Is exposure to agents in the workplace a risk factor for developing occupational asthma?


*** 2++ The risk of sensitisation and occupational asthma is increased by higher exposures to many workplace agents.

Evidence

Brisman J, Jaervholm B, Lillienberg L , Exposure-response relations for self report asthma and rhinitis in bakers , Occup Environ Med , 2000 ; 57 : 335-340

Brooks SM, Edwards JJ, Apol A et al , An epidemiologic study of workers exposed to western red cedar and other wood dusts , Chest , 1981 ; 80 : 30S-32S

Calverley AE, Rees D, Dowdeswell RJ et al , Platinum salt sensitivity in refinery workers: incidence and effects of smoking and exposure , Occup Environ Med , 1995 ; 52 : 661-666

Cathcart M, Nicholson P, Roberts D, Bazley M, Juniper C, Murray P, Randell M , Enzyme exposure, smoking and lung function in employees in the detergent industry over 20 years. Medical Subcommittee of the UK Soap and Detergent Industry Association , Occup Med (London) , 1997 ; 47 : 473-478

Coutts IL, Lozewicz S, Dally MB, et al , Respiratory symptoms related to work in a factory manufacturing cimetidine tablets , Br Med J , 1984 ; 288 : 1418

Cullinan P, Cook A, Gordon S, Nieuwenhuijsen MJ, Tee RD, Venables KM, McDonald JC, Newman Taylor AJ , Allergen exposure, atopy and smoking as determinants of allergy to rats in a cohort of laboratory employees , Eur Respir J , 1999 ; 13 : 1139-1143

Cullinan P, Cook A, Nieuwenhuijsen MJ et al , Allergen and dust exposure as determinants of work-related symptoms and sensitisation in a cohort of flour-exposed workers; A case-control analysis , Ann Occup Hyg , 2001 ; 45 : 97-103

Cullinan P, Harris JM, NewmanTaylor AJ et al , An Outbreak Of Asthma In A Modern Detergent Factory , Lancet , 2000 ; 356 : 1899-1900

Cullinan P, Lowson D, Nieuwenhuijsen MJ et al , Work-related symptoms, sensitisation, and estimated exposure in workers not previously exposed to flour , Occup Environ Med , 1994 ; 51 : 579-583

Grammer LC, Shaughnessy MA, Lowenthal M et al , Risk factors for immunologically mediated respiratory disease from hexahydrophthalic anhydride , J Occup Med , 1994 ; 36 : 642-646

Hagmar L, Bellander T, Ranstam J, Skerfving S , Piperazine-induced airway symptoms: exposure-response relationships and selection in an occupational setting , Am J Ind Med , 1984 ; 6 : 347-357

Heederik D, Houba R , An exploratory quantitative risk assessment for high molecular weight sensitizers: wheat flour , Ann Occup Hyg , 2001 ; 45 : 175-185

Hnizdo E, Esterhuizen TM , Occupational Asthma As Identified By The Surveillance Of Work-Related And Occupational Respiratory Diseases Programme In South Africa , Clin Exp Allergy , 2001 ; 31 : 32-39

Juniper CP, How MJ, Goodwin BFJ, Kinshott AK , Bacillus Subtilis Enzymes: a 7 year clinical, epidemiological and immunological study of an industrial allergen , J Soc Occup Med , 1977 ; 27 : 3-12

Kruize H, Post W, Heederik D, Martens B, Hollander A, van der Beek E , Respiratory allergy in laboratory animal workers: a retrospective cohort study using pre-employment screening data , Occup Environ Med , 1997 ; 54 : 830-835

Liss GM, Bernstein D, Genesove L et al , Assessment of risk factors for IgE-mediated sensitisation to tetrachlorophthalic anhydride , J Allergy Clin Immunol , 1993 ; 92 : 237-247

McSharry C, Anderson K, McKay IC, Colloff MJ, Feyerabend C, Wilson, RB, Wilkinson PC , The IgE and IgG antibody responses to aerosols of Nephrops norvegicus (prawn) antigens: the association with clinical hypersensitivity and with cigarette smoking. , Clin Exp Immunol , 1994 ; 97 : 499-504

Meredith SK, Taylor VM, McDonald JC , Occupational respiratory disease in the United Kingdom 1989: a report to the British Thoracic Society and the Society of Occupational Medicine by the SWORD project group , Br J Ind Med , 1991 ; 48 : 292-298

Musk AW, Venables KM, Crook B et al , Respiratory symptoms, lung function, and sensitisation to flour in a British bakery , Br J Ind Med , 1989 ; 46 : 636-642

Ortega HG, Daroowalla F, Petsonk EL et al , Respiratory Symptoms Among Crab Processing Workers In Alaska: Epidemiological And Environmental Assessment , Am J Ind Med , 2001 ; 39 : 598-607

Osterman K, Zetterstrom O, Johansson SG , Coffee workers asthma , Allergy , 1982 ; 37 : 313-322

PlattsMills TAE, Longbottom J, Edwards J, Cockcroft A, Wilkins S , Occupational asthma and rhinitis related to laboratory rats: serum IgG and IgE antibodies to the rat urinary allergen , J Allergy Clin Immunol , 1987 ; 79 : 505-515

Tarlo SM, Liss GM, Dias C et al , Assessment of the relationship between isocyanate exposure levels and occupational asthma , Am J Ind Med , 1997 ; 32 : 517-521

Vanhanen M, Tuomi T, Nordman H et al , Sensitisation to industrial enzymes in enzyme research and production , Scand J Work Environ Health , 1997 ; 23 : 385-391

Weill H, Waddell LC, Ziskind M , A study of workers exposed to detergent enzymes , JAMA , 1971 ; 26 : 425-433

Principal reccomendations

This statement supports the following principal reccomendations

View the principal reccomendations

Employers and their health and safety personnel should be aware that the major determinant of risk for the development of occupational asthma is the level of exposure to its causes.

Employers should implement programmes to prevent (i.e. reduce the incidence) of occupational asthma by removing or reducing exposure to its causes through elimination or substitution and where this is not possible, by effective control of exposure.

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