Occupational Asthma Reference

Brant A, Zekveld C, Welch J, Jones, M Newman Taylor AJ, Cullinan P, The prognosis of occupational asthma due to detergent enzymes: clinical, immunological and employment outcomes, J Allergy Clin Immunol, 2006;36:483-488,

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Known Authors

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

Tony Newman Taylor, Royal Brompton Hospital, London Tony Newman Taylor

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Abstract

Background
Little is known about the prognosis of occupational asthma induced by high molecular weight proteins.

Objective
Our objective was to measure the clinical, immunological and employment outcomes of individuals with occupational asthma induced by detergent enzymes.

Methods
We undertook a workforce-based follow-up study in 35 (78%) of the 45 ex-employees from a single factory with occupational asthma. In each case the diagnosis was supported by evidence of specific sensitization and characteristic changes in peak flow or a positive response to specific bronchial provocation testing.

Results
This group had left the factory on average 37 months before study. On review 25 (71%) reported chest symptoms during the last month. Compared with when working at the factory, most (86%) reported that their symptoms had improved. Twenty continued to attend their general practitioner for respiratory symptoms and 19 still used asthma medications. Since leaving the factory 16 (46%) and four (11%) had found full-time or part-time employment, respectively; of these 16 found they were paid less than when they worked at the factory. The remaining 15 subjects had not had any paid employment. All but two had positive skin prick tests to one or more three detergent enzymes. The estimated half-life of serum-specific IgE antibodies was 20 months for protease, and 21 months for cellulase and amylase.

Conclusions
Population-based follow-up studies of the prognosis of occupational asthma are rare but probably avoid the bias in clinic-derived surveys. This study demonstrates that 3 years after the avoidance of exposure with detergent enzymes most patients continue to be troubled by, albeit improved, symptoms and experience difficulty in re-employment.

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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.

What is the prognosis of occupational asthma?
burgeps Symptomatic improvement not related to the level of specific IgE while exposed (this is not surprising as exposure to detergent enzymes is unlikely outside the workplace). The situation may be different if low level exposure was possible in the normal environment.
What are the sensitivity and the specificity of specific bronchial provocation testing while at work, and after removal from work, in the diagnosis of validated cases of occupational asthma?
burgeps This doesnt address sensitivity and specificity, but estimates the half life of specific IgE to detergent enzymes at 20-21 months.

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Comments

Three years after leaving work with occupational asthma half were still unemployed, 86% less symptomatic and a half still taking treatment for asthma. The half life for specific IgE to the detergent enzymes was 20-21 months. The study followed up 35/45 workers with occupational asthma from a single outbreak giving added validity to the results

4/18/2008

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