Occupational Asthma Reference
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Tsui H-C, Ronsmans S, Hoet PHM, Nemery B, Vanoirbeek JAJ,
Is Occupational Asthma Caused by Low-Molecular-Weight Chemicals Associated With Contact Dermatitis? A Retrospective Study,
The Journal of Allergy and Clinical Immunology: In Practice,
2022;:,https://doi.org/10.1016/j.jaip.2022.05.014
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Keywords: OA, patch test, type IV, contact dermatitis, Belgium
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Abstract
Background
Occupational asthma (OA) may have different etiologies, but it is not clear whether the etiologic agents influence the clinical presentation, especially the co-occurrence of skin lesions.
Objective
To determine the impact of different asthmagens on the characteristics of OA, with a focus on the occurrence of prior or concomitant skin disorders.
Methods
In a retrospective analysis of patients who visited the Occupational and Environmental Disease Clinic of a tertiary referral hospital from 2009 to 2019, we classified patients into definite, probable, or possible OA according to prespecified diagnostic guidelines. In multivariate logistic regression with sensitivity analysis, we examined the relation of high- and low-molecular-weight (HMW and LMW) agents with the clinical presentation.
Results
Of 209 cases of OA, 66 were caused by HMW agents and 143 by LMW agents. Patients with OA exposed to LMW agents had higher odds of having (had) allergic contact dermatitis (odds ratio, 5.45 [1.80-23.70]; P < .01), compared with patients exposed to HMW agents. Conversely, HMW agents were associated with higher odds of rhinitis symptoms (odds ratio of LMW/HMW, 0.33 [0.17-0.63]; P < .001) and high total IgE (odds ratio of LMW/HMW, 0.35 [0.17-0.70]; P < .01). Risk factors for having coexisting contact dermatitis included construction work, hairdressing, and exposure to metals or epoxy resins.
Conclusions
Among patients with OA, exposure to specific LMW agents was associated with a high frequency of contact dermatitis. Different types of asthmagens within HMW or LMW agents appear to determine the phenotype and comorbidity of OA.
Full Text
Comments
Patients had high odds of contact dermatitis when exposed to metals (OR, 5.35 [2.13-13.44]), fragrance/hair products (OR, 6.79 [2.04-22.57]), or epoxy resins (OR, 4.40 [1.20-16.20]). Patients in these 3 job categories also showed high OR of allergic contact dermatitis. Symptoms of conjunctivitis developed especially in patients exposed to rodents (OR, 7.56 [1.87-30.60]) or epoxy resins (OR, 4.68 [1.09-20.14]). Patients exposed to rodents also had high odds of rhinitis (OR, 8.86 [1.59-49.29]). In contrast, exposure to isocyanates (OR, 0.40 [0.19-0.87]) or metals (OR, 0.34 [0.13-0.87]) was associated with low odds of rhinitis symptoms
There was a longer latency for exposures to bakery, wood, and hairdressing products. The median latency of our patients working with bakery products is around 10 years.
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