[Idiopathic environmental intolerance: 2 disabling entities to recognize]. / Intolérance environnementale idiopathique: deux entités invalidantes à reconnaître.

Idiopathic environmental intolerance is characterized by a variety of non-specific symptoms involving several organs within the same individual, and attributed to the exposure to chemical odors (multiple chemical sensitivities) or to the exposure to electromagnetic fields (electromagnetic hypersensitivity). Symptoms occur following an exposure to agents generally regarded as harmless due to the low levels of exposure, and they do not answer to any definition of organic diseases. The lack of established etiology renders treatment difficult. It is important for practitioner to recognize such disorders and assess the social and professional impact so as to improve patients' quality of life.

Occupational asthma and occupational rhinitis: the united airways disease model revisited.

OBJECTIVES: Whereas accumulating evidence indicates close associations between rhinitis and asthma, little is known about the relationships between occupational rhinitis (OR) and occupational asthma (OA). This study analyses the prevalence of OR associated with OA, globally and according to the various causal agents, and investigates the temporal relationships between these two conditions. METHODS: Data on incident cases of OA (2008-2010) were collected through the French national occupational disease surveillance and prevention network, using a standardised form including information on occupation, causal agents, presence of OR, and respective dates of occurrence of rhinitis and asthma. RESULTS: Among the 596 reported OA cases with latency period, 555 could be attributed to identified agents: high molecular weight (HMW) agents (n=174); low molecular weight (LMW) agents (n=381). Overall, OR was associated with OA in 324 (58.4%) cases. The frequency of association was significantly higher for HMW agents than for LMW agents (72.2% vs 51.5%, p<0.001). OR occurred before OA significantly more frequently for HMW agents than for LMW agents (p<0.01). CONCLUSIONS: These results show that OR is frequently associated with OA, especially when HMW agents are involved. They are consistent with the hypothesis that OR, in conjunction with OA, is more likely to be caused by sensitisers that cause disease via IgE-mediated mechanisms and suggest that symptoms of OR should be taken into account in the medical surveillance of workers exposed to HMW agents.

Work-related asthma in France: recent trends for the period 2001-2009.

OBJECTIVE: Knowledge on the time-course (trends) of work-related asthma (WRA) remains sparse. The aim of this study was to describe WRA trends in terms of industrial activities and the main causal agents in France over the period 2001-2009. METHOD: Data were collected from the French national network of occupational health surveillance and prevention (Réseau National de Vigilance et de Prévention des Pathologies Professionnelles (RNV3P)). Several statistical models (non-parametric test, zero-inflated negative binomial, logistic regression and time-series models) were used and compared with assess trends. RESULTS: Over the study period, 2914 WRA cases were included in the network. A significant decrease was observed overall and for some agents such as isocyanates (p = 0.007), aldehydes (p = 0.01) and latex (p = 0.01). Conversely, a significant increase was observed for cases related to exposure to quaternary ammonium compounds (p = 0.003). The health and social sector demonstrated both a growing number of cases related to the use of quaternary ammonium compounds and a decrease of cases related to aldehyde and latex exposure. CONCLUSIONS: WRA declined in France over the study period. The only significant increase concerned WRA related to exposure to quaternary ammonium compounds. Zero-inflated negative binomial and logistic regression models appear to describe adequately these data.

[The National Occupational illness surveillance and Prevention Network (RNV3P) and health monitoring]. / Réseau National de Vigilance et de Prévention des Pathologies Professionnelles (RNV3P) et veille sanitaire.

The National Occupational Illness Surveillance and Prevention Network (RNV3P) established in 2002 as a network of experts from 29 university hospitals as well as occupational physicians records and monitors occupational health problems (OHPs) based on Soccupational health consultations in university hospitals in mainland France and in occupational medical health services (approximately 5000 OHPs/year for patients seen in hospital consultations). The OHP data are collected systematically according to a standardised code which is attributed based on main variables of interest: disease and co-morbidity (CIM-10), 1-5 impact codes (INRS), an occupational code (ILO) and a code for the type and domain of professional activity (NAF-93). For certain problems recorded, the clinician also reports a degree of imputance for attributing the level of certainty for the problem's relationship to the S main illness (weak, probable, strong). At present, 30,000 OHPs diagnosed and recorded in occupational illness consultation centers have been recorded in the information database and have been utilised for epidemiological surveillance. The surveillance activity of the network is carried out on two levels. First, a planned epidemiological health activity is programmed which focuses on estimating the incidence of illness--predefined problems. In a parallel fashion, research is developed to explore the tools which can be used to highlight emerging illness and develop methodologies to detect the relationships of unknown problems to the incidence of these illnesses--including those that present a communicable nature (either temporarily or over the long term), in certain professions or sectors.