Occupational Asthma Reference

Dong S, Acouetey DS, Guéant-Rodriguez R-M, Zmirou-Navier D, Rémen T, Blanca M, Mertes PM, Guéant J-L, Prevalence of IgE against neuromuscular blocking agents in hairdressers and bakers, Clin Exp Allergy, 2013;43:1256-1262,
(Plain text: Dong S, Acouetey DS, Gueant-Rodriguez R-M, Zmirou-Navier D, Remen T, Blanca M, Mertes PM, Gueant J-L, Prevalence of IgE against neuromuscular blocking agents in hairdressers and bakers, Clin Exp Allergy)

Keywords: hairdresser, neuromuscular blocking agents, quaternary ammonium ion, benzalkonium chloride, IgE, anaphylaxis, anaesthesia, key, pholcodeine

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Allergic IgE-mediated reactions to neuromuscular blocking agents (NMBAs) are the main cause of immediate hypersensitivity reactions in anaesthesia; their predominant occurrence in the absence of previous exposure to NMBAs suggests a risk related to environmental exposure.

To investigate the prevalence of specific IgE to quaternary ammonium ions in two populations professionally exposed to quaternary ammonium compounds, in the north-eastern France.

The study had a retrospective follow-up design whereby apprentices were assessed after their 2-year training period as apprentices. The professionally exposed hairdresser populations (n = 128) were compared with baker/pastry makers (n = 108) and ‘non-exposed’ matched control subjects (n = 379).

We observed a 4.6-fold higher frequency of positive IgE against quaternary ammonium ions in hairdressers (HD), compared with baker/pastry makers (BP) and control (C) groups. The competitive inhibition of quaternary ammonium Sepharose radioimmunoassay (QAS-IgE RIA) with succinylcholine was significantly higher in HD, compared with BP and C groups, with inhibition percentage of 66.2 ± 7.4, 39.7 ± 6.0 and 43.8 ± 9.9, respectively (P < 0.001). The specific IgE against quaternary ammonium ions recognized also two compounds widely used by hairdressers, benzalkonium chloride and polyquaternium-10, in competitive inhibition of IgE RIA. When considering the whole study population, hairdresser professional exposure and total IgE > 100 kU/L were the two significant predictors of IgE-sensitization against quaternary ammonium ions in the multivariate analysis of a model that included age, sex, professional exposure, increased concentration of total IgE (IgE > 100 kU/L) and positive IgE against prevalent allergens (Phadiatop®; P = 0.019 and P = 0.001, respectively).

Conclusion and Clinical Relevance
The exposure to hairdressing professional occupational factors increases IgE-sensitization to NMBAs and quaternary ammonium ion compounds used in hairdressing. Besides the pholcodine hypothesis, our study suggests that repetitive exposure to quaternary ammonium compounds used in hairdressing is a risk factor for NMBAs sensitization.

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