Work-related Respiratory Symptoms Research Articles

Diagnosis and frequency of work-exacerbated asthma among bakers

BackgroundWork-exacerbated asthma (WEA) is asthma worsened by workplace exposures, although the asthma is not caused by sensitizers in the work environment. ObjectivesTo evaluate the frequency of WEA in bakers reporting work-related respiratory symptoms and the usefulness of diagnostic tests in differentiating WEA from occupational asthma (OA). MethodsThe study group included 393 bakers reporting respiratory symptoms at the workplace. In all patients, questionnaire, spirometry, skin prick tests (SPTs), and evaluation of serum total and specific IgE levels were performed. Recognition of OA was based on a specific inhalation challenge test. ResultsOccupational asthma was found in 44.5% of patients, whereas WEA was recognized in 16%. The latency period was 11.2 ± 8.2 years in patients with OA vs 13.3 ± 9.7 years in those with WEA. Sixty percent of patients with OA and 50.8% of those with WEA had positive SPT reactions to common allergens; occupational SPT results were positive in 74.9% and 34.9%, respectively. Specific IgE to flours were found in 61.7% of patients with OA and 28.6% of those with WEA. In addition, OA frequently coexisted with occupational rhinitis (53.7% of patients), whereas WEA and rhinitis were found in 31.7% of patients. ConclusionWork-exacerbated asthma was diagnosed in 16% of bakers who reported allergic respiratory symptoms. The specific challenge test for occupational allergens should be performed in bakers with suspected work-related asthma, because an assessment of sensitization (SPT to occupational allergens, evaluation of specific IgE) is not specific enough to differentiate OA from WEA.

Challenge Exposure to Isocyanates Induces Changes in Nasal Patency in Patients Reporting Work-Related Respiratory Symptoms

To examine the utility of specific inhalation challenge (SIC) in assessing the nasal congestive response to isocyanate exposure. Nine patients complaining of work-related respiratory symptoms underwent SIC with exposure to isocyanate for 4 and 120 minutes on different days. Nasal volume was monitored by acoustic rhinometry and nasal congestion by the visual analogue scale (VAS) for up to 6 hours. The 4-minute isocyanate SIC induced a nonsignificant fall in nasal volume and no increase in the VAS score. The 120-minute isocyanate SIC induced a significant fall in nasal volume at 15, 30, and 60 minutes postchallenge that was associated with a significant increase in the VAS score at 15 and 30 minutes postchallenge. SIC appears useful to assess changes in nasal patency after exposure to isocyanate. Exposure to isocyanates can induce nasal congestion that can be objectively monitored during SIC.

Early incidence of occupational asthma is not accelerated by atopy in the bakery/pastry and hairdressing sectors

Occupational asthma (OA) is most likely to develop in the very early years of exposure. To describe the early incidence of OA among bakers/pastry-makers (BP) and hairdressers and to explore the role of atopy. Following a retrospective follow-up design, subjects were invited to undergo telephone interviews. Those who declared work-related respiratory or rhinitis symptoms and a sample group of others were offered a medical visit for OA investigations. Data from interviews and from medical visits were used to estimate the incidence of OA according to increasing durations of exposure. A total of 866 subjects were interviewed (mean age 25.3 years, 43.8% females), of whom 282 underwent a medical visit. Total estimated incidence rates of 'confirmed or probable' OA during the first 12 years of exposure were high in BP (2.63 per 100 person-years [py]) and in hairdressers (0.58/100 py), particularly in the first 4 years. Atopy is a strong risk factor for incidence among BP but, irrespective of the occupational sector, it does not influence the timing of OA symptoms. OA symptoms occur soon after the start of exposure. Our results suggest that atopy does not precipitate the occurrence of symptoms in two different allergen exposure settings.

IL-4 Receptor α Polymorphisms May Be a Susceptible Factor for Work-Related Respiratory Symptoms in Bakery Workers

PurposeThe IL-4 and IL-4 receptor α (IL-4Rα) genes are the key candidate genes for atopy and asthma susceptibility. Exposure to wheat flour can cause IgE sensitization and respiratory symptoms in bakery workers. Therefore, we hypothesized that IL-4 and IL-4Rα single nucleotide polymorphisms (SNPs) may be involved in the pathogenic mechanism of baker's asthma.MethodsClinical and genetic data from 373 bakery workers were analyzed. A survey questionnaire, spirometry, and skin prick tests with wheat flour were performed. Serum-specific IgE, IgG1, and IgG4 to wheat flour were determined using ELISA. Five candidate IL-4 (-729 T>G, 589 T>C, and 33 T>C) and IL-4Rα (Ile75Val A>G and Gln576Arg A>G) SNPs were genotyped and analyzed.ResultsWorkers with the G allele of IL-4Rα Ile75Val A>G had a significantly higher prevalence of work-related lower respiratory symptoms than those with the AA genotype (P=0.004, 16.0% vs. 2.9%). In the skin prick test, workers with the AA genotype of IL-4Rα Gln576Arg A>G had a significantly higher positive rate to wheat flour (P=0.015, 8.2% vs. 1.1%) than those with AG/GG genotype. No significant associations were found in the three genetic polymorphisms of IL-4. For the predicted probabilities, workers with the AA genotype of Gln576Arg A>G had a higher prevalence of IgG1 and IgG4 in response to wheat flour, according to increased exposure intensity (P=0.001 for IgG1 and P=0.003 for IgG4).ConclusionsThese findings suggest that the IL-4Rα Ile75Val and Gln576Arg polymorphisms may be associated with work-related respiratory symptom development.

Mould Sensitisation among Bakers and Farmers with Work-related Respiratory Symptoms

Fungi belong to common allergens, which can be found both in occupational and non-occupational environment. The aim of the study was to determine the frequency and factors associated with mould allergy among bakers and farmers reporting work-related respiratory symptoms. The study group comprised 117 bakers and 83 farmers reporting work-related respiratory symptoms. Skin prick tests (SPT) with common, fungal and occupational allergens, estimation of serum total IgE level, spirometry, histamine test and specific inhalative challenge test with occupational allergens were performed in all subjects. The prevalence of hypersensitivity to fungal species was higher among farmers (32.5%) than bakers (16.2%). Positive SPT with mould allergens were found among 10.8% farmers and 6.8% bakers with occupational allergy. The fungi allergens giving positive SPT results most frequently were Candida albicans, Levures mélanges, Aspergillus mix. and Charbons cerealiers in both groups. Among mould allergens, hypersensitivity to Aspergillus genus was the most common in farmers and bakers group, while among Saccharomyces - Candida albicans sensitization was the most frequently detected. Mould hypersensitivity is related to occupational respiratory allergy, especially to asthma and rhinitis in farmers, and occupational asthma in bakers. Although sensitization to Saccharomyces was more frequent, similar correlation was not observed.

Oxidative Activity of Ammonium Persulfate Salt on Mast Cells and Basophils: Implication in Hairdressers’ Asthma

Background: Persulfate salts are components of bleaching powders widely used by hairdressers during hair-bleaching procedures. Hairdressers are at high risk for occupational asthma and rhinitis, and ammonium persulfate is the main etiologic agent. Objective: To explore the effects of ammonium persulfate on human albumin, mast cells, and basophils in order to evaluate a possible effect of ammonium persulfate oxidizing activity in the mechanism of ammonium persulfate-induced occupational asthma. Methods: High-performance liquid chromatography/mass spectrometry was performed on ammonium persulfate-incubated human albumin. The activation of LAD2 human mast cell and KU812 human basophil cell lines incubated with ammonium persulfate was evaluated. CD63 expression on persulfate-in-vitro-incubated blood basophils from nonexposed healthy controls (n = 31) and hairdressers with work-related respiratory symptoms (n = 29) was assessed by flow cytometry. Results: No persulfate-albumin conjugate was found. An oxidative process on tryptophan and methionine was detected. Ammonium persulfate induced reactive oxygen species (ROS) generation and the degranulation of LAD2 and KU812 cells. Human basophils from healthy controls, incubated in vitro with ammonium persulfate, showed increased CD63 expression and ROS production. In hairdressers with ammonium persulfate-caused occupational asthma (positive persulfate challenge), basophil-CD63 expression was higher than in those with a negative challenge and in healthy controls. Conclusions: Ammonium persulfate incubated with human albumin did not generate any adduct but oxidized some amino acids. This oxidizing activity induced human mast cell and basophil activation which might be crucial in the mechanism of persulfate-induced occupational asthma and rhinitis.

Respiratory Symptoms and Pulmonary Function Testes in Lead Exposed Workers

BackgroundThe exposure to noxious agwents such as lead my cause lung disorders.ObjectivesIn the present study, pulmonary function tests and self-reported respiratory symptoms in lead exposure workers were compared with matched control subjects.Materials and MethodsThe frequency of respiratory symptoms were evaluated in a sample of 108 lead exposure workers and 100 control subjects with similar age using a questionnaire including questions on respiratory symptoms in the past year. Pulmonary function tests (PFT) were also measured in lead exposure workers and in controls.ResultsMost lead exposure workers (63%) reported work-related respiratory symptoms. Chest tightness (26%), cough (17%) and sputum (16%) were the most common symptoms and only 6% of lead exposure workers reported wheezing (P < 0.001 for all case except wheezing). Most PFT values were also significantly reduced among lead exposure workers (P < 0.05 to P < 0.001 except MEF75, MEF50, MEF25, and MMEF. The lead concentration in urine and serum of lead exposure workers were significantly higher than control (P < 0.001 for both cases).ConclusionsThese results showed that c lead exposure workers have higher frequencies of respiratory symptoms higher serum and urine lead concentration but lower PFT values.

Skin and respiratory symptoms among workers with suspected work-related disease

Many workers are exposed to chemicals that can cause both respiratory and skin responses. Although there has been much work on respiratory and skin outcomes individually, there are few published studies examining lung and skin outcomes together. To identify predictors of reporting concurrent skin and respiratory symptoms in a clinical population. Patients with possible work-related skin or respiratory disease were recruited. An interviewer- administered questionnaire collected data on skin and respiratory symptoms, health history, smoking habits, workplace characteristics and occupational exposures. Predictors of concurrent skin and respiratory symptoms were identified using multiple logistic regression models adjusted for age, sex and atopy. In total, 204 subjects participated; 46% of the subjects were female and the mean age was 45.4 years (SD = 10.5). Most subjects (n = 167, 82%) had possible work-related skin disease, compared with 37 (18%) subjects with possible work-related respiratory disease. Subjects with a history of eczema (OR 3.68, 95% CI 1.7-7.8), those from larger workplaces (OR 2.82, 95% CI 1.8-7.4) and those reporting respirator use at work (OR 2.44, 95% CI 1.2-4.8) had significantly greater odds of reporting both work-related skin and respiratory symptoms. Current smoking was also associated with reporting concurrent skin and respiratory symptoms (OR 2.57, 95% CI 1.2-5.8). Workers reported symptoms in both systems, and this may be under-recognised both in the workplace and the clinic. The association between history of eczema and concurrent skin and respiratory symptoms suggests a role for impaired barrier function but needs further investigation.

Upper airway symptoms among workers with work-related respiratory complaints

Work-related rhinitis and asthma symptoms frequently co-exist. To determine the prevalence and nature of nasal, pharyngeal, laryngeal and sinus symptoms among individuals with work-related respiratory symptoms. Individuals referred to a tertiary occupational asthma clinic for investigations with specific inhalation challenges were evaluated using the RHINASTHMA quality of life questionnaire and a questionnaire that assessed the nature and frequency of upper airway symptoms, their relationship to the workplace and their temporal relationship with the onset of asthma symptoms. There were 83 study participants. At least one upper airway symptom was reported by all of these individuals: nasal in 92%; pharyngeal in 82%; laryngeal in 65% and sinus in 53% of participants. Overall, there were no significant differences in the frequencies of nasal, pharyngeal, laryngeal and sinus symptoms when comparing these with occupational asthma (OA), work-exacerbated asthma (WEA) and work-related respiratory symptoms (WRS), except that nasal bleeding was most frequent among those with WRS. The presence of laryngeal symptoms was significantly associated with rhinitis-specific quality of life impairment. Individuals with workplace exposures to high molecular weight agents had greater impaired quality of life than those who were exposed to low molecular weight agents (RHINASTMA Upper Airway sub-scores: 24.0±10.4 versus 19.8±6.8; P < 0.05). Individuals who were referred for work-related respiratory symptoms experienced high rates of work-related nasal, pharyngeal, laryngeal and sinus symptoms, regardless of having OA, WEA or WRS.

The effect of exposure to chlorine on pulmonary function tests and respiratory and allergic symptoms in Iranian lifeguards

Lifeguards are frequently exposed to various irritant chemicals including chlorine during work, which can induce respiratory and allergic disorders. In this study, pulmonary function tests (PFTs) and self-reported respiratory and allergic symptoms in lifeguards were compared with matched control subjects. The frequency of respiratory and allergic symptoms was evaluated in a sample of 38 Iranian male lifeguards and 38 control subjects with similar age, having other jobs from the general population, using a questionnaire including questions on work-related respiratory and allergic symptoms in the past year, smoking habits, and duration of working as a lifeguard. PFTs were also measured in lifeguard subjects before and 15min after 200µg inhaled salbutamol and baseline PFT in controls. A total of 22 (55%) participants reported work-related respiratory symptoms. Sputum (39.4%) and cough (18.4%) were the most common symptoms and only 7.9% and 15.8% of lifeguards reported wheezing and shortness of breath, respectively. Both sputum and breathlessness were significantly higher in lifeguards than control group (p<0.05 and p<0.005, respectively). Most allergic symptoms (sneezing and runny nose) in lifeguards were also significantly greater than control group (p<0.05 for both cases). In addition, all respiratory (except sputum and wheezing) and allergic symptoms were significantly higher in lifeguards during work compared with rest period (p<0.05 to p<0.005). Most PFT values were also significantly lower in lifeguards than control subjects (p<0.05 to p<0.001). In addition, most (all) PFT values were significantly improved after 200µg inhaled salbutamol (p<0.05 to p<0.001). These results showed that lifeguards have higher frequencies of work related respiratory symptoms and allergic symptoms particularly during the work period. PFT values were also significantly reduced among lifeguards.

Occupational asthma due to spruce wood

Workers exposed to a variety of wood dusts are known to experience work-related respiratory symptoms, including occupational asthma. There are, however, few reports of occupational asthma due to spruce wood. We present the case of a 31-year-old sawmill owner with severe asthma caused by exposure to spruce wood dust, who developed asthmatic symptoms after 2 years of working. Investigations included clinical examination, routine laboratory tests, spirometry, chest X-ray, total serum immunoglobulin E (IgE) and specific serum IgEs against various woods and other occupational allergens. Additionally, we monitored the peak expiratory flow rate (PEFR) and symptom score both at work and when off work. Specific serum IgE for spruce wood was detected (7.8 IU/ml). The results of PEFR and workplace symptom-score monitoring, coupled with an elevated eosinophil count in induced sputum, supported the diagnosis of occupational asthma. To our knowledge, this is the first well-documented case of occupational asthma induced by spruce wood dust. A type I immunological mechanism seems to be responsible.

Occupational respiratory and skin diseases among Finnish machinists: findings of a large clinical study

Machinists are exposed to many sensitizing and irritant substances, but no previous study has assessed the occurrence of clinically verified occupational diseases in an unselected large workforce of machinists. Our aim was to study the occurrence of clinically verified occupational respiratory and skin diseases cross-sectionally in a large sample of machinists in southern Finland. A computer-assisted telephone interview on occupational exposures and health was carried out in a sample of 961 machining workers from 64 metalworking companies. Of these, 757 (79%) answered the interview. A total of 245 subjects reported work-related respiratory or skin symptoms and were invited to clinical examinations; 138 of these underwent a clinical interview and examination by an occupational health physician. On the basis of this examination, 32 subjects were further examined at the Finnish Institute of Occupational Health (FIOH) for occupational skin or respiratory diseases. One case of occupational asthma (OA) and seven cases of occupational dermatoses (OD) were diagnosed, giving a prevalence of 0.13% (95% CI 0-0.39) for OA, and 0.92% (95% CI 0.24-1.16) for OD. The OA was induced by the patient's own MWF. Additional five cases of newly diagnosed non-occupational asthma (0.79%, 95% CI = 0.16-1.42) were detected. No cases of occupational rhinitis or COPD were diagnosed. The dermatoses diagnoses consisted of four cases of allergic contact dermatitis and three cases of irritant contact dermatitis. The most common causes of the ODs were MWFs. This large clinical study of machinists representing metalworking in South Finland showed a prevalence of 0.13% of OA and 0.92% of OD. This relatively low occurrence of occupational diseases may reflect the strict Finnish criteria for the diagnosis of these occupational diseases and the relatively good level of occupational hygiene in machining workshops in Finland. Reported respiratory and skin symptoms were common, and these milder conditions may be linked to irritant rather than sensitizing exposures.

472 Heterogeneity of the Ige Response to Allergenic Determinants of Cefotiam in Serum Samples From Patients with Cefotiam-induced Occupational Allergy

BackgroundExposure to cefotiam could cause IgE-mediated occupational allergies in hospital personnel. However, the clinically available serologic test has not been widely accepted, and the antigenic determinant of this drug is unclear. We investigated patterns of the IgE response to cefotiam in patients with occupational allergies to cefotiam.MethodsA total of 161 health care workers and 86 nonatopic healthy controls, never exposed to antibiotics, were recruited from a single tertiary hospital and the general population. A questionnaire regarding work-related symptoms associated with cefotiam was administered. Serum specific IgE antibodies to cefotiam-human serum albumin (HSA) conjugate was measured by enzyme-linked immunosorbent assay (ELISA). Patients with work-related symptoms to cefotiam and positive specific IgE antibody to cefotiam were selected and ELISA inhibition studies were performed using sera of these patients. The inhibitors included various concentrations of free and conjugated cefotiam, ceftriaxone, ceftizoxime, and HSA alone.ResultsFour patients showed work-related upper respiratory symptoms and high levels of serum specific IgE to cefotiam-HSA conjugate compared to controls. Significant inhibition patterns to free cefotiam and cefotiam-HSA conjugate were noted in patient 1 on ELISA inhibition testing, while minimal inhibitions to the other cephalosporins, both free and conjugated, were noted. In the other 3 patients, significant dose-dependent inhibitions were noted with additions of cefotiam-HSA conjugate, while minimal inhibitions were noted with free cefotiam. Among the patients, patient 2 showed minimal inhibitions with the other cephalosporins, both free and conjugated, while patient 3 and 4 showed marked dose-dependent inhibition with ceftriaxone-HSA and ceftizoxime-HSA respectively.ConclusionsThe specific IgE response to cefotiam-HSA conjugate in patients with occupational allergies occurs against the hapten or new allergenic determinant in which heterogeneity of the antigenic determinant were noted depending on the individual.

Serum IgE Antibodies against Hazelnut in Hazelnut Processing Workers

Aim. Previous studies have shown a higher sensitization rate to hazelnut in processing workers but no relation was found between the respiratory symptoms in workplace and hazelnut sensitization. Material and Method. To evaluate the association between the hazelnut sensitization and workplace-related respiratory complaints, hazelnut processing workers had undergone a questionnaire included work-related respiratory symptoms, smoking history, pulmonary function testing, and measurement of serum IgE antibodies against hazelnut. Results. This study consisted of 88 hazelnut processing workers (79 females and 9 males), aged 14–59 years (Mean ± SD: 33.8 ± 10.5 years). The mean working duration was 38.8 ± 36.6 months (min: 1–max: 180). Specific IgE against hazelnut allergens was positive in 14 of cases (17.1%). There was no significant difference between the cases with and without specific IgE against hazelnut allergens regarding respiratory symptoms, history of allergy, smoking status and spirometric values. Conclusion. 17.1% of the hazelnut processing workers were seropositive against hazelnut. Being sensitized to hazelnut was not found to be associated with work-related respiratory symptoms in this study. Further studies are needed in hazelnut workers respiratory health to search topics other than asthma.

Effect of Interleukin-18 Gene Polymorphisms on Sensitization to Wheat Flour in Bakery Workers

Lower respiratory symptoms in bakery workers may be induced by wheat flour and endotoxins. We hypothesized that endotoxins from wheat flour may stimulate innate immunity and that interleukin-18 (IL-18) gene polymorphisms may affect their regulatory role in innate immune responses to endotoxins. To investigate the genetic contribution of IL-18 to sensitization to wheat flour, we performed a genetic association study of IL-18 in Korean bakery workers. A total of 373 bakery workers undertook a questionnaire regarding work-related symptoms. Skin prick tests with common and occupational allergens were performed and specific antibodies to wheat flour were measured by ELISA. Three polymorphisms of the IL-18 gene (-607A/C, -137G/C, 8674C/G) were genotyped, and the functional effects of the polymorphisms were analyzed using the luciferase reporter assay. Genotypes of -137G/C (GC or CC) and haplotype ht3 [ACC] showed a significant association with the rate of sensitization to wheat flour. Luciferase activity assay indicated ht3 [AC] as a low transcript haplotype. In conclusion, the regulatory role of IL-18 in lipopolysaccharide-induced responses in bakery workers may be affected by this polymorphism, thus contributing to the development of sensitization to wheat flour and work-related respiratory symptoms.

Respiratory morbidity among welders in the shipbuilding industry, Goa

Context:Welding is pivotal in shipbuilding. The fumes and gases involved in welding may cause respiratory morbidity.Aim:To study the prevalence of respiratory morbidity (RM) among welders vis à vis among nonwelders and its association with certain relevant factors.Settings and Design:A cross-sectional study of 276 welders and 276 nonwelders was conducted in the shipbuilding industry.Materials and Methods:An interviewer-administered questionnaire was followed by spirometric examination.Statistical Analysis:Odds ratio and its 95% CI and two-way ANOVA.Results:Prevalence of RM was found to be significantly higher among welders compared to nonwelders (who were comparable in age, duration of employment (DOE) and smoking habits,) with odds ratio (OR) of 1.78 (95% confidence interval (CI):1.20-2.63). Obstructive type of RM was predominant in both welders (26% (n = 73)) and nonwelders (17% (n = 49)) with welders being at a significantly higher risk (OR = 1.66 (95%: 1.10-2.49)). RM was commoner after the 40 years of age or after 20 years of employment in both groups. Smoking was associated with RM among welders (OR = 1.48, 95% CI: 1.24-1.75) as well as nonwelders (OR = 2.83, 95% CI: 2.26-3.54). Work-related respiratory symptoms (WRRS) was not found to be related to RM (OR = 1.69, 95% CI: 1.00-2.84). Consistent use of personal protective equipment (PPE) was protective against RM in welders (OR = 0.33, 95% CI: 0.28-0.37).Conclusion:Welders had a greater burden of RM and this was related to increasing age, DOE, smoking and inconsistent use of PPE. WRRS were not indicative of RM.

S6 Supermarket bakers asthma: a report of three successive rounds of surveillance

In 2006, we set up a surveillance programme with a large UK supermarket employing almost 4000 “scratch” bakers (who mix dough and bake bread from scratch using raw ingredients) in around 350 stores. We report here the analysis of the programme through to 2010. The company occupational health provider screened all bakery workers for respiratory symptoms every other year, using a initial questionnaire (Level 1), with positive responders completing a subsequent, more detailed telephone-administered questionnaire (Level 2). Those who reported work-related nasal or respiratory symptoms were asked to provide a serum sample for specific IgE to bakery antigens. Those with positive specific IgE to flour or α-amylase (>0.35 kU/l) were directly referred for a specialist opinion. Abstract S6 table 1 shows the results of three surveillance rounds in 2006, 2008 and 2010. The frequency of work-related symptoms, sensitisation and disease across the three rounds of surveillance were remarkably constant. Measured prevalence is low (0.3–2 in 1000 bakers) although this figure is likely to be an underestimate; a previous study in the same workforce has demonstrated a reluctance to report symptoms and incomplete response rates.1 This system of surveillance is efficient but has thus far not been effective in reducing the incidence of occupational allergy.

Abstract Title

Title AbstractBackground. Bakery and hairdressing rank high among occupations at risk of asthma. We explored the early incidence of occupational asthma (OA) along the first years of activity among young workers.Methods. Subjects who graduated between 2001 and 2006 underwent telephone interviews on the occurrence of respiratory symptoms. Workers in occupations not exposed to known airways irritants or allergens were also included. Subjects who had asthma when starting apprenticeship were excluded. Those who declared work-related respiratory or ENT symptoms and a sample of asymptomatic subjects were proposed a medical visit (spirometry tests, exhaled NO measurements, daily surveillance of peak flow values, blood sample for assessment of common allergens and work-specific IgE). Diagnosis of OA was established by expert judgment and the sensitivity and specificity of symptoms declared during the telephone interviews were assessed.Results. 866 subjects were interviewed (mean age: 25.3 years), among which 282 underwent a medical visit.The cumulative incidence of ‘probable’ OA among bakers was high in the first quartile of exposure duration (median value=3.0 years; risk = 15.8 % [95%CI=9.9–21.7]); several had to quit this activity because of this condition. It was reduced to 13.1 % [7.2–19.0] in the second exposure duration quartile (5.3 years) and increased regularly across the third (7.4) and fourth (9.5) quartiles, with 14.7 % [7.8– 21.7]) and 17.2 % [8.7–25.6]), respectively. The corresponding figures among hairdressers are 8.3 % [0.6–16.0]), 6.1 % [0.7–11.5], 4.3 % [0.1–8.6] and 6.4 % [1.5– 11.3]. Atopy is highly associated with incidence of OA among bakers (RR= 7.4), and, to a lesser extent, among hairdresser (RR= 3.6). No new case of OA occurred in the reference group.Conclusion. Incidence of OA starts soon after engaging in bakery and hairdressing, activities that entail exposure to low or high molecular weight agents.

Work-related respiratory symptoms and lung function among solderers in the electronics industry: a meta-analysis

Research on the respiratory effect of exposure to solder fumes in electronics workers has been conducted since the 1970s, but has yielded inconsistent results. The aim of this meta-analysis was to clarify the potential association. Effect sizes with corresponding 95% confidence intervals (CIs) for odds of respiratory symptoms related to soldering and spirometric parameters of solderers were extracted from seven studies and pooled to generate summary estimates and standardized mean differences in lung function measures between exposed persons and controls. Soldering was positively associated with wheeze after controlling for smoking (meta-odds ratio: 2.60, 95% CI: 1.46, 4.63) and with statistically significant reductions in forced expiratory volume in 1s (FEV1) (-0.88%, 95% CI: -1.51, -0.26), forced vital capacity (FVC) (-0.64%, 95% CI: -1.18, -0.10), and FEV1/FVC (-0.35%, 95% CI: -0.65, -0.05). However, lung function parameters of solderers were within normal ranges [pooled mean FEV1: 97.85 (as percent of predicted), 95% CI: 94.70, 100.95, pooled mean FVC: 94.92 (as percent of predicted), 95% CI: 81.21, 108.64, and pooled mean FEV1/FVC: 86.5 (as percent), 95% CI: 78.01, 94.98]. Soldering may be a risk factor for wheeze, but may not be associated with a clinically significant impairment of lung function among electronics workers.

Impact of worker education on respiratory symptoms and sensitization in bakeries

Flour exposure is known to cause significant respiratory problems. To investigate the development of work-related sensitization, the period between first exposure and the development of symptoms (latent period) and the impact of workplace training programmes on respiratory health in plant bakers. Two hundred and sixty-four bakers were investigated by assessing work-related respiratory symptoms and latent period before symptoms/sensitization, spirometry and testing for an array of workplace-specific IgE. There was a significant relationship between the presence of work-related respiratory symptoms and flour dust allergen-specific IgE. Latent periods varied widely: median for work-related nasal symptoms 36 months, cough 42 months and chest tightness 120 months. Latent periods were shorter for workers with evidence of flour sensitization (work-related wheeze: mean 13 months with sensitization, 97 months without, P < 0.05, work-related nasal symptoms, respectively; mean 19 months, 71 months, P < 0.01). Those warned of the health implications of flour dust had less work-related wheeze (warned; 1%, not warned 11%, P < 0.05). There was an excess of work-related symptoms and work-related-specific IgE combined in those who had not been warned of these health implications (12 versus 1%, P <0.01). Reporting of 'being warned' of potential health implications from breathing flour dust protected strongly against the reporting of important health end points. Latent periods for the development of work-related symptoms varied widely. Simple health messages, which may be overlooked in worker training programmes, can have significant benefits for worker health in the bakery population.