Occupational Asthma Reference

Angulo SD, Szram J, Welch J, Cannon J, and Cullinan P, Occupational Asthma in Antibiotic Manufacturing Workers: Case Reports and Systematic Review, J Allergy, 2011;ID 365683:9 pages,

Keywords: review, antibiotic, occupational asthma, erythromycin, IgE, nc, ch, SIC, NSBR,

Known Authors

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

Julie Cannon, Royal Brompton Hospital London Julie Cannon

Joanna Szram, Royal Brompton Hospital Joanna Szram

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Abstract

Background.
The risks of occupational asthma (OA) from antibiotics are uncertain. We report 4 new cases and a systematic review of the literature.

Methods.
Cases were identified through a specialist clinic, each underwent specific provocation testing (SPT). We subsequently reviewed the published literature.

Results.
The patients were employed in the manufacture of antibiotics; penicillins were implicated in three cases, in the fourth erythromycin, not previously reported to cause OA. In two, there was evidence of specific IgE sensitisation. At SPT each developed a late asthmatic reaction and increased bronchial hyperresponsiveness.
36 case reports have been previously published, 26 (citing penicillins or cephalosporins). Seven cross-sectional workplace-based surveys found prevalences of 5–8%.

Conclusions.
OA in antibiotic manufacturers may be more common than is generally recognised. Its pathogenesis remains unclear; immunological tests are of uncertain value and potential cases require confirmation with SPT. Further study of its frequency, mechanisms, and diagnosis is required.

Plain text: Background. The risks of occupational asthma (OA) from antibiotics are uncertain. We report 4 new cases and a systematic review of the literature. Methods. Cases were identified through a specialist clinic, each underwent specific provocation testing (SPT). We subsequently reviewed the published literature. Results. The patients were employed in the manufacture of antibiotics; penicillins were implicated in three cases, in the fourth erythromycin, not previously reported to cause OA. In two, there was evidence of specific IgE sensitisation. At SPT each developed a late asthmatic reaction and increased bronchial hyperresponsiveness. 36 case reports have been previously published, 26 (citing penicillins or cephalosporins). Seven cross-sectional workplace-based surveys found prevalences of 5-8%. Conclusions. OA in antibiotic manufacturers may be more common than is generally recognised. Its pathogenesis remains unclear; immunological tests are of uncertain value and potential cases require confirmation with SPT. Further study of its frequency, mechanisms, and diagnosis is required.

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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 Agent Erythromycin ethyl succinate Job Pharmaceutical packer Specific IgE neg Skin prick test not done Non-specific reactivity Increased after SIC, values not given Serial Peak Flow Done, said to show asthma without work effect BAL Not done FENO Not done Basophil histamine release Not done Specific Challenge positive late reaction Follow-up Relocated, improved, no details

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