Work-related Sensitization Research Articles

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.

Exposure-response analyses for platinum salt–exposed workers and sensitization: A retrospective cohort study among newly exposed workers using routinely collected surveillance data

Chloroplatinate salts are well-known respiratory sensitizing agents leading to work-related sensitization and allergies in the work environment. No quantitative exposure-response relation has been described for chloroplatinate salts. We sought to evaluate the quantitative exposure-response relation between occupational chloroplatinate exposure and sensitization. A retrospective cohort study was conducted using routinely collected health surveillance data and chloroplatinate exposure data. Workers who newly entered work between January 1, 2000, and December 31, 2010, were included, and the relation between measured chloroplatinate exposure and sensitization (as determined by skin prick test responses) was analyzed in more than 1000 refinery workers from 5 refineries for whom a total of more than 1700 personal exposure measurements were available. A clear exposure-response relation was observed, most strongly for more recent platinum salt exposure. Average or cumulative exposure over the follow-up period was less strongly associated with sensitization risk. The exposure-response relation was modified by smoking and atopy. Indications exist that recent exposure explains the risk of platinum salt sensitization most strongly. The precision of the estimate of the exposure-response relation derived from this data set appears superior to previous epidemiologic studies conducted on platinum salt sensitization and as a result, might have possible utility for the development of preventive strategies.

Predictors of work-related sensitisation, allergic rhinitis and asthma in early work life.

Although work-related asthma and allergies are a huge burden for society, investigation of occupational exposures in early work life using an unexposed reference group is rare. Thus, the present analyses aimed to assess the potential impact of occupational exposure and other risk factors on the prevalence of work-related sensitisation and incidence of allergic rhinitis/asthma using a population-based approach and taking into account an unexposed reference group. In SOLAR (Study on Occupational Allergy Risks) II, German participants of ISAAC (International Study of Asthma and Allergies in Childhood) phase II were followed from childhood (9-11 years) until early adulthood (19-24 years). Data on 1570 participants were available to fit predictive models. Occupational exposure was not statistically significantly associated with disease prevalence/incidence. Sensitisation in childhood, parental asthma, environmental tobacco smoke exposure during puberty, sex and study location were statistically significant predictors of outcome. Our results indicate that occupational exposure is of little relevance for work-related sensitisation prevalence and allergic rhinitis/asthma incidence in early work life, while other risk factors can be used to improve career guidance for adolescents. Further research on the role of a potential healthy hire effect and the impact of longer exposure duration is needed.

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.

Work-related sensitization and respiratory symptoms in carpentry apprentices exposed to wood dust and diisocyanates

Exposure to certain substances in the workplace may lead to sensitization and increased respiratory symptoms. To evaluate the frequency of work-related specific sensitization and respiratory symptoms in carpentry apprentices with occupational exposure to wood dust and diisocyanates. Apprentices (n=101) completed an occupational and symptoms questionnaire. Spirometry and skin prick tests to aeroallergens and to a battery of 14 different woods were performed in all the participants. Blood samples were collected for total IgE measurement and detection of specific IgE to diisocyanates. Half the participants (56%) had work-related respiratory symptoms: 54% due to wood dust, 15% due diisocyanates, and 9% to both. Participants with respiratory symptoms related to wood dust exposure had a significantly lower forced expiratory volume in 1 second compared with symptomatic individuals due to diisocyanates and asymptomatic individuals (P < .05). A history of rhinitis or asthma was associated with a 2.1- or 2.8-fold increase, respectively, in the likelihood of having respiratory symptoms due to wood dust exposure. Sensitization to wood was detected in 9% of participants, all of whom were atopic with a history of rhinitis and a high total IgE level (P < .05). Sensitization to diisocyanates was detected in 2% of exposed participants. Work-related respiratory symptoms are common in carpentry apprentices and are more frequently related to exposure to wood dust than to diisocyanates. Symptomatic participants due to wood dust exposure had a lower forced expiratory volume in 1 second. Individuals with a history of rhinitis or asthma had an increased risk of respiratory symptoms. Sensitization to wood was more common in atopic apprentices with a history of rhinitis and a high total IgE level.

Application of a prediction model for work-related sensitisation in bakery workers

Identification of work-related allergy, particularly work-related asthma, in a (nationwide) medical surveillance programme among bakery workers requires an effective and efficient strategy. Bakers at high risk of having work-related allergy were indentified by use of a questionnaire-based prediction model for work-related sensitisation. The questionnaire was applied among 5,325 participating bakers. Sequential diagnostic investigations were performed only in those with an elevated risk. Performance of the model was evaluated in 674 randomly selected bakers who participated in the medical surveillance programme and the validation study. Clinical investigations were evaluated in the first 73 bakers referred at high risk. Overall 90% of bakers at risk of having asthma could be identified. Individuals at low risk showed 0.3-3.8% work-related respiratory symptoms, medication use or absenteeism. Predicting flour sensitisation by a simple questionnaire and score chart seems more effective at detecting work-related allergy than serology testing followed by clinical investigation in all immunoglobulin E class II-positive individuals. This prediction based stratification procedure appeared effective in detecting work-related allergy among bakers and can accurately be used for periodic examination, especially in small enterprises where delivery of adequate care is difficult. This approach may contribute to cost reduction.

A dynamic population-based model for the development of work-related respiratory health effects among bakery workers

Objectives:This paper presents a dynamic population-based model for the development of sensitisation and respiratory symptoms in bakery workers. The model simulates a population of individual workers longitudinally and tracks the...

Application of a dynamic population-based model for evaluation of exposure reduction strategies in the baking industry

Recently a dynamic population model was developed that simulates a population of bakery workers longitudinally through time and tracks the development of work-related sensitisation and respiratory symptoms in each worker. Input for this model comes from cross-sectional and longitudinal epidemiological studies which allowed estimation of exposure response relationships and disease transition probabilities This model allows us to study the development of diseases and transitions between disease states over time in relation to determinants of disease including flour dust and/or allergen exposure. Furthermore it enables more realistic modelling of the health impact of different intervention strategies at the workplace (e.g. changes in exposure may take several years to impact on ill-health and often occur as a gradual trend). A large dataset of individual full-shift exposure measurements and real-time exposure measurements were used to obtain detailed insight into the effectiveness of control measures and other determinants of exposure. Given this information a population wide reduction of the median exposure with 50% was evaluated in this paper.

Which tools best predict the incidence of work-related sensitisation and symptoms

Background/aim: This study used information from the questionnaire alone or in conjunction with clinical tests, such as skin-prick testing (SPT) and bronchial responsiveness (BR) testing at entry, to develop models...

Frequency of allergic rhinitis to laboratory animals in university employees as confirmed by chamber challenges.

Occupational risk for laboratory animal allergy (LAA) is well known, but prevention is often insufficient and new cases keep appearing. A questionnaire on work-related symptoms was sent to all laboratory animal workers in Kuopio University. Subjects with rhinitis were invited to an examination for LAA, which consisted of an otorhinolaryngological examination and skin prick testing (SPT) with 16 common environmental allergens and two to five relevant laboratory animals. In cases of occupational sensitization, a challenge test was performed. The questionnaire was completed by 156 of 245 (64%) subjects. Rhinitis was reported by 65 of the respondents (42%) of whom 47 were examined for LAA. The duration of exposure before the onset of rhinitis varied from 1 month to 18 years. Twenty-seven persons (57%) had a history of some previous atopic symptoms. Forty subjects (85%) showed positive reactions in SPT, 24 (51%) for laboratory animals. Fifteen of the 26 animal challenge tests performed were positive, confirming the diagnosis of occupational allergic rhinitis in three subjects, occupational dermatitis in five and both diseases in seven subjects. The frequency of occupational allergic rhinitis among all participants was 10 of 156 (6%). Atopic constitution and work-related sensitization were common in rhinitic laboratory animal workers. Occupational allergic disease was diagnosed in nearly every third case.

Incidence and determinants of IgE-mediated sensitization in apprentices. A prospective study.

We investigated prospectively the incidence and determinants of work-related specific skin sensitization in a cohort of 769 apprentices, including 417 in animal health technology, 230 in pastry-making, and 122 in dental-hygiene technology. Subjects were recruited when starting exposure to laboratory animals, flour, or latex. A questionnaire and skin-prick tests with common and work-related allergens were administered on entry and at follow-up visits from 8 to 44 mo; information on number of hours of exposure to specific allergens was obtained. Among 769 apprentices, 698 attended >/= 1 follow-up visit. A total of 111 subjects developed specific sensitization over the study period. The incidence of work-related sensitization (per person-year) was 8.9% (95% CI 7.3 to 11.0%) in the animal-health program, 4.2% (95% CI 1.8 to 8.2%) in the pastry-making program, and 2.5% (95% CI = 0.7 to 4.3%) in the dental-hygiene program. In the animal health group, Cox regression analyses showed that atopy, nasal, and respiratory symptoms in the pollen season, and exposure assessed by the school attended or by duration of exposure to rodents were the most significant predictors of sensitization. In the dental-hygiene program, atopy and asthma were significant determinants. This study shows that: (1) an apprenticeship in animal-health technology carries a greater risk of developing specific sensitization than do apprenticeships in pastry-making and dental-hygiene; (2) atopy, respiratory symptoms in the pollen season, and number of hours in contact with rodents determine the risk of sensitization in apprentices in the animal health program.

Exposure-response relationships for work-related sensitization in workers exposed to rat urinary allergens: Results from a pooled study

Background: Recent studies in a few industries have shown that the likelihood of IgE-mediated sensitization increases with increasing exposure. The shape of the exposure-response relationships and modification by age, sex, and smoking habit has hardly been studied. Objective: The purpose of this study was to determine exposure sensitization relationships for rat sensitization and to evaluate the influence of atopy, smoking habits, and sex. Methods: Data from 3 cross-sectional studies in The Netherlands, the United Kingdom, and Sweden were used and involved 1062 animal laboratory workers. Selection criteria were harmonized, and this resulted in a study population of 650 animal laboratory workers (60.6% female) with less than 4 years of exposure. Air allergen levels were assessed previously and converted on the basis of an interlaboratory allergen analysis comparison. Available sera were analyzed for the presence of specific antibodies against common allergens (house dust mite, cat, dog, and grass and birch pollen) and work-related allergens (rat and mouse urinary proteins). Questionnaire items on work-related respiratory symptoms, hours worked with rats per week, job performed, smoking habits, and sex were used in this analysis Results: The prevalence of work-related sensitization to rat urinary allergens (IgE >0.7 KU/L) was 9.7 % (n = 63). Thirty-six of the sensitized workers had work-related symptoms (asthma or rhinitis). Two hundred forty-eight workers (38.2%) were atopic (defined as specific IgE to 1 of the common allergens). The sensitization rate increased with increasing air allergen exposure. Atopic workers exposed to low levels of allergen had a more than 3-fold increased sensitization risk compared with nonexposed atopic workers. For atopic subjects, the risk increased little with increasing exposure, whereas for nonatopic subjects, a steadily increasing risk was observed. Smoking and sex did not modify the sensitization risk. Conclusion: Rat urinary allergen–sensitization risk increased with increasing exposure intensity. Workers who were atopic had a clearly elevated sensitization risk at low allergen exposure levels. (J Allergy Clin Immunol 1999;103:678-84.)

On the choice of fluid for the hydration of middle-aged marathon runners.

Nine subjects (five well-trained post-coronary patients and four other middle-aged joggers) paticipated in a 42 km "Marathon" race. The course was covered in an average of 212 minutes under pleasantly warm conditions (Maximum 21.7 degree C, 69% relative humidity). Subjects were given initial hyperhydration and repeated subsequent doses of water, "Erg" (Na+ 19mE/l K+ 10.7mE/l, glucose 5.3g/100 ml) or a "Special Solution" (during the race Na+ 21mE/1 glucose 4.1g/100 ml; after the race Na+ 20 mE/l, K+ 4.7mE/l., glucose 4.1 g/100 ml). Weight loss averaged 2.2 kg and sweat production 3.3l taking account of water liberated from the hydration of glycogen and the oxidation of food stuffs, it was estimated that most subjects suffered relatively little dehydration over the race (0.4--0.8l). This was confirmed by a sustained urine production of greater than 100ml/hr. Nevertheless, rectal temperatures showed substantial elevation over the race (final readings 38.3 - 40.2 degree C). In terms of fluid balance and stability of plasma mineral composition, the runners drinking water performed slightly better than those receiving the other two solutions. Nevertheless, there may be merit in giving potassium solutions during recovery from vigorous effort.