Abstract

Introduction: Occupational disease linked to the paper recycling industry has not as of yet been well documented. No previously confirmed formal diagnosis of occupational asthma caused by hydroxylamine has been made.

Methods and results: We have assessed and performed occupational assessment of 8 workers involved in this industry. Two of these original 8 assessed workers were later diagnosed with occupational asthma (OA). Both workers developed their respiratory symptoms within 2 years of the first use of the chemical hydroxylamine as part of the "de-inking" process (it was used as a substitute for glutaraldehyde on risk grounds although no prior cases of OA had been found, while glutaraldehyde was used for this process). The 2 positive cases had worked at the same plant for 11 and 20 years, respectively. Both gave histories of work related wheeze, shortness of breath and cough. Both cases performed OASYS peak flow records over a three week period and had OASYS II index of 2.85 and 2.67 respectively. Both cases were redeployed on site to non-exposed areas and subsequently demonstrated improvement in bronchial reactivity.

Case 1: diagnosis PC20 = 1.25 mg/ml; 12 months post cessation of exposure 4.5 mg/ml;

Case 2: diagnosis PC20 6 mg/ml; 6 months post cessation of exposure >8.0 mg/ml).

Case 2 subsequently consented to and underwent blinded, placebo controlled occupational challenge using hydroxylamine by first painting on to a board, then by aerosol exposure within the challenge room demonstrates the late asthmatic reaction occurring on the high exposure hydroxylamine challenge (aerosolised). Since the first 2 cases were found 1 of 2 further referrals from the same industry site has also been provisionally diagnosed with OA.

Conclusion: We believe these are the first 2 confirmed cases of OA caused by hydroxylamine in the paper recycling industry.

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Comments

Evidence table: Occupational Asthma from Hydroxylamine (new cause)

7/25/2008