characterize housecleaners' EQ and its association with depression, perceived stress, and self-reported health. We also measured work-related irritant eye, skin, and respiratory symptoms, which have been shown in previous research to be associated with housecleaners' exposure to chemical components of cleaning products. Our housecleaner cohort was largely female and immigrant and most had worked at least five years. Survey items capturing the EQ dimensions of unbalanced interpersonal relations, low material resources, and violations of workers' rights were associated with increased odds of depression, perceived stress, and self-reported ill-health. Work-related irritant eye, skin, and respiratory symptoms were also independently associated with mental and self-reported ill-health and some of the effects of EQ on health were potentially partially mediated through their association with work-related irritant symptoms. Findings can inform directions for community-based educational and policy initiatives to improve housecleaners' employment quality.

Respiratory afflictions during hairdressing jobs: case history and clinical evaluation of a large symptomatic case series

ObjectivesRespiratory symptoms at work are common among hairdressers. Various working materials, most notably bleaching ingredients such as ammonium persulfate, have been made responsible. The objective of this study is to achieve a better understanding of work-related respiratory symptoms of hairdressers by describing common features in a large affected collective.MethodsOne hundred forty-eight hairdressers with respiratory symptoms at work presenting between 2012 and 2019 were consecutively included in a case series. Anamnestic and diagnostic data including pulmonary function and allergy testing were retrospectively compiled from records and analysed. Additionally, cases were categorised in five groups with respect to occupational causation certainty.Results30% of the predominantly female collective had changed jobs or were on longer sick-leave. Besides respiratory symptoms, 10% also reported contact urticaria to blonde dyes. In 60% an obstructive airway disease was confirmed. A specific hypersensitivity reaction to ammonium persulfate was found in 15%. Group 1 with a proven immunological occupational causation showed significantly lower age (p < 0.001) and tenure time (p = 0.001), higher sensitization rates against environmental allergens as well as a higher total IgE (p = 0.015), compared to group 4 (obstructive airway disease, specific occupational causation unlikely).ConclusionsThis case series contributes to a better characterization of work-related respiratory symptoms in hairdressing as one of the largest examined collectives of symptomatic hairdressers. Ammonium persulfate as the most common specific cause showed signs of a type-I-like hypersensitivity reaction with typical risk factors for atopy. Prick testing is recommended in all symptomatic cases. However, a specific occupational causation often cannot be proved.

Respiratory symptoms and dust exposure among cement processing factory workers,Tanzania

Background: Cement manufacturing is among the growing industry in Tanzania. It involves processes from blending, kiln burning, clinker, grinding and cement final production. All of these cement manufacturing processes generates cement dust which contain silica and other toxic materials which can potentially affect respiratory system of exposed workers. Methods: This cross sectional comparative study design was conducted at cement processing factory and Ndanda mineral water processing factory as control, all of these factories are located in Mtwara region in Tanzania. A total of 398 workers were selected randomly from these two factories. Data were collected using structured questionnaires for respiratory health symptoms, Checklists was used for the observational parameters. Dust sampling was done using Side Kick Casella (SKC) pumps and PVC filter on IOM cassettes was used to determine dust exposures. The analysis was done by SPSS program vers 20. The significant association between the dependent variable and the factors was registered when Pvalue was less the 0.05. Results: Packing and cleaner were the sections with higher total cement dust concentrations above Occupational Exposure Limit which were 33.24 and 15.39 mg/m3 respectively. Workers in cement processing factory were exposed to higher levels of total dust with AM 14.1033 mg/m3 (SD 4.357) than in mineral water processing factory AM 0.0867 mg/m3 (SD 0.035). The Prevalence of respiratory symptoms was higher among workers in cement processing factory (45.7%) than in mineral water processing factory (25%), this was statistically significant. Conclusion: Exposure to cement dust in a working environment causes the increase in work related respiratory symptoms and reduced lung function. A control measure to decrease the dust exposure level among cement workers in line with periodic medical examination is highly needed.

Identifying cleaning products associated with short-term work-related respiratory symptoms: A workforce-based study in domestic cleaners.

Domestic cleaners have an increased risk of asthma-like and other respiratory symptoms and conditions. Uncertainty exists about which products are most hazardous. We aimed to investigate, among professional domestic cleaners, the associations of ocular/respiratory outcomes with using specific types of products at work and with the ability to choose their own products. Among domestic cleaners employed by "service vouchers" companies in Belgium, we administered an online questionnaire on ocular/respiratory symptoms (frequency and time relation to workdays), frequency of use of 40 types of products, and ability to choose one's own products. Work-relatedness was defined as symptoms improving/disappearing on days off-work. We studied associations between frequency of product-use with work-related outcomes (eye irritation, rhinitis symptoms, sore throat, laryngeal symptoms, asthma symptoms, cough) and with chronic bronchitis, using multivariable logistic and elastic net regression. Adjusted odds ratios (OR) with 95%-confidence intervals were obtained per time a product was used per week. Among 1,586 domestic cleaners (99% women), the number of times sprays were used (median 13/week) was significantly associated with all outcomes (ORs between 1.012 and 1.024 per time sprays were used per week). Bleach/disinfectant-containing liquid products were associated with all outcomes, except for laryngeal symptoms (ORs 1.086 to 1.150); ammonia with work-related upper airway symptoms and chronic bronchitis. Cleaners able to choose their own products had fewer work-related eye symptoms (OR 0.728;0.556-0.954), rhinitis (OR 0.735;0.571-0.946) and cough (OR 0.671;0.520-0.865). Using elastic net regression, work-related rhinitis was most strongly associated with mould removal spray (OR 1.108;1.006-1.248), carpet/seat/curtain spray (OR 1.099;1.001-1.304) and ammonia (OR 1.081;1.002-1.372); work-related asthma with carpet/seat/curtain spray (OR 1.103;1.017-1.322), mould removal spray (OR 1.029;0.995-1.199) and drain cleaner (OR 1.023;0.979-1.302). In a large group of domestic cleaners, we documented that cleaning products have a range of adverse respiratory effects. Empowering cleaners to choose their products may reduce the burden of symptoms.

Work-related allergy and asthma associated with cleaning agents in health workers in Southern African tertiary hospitals.

Health workers (HWs) are exposed to diverse cleaning agents in large hospitals. This study determined the prevalence of work-related symptoms, allergic sensitization, and lung function abnormalities in HWs of two tertiary hospitals in Southern Africa. A cross-sectional study of 699 HWs (South Africa: SAH, n = 346; Tanzania: TAH, n = 353) was conducted. Health outcomes were assessed using a standardized ECRHS questionnaire, immunological tests (specific IgE antibody to common aero-allergens and to occupational allergens: natural rubber latex [NRL] Hev b5 and Hev b6.02, chlorhexidine, and ortho-phthalaldehyde [OPA]), spirometry [pre-and post- bronchodilator], methacholine challenge, and fractional exhaled nitric oxide (FeNO). A large proportion of participants (78%) were women. Median age was 42 years, with 76% nurses, 12% cleaners, and 5% administrative workers. Current smoking was more common in SAHWs (12%) than TAHWs (1%). The overall prevalence of doctor-diagnosed asthma was 7%. Atopy was present in 43% of HWs, while 4% were sensitized to OPA, 2% to NRL, and 1% to chlorhexidine. Prevalence of work-related ocular-nasal symptoms (16%) was higher than skin (12%) and chest (7%) symptoms. TAHWs had significantly lower mean lung volumes, higher degrees of significant airflow obstruction and impaired lung function. The prevalence of bronchial hyperresponsiveness in SAHWs (14%) was high. Overall, 23% of HWs had abnormal FeNO; 6% having high (>50 ppb) levels. FeNO was positively associated with sensitization to occupational allergens, primarily OPA and NRL. HWs from both hospitals had similar prevalence of work-related respiratory symptoms. Sensitization to OPA and NRL appears to be contributing to allergic airway inflammation in these HWs.

“Work-related Respiratory Symptoms and associated factors among Cement Factory Workers in Rupandehi district, Nepal”

“Work-related Respiratory Symptoms and associated factors among Cement Factory Workers in Rupandehi district, Nepal”

Characteristics and Determinants of the Presence of Respiratory Symptoms among Sewage Workers in Malaysia.

Background The purpose of this study was to determine the relationships of PM 2.5 and H2S exposure with the presence of work-related respiratory symptoms among sewage workers. Methods A cross-sectional study was conducted in eleven sewage plants located in the central region of Peninsular Malaysia. One hundred ninety-one sewage workers were assessed using the British Medical Research Council (BMRC) questionnaire. Area air sampling was performed in three different sewage plants to measure the following parameters: physical air quality and concentration of PM 2.5 and H2S. Result Chronic cough (34.0%) was reported as the most common symptom, followed by chronic phlegm (26.2%), shortness of breath (7.9%), and chest tightness (3.7%). There were five significant determinants of the presence of respiratory symptoms among the sewage workers: shift work (AOR 23.50, 95% CI: 1.90–616.52), working at a sludge treatment facility (STF) (AOR 25.46, 95% CI: 2.06–314.29), a longer duration of working years (AOR 1,21, 95% CI: 1.01–1.44), individual cumulative exposure to PM 2.5 (AOR 9.01, 95% CI: 1.98–83.33), and individual cumulative exposure to H2S (AOR 1.04, 95% CI: 1.01–1.07). The majority of STF and non-STF workers had higher exposure to PM 2.5 and H2S concentrations in the air than office workers. Conclusion Sewage workers working at non-STFs or STFs reported a significantly higher prevalence of work-related respiratory symptoms and exposure to PM 2.5 and H2S compared with office workers. Exposure-response relationships were also found in sewage workers' cumulative exposure to PM 2.5 and H2S and the presence of respiratory symptoms.

The Toxicity of Wiped Dust and Airborne Microbes in Individual Classrooms Increase the Risk of Teachers' Work-Related Symptoms: A Cross-Sectional Study.

Background: The causes and pathophysiological mechanisms of building-related symptoms (BRS) remain open. Objective: We aimed to investigate the association between teachers’ individual work-related symptoms and intrinsic in vitro toxicity in classrooms. This is a further analysis of a previously published dataset. Methods: Teachers from 15 Finnish schools in Helsinki responded to the symptom survey. The boar sperm motility inhibition assay, a sensitive indicator of mitochondrial dysfunction, was used to measure the toxicity of wiped dust and cultured microbial fallout samples collected from the teachers’ classrooms. Results: 231 teachers whose classroom toxicity data had been collected responded to the questionnaire. Logistic regression analysis adjusted for age, gender, smoking, and atopy showed that classroom dust intrinsic toxicity was statistically significantly associated with the following 12 symptoms reported by teachers (adjusted ORs in parentheses): nose stuffiness (4.1), runny nose (6.9), hoarseness (6.4), globus sensation (9.0), throat mucus (7.6), throat itching (4.4), shortness of breath (12.2), dry cough (4.7), wet eyes (12.7), hypersensitivity to sound (7.9), difficulty falling asleep (7.6), and increased need for sleep (7.7). Toxicity of cultured microbes was found to be associated with nine symptoms (adjusted ORs in parentheses): headache (2.3), nose stuffiness (2.2), nose dryness (2.2), mouth dryness (2.8), hoarseness (2.2), sore throat (2.8), throat mucus (2.3), eye discharge (10.2), and increased need for sleep (3.5). Conclusions: The toxicity of classroom dust and airborne microbes in boar sperm motility inhibition assay significantly increased teachers’ risk of work-related respiratory and ocular symptoms. Potential pathophysiological mechanisms of BRS are discussed.

Respiratory symptoms related to flour dust exposure are significantly high among small and medium scale flour mill workers in Ethiopia: a comparative cross-sectional survey

BackgroundInternational Labour Organization (ILO) report indicates more than 2.4 million workers die from work-related diseases and accidents each year. Work-related respiratory ailments related to airborne particulate matter such as flour dust are responsible for about 386,000 deaths and 6.6 million illness-adjusted life years. Even though exposure to flour dust together with the extreme expansions of flour mill sectors is a priority health concern, extent of the problem is little investigated in Ethiopia. The aim of this study was to evaluate the magnitude and risk factors of work-related respiratory symptoms among flour mill workers in Bahir Dar City, Ethiopia.MethodsThis study employed a comparative cross-sectional survey of 560 samples (280 exposed group from flour mill workers and 280 unexposed group from office workers) with a stratified random sampling technique. The study was conducted from March to April 2019 in Bahir Dar City, Northwest Ethiopia. We used the British Medical Research Council (BMRC) questionnaire to assess work-related respiratory symptoms. The questionnaire was pretested and interview administered to collect data. Binary logistic regression analysis was fitted to evaluate significant factors of respiratory symptoms at a < 0.05 p value. Adjusted odds ratio (AOR) with a confidence interval (CI) of 95% was calculated to determine a strength of association.ResultsAll the sampled participants had fully responded to the interview. The median age of exposed and unexposed groups was 28.5 interquartile range (IQR, 20) and 31 (IQR, 15) years, respectively. The prevalence of work-related respiratory symptoms among flour mill workers was substantially higher than that of among controls, 63.9% and 20.7%, respectively (Χ2 = 107.11; p < 0.0001). Chest illness among flour mill workers was higher, 43.6% (N = 122) compared to that of among control group, 7.9% (N = 22) followed by dyspnea, 33.6% (N = 94) versus 2.5% (N = 7) among flour mill workers and control group, respectively. Age > 35 years [AOR, 2.03; 95% CI (1.34, 5.48), having no education [AOR, 1.54; 95% CI (1.28, 3.06)], work set up with inadequate ventilation [AOR, 2.05; 95% CI (1.18, 3.56)], work experience > 5 years [AOR, 1.89; 95% CI (1.23, 4.67)] and having no training in safety [AOR, 2.45; 95% CI (1.45, 4.76)] significantly affected the experience of respiratory symptoms among flour mill workers whereas age [AOR, 1.79; 95% CI (1.06, 3.04)], monthly salary [AOR, 1.98; 95% CI (1.04, 3.78)] and exposure status [AOR, 5.18; 95% CI (3.34, 8.04)] were detected to be significant factors of respiratory symptoms in the exposed and the unexposed combined model.ConclusionRespiratory symptoms emanating from exposure to various flour dusts were significantly higher among flour mill workers than among the control group. Therefore, we recommend the need to effectively implement health and safety programs that account for the reduction of dust at a source, use of engineering controls (e.g., provision of adequate ventilation systems), use of administrative measures (e.g., training program and health surveillance) and provision of a suitable personal protective equipment (PPE). Furthermore, it is vital to integrate workplace health and safety programs to the wider public health policies and strategies to effectively mitigate the burden of work-related respiratory conditions. We also encourage future studies to evaluate concentration of flour dusts combined with physical examinations to establish plausible associations of respiratory symptoms with dusts of flour mill-related origin.

A cluster of hypersensitivity pneumonitis associated with exposure to metalworking fluids.

Workers exposed to metalworking fluids (MWF) can develop respiratory illnesses including hypersensitivity pneumonitis (HP). These respiratory manifestations are likely due to microbial contamination of aerosolized MWF. This paper reports a cluster of HP and respiratory symptoms at a manufacturing plant where MWF and workplace air were contaminated with bacterial endotoxin despite frequent negative bacterial cultures of MWF. A pulmonologist assessed and treated three workers with respiratory symptoms. The Occupational Safety and Health Administration (OSHA) inspected the plant. OSHA's investigation included bacterial culture of MWF, measurement of endotoxin concentrations in MWF and workplace air, review of the employer's fluid management program, and distribution of a cross-sectional symptom questionnaire. Three workers had biopsy-confirmed HP. In addition, 30.8% of questionnaire respondents reported work-related respiratory symptoms. OSHA detected endotoxin levels as high as 92,000 endotoxin units (EU)/ml in MWF and 3200 EU/m3 in air. Endotoxin concentrations and risk of MWF inhalation were highest near an unenclosed multistation computer numerical control machine. A contractor had tested this machine's MWF for bacterial growth weekly during the preceding three years, and most (96.0%) of those tests were negative. Contaminated MWF can cause severe occupational lung disease even if microorganisms do not grow in fluid cultures. Endotoxin testing can increase the sensitivity of detection of microbial contamination. However, employers should not rely solely upon MWF testing data to protect workers. Medical surveillance and meticulous source control, such as engineering controls to suppress MWF mist and prevent its inhalation, can reduce the likelihood of respiratory disease.

Work-related Respiratory Symptoms and Associated Factors among Cement Factory Workers in Rupandehi District, Nepal

Background Cement factory workers are exposed to cement dust at workplace. It leads to a greater prevalence of chronic respiratory signs and symptoms.&#x0D; Objective To identify the prevalence of Work-related respiratory symptoms, its association with various risk factors, and to assess the outcomes like hospitalization and sickness absenteeism.&#x0D; Method Cross-sectional study was conducted in the Argakhanchi Cement factory among 190 workers with minimum work experience of 1 year. Census method was used for data collection. To assess the respiratory symptoms, sputum samples were collected; smears prepared by pick and smear method, and later stained by Leishman and pap stain. Smears devoid of alveolar macrophages were considered unsatisfactory for evaluation.&#x0D; Result The mean age of respondents with standard deviation was 35.56±11.45 years. The prevalence of Work-related respiratory symptoms was 31.6%. Age, no. of years worked, working in the raw materials department, burner and clinker department, cleaning department and wearing mask were the significant risk factors. On cytological analysis of the sputum sample, mild inflammatory cell noticed in 71.6%, moderate inflammation in 23.7%, and dense inflammation in 4.2%. Fungal spores were seen in 3.7%, fungal pseudohyphae in 0.5%, and bacterial colonies in 27% of the sputum samples. Out of 190 participants, 8(4.2%) of them had to be hospitalized and 17(8.9%) were on sick leave due to respiratory symptoms.&#x0D; Conclusion Pre-employment and periodic medical examination, frequent work shift, training on occupational health and safety, use of appropriate personnel protective equipment is recommended to reduce respiratory symptoms.

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.

Respiratory symptoms, lung function and dust exposure among workers in grain milling industries in Dar Es Salaam, Tanzania

Background: Workers in grain milling industries are exposed to grain dust released during milling processes. Exposure to grain dust is associated to various respiratory symptoms such as phlegm, breathlessness, and cough and wheezing and it also leads reduced lung function. This study aimed at determining grain dust exposure levels and the prevalence of respiratory symptoms and Lung function among grain mill workers Dar es Salaam. Methodology: A descriptive cross sectional study was used to collect information on Respiratory symptoms among 264 grain mill workers and 100 controls by using a Questionnaire. Lung function tests were carried out on 180 grain mill workers and 68 controls by using an easy one spirometer while Personal dust exposure was measured on 30 grain mill workers and 5 controls by using PVC filters of 8µm pore size on two piece filter cassette mounted on Sidekick Casella (SKC) pump. P value of less than 0.05 was used as criteria for significant association. Ethical clearance was approved by the ethical clearance board of Muhimbili University of Health and Allied Sciences research and publication Committee. Results: Grain workers were exposed to higher levels of total dust with GM 12.15mg/m3 (GSD 1.53) than the control GM mg/m3 (GSD). Most of the workers in grain milling industries 66.7% were exposed to dust concentrations above the OEL (10mg/m3). The Prevalence of respiratory symptoms was higher among grain mill workers, (51.1%, 41.3%, 33.7%, 17%and 9.8% for cough, phlegm, breathlessness, tightness and wheezing respectively than in controls (28%, 19%, 21%, 8% and 5% for cough, phlegm, breathlessness, tightness and wheezing respectively. 26% and 21% of Grain workers were exposed to higher levels of total dust with GM 12.15 mg/m3(GSD 1.53) than control GM 0.17 mg/m3 (GSD 0.35). Conclusion: Exposure to grain dust in a working environment causes the increase in work related respiratory symptoms and reduced lung function. This study recommends the use of control measures to decrease dust exposure level among mill workers, also periodic medical examination should be conducted to assess workers health. A cohort study nationwide might give yield a more generalized outcome.

Respiratory symptoms of exposure to substances in the workplace among dental laboratory technicians.

As dental technicians are exposed to a variety of airborne chemicals that can act as irritants and sensitizers, and may give rise to work-related respiratory symptoms, the aim of this study was to estimate the prevalence of respiratory symptoms of exposure to substances in the workplace and associated risk factors in dental laboratory technicians. A cross-sectional study was performed among 539 dental technicians in the Plovdiv region using a self-report questionnaire. A multiple logistic regression analysis was performed in order to investigate the relationship between sex, work experience, daily exposure to chemicals from the dental environment, and a history of atopic disorder with work-related respiratory symptoms. A total of 539 dental technicians completed the questionnaire. The prevalence of self-reported work-related respiratory symptoms was 26.2%. Based on logistic regression, the most significant factors associated with work-related respiratory symptoms were daily exposure of >8 h (OR = 5.83, 95% CI: 1.96-17.34) and the lack of a ventilation system (OR = 4.26, 95% CI: 2.39-7.58). Dental technicians with work experience of <5 years more often reported work-related respiratory symptoms (OR = 1.83, 95% CI: 1.14-3.44) compared to those with long-term exposure of >20 years. A personal history of asthma (OR = 3.74, 95% CI: 1.39-10.07), allergic rhinoconjunctivitis (OR = 2.10, 95% CI: 1.29-3.41) and atopic dermatitis (OR = 2.32, 95% CI: 1.23-4.38) was also associated with work-related respiratory symptoms. The findings of this study suggest that work-related respiratory symptoms are frequent among dental technicians and occur early in their career. A more comprehensive study should be conducted throughout the country in order to estimate the prevalence, and to establish effective programs and techniques of preventing work-related respiratory symptoms in dental technicians. Med Pr. 2021;72(2):105-11.

Respiratory symptoms of exposure to substances in the workplace among Bulgarian dentists.

Dentists are exposed to a variety of airborne chemicals that can act as irritants and sensitizers and may give rise to work-related respiratory symptoms. The aim of this study was to estimate the prevalence of respiratory symptoms of exposure to substances in the workplace and associated risk factors in Bulgarian dentists. A cross-sectional study was performed among Bulgarian dentists by using a self-report questionnaire. A direct acyclic graph (DAG) was elaborated to illustrate the direct and indirect causal pathways between exposure to irritants and/or allergens from dental environment and work-related respiratory symptoms among dentists. Multiple logistic regression analysis was conducted in order to investigate the relationship between sex, work experience, daily exposure to chemicals from dental environment, history of atopic disorder and work-related respiratory symptoms. A total of 4675 dentists completed the questionnaire (response rate 48.1%). The prevalence of self-reported work-related respiratory symptoms was 20.7%. The most common repeated causes of respiratory reactions were disinfectants (65.7%) and materials based on acrylic resins (29.7%). Factors associated with work-related respiratory symptoms are personal history of asthma (odds ratio (OR) 2.50, 95% confidence interval [CI]: 1.71-3.64), work experience >20years (OR 2.17, 95% CI: 1.74-2.70) and female gender (OR 2.14, 95% CI: 1.81-2.56). Work-related respiratory symptoms are frequent among dentists and indicate a need for efforts to establish effective programmes and techniques of reducing or eliminating direct exposure to airborne chemicals in the dental environment.

Work-related Symptoms and Asthma among Fish Processing Workers

ABSTRACT After observing several clinical patients with respiratory symptoms, we initiated a questionnaire survey to assess prevalence of and predictors for asthma and work-related symptoms among workers in fish processing plants. A questionnaire with items on work conditions, work-related symptoms, and respiratory symptoms/diseases was sent to 916 fish processing workers, the 1836 licenced fishermen in Sweden, and 1965 controls; of those, 43%, 57%, and 53%, respectively, responded. Risks, hazard ratios (HRs), and prevalence ratios (PRs) were calculated with Cox regression, and 95% confidence intervals (CIs) were computed. The risk of asthma among fish filleting workers was increased during the years working in the fish processing industry when compared to the other fish processing workers and controls (HR 3.6, 95% CI 1.6–8.1, adjusted for atopy, gender, and ever smoking). The filleters had an increased PR for most of the work-related respiratory symptoms investigated. All fish processing workers had a higher PR for flu-like symptoms. Use of a pressure sprayer was identified as a risk for asthma and respiratory symptoms among both fish processing workers and controls. Filleters had changed work tasks because of respiratory symptoms more often (Fisher’s exact test, p = 0.02) than other fish processing workers. In conclusion the fish filleters and pressure sprayer users reported more adult asthma and cough with phlegm compared to the other fish processing workers and controls. The use of pressure sprayers must be reduced and machinery should be completely encased to reduce workers’ exposure to bioaerosols and its effects on the respiratory tract.