Occupational Asthma Reference

Beach J, Russell K, Blitz S, Hooton N, Spooner C, Lemiere C, Tarlo SM, Rowe BH, A Systematic Review of the Diagnosis of Occupational Asthma, Chest, 2007;131:569-578,

Keywords: nsbr, systematic review, SIC, key, br,

Known Authors

Jeremy Beach, University of Alberta Jeremy Beach

Catherine Lemière, Hôpital de Sacré Coeur, Montreal, Quebec, Canada Catherine Lemière

Susan Tarlo, Toronto Susan Tarlo

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Background: This study systematically reviews literature regarding the diagnosis of occupational asthma (OA) and compares specific inhalation challenge (SIC) testing with alternative tests.

Methods: Electronic databases and trials registries were searched; additional references were identified from bibliographic searches of included studies, hand searches of conferences, and author contacts. Various study designs (clinical trials, cohorts, cross-sectional, or case series) were included involving workers with suspected OA. All diagnostic tests were compared to a "reference standard," and two researchers independently extracted 2 x 2 data. Pooled sensitivities and specificities (95% confidence intervals [CIs]) were derived.

Results: Seventy-seven studies were included. For high molecular weight (HMW) agents, the nonspecific bronchial provocation (NSBP) test, skin-prick test (SPT), and serum-specific IgE had sensitivities > 73% when compared to SIC. Specificity was highest for specific IgE vs SIC (79.0%; 95% CI, 50.5 to 93.3%). The highest sensitivity among low molecular weight asthmagens occurred between combined NSBP and SPT vs SIC (100%; 95% CI, 74.1 to 100%). When compared to SIC, specific IgE and SPT had similar specificities (88.9%; 95% CI, 84.7 to 92.1%; and 86.2%; 95% CI, 77.4 to 91.9%, respectively). For HMW agents, high specificity was demonstrated for positive NSBP tests and SPTs alone (82.5%; 95% CI, 54.0 to 95.0%) or when combined with specific IgE (74.3%; 95% CI, 45.0 to 91.0%) vs SIC. Sensitivity was somewhat lower (60.6% and 65.2%, respectively).

Conclusions: In appropriate clinical situations when SIC is not available, the combination of a NSBP test with a specific SPT or specific IgE may be an appropriate alternative to SIC in diagnosing OA. While positive results of single NSBP test, specific SPT, or serum-specific IgE testing would increase the likelihood of OA, a negative result could not exclude OA.

Full Text


This systematic review supports the BOHRF evidence based review using inverse variance methods for random effects to calculate pooled estimates of sensitivity and specificity. Comparing results with specific challenge tests the rresults showed (mean and 95% CI)
Non-specific hyper-responsibeness sensitivity 79.3% (68-88) High MW
66.7% (58-74) Low MW
specificity 51.3% (35-67) High MW
63.9% (56-71) Low MW

Skin prick tests sensitivity 80.6% (70-88) High MW
72.9% (60-83) Low MW
specificity 59.6% (42-75) High MW
86.2% (77-92) Low MW

Specific IgE sensitivity 73.3% (64-81) High MW
31.2% (23-41) Low MW
specificity 79.0% (50-93) High MW
88.9% (77-92) Low MW

Skin prick test plus NSBR sensitivity 60.6% (21-90) High MW

specificity 82.5% (54-95) High MW

Full report available at http://www.ahrq.gov/downloads/pub/evidence/pdf/asthmawork/asthwork.pdf

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