Can acute formaldehyde exposure trigger sensitisation to another agent?

I carry our respiratory health surveillance for a poultry hatchery company. One of their workers was acutely exposed to ? formaldehyde in November 2016 enough to prompt an A&E attendance, and subsequently developed respiratory symptoms. Initially these were unrelated to work but at his kast surveillance he noted work related symptoms suggestive of OA. His FEV1 has not significantly declined since he started surveillance in 2011 and until 2017 he was symptom free. I have just got his serial peak flow results back and this is strongly suggestive of OA with an OASYS score of 3.4, PEF difference of 5.24%, ABC of 35.51 and positive (+6) timepoint analysis. It wold seem that he has developed occupational asthma sensitised to poultry dust. He has worked in the industry since 2011 as a maintenance engineer but has only recently developed problems, since his acute formaldehyde exposure. Could this be a trigger to his developing OA? Many thanks.

Occupational Asthma, Health Professional, 8/18/2018, 8/20/2018,

It is possible that an acute irritant exposure unmasked sensitisation that was not causing any problems (for instance there are many more people with IgE (sensitised) to grass pollen than those with pollen asthma). It is also possible that the high formaldehyde exposure has sensitised him to low concentrations of formaldehyde. There are also potential problems with hens egg proteins (both ovalbumin and egg proteins) if inhaled. There are no reliable IgE tests to formaldehyde, and I don't know of any related to one day old chicks, but IgE tests are available for hens egg proteins. Jones M, Skidmore A, Glozier N, Welch J, Hunter AS, Cullinan P, Occupational egg allergy in an embryological research facility, Occup Med, 2013;63:348-353, Bernstein JA, Kraut A, Bernstein DI, Warrington R, Bolin T, Warren CP, Bernstein IL, Occupational asthma induced by inhaled egg lysozyme, Chest, 1993;103:532-535, Carmona JGB, Picon SJ, Sotillos MG, Gaston PG, Occupational asthma in the confectionary industry caused by sensitivity to egg, Allergy, 1992;47:190-191, Berrens L, Edwards JH, Antibodies to bird serum proteins in confectionary workers exposed to egg spray, Clin Allergy, 1987;17:405-408, Edwards J, McConnochie K, Davies BH, Skin-test reactivity to egg protein-exposure by inhalation compared with ingestion, Clin Allergy, 1985;15:147-150, Edwards JH, McConnochie K, Trotman DM, Collins G, Saunders MJ, Latham SM, Allergy to inhaled egg material, Clin Allergy, 1983;13:427-432,

8/20/2018