Chlorhexidine--still an underestimated allergic hazard for health care professionals.

Chlorhexidine is a low molecular weight occupational sensitizer that can cause different delayed and immediate-type allergic reactions including anaphylaxis. It is widely used as an antiseptic and disinfectant and not only in the occupational environment as it is present in toothpaste, mouthwash, nose and eye drops and ointments. We present three cases of occupationally exposed workers with airway allergy to chlorhexidine. The role of chlorhexidine as an occupational allergen was confirmed by placebo-controlled specific inhalative challenge tests monitored by spirometry and analysis of induced sputum (influx of eosinophils after provocation has been observed). One of these patients presented with a systemic reaction with ordinary environment exposure. These findings are a reminder to clinicians of chlorhexidine's ability to cause various hypersensitivity reactions and the potential risk of this widely used antiseptic.

Occupational allergy to squid (Loligo vulgaris).

Occupational allergy from exposure to squid has been rarely described, mainly as contact dermatitis or urticaria. Our report presents the first case of occupational asthma, rhinitis, conjunctivitis and contact urticaria to squid in a 33-year-old seafood production worker, with documented increased eosinophilia in the nasal and tear fluids after specific inhalation challenge test (SICT) with squid. IgE-mediated sensitization to squid was confirmed by positive skin prick test and opened skin test with squid extract. SICT demonstrated a direct and significant link between the exposure to squid and the allergic response from the respiratory system and conjunctiva.

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.

Effect of disodium cromoglycate on deuterium oxide-induced degranulation of human eosinophils in allergic asthmatic patients in vitro.

Eosinophils from many atopic asthmatic patients have been shown to degranulate in response to 44% deuterium oxide, in contrast to eosinophils from healthy persons. Several pieces of evidence have been obtained recently, indicating that disodium cromoglycate (DSCG) may act on eosinophils. In the present study we show, that prior incubation of eosinophils obtained from the blood of 26 of 30 atopic asthmatic deuterium oxide-responders with DSCG significantly inhibited D2O-induced eosinophil degranulation in the dose dependent manner. Eosinophil degranulation was assayed using haemacytomether method. These results suggest, that DSCG may have direct action on eosinophils.

Reactive airways dysfunction syndrome.

Reactive airways dysfunction syndrome (RADS) is an asthma-like bronchoconstriction state which develops after a short-term exposure to highly irritating volatile substances. Although some of the clinical manifestations can be considered as very similar to those of asthma (e. g. inflammation, hyperresponsiveness and reversibility of the bronchial constriction) the most essential difference lies in the absence of asthma attacks after exposure to small amounts of causative agents few weeks after onset. Thus, the mechanism of RADS cannot be considered to be of an allergic origin. This is supported by the results of the pathomorphologic biopsies taken from bronchi which usually show neutrophilic and lymphocytic infiltrations as well as frequent and severe destruction of the bronchial epithelium. Eosinophilic infiltrations and basement membrane thickness have never been found. The therapy of severe dyspnoea attacks is similar to that of bronchial asthma. Factors that cause RADS comprise a wide range of volatile irritant substances, provided that they occur in high concentrations. Exposure to isocyanates in plumbers heating polyurethane pipes seems to be the major cause of RADS in Poland.

Occupational allergy to latex--life threatening reactions in health care workers. Report of three cases.

During the last decade natural rubber latex (NRL) allergy has been acknowledged as a major problem among rubber glove-wearing medical personnel. Epidemiological studies carried out in the European Union member states as well as in the United States reveal that 2% to 15% of health care workers are allergic to latex. Latex allergy symptoms range from mild contact urticaria to severe systemic reactions. Serious, generalised reactions occur in 6-8% of patients allergic to latex. The risk factors for latex-induced anaphylaxis have not as yet been identified. NRL allergy symptoms may occur in the workplace as well as outside the occupational environment. The authors present clinical cases of 2 nurses and 1 laboratory worker, who developed severe allergic reactions to latex: case 1--during prophylactic gynaecologic examination, case 2--in the course of inhalative bronchial challenge test with latex aqueous extract and case 3--while blowing up balloon at home.

Cardiac arrhythmia in women performing heavy physical work.

The objective of this work was to determine the response of the circulatory system to heavy physical work (the average energy expenditure was about 5000 kJ/shift). The tests were performed on a group of 35 women aged between 24 and 50 years, employed at a printing office as printing machine operators. The average length of employment for the group was 17 years (3-28 years). A 24-hour Holter ECG recording was taken on these women with the aid of an Oxford Medilog 3000 system. Before and after each recording, the arterial blood pressure was measured. Based on the ECG recordings, the heart rates during work, leisure time and sleep were calculated and the morphologies of the recordings were evaluated. In the group investigated, the abnormality in 24-hour ECG recordings classified as pathology, were found in 9 women within this group. Frequent ventricular premature beats (ExV) occurred in 3 women, ventricular bigeminy in 1 women, and single R/T excitations in 1 women. Frequent premature supraventricular extrasystols (ExSV) were found in 4 women, and within this number, in 1 woman both those heart rhythm disturbances were found. The heart rhythm disturbances occurred in connection with the performed physical task. Sinusal pauses were found in 2 women and A-V Mobitz II block was found in 1 women within the group investigated. Those changes occurred at night. No resting ECG changes were observed. The high frequency of occurrence of pathological changes in the group investigated indicates that the careful control of the state of the circulatory system in people performing heavy physical work is required.

Problems in diagnosing occupational allergy to flour: results of allergologic screening in apprentice bakers.

Baker's respiratory allergy is reported as one of the most common forms of occupational allergy in many countries. At the first stage of a three-year study of risk factors of occupational allergy we investigated the symptoms reported, and the results of skin prick tests (SPT) to common and flour allergens in 461 current apprentice bakers from three different regions of Poland before starting occupational exposure. The occurrence of cough was reported by 14 subjects (3%), dyspnoea by 4 (0.87%), rhinitis by 18 (3.9%), conjunctivitis by 12 (2.6%) and skin symptoms by 12 subjects (2.6%). Generally, 48 subjects (10.41%) reported at least one symptom, which might suggest the existence of allergic disease. Positive SPT to at least one allergen was found in 99 subjects (21.5%), including 82 subjects (17.78%) with positive SPT to common allergens, 13 subjects (2.81%) to flour allergens and 4 subjects (0.88%) sensitised only to Dermatophagoides farinae. The statistical analysis revealed significant correlation between positive SPT to common allergens and reported rhinitis and conjunctivitis, and between positive SPT to occupational allergens and reported dyspnoea. Moreover, a significant correlation between positive SPT to D. pteronyssinus and D. farinae was found. In our opinion, the results of SPT should be very carefully examined, when diagnosing occupational allergy, as in some apprentice bakers positive results of SPT to flour allergens are found before vocational training. In all apprentice bakers, SPT to common and occupational allergens should be performed before starting occupational exposure. It would ensure the exclusion of subjects already sensitised to occupational allergens. Positive SPT to Dermatophagoides farinae has a very limited value in recognising baker's allergy.

Ambulatory ECG monitoring in workers exposed to electromagnetic fields.

The aim of this study was to evaluate the function of the circulatory system in workers occupationally exposed to medium frequency electromagnetic fields. The subjects were 71 workers at four AM broadcast stations [0.738-1.503 MHz] aged 20-68 (mean 46.9 +/- 13.1) years and 22 workers at radio link stations aged 23-67 (mean 48.2 +/- 17.4) years. Workers at AM broadcast stations experienced 2-40 (mean 18.6 +/- 12.1) years' exposure to electromagnetic fields (average daily exposure dose about 115 Vh m-1, maximum exposure levels during shift about 165 V m-1), workers at radio link stations had no history of regular exposure to electromagnetic fields. In all the subjects a general medical examination, resting ECG and 24 h Holter monitoring were performed. The work organization, work period structure, age, lifestyle, nutritional habits and health status in both groups remained fairly similar. The electrocardiographic abnormalities detected in the resting and/ or 24 h ECG were significantly more frequent (p = 0.006) in workers exposed to electromagnetic fields than in non-exposed subjects (75% versus 25%). A clear tendency for a higher number of rhythm disturbances (mostly ExV) was observed in AM broadcast station workers.

[Occupational immediate allergy to latex. I. Introduction, epidemiology and clinical findings]. / Zawodowa alergia typu natychmiastowego na lateks. I. Wprowadzenie, epidemiologia i obraz kliniczny.

For the 10 recent years the incidence of natural rubber latex (NRL) immediate allergy has dramatically increased. Allergy to latex is observed mostly among persons who regularly use rubber devices (particularly rubber gloves) or their mucous membrane is exposed to frequent contact with rubber products. The health service and the rubber industry workers are at the highest risk of latex allergy (10%). Urticaria, angioedema, bronchial asthma, conjunctivitis, rhinitis and anaphylactic shock are most common symptoms of allergy to latex. Severe systemic reactions are frequently first clinical manifestations of latex hypersensitivity.

[Occupational immediate allergy to latex. II. Diagnosis and prevention]. / Zawodowa alergia typu natychmiastowego na lateks. II. Diagnostyka i prewencja.

In vitro methods play an extremely important role in the diagnosis of natural rubber allergy (NRL). In vivo diagnostic procedures may be life-threatening and clinical history is usually of low sensitivity and specificity. CAP-RAST and AlaSTAT--laboratory methods for detection of specific IgE--display most likely the highest clinical value in NRL diagnosis. Skin prick tests, the test with a piece of glove, bronchial and nasal challenge tests are also used in the diagnosis of natural rubber allergy. The most essential preventive issues of NRL are as follows: the drawing up guidelines on labelling of latex containing medical devices, high risk group screening, and the development of facilities in health institutions for taking care of patients sensitized to latex.

["Sick building syndrome"--a new problem of occupational medicine]. / "Sick building syndrome"--nowy problem w medycynie pracy.

"Sick building syndrome" (SBS) is a group of symptoms experienced by people working in various buildings. This term or another one "building-related illness" (BRI) is used to define illnesses related to non-industrial and non-residential buildings, mainly modern offices, in which people spend many working hours. Specific BRI applies to a group of illnesses with a fairy homogeneous clinical picture and known etiology (infectious, immunological or allergic). Non-specific BRI applies to a group of heterogeneous and non-specific, work-related symptoms, including irritation of skin and mucous membranes of the eyes, nose and throat, headache, fatigue and concentration difficulties. BRI seems to be related to inadequate ventilation, humidity and temperature changes, chemical and biological contaminants from indoor and outdoor sources. Sick building syndrome is considered as an important problem of occupational medicine, bearing in mind that 50% of the entire workforce in industrialized countries work in this type of buildings, and nearly 20-30% of this group of workers report symptoms suggesting the prevalence of sick building syndrome.

[Evaluation of selected functional circulation parameters of workers from various occupational groups exposed to electromagnetic fields of high frequency. III. 24-h monitoring of arterial blood pressure (ABP)]. / Ocena wybranych parametrów czynnosci ukladu krazenia pracowników róznych grup zawodowych eksponowanych na pola elektromagnetyczne wielkiej czestotliwosci. III. 24-h monitorowanie cisnienia tetniczego krwi (ABP).

The problem of blood pressure regulation in persons occupationally exposed to electromagnetic fields (EMF) has not as yet been elucidated, and most data come from studies carried out long time ago (1960-70) in the former Soviet Union. Our study was aimed at verifying the Soviet data by means of modern methods. Together with traditional methods, a 24-h monitoring of arterial blood pressure (ABP) using a Medilog ABP kit (Oxford) were employed. Measurements were taken automatically every 0.5 h during daily activities and every 1 h during the night rest (about 41 measurements/day). The mean systolic and diastolic blood pressure and heart rate were calculated over day (BPSDOver, BPDOver, HROver), during daily activities (HPDD, BPSD, HRD) and during the night rest (BPSN, BPDN, HRN). The subjective and objective examinations were carried out as well as resting ECG and a 24-h Holter were performed (the results have been published earlier). The study covered male workers of middlewave broadcast stations (71), radioservice (40) and radio line stations (42). The subjects were aged 21-60 years and the duration of their work with devices generating high frequency EMF ranged between 1 and 42 years. The first group of workers was exposed to EFM at the frequency of 1 Mhz, the second at about 150 Mhz and the third group, not exposed, served as the control group. The study revealed that the mean arterial blood pressure and the day/night blood pressure variability indicator showed no significant differences between the groups, whereas the daily heart rate was significantly lower in the workers of middlewave broadcast stations in comparison with the controls despite similar type of work as far as physical effort and psychic burden are concerned, and similar non-occupational activities. The day/night heart rate variability indicator was significantly lower in the groups exposed. The decreased value of this indicator may suggest the occurrence of disorders in the neurovegetative regulation. In persons employed at radioservice stations a higher incidence of the increased arterial blood pressure, in comparison with the control group, was observed.

[Rules for prevention and certification of occupational diseases in workers occupationally exposed to antineoplastic drugs]. / Zasady postepowania profilaktycznego i orzeczniczego u pracowników zawodowo narazonych na leki cytostatyczne.

The risk of occupational exposure to antineoplastic drugs is related to cancerogenesis and reproductive dysfunction, including fertility disorders, congenital defects and toxic effects inter alia on the liver, kidneys, skin and bone marrow. The authors review current legal regulations of antineoplastic drug administration, the present state of the patients' care and guidelines for prophylactic examinations in this occupational group.

[Laboratory animals as a cause of occupational allergy]. / Zwierzeta laboratoryjne jako przyczyna uczulen zawodowych.

Animal allergens are the strongest occupational allergens which sensitize the respiratory tract. Allergy to the animal is the most important occupational health hazard among people working with experimental animals in university and other research laboratories. The most common manifestations of allergy to laboratory animals are: bronchial asthma, rhinitis, contact urticaria, angioedema and contact dermatitis. The major source of allergen is the excreta and secreta of such animals as: rat, mouse, guinea pig, rabbit, dog, cow and horse. Among risk factors responsible for the development of animal allergy are: atopy, tobacco smoking and allergy to domestic pets. The diagnosis of laboratory animal allergy is usually based on a medical history. The objective evidence to support the diagnosis can be obtained from skin testing, a specific immunologic response and work related changes in peak flow rate. Reduction in the airborne levels of animal allergens not only at home, but also at work (proper ventilation, filter masks, elimination of domestic animals) and reduction of factors responsible for the development of bronchial hyperreactivity (avoidance of smoking), can contribute to decreasing the incidence of diseases.

[Bronchial asthma with inflammation of the nose mucous membrane induced by occupational exposure to methyl methacrylate in a dental technician ]. / Astma oskrzelowa z zapaleniem blony sluzowej nosa w nastepstwie zawodowej ekspozycji na metakrylan metylu u technika dentystycznego.

A case report of a 40-year-old female dental technician with a 13-year history of methyl methacrylate exposure is presented. Symptoms of dyspnea, wheezing, coughing and rhinorrhea occurred 6-8 months after the first occupational contact with methyl-methacrylate containing substances. Skin tests performed with a battery of common allergens produced negative results. While performing a provocation test with methyl-methacrylate, the patient developed severe stridor and dyspnea with concomitant decrease in I second forced expiratory volume (FEV1) and peak respiratory flow (PEF). The increase in leukocytes, eosinophils, basophils, albumin, eosinophil cationic protein (ECP) and mast cell tryptase occurred in nasal lavage fluid after bronchial provocation test. The authors conclude that methyl-methacrylate may cause asthma (probably non-atopic) in persons occupationally exposed to its effect.

[Natural history of occupational allergy to latex in health care workers]. / Historia naturalna alergii zawodowej na lateks u pracowników sluzby zdrowia.

The analysis of natural history of allergy to natural rubber latex (NRL) in health care workers, including the influence of exposure cessation on the clinical status and objective allergy markers was the objective of the study. The study covered 58 patients with recognised allergy to NRL. Of this number, 26 were followed up for 2 years after diagnosing NRL allergy. Medical examination, skin prick tests for common allergens and NRL, determination of total serum IgE and NRL-specific IgE antibodies, rest spirometry and non-specific bronchial hyperactivity test with histamine were performed. The retrospective analysis of clinical manifestation of NRL allergy revealed in 36% of patients progression of symptoms from local urticaria and rhinitis to systemic reactions. Two years after the cessation of exposure to NRL, symptoms became less severe in the majority of patients and even a clearance of allergic symptoms was observed, as well as the decrease in doses of inhalative glicocorticosteroids was noted. This was accompanied by the decline in non-specific bronchial hyperactivity. Although the skin prick tests showed the tendency to remain positive, the decrease in the level of specific anti-NRL IgE was found in 10 patients (including the RAST negativisation in one case). In conclusion, clinical progress from NRL-induced contact urticaria and allergic rhinitis to systemic reactions was observed only in part of patients with NRL allergy, which cannot be taken as a rule. Significant reduction of clinical symptoms or even total remission of NRL-allergic symptoms could be observed after exposure cessation.

Eosinophils in bronchial asthma.

A lot of recent works point out the role of the eosinophil as one of the most harmful cells in asthma. Eosinophilic granules contain strongly basiec cytotoxic proteins. Some of these proteins were shown to damage airway epithelial cells and degranulate basophils and mast cells. The concentration of eosinophil-derived major basic protein (MBP) in sputum is a good marker for clinical state in asthma. Extracellular MBP deposits were detected in lung tissue from patients who died of asthma. Several pieces of evidence indicate that eosinophil is stimulated to secrete its content in asthmatic reaction. Besides basic proteins the eosinophil can release other potent mediators of inflammation i.e. leukotriene C4 and PAF. Glucocorticosteroids, adrenergic agonists, disodium cromoglycate and specific immunotherapy were shown to inhibit eosinophil function.

[Clinical evaluation of budesonide forte action in patients with atopic bronchial asthma]. / Kliniczna ocena dzialania preparatu Budesonidu forte u chorych na atopowa astme oskrzelowa.

An effect of a 6-week therapy with Budesonide forte aerosol Polfa on the course of bronchial asthma has been investigated in 30 atopic asthmatics with double-blind trial. The drug has been administrated in the dose of 200 micrograms four times daily and the results have been compared with placebo and foreign made analogue. Twelve patients required chronic administration of oral glucocorticosteroids in the daily dose of 9.2 mg of prednisone. Dyspnoea, cough, doses of bronchodilators and oral corticosteroids, pulmonary function and bronchial reactivity to histamine have been considered in the clinical analysis. A decrease in the severity of dyspnoea and in the doses of used bronchodilators as well as intensity of cough have been observed during the treatment with inhaled steroids. The mean daily dose of prednisone has decreased to 5.8 mg and oral corticosteroids could be withdrawn in 4 of the patients treated chronically with these drugs. Budesonide forte significantly reduced bronchoconstriction and bronchial reactivity to histamine, compared with baseline values.