Occupational Asthma Reference

Vellore AD, Drought VJ, Sherwood-Jones D, Tunnicliffe B, Moore VC, Robertson AS, Burge PS, Occupational asthma and allergy to sevoflurane and isoflurane in anaesthetic staff, Allergy, 2006;61:1485-6,

Keywords: anaesthetic, health care, asthma, challenge, peak flow, isoflurane, sevoflurane, angiooedema, dermatitis

Known Authors

Sherwood Burge, Oasys Sherwood Burge

Vicki Drought, Oasys Vicki Drought

Vicky Moore, Oasys Vicky Moore

Alastair Robertson, Selly Oak Hospital Alastair Robertson

Arun Dev Vellore, Oasys Arun Dev Vellore

Bill Tunnicliffe, University Hospital Birmingham Bill Tunnicliffe

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Abstract

Isoflurane has caused contact dermatitis in an anaesthetist (1), and dermatitis is common in anaesthetic workers (2). However, there are no prior reports of occupational asthma. We report three cases with occupational asthma, work-related angioedema or dermatitis to isoflurane (1-chloro-2,2,2-
trifluoroethyl difluoromethyl ether) and sevoflurane [fluoromethyl 2,2,2-trifluoro- 1-(trifluoromethyl) ethyl ether] with positive specific bronchial provocation testing. All worked as anaesthetic assistants or nurses in the same hospital.

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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?
Cedd Burge Isoflurane and Sevoflurane have been identified as agents causing Occupational Asthma. 1 patient had positive broncial challenge to isoflurane and sevoflurane. The second patient had specific bronchial challenge to isoflurane. The third patient had a significant change in methacholine reactivity after ceasing exposure to isoflurane.

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Comments

Agent
Isoflurane and sevofluorane; anaesthetic gasses

Job
Anaesthetic assistant and nurse mostly exposed in recovery areas

Proof
IgE not tested

Skin prick test to allergen extract not tested

Non specific bronchial reactivity developed post challenge in 3/3; normal before challenge 3/3

Serial peak flow records positive 1/3; equivocal 1/3; not done 1/3

Specific Bronchial Challenge: late reaction to isoflurane and sevoflurane 15 breaths 0.5% (1); late reaction isoflurane alone 18 breaths 0.5% (1); rash and nsbr decline isoflurane alone 18 breaths 0.5% (1); controls no reaction

Follow up
Better after relocation away from recovering post-op patients exhaling anaesthetic gasses. One had anaphylactic reaction during a general anaesthetic using sevoflurane
4/18/2008

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