Occupational Asthma Reference
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Munoz X, Cruz MJ, Orriols R, Torres F, Espuga M, Morell F,
Validation of specific inhalation challenge for the diagnosis of occupational asthma due to persulphate salts,
Occup Environ Med,
2004;61:861-866,
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Keywords: Spain, Barcelona, sensitivity, specificity, persulphates, challenge
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Abstract
BACKGROUND: The significant value of tests used to certify the diagnosis of occupational asthma due to persulphate salts remains uncertain.
AIMS: To validate the specific inhalation challenge (SIC) test for the diagnosis of occupational asthma.
METHODS: Eight patients with occupational asthma due to persulphate salts, eight patients with bronchial asthma who were never exposed to persulphate salts, and ten healthy subjects were studied. Clinical history taking, spirometry, bronchial challenge with methacholine, skin prick testing to common inhalant allergens and persulphate salts, total IgE levels, and SIC to potassium persulphate were carried out in all subjects. The SIC used increasing concentrations of potassium persulphate (5, 10, 15, and 30 g) mixed with 150 g of lactose. Patients tipped the mixture from one tray to another at a distance of 30 cm from the face for 10 minutes in a challenge booth.
RESULTS: The SIC was positive in all subjects with persulphate induced asthma and in one patient with bronchial asthma who had never been exposed to persulphate salts. Sensitivity was 100% (95% CI 67.6 to 100) and specificity was 87.5% (95% CI 52.9-97.8) when patients with occupational asthma due to persulphate salts were compared with those with bronchial asthma never exposed to persulphate salts.
CONCLUSIONS: SIC to persulphate salts performed according to the protocol described appears to be useful for the diagnosis of occupational asthma secondary to inhalation of this substance
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Comments
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Specific challenge possible in 8/11 (2 FEV1 too low, one anaphylactic on skin test), sensitivity when done 100%, specificity7/8, 87.5%). Challenges with potassium persulphate 5-30g diluted in 150g lactose and tipped, persulphate air levels 1-6mg/m3 during 10 minute tipping exposures. One late reaction in unexposed asthmatic at 30g/150g. NSBR normal in 2/8, sensitivity 75%, specificity1/8 (12.5%). (3/8 not currently exposed, no information on whether these were reactive or not. PEF done in the 5 still at work, 2 weeks at work 2 weeks off, positive in 4/5 (80%), criteria not given. Skin prick tests at 5% weight/vol sensitivity 4/8 (50%) specificity 8/8 (100%)
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sensitivity 100%, but challenge a criteria of diagnosis, specificity 87.5% at 30g persulphate in 150g lactose tipped for 10 minutes with air levels up to 6mg/m3 persulphate
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