Occupational Asthma Reference

Leal A, Caselles I, Rodriguez-Bayarri MJ, Muñoz X, Non-IgE-Mediated Asthma after Zinc Exposure, Archivos de Bronconeumología (English Edition, 2017;53:346-347,https://doi.org/10.1016/j.arbres.2016.09.009
(Plain text: Leal A, Caselles I, Rodriguez-Bayarri MJ, Munoz X, Non-IgE-Mediated Asthma after Zinc Exposure, Archivos de Bronconeumologia (English Edition),)

Keywords: Spain, Zinc, OA, ch, late reaction, cr, mechanic,

Known Authors

Xavier Munoz, Barcelona Xavier Munoz

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Abstract

Various metals have been described as causing occupationalasthma (OA), mostly chromium, nickel, and cobalt. The mecha-nism of action by which these metals can produce OA is generallyimmunological, either IgE-mediated or not.1,2To date, only 2 casesof OA caused by zinc have been described, and in both cases, anIgE-dependent mechanism was involved in the pathogenesis of thedisorder.3,4We describe, for the first time, a worker exposed to zinc whodeveloped OA via a non-IgE-mediated immunological mechanism.Our patient was a 30-year-old man, former smoker of 5 pack-years,whose only clinical history consisted of a diagnosis of bronchialasthma in childhood, which had remitted, and for which he had notrequired treatment for 15 years. He had been working for 4 yearsas an industrial mechanic, making metal parts, and was in regu-lar contact with copper, cadmium, zinc, and manganese dust. Thepatient consulted due to a 5-month history of cough, expectoration,wheezing, and dyspnea. Symptoms appeared some time after startof exposure and improved during the weekends and periods of sickleave. He had had to attend the emergency department on 5 occa-sions since the onset of symptoms. Chest radiograph was normal.Clinical laboratory tests showed a total IgE of 140 kU/l. Skin tests forairborne allergens were positive for house dust mites, while contactskin tests for metal, including nickel sulfate, potassium dichromate,cadmium, cobalt chloride, and zinc 2.5%, were negative. Forcedspirometry showed FVC 6360 ml (112%), FEV14390 ml (98%), andFEV1/FVC 69%. A methacholine challenge was positive with a PC20of4 mg/ml. A provocation test was performed, according to standardmethodology for testing metals,1,5for which concentrations of0.1 mg/ml, 1 mg/ml, and 10 mg/ml of zinc sulfate were prepared.The 0.1 mg/ml solution was nebulized for a total of 5 min, split intoperiods of 1, 2, and 2 min. Four hours after exposure, a 23% reduc-tion in FEV1from baseline was observed (Fig. 1), along with cough,wheezing, and dyspnea. These symptoms abated after administra-tion of a ß2 agonist. Ten hours after exposure, the patient presentedthe same symptoms, with a 29% reduction in FEV1, requiring admin-istration of intravenous corticosteroids in addition to ß2 agonist,and a 12-h stay in the emergency department

Plain text: Various metals have been described as causing occupationalasthma (OA), mostly chromium, nickel, and cobalt. The mecha-nism of action by which these metals can produce OA is generallyimmunological, either IgE-mediated or not.1,2To date, only 2 casesof OA caused by zinc have been described, and in both cases, anIgE-dependent mechanism was involved in the pathogenesis of thedisorder.3,4We describe, for the first time, a worker exposed to zinc whodeveloped OA via a non-IgE-mediated immunological mechanism.Our patient was a 30-year-old man, former smoker of 5 pack-years,whose only clinical history consisted of a diagnosis of bronchialasthma in childhood, which had remitted, and for which he had notrequired treatment for 15 years. He had been working for 4 yearsas an industrial mechanic, making metal parts, and was in regu-lar contact with copper, cadmium, zinc, and manganese dust. Thepatient consulted due to a 5-month history of cough, expectoration,wheezing, and dyspnea. Symptoms appeared some time after startof exposure and improved during the weekends and periods of sickleave. He had had to attend the emergency department on 5 occa-sions since the onset of symptoms. Chest radiograph was normal.Clinical laboratory tests showed a total IgE of 140 kU/l. Skin tests forairborne allergens were positive for house dust mites, while contactskin tests for metal, including nickel sulfate, potassium dichromate,cadmium, cobalt chloride, and zinc 2.5%, were negative. Forcedspirometry showed FVC 6360 ml (112%), FEV14390 ml (98%), andFEV1/FVC 69%. A methacholine challenge was positive with a PC20of4 mg/ml. A provocation test was performed, according to standardmethodology for testing metals,1,5for which concentrations of0.1 mg/ml, 1 mg/ml, and 10 mg/ml of zinc sulfate were prepared.The 0.1 mg/ml solution was nebulized for a total of 5 min, split intoperiods of 1, 2, and 2 min. Four hours after exposure, a 23% reduc-tion in FEV1from baseline was observed (Fig. 1), along with cough,wheezing, and dyspnea. These symptoms abated after administra-tion of a b2 agonist. Ten hours after exposure, the patient presentedthe same symptoms, with a 29% reduction in FEV1, requiring admin-istration of intravenous corticosteroids in addition to b2 agonist,and a 12-h stay in the emergency department

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