EAACI position paper on occupational rhinitis.

The present document is the result of a consensus reached by a panel of experts from European and non-European countries on Occupational Rhinitis (OR), a disease of emerging relevance which has received little attention in comparison to occupational asthma. The document covers the main items of OR including epidemiology, diagnosis, management, socio-economic impact, preventive strategies and medicolegal issues. An operational definition and classification of OR tailored on that of occupational asthma, as well as a diagnostic algorithm based on steps allowing for different levels of diagnostic evidence are proposed. The needs for future research are pointed out. Key messages are issued for each item.

[Welding-related respiratory diseases]. / Choroby ukladu oddechowego u spawaczy.

Welders are exposed to fumes containing different gases, fumes and particles, depending on the composition of the welding electrodes, welded material and the welding method used. Welders are workers at risk of developing various respiratory signs and symptoms. Health effects associated with welding include different lung function abnormalities, including metal fume fever, bronchial asthma, chronic obstructive pulmonary disease, pneumoconiosis and other pulmonary fibrosis (chronic beryllium disease, cobalt lung), and lung cancer. The authors describe some aspects of etiology, pathogenesis, diagnostics, prophylaxis, and medical certification of welding-related respiratory diseases.

Exhaled nitric oxide levels after specific inahalatory challenge test in subjects with diagnosed occupational asthma.

OBJECTIVES: Measuring exhaled nitric oxide (eNO) is a useful method for the assessment of bronchial inflammation in asthmatic subjects. The aim of the study was to evaluate the changes in eNO level in the subjects with suspected occupational asthma (OA) after a specific inhalation test (SIT) with occupational agents. MATERIALS AND METHODS: Forty two patients, including 17 farmers, 15 bakers and 10 health care workers had a physical examination, skin prick tests with common and occupational allergens, total serum IgE level, specific anti-allergen IgE determinations, spirometry and SIT. Also, morphological changes in induced sputum (ISP) and nasal lavage fluid (NLF) were analysed and eNO measurements were performed. RESULTS: SIT revealed a significant increase in the proportion of eosinophils in NLF and in ISP in the cases with diagnosed OA. Moreover, these cases showed significantly increased eNO levels only 24 h after SIT, compared to the measurements before SIT. We also found a significant correlation between eNO level at 24 h after SIT and the percentage of eosinophils in NLF before, and 4 and 24 h after SIT, as well as in ISP before and 24 h after SIT in all subjects with diagnosed OA. CONCLUSION: The findings may confirm the usefulness of exhaled nitric oxide measurements for diagnosing OA.

Occupational asthma due to manganese exposure: a case report.

Manganese belongs to a group of agents called "transitional metals" that are known to induce occupational asthma. However, well-documented cases of manganese-induced asthma have been lacking thus far. We have discussed a case of a 42-year-old non-smoking welder with work-related dyspnea. A number of clinical procedures were performed including clinical examination, routine laboratory tests, total serum IgE, skin prick tests to common aeroallergens and manganese nitrate, resting spirometry test, histamine challenge, and a single-blind, placebo-controlled specific inhalation challenge with 0.1% manganese chloride solution. Clinical findings and laboratory test results remained normal but a significant bronchial hyperreactivity was found. During the specific inhalation challenge, dyspnea and a significant decrease in forced expiratory volume (FEV1) were observed. An increased proportion of eosinophils and basophils in induced sputum could also be noted at 4 and 24 h after the challenge. The argument for recognizing the condition as occupational asthma was a positive clinical response to the specific challenge test as well as the morphological changes found in induced sputum. To our knowledge, this is the first well-documented case of manganese-induced occupational asthma.

IL-18 levels in nasal lavage after inhalatory challenge test with flour in bakers diagnosed with occupational asthma.

OBJECTIVES: The authors discuss the outcomes of a study on IL-18 concentration in nasal washings after the inhalatory challenge test with flour allergens (ICHT-F) in bakers with flour-induced occupational airway allergy (OAA). METHODS: We measured IL-18 concentration using ELISA kit and assessed morphological changes in nasal lavage fluid (NLF) before, and 4 h and 24 h after ICHT-F in three groups of subjects: Group A - 9 patients with diagnosed OAA (occupational asthma and rhinitis), Group B - 10 patients with atopic asthma and rhinitis, and Group C - 9 healthy volunteers. RESULTS: In Group A, significant differences in the basophil proportion in NLF were noted only 24 h after ICHT-F. Both the basophil proportion and total eosinophil count were higher in Group A than in Group C at this time-point. Group A also showed a statistically significant increase in IL-18 levels 4 h after the challenge. A significant relationship was noted between the proportion of basophils 4 h after ICHT-F and IL-18 level at 24 h after the test. CONCLUSIONS: This is the first study demonstrating an increased expression of IL-18 in nasal washings of subjects diagnosed with OAA to flour allergens. The observed higher concentrations of IL-18 in nasal washings after ICHT as well as the increase in the proportion of basophils provide evidence for the important role of IL-18 in persistent allergic inflammation.

[Preventive care of workers at risk of blood-born infections in view of binding regulations]. / Opieka profilaktyczna nad pracownikami zagrozonymi zakazeniem krwiopochodnym w swietle obowiazujacych przepisów prawnych.

The principles of performing prophylactic medical examinations of workers are regulated by the Labor Code and relevant executive regulations. There are also other regulations that concern particular groups of workers--like health care workers. The range and frequency of medical examinations are determined by the doctor who performs the examination on the basis of "Guidelines on prophylactic medical examinations of workers". Before determining the range of medical tests, the risk of occupational exposure to biological hazards in some of health care workers must be taken into account. This article presents legal regulations that determine the standards of prophylactic medical examinations of workers who are at risk of contracting pathogens such as HBV, HCV and HIV.

Occupational upper airway disease.

PURPOSE OF REVIEW: This article reviews recent findings concerning occupational upper airway diseases, which, although very frequent, are usually not considered serious. However, the concept of the 'united airway', evoked during recent years, should change our attitude regarding these diseases. Moreover, new agents in the occupational environment must be characterized. Furthermore, exposure to carcinogens has changed over the years, and in most cases risk should be reassessed. RECENT FINDINGS: Recent findings concerning work-related upper airway diseases caused by allergens and irritants, and their relationship to lower airway diseases, are reviewed. Findings of studies aimed at characterizing occupational allergens of plant and animal origin are presented. Recognition of work-related upper airway diseases both in clinic and in epidemiological studies is discussed. Current evidence on occupational cancer of the upper airways, its risk factors and changes in them over the years resulting from preventative measures are also described. SUMMARY: There is significant evidence that occupational allergic diseases of the upper airways can pose important health problems because they represent an early stage of allergy throughout the respiratory system. However, how to detect those rhinitic patients who will develop asthma remains unresolved. New occupational health problems due to irritants were recently reported, and both follow-up studies and evaluations of their implications for the lower airways are warranted. Although preventative measures have been effective to some extent, risk for occupational cancer of the upper airways persists and more targeted epidemiological studies in this area are needed.

Outbreak of lead poisoning in high voltage tower conservators.

OBJECTIVES: A changing character of lead exposure has been observed over many years. However, construction workers involved in the renovation of painted steel structures are still severely exposed to lead and its compounds. In 2004, we observed an outbreak of lead poisoning in high voltage tower conservators working abroad. MATERIALS AND METHODS: As many as 27 male workers with suspected lead poisoning were hospitalized in the Department of Occupational Disease, Nofer Institute of Occupational Medicine, Lódz, Poland. They were involved in removing an old lead-containing paint from high voltage towers. RESULTS: On admission to the department, 70% of treated workers showed laboratory signs of anemia in their blood count. After treatment the signs persisted in 25% of patients. Also alkaline dotting in erythrocytes was present in 13 subjects. Sub-acute lead poisoning manifested by abdominal cramps with coexisting anemia and increased lead absorption symptoms was most frequently diagnosed. CONCLUSIONS: The high lead exposure of the examined high voltage tower cleaners was due to specific working conditions. In such cases overprotection of the environment may lead to severe health effects in humans.

[Sick building syndrome due to exposure to pentachlorophenol in the office: a case report]. / Narazenie na pentachlorofenol podczas pracy biurowej przyczyna "sick building syndrome"--opis przypadku klinicznego.

"Sick building syndrome" (SBS) is a group of symptoms experienced by people working in various buildings. This or another term "building-related illness" (BRI) is used to define illnesses related to modern buildings, mainly offices, in which people spend many working hours. SBS applies to a group of diseases with a fairly homogenous clinical picture and etiology (specific - infectious, allergic and non-specific--for example irritant symptoms). A case of a 51-year-old non-smoking female office worker is reported. After having her working premise renovated, she started to suffer from irritation of mucous membrane of the throat, sore throat and dysphonia. She claimed that these symptoms were associated with exposure to pentachlorophenol (PCP) emitted by the elements of ceiling impregnated with PCP-containing varnish. The concentration of PCP was below the hygiene standards adopted for the work environment. There were no grounds for recognizing occupational intoxication, but the case met the criteria for the sick building syndrome.

Changes in cellular and biochemical profiles of induced sputum after allergen-induced asthmatic response: method for studying occupational allergic airway inflammation.

OBJECTIVES: The purpose of the study was to analyze morphological and biochemical changes in induced sputum after the provocation with occupational allergens (mixture of flours and grains) in subjects with diagnosed occupational asthma. MATERIALS AND METHODS: Subjects with occupational asthma and healthy volunteers had physical examination, skin prick tests with common and occupational allergens, and spirometry. Specific IgE against common and occupational allergens was also measured. Bronchial inflammation was characterized by the percentage of cells, levels of eosinophil cationic protein (ECP), and changes in mucosal permeability index. RESULTS: There was a significant increase in the proportion of eosinophils, basophils, lymphocytes, and in the ECP level in induced sputum of occupational allergics after the specific provocation. CONCLUSION: Sputum induction is a reliable method for measuring allergen-induced airway inflammation.

Natural rubber latex allergy: antigen specific IgE in Polish blood donors, prevalence and risk factors--preliminary data.

OBJECTIVES: There is insufficient data on the prevalence of latex allergy in the general population in Poland. The aim of the study was to evaluate natural rubber latex (NRL) sensitization and its risk factors among Polish blood donors. MATERIALS AND METHODS: The study group comprised 1000 consecutive blood donors attending the Regional Centre for Transfusion Medicine. Total IgE and allergen specific IgE to NRL (asNRL-IgE) were assayed using the EIA (enzyme immunoassay) test. In the subjects with asNRL-IgE equal to or above Class II further surveys were performed: questionnaire, skin prick tests (SPT) to common allergens, NRL and food allergens cross reactive to NRL, asNRL-IgE with FDA (Food and Drug Administration) approved FEIA (fluorescent enzyme immunoassay) test and antigen profile of asNRL-IgE. RESULTS: asNRL-IgE (EIA) was observed in 17.9% of blood donors. Only 10% of positive results equal to or above Class II were confirmed with the FEIA test. The positive FEIA results were confirmed with SPT to NRL in 60% and the negative FEIA results in 5.4% of cases. The specific IgE to Hev b 3, 5, 6 and 13 were observed in the subjects with occupational exposure to NRL. The highest concentration of Hev b 8 was observed in the subjects not symptomatic to NRL with positive SPT to grass and tree pollens. CONCLUSION: The EIA test showed the high prevalence of antigen specific IgE to NRL among Polish blood donors. There was low concordance between EIA and FEIA tests. Therefore, the EIA test should be used only for screening purposes along with the establishment of sensitivity and specificity of the method. Elevated total IgE level, active tobacco smoking, and history of atopic disease symptoms were revealed to be risk factors for the presence of asNRL-IgE.

Exposure to moulds in flats and the prevalence of allergic diseases--preliminary study.

The presented study concerned mycological analysis of buildings in Lódz and evaluation of the role between filamentous fungi contaminated flats and inhabitants health (allergic airway diseases). 49 inhabitants of 20 flats with signs of moulds contamination were examined. Air samples were collected in houses and outdoors. In all inhabitants skin prick tests (SPT) to common allergens and to standardized particular fungal extracts were performed. Moreover, total and serum specific IgE to moulds, rest spirometry were measured in all subjects. Level of moulds contamination in the air of flats was high and in 75% cases exceed accepted limits. The most frequent species isolated from examined rooms were: Penicillium, Cladosporium, Aspergillus, Acremoniu and Alternaria. The most frequent symptoms reported by examined subjects were rhinitis (N = 29, 59.2%), conjunctivitis (N = 29, 59.2%), chronic cough (N = 24, 49%), dyspnea (N = 15, 30.6%) and skin symptoms (N = 24, 49%). Elevated IgE level was found in 12 subjects (24.5%) and in three patients (6.1%) mould specific serum IgE were detected. Nineteen out of all subjects (38.8%) had positive SPT to common allergens (house dust mites, grass and tree pollens). Eight out of these patients (16.3% of the group) were sensitized to moulds (Candida albicans, Alternaria alternata, Botrytis cinerea, Trichophyton mentagrophytes, Helminthosporium halodes, Aspergillus). In all cases sensitisation to moulds was accompanied by allergy to other common allergens. No isolated hypersensitivity to moulds was found. Although the frequency of self-reported symptoms was high, the prevalence of atopy and allergic diseases seems to be similar to that found in general population, but that statement must be confirmed by comparison of the control group.

[Chronic fatigue syndrome: its importance in occupational medicine]. / Zespól przewleklego zmeczenia i jego znaczenie w medycynie pracy.

The paper reviews the etiology of chronic fatigue syndrome (CFS), its clinical symptoms and diagnostic procedures. Forasmuch the fatigue is the main symptom of CFS and it may appear in many somatic and mental disorders. The principles of differential diagnostics are reviewed and the methods of management and treatment are presented. The knowledge of CFS is needed among occupational medicine physicians, especially from the point of view of health protection.

[Allergyto alpha-amylase in apprentice bakers--prevalence, incidence, risk factors and clinical symptoms]. / Uczulenie na alpha-amylaze u uczniów szkól piekarskich-- zapadalnosc, czynniki ryzyka i obraz kliniczny.

BACKGROUND: The aim of the study was to evaluate the prevalence, incidence and risk factors of hypersensitivity to alpha-amylase as well as to identify allergy-related clinical symptoms in apprentice bakers. MATERIALS AND METHODS: A group of 287 apprentice bakers was examined by using a questionnaire, performing skin prick tests to common and occupational allergens, and evaluating total serum IgE level, specific anti-flour and alpha-amylase IgE before, 1 year and 2 years after the onset of vocational training. To diagnose occupational respiratory disease, spirometry, histamine and allergen specific inhalation challenge tests were performed. RESULTS: None of the apprentices displayed the presence of alpha-amylase-specific IgE before starting vocational training. After the first year of occupational exposure, one subject developed hypersensitivity to alpha-amylase, and other 27 subjects after the second year. Generally, 28 (9.8%) apprentices showed hypersensitivity to alpha-amylase after two years of occupational exposure. Of those subjects, 17 (60.7%) had occupational allergic rhinitis recognized and 15 (53.6%) occupational asthma. Logistic regression analysis revealed that the positive results of SPT to common allergens and moulds are significant risk factor for the development of hypersensitivity to alpha-amylase (OR = 11.98, 95% CI: 2.60-55.08 and OR = 7.45, 95% CI: 1.12-49.61, respectively). CONCLUSION: The incidence of allergy to alpha-amylase increases with increasing duration of exposure. Hypersensitivity to common allergens, especially to moulds, is a risk factor of occupational allergy to alpha-amylase. The study results confirm that skin prick tests to common allergens, particularly to moulds, should be performed in bakers before starting occupational exposure and subjects with positive results should be considered as a group of high risk of occupational allergy.

Occupational allergy to wheat flour. Nasal response to specific inhalative challenge in asthma and rhinitis vs. isolated rhinitis: a comparative study.

OBJECTIVES: The purpose of the study was to compare cytological and biochemical changes in nasal lavage fluid induced by wheat flour inhalatory challenge in bakers with allergic rhinitis and with asthma accompanied by rhinitis. MATERIALS AND METHODS: A single-blind, placebo controlled study was conducted in 64 bakers with allergic rhinitis (n = 17), bronchial asthma and rhinitis (n = 24) and without occupational allergy (n = 23). Nasal washings were examined before, 30 min, 4 and 24 h after the specific provocation, wheras non-specific bronchial hyperreactivity (PC20) before and after 24 h. RESULTS: A significant decrease in PC20 after the challenge test was observed only in patients with asthma and rhinitis. Eosinophil count and percentage, basophil count and the permeability index induced by specific provocation were significantly increased in both rhinitis patients and asthmatics. Moreover, the increase especially in total count and proportion of eosinophils as well as in the permeability index was more pronounced in subjects suffering from asthma and rhinitis than in those with rhinitis alone, although the changes were not statistically significant. CONCLUSIONS: The results indicate the applicability of the "nasal pool" technique as a simple diagnostic procedure in flour-induced airway allergy. However, the evaluation of nasal lavage fluid, although a very sensitive and specific method of diagnosing respiratory allergic disease, cannot be used to distinguish patients with upper and lower airway allergy.

Nasal lavage fluid examination in diagnostics of occupational allergy to chloramine.

OBJECTIVES: Chloramine T is a known sensitising agent in the occupational environment of health care workers. In cases of occupational hazards induced by this agent, a clinical history may be far from conclusive, hence appropriate provocation tests are absolutely essential. The aim of the study was to evaluate the usefulness of the nasal challenge test in diagnostics of respiratory allergy to chloramine T. MATERIALS AND METHODS: A single-blind, placebo-controlled study was conducted in 6 subjects with chloramine T asthma and rhinitis. Two control groups comprised 7 atopic subjects with asthma and rhinitis and 6 healthy persons. All the controls had negative results of skin prick tests with chloramine T and none displayed any respiratory symptoms under exposure to the agent. A "nasal pool" technique was used to evaluate morphological and biochemical parameters (mast cell tryptase, eosinophil cationic protein, permeability index) in nasal washings before and 30 min, 4 h and 24 h after the provocation with chloramine T and placebo. RESULTS: A significant increase was found in the total count and percentage of eosinophils and basophils, albumin, tryptase and eosinophil cationic protein levels in the nasal lavage fluid from patients with chloramine T respiratory allergy when compared to both control groups. Also a dual asthmatic reaction in 4 patients and an isolated late reaction in 2 cases were observed in chloramine-sensitive subjects. CONCLUSIONS: The results indicate the applicability of the "nasal pool" technique as a diagnostic procedure in chloramine T-induced airway allergy.

[Bronchial asthma in rural environment]. / Astma oskrzelowa w srodowisku wiejskim.

This paper reviews basic problems concerning epidemiology and pathogenesis of bronchial asthma in the rural environment. Possible causes of the decreased prevalence of atopy and allergic diseases are analyzed. Etiology, pathogenesis and clinical findings of asthma-like syndromes, a major problem of differential diagnosis, as well as the principles of occupational asthma diagnostics in farmers are also presented.

[Airway remodeling in occupational asthma: clinical implications and medical-legal certification]. / Remodeling dróg oddechowych w astmie zawodowej--implikacje kliniczne i orzecznicze.

This review focuses on the major cellular and structural changes in the airways in occupational asthma and underlines mechanisms that contribute to airflow limitation found in asthmatic patients. Asthma is characterized by thickening of the airway wall and developing of the inflammatory process, including infiltration of inflammatory cells, release of a wide spectrum of molecules (fibronectin, growth factors, cytokines and chemokines), deposition of immunoglobulins and collagen, smooth muscle hyperplasia and fibrosis. These cellular and structural changes may contribute to thickening of the reticular basement membrane and the stable increase in airflow limitation. Airway remodeling is of clinical importance in occupational asthma because it is the main reason for persistent, progressive impairment of respiratory function and makes it necessary to re-evaluate the patient's respiratory disability two years after cessation of occupational exposure.

[Occupational asthma and interstitial cobalt-induced changes in a dental technician: a case report]. / Zlozona postac kobaltozy (zmiany sródmiazszowe i astma oskrzelowa) u technika dentystycznego--opis przypadku klinicznego.

It is a case report on a 55-year-old non-smoking female, dental technician, with a 36-year history of cobalt exposure. The patient suffered from dyspnea, coughing and decrease in physical load tolerance about 20 years after the first occupational contact with cobalt-containing metal dentures. Skin tests performed with a battery of common allergens (metals: nickel, chrome, cobalt; acrylates; disinfectants; and natural rubber latex) were negative. In the patient, interstitial radiological changes, respiratory insufficiency and decrease in diffusion capacity were observed. While performing a provocation test with 0.05% cobaltous chloride, the patient developed dyspnea with concomitant decrease in 1 second forced expiratory volume (FEV1) and peak respiratory flow (PEF) from the beginning of the 3rd hour after provocation and maximum intensity at the 8th hour. These symptoms persisted until the 24th hour. The authors conclude that occupational exposure of the dental technician to cobalt dust derived from metal dentures may cause chronic airway disease with interstitial inflammation, fibrosis and occupational asthma.

[Health effects of occupational exposure to cytostatics in medicinal personnel in the light of compulsory prophylactics: a cross-sectional study]. / Ocena skutków zdrowotnych zawodowej ekspozycji na cytostatyki u personelu medycznego w swietle obowiazujacej profilaktyki: badanie przekrojowe.

The aim of the study was to evaluate health effects of occupational exposure to antineoplastic drugs. The study group comprised 104 cytostatic-exposed health care workers employed in departments of chemotherapy; the control group consisted of 103 non-exposed workers employed in wards where cytostatics were not used. A questionnaire survey and routine laboratory assays (morphology, liver and kidney tests) were performed in all subjects. The exposed subjects reported hair loss significantly more frequently than controls (50.6% vs. 10.7%, respectively) Moreover, serious congenital defects were more frequent in the study group than in controls (4/84 pregnancies vs. 1/169 pregnancies, respectively). In conclusion, the results of the study did not reveal any significant differences in routinely performed tests between the subjects exposed to cytostatics and controls. This may be due to low sensitivity of laboratory tests or to the absence of health effects induced by antineoplastic drugs. Because of an increased frequency of congenital effects, women who plan conception should not be exposed to cytostatics or at least this group of women should use any possible individual protectors at work.