Occupational Asthma Reference

Suojalehto H, Suuronen K, Cullinan P, Lindström I, Sastre J, Walusiak-Skorupa J, Munoz X, Talini D, Klusackova P, Moore V, Merget R, Svanes C, Mason P, dell'Omo M, Moscato G, Quirce S, Hoyle J, Sherson D, Preisser A, Seed M, Rifflart C, Godet J, de Blay F, Vandenplas O, European network for the Phenotyping of Occupational Asthma (E-PHOCAS) investigators., Phenotyping occupational asthma caused by acrylates in a multicentre cohort study., J Allergy Clin Immunol Pract, 2019;:,10.1016/j.jaip.2019.10.017
(Plain text: Suojalehto H, Suuronen K, Cullinan P, Lindstrom I, Sastre J, Walusiak-Skorupa J, Munoz X, Talini D, Klusackova P, Moore V, Merget R, Svanes C, Mason P, dell'Omo M, Moscato G, Quirce S, Hoyle J, Sherson D, Preisser A, Seed M, Rifflart C, Godet J, de Blay F, Vandenplas O, European network for the Phenotyping of Occupational Asthma (E-PHOCAS) investigators., Phenotyping occupational asthma caused by acrylates in a multicentre cohort study., J Allergy Clin Immunol Pract)

Keywords: acrylate, or, oa, rhinitis, FeNO, EU,

Known Authors

Paul Cullinan, Royal Brompton Hospital, London, UK Paul Cullinan

Olivier Vandenplas, Universite Mont-Goginne, Yvoir Olivier Vandenplas

Vicky Moore, Oasys Vicky Moore

Joaquin Sastre, Fundacion Jimenez Diaz, Madrid Joaquin Sastre

Jennifer Hoyle, North Manchester General Hospital Jennifer Hoyle

Martin Seed, Manchester University Martin Seed

Rolf Merget, Bochum Rolf Merget

Giana Moscato, Fondazione Salvatore Maugeri, Pavia Giana Moscato

Xavier Munoz, Barcelona Xavier Munoz

Santiago Quirce, Madrid Santiago Quirce

Hille Suojalehto, Finnish Institute of Occupational Health Hille Suojalehto

Irmeli Lindstrom, Finnish Institute of Occupational Health Irmeli Lindstrom

Alexandra Preisser, Hamburg Alexandra Preisser

Cecile Svanes, University of Bergen, Norway Cecile Svanes

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Abstract

BACKGROUND:
While acrylates are well-known skin sensitisers, they are not classified as respiratory sensitisers although several cases of acrylate-induced occupational asthma (OA) have been reported.

OBJECTIVES:
The aim of this study was to evaluate the characteristics of acrylate-induced OA in a large series of cases and compare those with OA induced by other low-molecular-weight (LMW) agents.

METHODS:
Jobs and exposures, clinical and functional characteristics, and markers of airway inflammation were analysed in an international, multicentre, retrospective cohort of subjects with OA ascertained by a positive inhalation challenge to acrylates (n= 55) or other LMW agents (n=418) including isocyanates (n=125).

RESULTS:
Acrylate-containing glues were the most prevalent products and industrial manufacturing, dental work and beauty care were typical occupations causing OA. Work related rhinitis was more common in acrylate than isocyanate-induced asthma (p< 0.001). The increase in post-challenge fractional exhaled nitric oxide (FeNO) was significantly greater in acrylate-induced OA (26.0, 8.2-38.0 ppb) than in OA induced by other LMW agents (3.0, -1.0-10.0 ppb, p< 0.001) or isocyanates (5.0, 2.0-16.0 ppb, p=0.010). Multivariable models confirmed that OA induced by acrylates was significantly and independently associated with a post-challenge increase in FeNO (=17.5 ppb).

CONCLUSIONS:
Acrylate-induced OA shows specific characteristics, concomitant work-related rhinitis and exposure-related increases in FeNO, suggesting that acrylates may induce asthma through different immunological mechanisms than other LMW agents. Our findings reinforce the need for a re-evaluation of the hazard classification of acrylates, and further investigation of the pathophysiological mechanisms underlying their respiratory sensitizing potential.

Plain text: BACKGROUND: While acrylates are well-known skin sensitisers, they are not classified as respiratory sensitisers although several cases of acrylate-induced occupational asthma (OA) have been reported. OBJECTIVES: The aim of this study was to evaluate the characteristics of acrylate-induced OA in a large series of cases and compare those with OA induced by other low-molecular-weight (LMW) agents. METHODS: Jobs and exposures, clinical and functional characteristics, and markers of airway inflammation were analysed in an international, multicentre, retrospective cohort of subjects with OA ascertained by a positive inhalation challenge to acrylates (n= 55) or other LMW agents (n=418) including isocyanates (n=125). RESULTS: Acrylate-containing glues were the most prevalent products and industrial manufacturing, dental work and beauty care were typical occupations causing OA. Work related rhinitis was more common in acrylate than isocyanate-induced asthma (p< 0.001). The increase in post-challenge fractional exhaled nitric oxide (FeNO) was significantly greater in acrylate-induced OA (26.0, 8.2-38.0 ppb) than in OA induced by other LMW agents (3.0, -1.0-10.0 ppb, p< 0.001) or isocyanates (5.0, 2.0-16.0 ppb, p=0.010). Multivariable models confirmed that OA induced by acrylates was significantly and independently associated with a post-challenge increase in FeNO (>=17.5 ppb). CONCLUSIONS: Acrylate-induced OA shows specific characteristics, concomitant work-related rhinitis and exposure-related increases in FeNO, suggesting that acrylates may induce asthma through different immunological mechanisms than other LMW agents. Our findings reinforce the need for a re-evaluation of the hazard classification of acrylates, and further investigation of the pathophysiological mechanisms underlying their respiratory sensitizing potential.

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Associated Questions

Registered users of this website have associated this reference with the following questions. This association is not a part of the BOHRF occupational asthma guidelines.

Which agents cause occupational asthma and which workers are at risk?
burgeps Good collection of OA from Europe showing that acrylic OA has the features of an IgE type with raised FeNO and more rhinitis than isocyanates. As far as I know there are no successful studies identifying specific IgE to acrylates

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