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1.
Handb Exp Pharmacol ; 268: 213-225, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34031758

RESUMO

Occupational allergies are among the most common recorded occupational diseases. The skin and the upper and lower respiratory tract are the classical manifestation organs. More than 400 occupational agents are currently documented as being potential "respiratory sensitizers" and new reported causative agents are reported each year. These agents may induce occupational rhinitis (OR) or occupational asthma (OA) and can be divided into high-molecular weight (HMW) and low-molecular weight (LMW) agents. The most common occupational HMW agents are (glycol)proteins found in flour and grains, enzymes, laboratory animals, fish and seafood, molds, and Hevea brasiliensis latex. Typical LMW substances are isocyanates, metals, quaternary ammonium persulfate, acid anhydrides, and cleaning products/disinfectants. Diagnosis of occupational respiratory allergy is made by a combination of medical history, physical examination, positive methacholine challenge result or bronchodilator responsiveness, determination of IgE-mediated sensitization, and specific inhalation challenge tests as the gold standard. Accurate diagnosis of asthma is the first step to managing OA as shown above. Removal from the causative agent is of central importance for the management of OA. The best strategy to avoid OA is primary prevention, ideally by avoiding the use of and exposure to the sensitizer or substituting safer substances for these agents.


Assuntos
Asma Ocupacional , Hipersensibilidade , Doenças Profissionais , Alérgenos , Animais , Asma Ocupacional/diagnóstico , Asma Ocupacional/epidemiologia , Asma Ocupacional/etiologia , Doenças Profissionais/diagnóstico , Doenças Profissionais/epidemiologia , Doenças Profissionais/etiologia , Fatores de Risco
2.
Artigo em Inglês | MEDLINE | ID: mdl-34948791

RESUMO

Isocyanate, whose disease-inducing mechanism is poorly understood, with poor prognosis, is widely used. Asthma is the most frequent manifestation of prolonged exposure. We assessed the evolution of the incidence of isocyanate-induced occupational asthma over time. PubMed and Cochrane databases were systematically searched for studies published since 1990 that assessed the relationship between occupational exposure to isocyanates and asthma. We identified 39 studies: five retrospective cohort studies, seven prospective cohort studies, three of which were inception cohorts), seven observational cross-sectional studies, five literature reviews, two case series, and 13 registry studies. The incidence of occupational asthma secondary to isocyanate exposure has decreased from more than 5% in the early 1990s to 0.9% in 2017 in the United States. Despite the wide use of optimal collective and individual protection measures, the risk of occupational asthma has stabilized. Occupational asthma risk can be assessed with good sensitivity using self-questionnaires and pulmonary function tests. Occupational avoidance should be implemented as soon as possible after the first symptoms appear because the prognosis becomes increasingly poor with the persistence of exposure. It is now necessary to study specifically cutaneous sensitization to isocyanates and to define what protective equipment is effective against this mode of exposure.


Assuntos
Asma Ocupacional , Doenças Profissionais , Exposição Ocupacional , Saúde do Trabalhador , Asma Ocupacional/induzido quimicamente , Asma Ocupacional/epidemiologia , Estudos Transversais , Humanos , Isocianatos/toxicidade , Exposição Ocupacional/estatística & dados numéricos , Estudos Prospectivos , Estudos Retrospectivos
3.
Rev Mal Respir ; 38(9): 914-935, 2021 Nov.
Artigo em Francês | MEDLINE | ID: mdl-34711451

RESUMO

Work-related asthma (WRA) accounts for 10-25% of all adult asthma. It therefore seems important to raise questions regarding an asthmatic's approach to occupational or job training activities. WRA takes on two forms: work-exacerbated asthma (WEA) and occupational asthma (OA), which encompasses different subtypes of heterogeneous mechanisms. It currently represents a major challenge for occupational medicine in terms of detailed diagnosis, social care, the economic repercussions for workers and employers and, last but not least, social insurance. This review aims to sensitize health care practitioners to the peculiarities of WRA management in routine practice. More specifically, prognosis depends on early diagnosis, medical care and work adjustment measures. WEA and OA are explained in detail in view of identifying causative agents and at-risk occupations and defining adapted medical strategy. Relevant lines of questioning and complementary exams are presented. In addition, the key role of the occupational physician, especially as regards recognition and identification of occupational disease, is underlined, the objective being to facilitate optimal professional and social management. In future studies, the key role of counseling and orientation mechanisms should be highlighted as means of preventing WRA occurrence.


Assuntos
Asma Ocupacional , Doenças Profissionais , Exposição Ocupacional , Adolescente , Adulto , Asma Ocupacional/diagnóstico , Asma Ocupacional/epidemiologia , Asma Ocupacional/etiologia , Humanos , Doenças Profissionais/diagnóstico , Doenças Profissionais/epidemiologia , Doenças Profissionais/etiologia
4.
J Bras Pneumol ; 47(4): e20200577, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34406224

RESUMO

Work-related asthma (WRA) is highly prevalent in the adult population. WRA includes occupational asthma (OA), which is asthma caused by workplace exposures, and work-exacerbated asthma (WEA), also known as work-aggravated asthma, which is preexisting or concurrent asthma worsened by workplace conditions. In adults, the estimated prevalence of OA is 16.0%, whereas that of WEA is 21.5%. An increasing number of chemicals used in industrial production, households, and services are associated with the incidence of adult-onset asthma attributable to exposure to chemicals. This review article summarizes the different types of WRA and describes diagnostic procedures, treatment, prevention, and approaches to patient management. It is not always easy to distinguish between OA and WEA. It is important to establish a diagnosis (of sensitizer-/irritant-induced OA or WEA) in order to prevent worsening of symptoms, as well as to prevent other workers from being exposed, by providing early treatment and counseling on social security and work-related issues.


Assuntos
Asma Ocupacional , Doenças Profissionais , Adulto , Asma Ocupacional/diagnóstico , Asma Ocupacional/epidemiologia , Asma Ocupacional/etiologia , Humanos , Doenças Profissionais/diagnóstico , Doenças Profissionais/epidemiologia , Doenças Profissionais/etiologia , Prevalência
5.
BMJ Open Respir Res ; 8(1)2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34362763

RESUMO

INTRODUCTION: Occupational asthma (OA) accounts for one in six cases of adult-onset asthma and is associated with a large societal cost. Many cases of OA are missed or delayed, leading to ongoing exposure to the causative agent and avoidable lung function loss and poor employment-related outcomes. Enquiry about work-related symptoms and the nature of work by healthcare professionals (HCPs) is limited, evident in primary and secondary care. Potential reasons cited for this are time pressure, lack of expertise and poor access to specialists. AIM: To understand organisational factors and beliefs and behaviours among primary HCPs that may present barriers to identifying OA. METHODS: We employed a qualitative phenomenological methodology and undertook 20-45 min interviews with primary HCPs in West Midlands, UK. We used purposive and snowball sampling to include general practitioners (GPs) and practice nurses with a range of experience, from urban and rural settings. Interviews were recorded digitally and transcribed professionally for analysis. Data were coded by hand, and thematic analysis was undertaken and determined theoretically until themes were saturated. RESULTS: Eleven HCPs participated (eight GPs, three nurses). Four themes were identified that were considered to impact on identification of OA: (1) training and experience, (2) perceptions and beliefs, (3) systems constraints, and (4) variation in individual practice. OA-specific education had been inadequate at every stage of training and practice, and clinical exposure to OA had been generally limited. OA-specific beliefs varied, as did clinical behaviour with working-age individuals with asthma. There was a focus on diagnosis and treatment rather than attributing causation. Identified issues regarding organisation of asthma care were time constraints, lack of continuity, referral pressure, use of guidelines and templates, and external targets. CONCLUSION: Organisation and delivery of primary asthma care, negative OA-related beliefs, lack of formal education, and exposure to OA may all currently inhibit its identification.


Assuntos
Asma Ocupacional , Asma Ocupacional/diagnóstico , Asma Ocupacional/epidemiologia , Asma Ocupacional/etiologia , Pessoal de Saúde , Humanos , Atenção Primária à Saúde , Pesquisa Qualitativa , Encaminhamento e Consulta
6.
Artigo em Chinês | MEDLINE | ID: mdl-34218568

RESUMO

Objective: To investigate the value of fractional exhaled nitric oxide (FeNO) in the diagnosis of occupational asthma (OA) , and analyze the correlation between FeNO and pulmonary function in patients with OA. Methods: In October 2019, clinical datas, including pulmonary function, FeNO and blood routine test of 64 workers who applied for the diagnosis of OA in January 2012 to October 2018 in our hospital were collected. The diagnostic value of FeNO in OA was evaluated, FeNO and pulmonary function in different degrees of OA were compared, and the correlations were analyzed. Results: The FeNO value of OA patients [ (58.4±13.1) ppb] was higher than non-OA patients[ (30.1±13.7) ppb] (P<0.05) . The FeNO value of patients with moderate OA [ (68.9±13.8) ppb] was higher than that of patients with mild OA[ (54.2±10.3) ppb] (P<0.05) . The area under the receiver operating characteristic (ROC) curve of FeNO in the diagnosis of OA was 0.9453 (95%CI: 0.8928-0.9978, P<0.05) , the optimal cut-off point is 47.5 ppb, and the sensitivity and specificity are 88.6% and 89.7% respectively. There was negative correlation between FeNO and FEV1% pred (r=-0.454, P<0.01) . Conclusion: FeNO has a clinical application value in the diagnosis of OA. It should be combined with pulmonary function index in practical work.


Assuntos
Asma Ocupacional , Óxido Nítrico , Testes Respiratórios , Expiração , Humanos , Pulmão , Curva ROC
7.
J Allergy Clin Immunol ; 148(4): 1072-1080, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34331994

RESUMO

BACKGROUND: Work exposures play a significant role in adult-onset asthma, but the mechanisms of work-related asthma are not fully elucidated. OBJECTIVE: We aimed to reveal the molecular mechanisms of work-related asthma associated with exposure to flour (flour asthma), isocyanate (isocyanate asthma), or welding fumes (welding asthma) and identify potential biomarkers that distinguish these groups from each other. METHODS: We used a combination of clinical tests, transcriptomic analysis, and associated pathway analyses to investigate the underlying disease mechanisms of the blood immune cells and the airway epithelium of 61 men. RESULTS: Compared with the healthy controls, the welding asthma patients had more differentially expressed genes than the flour asthma and isocyanate asthma patients, both in the airway epithelia and in the blood immune cells. In the airway epithelia, active inflammation was detected only in welding asthma patients. In contrast, many differentially expressed genes were detected in blood cells in all 3 asthma groups. Disease-related immune functions in blood cells, including leukocyte migration and inflammatory responses, and decreased expression of upstream cytokines such as TNF and IFN-γ were suppressed in all the asthma groups. In transcriptome-phenotype correlations, hyperresponsiveness (R ∼ |0.6|) had the highest clinical relevance and was associated with a set of exposure group-specific genes. Finally, biomarker subsets of only 5 genes specifically distinguished each of the asthma exposure groups. CONCLUSIONS: This study provides novel data on the molecular mechanisms underlying work-related asthma. We identified a set of 5 promising biomarkers in asthma related to flour, isocyanate, and welding fume exposure to be tested and clinically validated in future studies.


Assuntos
Poluentes Ocupacionais do Ar/efeitos adversos , Asma Ocupacional/genética , Farinha/efeitos adversos , Exposição por Inalação/efeitos adversos , Isocianatos/efeitos adversos , Exposição Ocupacional/efeitos adversos , Soldagem , Adulto , Asma Ocupacional/sangue , Asma Ocupacional/imunologia , Asma Ocupacional/fisiopatologia , Biomarcadores , Biópsia , Movimento Celular , Citocinas/sangue , Perfilação da Expressão Gênica , Humanos , Imunoglobulina E/sangue , Leucócitos/imunologia , Masculino , Pessoa de Meia-Idade , Mucosa Nasal/patologia , Óxido Nítrico/metabolismo , Testes de Função Respiratória
8.
Occup Environ Med ; 78(9): 661-668, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34282040

RESUMO

BACKGROUND: We hypothesised that occupational exposures differently affect subtypes of adult-onset asthma. OBJECTIVE: We investigated potential relations between occupation and three subtypes of adult asthma, namely atopic asthma, non-atopic asthma and asthma-COPD overlap syndrome (ACOS). METHODS: This is a population-based case-control study of incident asthma among working-age adults living in Pirkanmaa Hospital District in Southern Finland. The determinant of interest was occupation at the time of diagnosis of asthma or the job that the subject had quit due to respiratory symptoms. Asthma was divided into three mutually exclusive subtypes on the basis of any positive IgE antibody (atopic and non-atopic asthma) and presence of persistent airways obstruction in spirometry (ACOS). We applied unconditional logistic regression analysis to estimate adjusted OR (aOR), taking into account gender, age and smoking. RESULTS: The following occupational groups showed significantly increased risk of atopic asthma: chemical industry workers (aOR 15.76, 95% CI 2.64 to 94.12), bakers and food processors (aOR 4.69, 95% CI 1.18 to 18.69), waiters (aOR 4.67, 95% CI 1.40 to 15.56) and those unemployed (aOR 3.06, 95% CI 1.52 to 6.17). The following occupations showed clearly increased risk of non-atopic asthma: metal workers (aOR 8.37, 95% CI 3.77 to 18.59) and farmers and other agricultural workers (aOR 2.36, 95% CI 1.10 to 5.06). Some occupational groups showed statistically significantly increased OR of ACOS: electrical and electronic production workers (aOR 30.6, 95% CI 6.10 to 153.35), fur and leather workers (aOR 16.41, 95% CI 1.25 to 215.85) and those retired (aOR 5.55, 95% CI 1.63 to 18.97). CONCLUSIONS: Our results show that different occupations are associated with different subtypes of adult-onset asthma.


Assuntos
Asma Ocupacional/etiologia , Adulto , Fatores Etários , Asma Ocupacional/classificação , Asma Ocupacional/epidemiologia , Síndrome de Sobreposição da Doença Pulmonar Obstrutiva Crônica e Asma/epidemiologia , Síndrome de Sobreposição da Doença Pulmonar Obstrutiva Crônica e Asma/etiologia , Estudos de Casos e Controles , Indústria Química , Fazendeiros , Feminino , Finlândia/epidemiologia , Indústria Alimentícia , Humanos , Masculino , Pessoa de Meia-Idade , Restaurantes , Fatores de Risco , Fatores Sexuais , Fumar/efeitos adversos , Adulto Jovem
9.
J Occup Health ; 63(1): e12240, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34128301

RESUMO

Respirable organic chemicals were originally thought to cause allergic respiratory diseases, such as bronchial asthma and hypersensitivity pneumonitis, and believed not to cause lung disorders derived from inflammatory or fibrotic processes such as pulmonary fibrosis and interstitial pneumonitis. It has recently been reported, however, that exposure to organic chemicals can cause interstitial lung diseases. In this review, we discuss the clinical features of occupational asthma and hypersensitivity pneumonitis, as well as other lung disorders, including interstitial pneumonitis, caused by humidifier disinfectants in Korea and by a cross-linked acrylic acid-based polymer (CL-PAA) in Japan.


Assuntos
Exposição por Inalação/efeitos adversos , Pneumopatias/induzido quimicamente , Doenças Profissionais/induzido quimicamente , Exposição Ocupacional/efeitos adversos , Compostos Orgânicos/toxicidade , Resinas Acrílicas/toxicidade , Adulto , Alveolite Alérgica Extrínseca/induzido quimicamente , Asma Ocupacional/induzido quimicamente , Desinfetantes/toxicidade , Feminino , Humanos , Umidificadores , Japão , Doenças Pulmonares Intersticiais/induzido quimicamente , Masculino , Pessoa de Meia-Idade , República da Coreia
10.
J Allergy Clin Immunol Pract ; 9(9): 3387-3395, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33940212

RESUMO

BACKGROUND: Quaternary ammonium compounds (QACs) are used extensively for cleaning and disinfection and have been documented in scattered reports as a cause of occupational asthma (OA) through bronchoprovocation tests (BPTs). OBJECTIVE: To examine the clinical, functional, and inflammatory profile of QAC-induced OA compared with OA caused by other low-molecular weight (LMW) agents. METHODS: The study was conducted in a retrospective multicenter cohort of 871 subjects with OA ascertained by a positive BPT. Subjects with QAC-induced OA (n = 22) were identified based on a positive BPT to QACs after exclusion of those challenged with cleaning products or disinfectants that contained other potential respiratory sensitizers. They were compared with 289 subjects with OA caused by other LMW agents. RESULTS: Most subjects with QAC-induced OA were working in the health care sector (n = 14). A twofold or greater increase in the postchallenge level of nonspecific bronchial hyperresponsiveness was recorded in eight of 11 subjects with QAC-induced OA (72.7%) and in 49.7% of those with OA caused by other LMW agents. Although sputum assessment was available in only eight subjects with QAC-induced OA, they showed a significantly greater median (interquartile) increase in sputum eosinophils (18.1% [range, 12.1% to 21.1%]) compared with those with OA caused by other LMW agents (2.0% [range, 0% to 5.2%]; P < .001). CONCLUSIONS: This study indicates that QAC-induced OA is associated with a highly eosinophilic pattern of airway response and provides further evidence supporting the sensitizing potential of QACs. The findings highlight the heterogeneous nature of the pathobiologic pathways involved in OA caused by LMW agents.


Assuntos
Asma Ocupacional , Asma Ocupacional/induzido quimicamente , Asma Ocupacional/diagnóstico , Estudos de Coortes , Eosinófilos , Humanos , Compostos de Amônio Quaternário , Estudos Retrospectivos
11.
J Allergy Clin Immunol Pract ; 9(9): 3380-3386, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33940214

RESUMO

BACKGROUND: Data on the outcome of occupational asthma (OA) are heterogeneous. OBJECTIVE: To assess the impact of being part of a specific cluster at diagnosis on the long-term outcome of diisocyanate-induced OA. METHODS: We collected data from 56 patients who had a diagnosis of OA confirmed by a positive specific inhalation challenge. Patients sensitized to toluene diisocyanate were allocated to cluster 1 or 2 based on a tree analysis, using the 3 variables relevant for cluster segregation identified in a previous study: age, body mass index, and forced expiratory volume in 1 second/forced vital capacity at diagnosis. Patients sensitized to methylene diisocyanate were allocated to cluster 3, as in previous study. We defined OA remission when a patient had met a total of 3 criteria: no asthma symptoms and no antiasthma therapy for the last year, as well as having normal lung function. RESULTS: At follow-up, 16 patients showed OA remission. They exhibited better lung function, less bronchial hyperreactivity, as well as younger age at diagnosis. Twenty-eight patients were allocated to cluster 1, 10 to cluster 2, and 18 to cluster 3. The percentage of patients with OA remission was higher in cluster 2 (50% vs 25% in cluster 1 and 22.5% in cluster 3), although the difference was not statistically significant (P = .2789). CONCLUSIONS: Age at diagnosis was a strong predictor of OA remission. The outcome of diisocyanate OA tended to be more favorable for patients with toluene diisocyanate OA allocated in cluster 2, but this finding needs to be validated by further data.


Assuntos
Asma Ocupacional , Doenças Profissionais , Exposição Ocupacional , Tolueno 2,4-Di-Isocianato , Asma Ocupacional/diagnóstico , Asma Ocupacional/tratamento farmacológico , Seguimentos , Humanos , Exposição Ocupacional/estatística & dados numéricos , Fenótipo
13.
Artigo em Inglês | MEDLINE | ID: mdl-33652998

RESUMO

Work-related asthma (WRA) is a very frequent condition in the occupational setting, and refers either to asthma induced (occupational asthma, OA) or worsened (work-exacerbated asthma, WEA) by exposure to allergens (or other sensitizing agents) or to irritant agents at work. Diagnosis of WRA is frequently missed and should take into account clinical features and objective evaluation of lung function. The aim of this overview on pulmonary function testing in the field of WRA is to summarize the different available tests that should be considered in order to accurately diagnose WRA. When WRA is suspected, initial assessment should be carried out with spirometry and bronchodilator responsiveness testing coupled with first-step bronchial provocation testing to assess non-specific bronchial hyper-responsiveness (NSBHR). Further investigations should then refer to specialists with specific functional respiratory tests aiming to consolidate WRA diagnosis and helping to differentiate OA from WEA. Serial peak expiratory flow (PEF) with calculation of the occupation asthma system (OASYS) score as well as serial NSBHR challenge during the working period compared to the off work period are highly informative in the management of WRA. Finally, specific inhalation challenge (SIC) is considered as the reference standard and represents the best way to confirm the specific cause of WRA. Overall, clinicians should be aware that all pulmonary function tests should be standardized in accordance with current guidelines.


Assuntos
Asma Ocupacional , Doenças Profissionais , Exposição Ocupacional , Administração por Inalação , Asma Ocupacional/diagnóstico , Testes de Provocação Brônquica , Humanos , Doenças Profissionais/diagnóstico , Exposição Ocupacional/efeitos adversos , Espirometria
15.
Allergy Asthma Proc ; 42(1): 72-77, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33404390

RESUMO

Background: Baker's asthma (BA) is one of the most common causes of occupational asthma. Prevalence of BA varies from 3 to 24% in various studies; however, in our country, there are not enough data on its prevalence. Objective: The aim of this study was to evaluate wheat flour sensitivity and to determine the rate of BA in workers at a large bread factory in Ankara. Methods: All steps of the study were carried out in the workplace by the research team who made regular visits to the bread factory. A questionnaire was used to determine the presence of respiratory symptoms and its relation with the occupation. Skin-prick tests and specific immunoglobulin E measurements were performed. Pulmonary function tests and specific inhalation challenges (SIC) were performed to confirm the BA diagnosis. Results: A total of 162 workers (women/men, 3/159; mean ±standard error age, 38.25 ± 7.8 years) were included in the study. Of the 99 workers who described symptoms, 88 (88.8%) had nasal and 57 (57.5%) had lower respiratory symptoms. Sensitivity to wheat flour was present in 23 of the workers (14.2%) among all the workers. Among all the workers, seven (4.32%) were diagnosed with BA and SICs were positive in four (2.46%). Conclusion: Wheat sensitivity was high among the bakers who were exposed to wheat flour; however, the prevalence of BA was quite lower than the previous data in the literature.


Assuntos
Alérgenos/imunologia , Asma Ocupacional/imunologia , Triticum/imunologia , Adulto , Asma Ocupacional/epidemiologia , Pão , Feminino , Farinha , Humanos , Imunoglobulina E/sangue , Masculino , Instalações Industriais e de Manufatura , Pessoa de Meia-Idade , Prevalência , Testes de Função Respiratória , Turquia/epidemiologia
16.
Occup Environ Med ; 78(2): 82-85, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-32769140

RESUMO

INTRODUCTION: Inflammatory biomarkers are associated with negative health outcomes. In this study, we investigated the associations between airborne occupational exposures and levels and changes in inflammatory biomarkers. METHODS: We included 79 604 adults at baseline from the Lifelines cohort of which 48 403 (60.8%) subjects were followed for a median of 4.5 years. Airborne occupational exposures at the current or last-held job at baseline were estimated with the occupational asthma-specific job-exposure matrix. Both in cross-sectional and longitudinal analyses, we used linear regression models (adjusted for age, sex, education, monthly income, body mass index, smoking, pack-years, asthma and anti-inflammatory medication) to investigate the associations between airborne occupational exposures (allergens, reactive chemicals, pesticides and micro-organisms) and inflammatory biomarkers (C reactive protein (CRP), eosinophils and neutrophils). RESULTS: In the cross-sectional analyses, exposure to allergens, reactive chemicals and micro-organisms was associated with a lower (Log) CRP level (B(95% CI)=-0.05 (-0.08 to -0.02),-0.05(-0.08 to -0.02) and -0.09(-0.16 to -0.02), respectively). Likewise, exposure to allergens, reactive chemicals, pesticides and micro-organisms was associated with a lower (log) neutrophils count (-0.01 (-0.02 to -0.01), -0.01 (-0.02 to -0.01),-0.02 (-0.04 to -0.01) and -0.02(-0.03 to -0.01), respectively). No association between airborne occupational exposures and eosinophils count was found. In the longitudinal analyses, no association between airborne occupational exposures and changes in inflammatory biomarkers was found. CONCLUSIONS: At baseline, airborne occupational exposures are inversely associated with inflammation; no effect of occupational exposures on inflammation was found at follow-up. In the future studies, details of occupational exposures, such as duration of exposures and cumulative exposures, need to be included to investigate the airborne occupational exposures and inflammatory biomarkers.


Assuntos
Poluentes Ocupacionais do Ar/efeitos adversos , Asma Ocupacional/etiologia , Biomarcadores/sangue , Exposição Ocupacional/efeitos adversos , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Inquéritos e Questionários
17.
Occup Environ Med ; 78(2): 142-144, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33067336

RESUMO

OBJECTIVES: Several studies have described peach tree (PT) as an occupational allergen. The aim of this work was to assess the effect of Prunus persica 9 (Pru p 9), a recently identified allergen from PT pollen, in exposed workers. METHODS: The study included people who reported respiratory symptoms after handling PT in orchards during the flowering period (Blanca village, Murcia region, south-east Spain). After completing a detailed questionnaire, participants underwent skin prick test (SPT) and nasal provocation test (NPT). The IgE response was analysed by SDS-PAGE and immunoblotting assays. RESULTS: A total of 21 cases were included (mean age 45 years; 57% women). Most were polysensitised to common pollens, although one person was sensitised only to PT pollen. All cases had a positive SPT to this pollen, and 43% also to Pru p 9. All participants reported having rhinitis, and six participants reported having also asthma. Immunoblotting showed a heterogeneous IgE pattern for several proteins, with Pru p 9 recognised in nine cases. Most participants sensitised to PT pollen and Pru p 9 had positive NPTs, while those who were not sensitised to Pru p 9 tested negative. CONCLUSIONS: We demonstrate for the first time that Pru p 9, an allergen from PT pollen, can induce respiratory symptoms following occupational exposure. This must be considered a relevant allergen when people working with PT cultivars develop respiratory symptoms.


Assuntos
Doenças dos Trabalhadores Agrícolas/imunologia , Asma Ocupacional/imunologia , Exposição Ocupacional/efeitos adversos , Pólen/imunologia , Prunus persica/imunologia , Rinite Alérgica Sazonal/imunologia , Testes de Provocação Brônquica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Cutâneos , Espanha
18.
J Allergy Clin Immunol Pract ; 9(2): 937-944.e4, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-32920064

RESUMO

BACKGROUND: Occupational eosinophilic bronchitis (OEB) has been described only as anecdotal case reports. OBJECTIVE: We investigated the clinical and inflammatory characteristics of subjects with OEB identified in a cohort of subjects who completed a specific inhalation challenge (SIC) with occupational agents. METHODS: In this retrospective multicenter study, OEB was defined by (1) a fall in FEV1 less than 15% during the SIC and the absence of nonspecific bronchial hyperresponsiveness both before and after the SIC and (2) a postchallenge increase of 3% or more in sputum eosinophils. The subjects who fulfilled these criteria were compared with 226 subjects with a negative SIC and 30 subjects with a positive SIC who failed to show baseline nonspecific bronchial hyperresponsiveness. RESULTS: An isolated increase in postchallenge sputum eosinophils was documented in 33 of 259 subjects (13%) with a negative SIC. These subjects reported significantly more often an isolated cough at work compared with the negative and positive SIC controls. When compared with positive SIC controls, the subjects with OEB experienced less frequently work-related wheezing and reported a shorter duration of symptoms at work. The sensitivity of the post-SIC increase in fractional exhaled nitric oxide in identifying OEB among subjects with a negative SIC was low, ranging from 43% to 24% using cutoff values of 8 ppb to 17.5 ppb, whereas the specificity was high (90%-97%). CONCLUSIONS: This study highlights the relevance of induced sputum analysis in the investigation of work-related asthma symptoms to identify isolated increases in sputum eosinophils that are consistent with a diagnosis of OEB.


Assuntos
Asma Ocupacional , Asma , Bronquite , Asma Ocupacional/diagnóstico , Bronquite/diagnóstico , Eosinófilos , Expiração , Humanos , Óxido Nítrico , Estudos Retrospectivos , Escarro
19.
Am J Ind Med ; 64(3): 165-169, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33373055

RESUMO

BACKGROUND: The objective was to update the 2011 Cochrane systematic review on the effectiveness of workplace interventions for the treatment of occupational asthma. METHODS: A systematic review was conducted with the selection of articles and reports through 2019. The quality of extracted data was evaluated, and meta-analyses were conducted using techniques recommended by the Cochrane Handbook for Systematic Reviews of Interventions. RESULTS: Data were extracted from 26 nonrandomized controlled before-and-after studies. The mean number of participants per study was 62 and the mean follow-up time was 4.5 years. Compared with continued exposure, removal from exposure had an increased likelihood of improved symptoms and change in spirometry. Reduction of exposure also had more favorable results for symptom improvement than continued exposure, but no difference for change in spirometry. Comparing exposure removal to reduction revealed an advantage for removal with both symptom improvement and change in spirometry for the larger group of patients exposed to low-molecular-weight agents. Also, the risk of unemployment was greater for exposure removal versus reduction. CONCLUSIONS: Exposure removal and reduction had better outcomes than continued exposure. Removal from exposure was more likely to improve symptoms and spirometry than reduction among patients exposed to low-molecular-weight agents. The potential benefits associated with exposure removal versus reduction need to be weighed against the potential for unemployment that is more likely with removal from exposure. The findings are based on data graded as very low quality, and additional studies are needed to generate higher quality data.


Assuntos
Asma Ocupacional/terapia , Exposição Ocupacional/prevenção & controle , Serviços de Saúde do Trabalhador/métodos , Adulto , Poluentes Ocupacionais do Ar/efeitos adversos , Asma Ocupacional/etiologia , Recuperação e Remediação Ambiental , Feminino , Redução do Dano , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Observacionais como Assunto , Exposição Ocupacional/efeitos adversos , Espirometria , Local de Trabalho
20.
Curr Opin Allergy Clin Immunol ; 21(2): 110-113, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33332925

RESUMO

PURPOSE OF REVIEW: The purpose of this review was to list all new confirmed cases of immunological occupational asthma (IOA) described between mid-2014 and April 2020. RECENT FINDINGS: Several new agents, both of high and low molecular weight, have been identified in the last 6 years as potential respiratory sensitizers being able to induce immunological occupational asthma. This review confirms that new causes of IOA are still identified regularly, particularly in subjects exposed to high molecular agents, in the food industry (farming, pest control, food processing), pharmaceutical industry (antibiotics, various drugs) and cosmetic environment (dyes, powders). SUMMARY: It stressed the need for clinicians to stay alert and suspect occupational asthma in any adult with new onset asthma or newly uncontrolled asthma.


Assuntos
Asma Ocupacional , Exposição Ocupacional , Adulto , Asma Ocupacional/diagnóstico , Asma Ocupacional/epidemiologia , Indústria Alimentícia , Humanos , Doenças Profissionais , Exposição Ocupacional/efeitos adversos
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